Obstetric Women Research Articles

The Prophylactic Effect of Acetaminophen and Caffeine on Post Dural Puncture Headache after Spinal Anesthesia for Cesarean Section: A Randomized Double-Blind Clinical Trial.

Post-dural puncture headache (PDPH) is the most common complication following spinal anesthesia among parturients undergoing cesarean section surgery. The purpose of this study was to evaluate the effectiveness of acetaminophen and caffeine in preventing PDPH. This double-blind, randomized clinical trial was conducted on 96 obstetric women, who were candidates for elective cesarean section. Following the randomization of participants into two groups, participants in the intervention group received tablets of acetaminophen (500 mg)+caffeine (65 mg), and participants in the control group received placebo tablets orally 2 hours before spinal anesthesia induction and then every 6 hours after surgery up to 24 hours. All parturients were evaluated for frequency and intensity of PDPH every 6 hours until 24 hours after surgery and then 48 and 72 hours after surgery. Overall satisfaction during the first 72 hours of postpartum was evaluated. The data were analyzed using SPSS software. P<0.05 was considered statistically significant. Participants in the intervention group were 70% less likely to experience PDPH after spinal anesthesia (OR=0.31 P=0.01, 95% CI [0.12-0.77]). They also experienced significantly milder headaches 18 hours, 48 hours, and 72 hours later. Participants in the intervention group reported higher levels of satisfaction at the end of the study (P=0.01). No side effects related to the intervention were reported. Prophylactic administration of acetaminophen+caffeine decreases 70% the risk of PDPH and significantly attenuates pain intensity in obstetric patients who underwent spinal anesthesia for cesarean section.

Randomized Controlled Trial of Labetalol Versus Hydralazine, for Severe Hypertension in Obstetric Patients, at Tertiary Care Hospital of Karachi

Background: Blood pressure ≥160/110 mm Hg, is indication for urgent drug therapy in obstetric women, to prevent complications and deaths. There is limited data for comparison of Labetalol to Hydralazine in emergent treatment of severe pregnancy related hypertension. Methods: Randomized controlled trial, analyzed 184 women with severe hypertension at ≥28 weeks of pregnancy or within 72 hours after delivery, from October 2012 to September 2014. Ninety-two patients in each group received intravenous Labetalol or Hydralazine boluses, repeated every 10 or 20 minutes respectively (maximum 5 boluses). Outcome measures comprised blood pressure reduction &lt;160/110 mm Hg, mean arterial pressure, severe persistent hypertension, number of boluses, maternal hypotension, tachycardia, adverse effect on fetal heart, still birth and neonatal bradycardia. Data was collected on a semi -structured proforma and analyzed through SPSS version 20. Numeric outcome measures were compared by Mann Whitney U test or independent sample t test according to normality distribution. Qualitative measures were compared by Chi square or Fisher’s exact test. Level of significance was &lt;0.05 Results: There was no significant difference in reduction of systolic, diastolic blood pressure and severe persistent hypertension, between Labetalol and Hydralazine (p&gt;0.05). Tachycardia, palpitation, headache, were significantly higher (p &lt;0.05) in Hydralazine group. Adverse effects on fetal heart were not statistically significant. Numbers of boluses were significantly lower in labetalol group. Conclusion: Labetalol is equal to hydralazine in reducing severe pregnancy related hypertension. Maternal side effect profile of Labetalol is better, and it achieves blood pressure control with reduced boluses. Keywords: Pregnancy-induced hypertension, Hypertensive crisis, Labetalol, Hydralazine, Pregnancy, Preeclampsia, Antihypertensive agent.

S100B as a predictor of delirium in critically ill obstetric patients: A nested case-control study.

Delirium is a neuropsychiatric illness that lasts for a short period of time. The incidence of delirium in the intensive care unit (ICU) varies from 20% to 80%. A nested case-control study was carried out in the obstetric ICU. Individuals were divided into three groups: critically ill obstetric women who had delirium on admission (Group A), women who developed delirium within follow-up of 7 days (Group B), and women who did not develop delirium after follow-up of 7 days (Group C). The APACHE II score was used to assess critical illness severity. The Richmond Agitation-Sedation Scale was used to assess the alertness or sedation level of patients, and the Confusion Assessment Method (ICU scale) was used to assess the presence of delirium. S100B was measured by human S100B calcium-binding protein B ELISA kit (Elabscience Biotechnology, Houston, USA). Severe preeclampsia and antepartum eclampsia were significantly associated with delirium. S100B levels in Group B were found to be significantly higher than those in Group C. S100B levels were higher in patients with >2 morbidities in comparison to patients with two morbidities. At a cutoff value of >169.25 pg/ml, S100B had a sensitivity of 74% and a specificity of 87.2% to discriminate cases of delirium from nondelirium. The rise in S100B levels was approximately three times greater in those who developed delirium as compared to those who did not. It is a more specific predictor of delirium.

Midwifery care for a COVID-19 cohort of women in Northern Italy: two years of pandemic.

The rapid development of the COVID-19 pandemic has altered the context of healthcare around the world. SARS-CoV-2 positive pregnant and postnatal women, being at greater risk of complications, require continuous midwifery surveillance as well as specialized medical care. Scientific literature lacks studies related to midwifery care models in hospital settings during the pandemic. The aim of this work is to describe hospitalizations in an obstetric-gynecological COVID care unit and to provide a descriptive analysis of the organizational and care model adopted. A cohort retrospective descriptive study was carried out. The sample was stratified by COVID-related care complexity and by obstetric risk. The sample recruited pregnant women, postnatal women, and gynecological patients with confirmed SARS-CoV-2 infection admitted to the obstetric-gynecological COVID unit of a birth center in Northern Italy, from March 16, 2020, to March 16, 2022. A number of 1037 women were hospitalized, and of these, 551 were SARS-CoV-2 positive women. The 551 SARS-CoV-2 positive women included 362 pregnant women, 132 postnatal women, 9 gynecological patients with medical diagnosis while 17 with a surgical path, and 31 women undergoing voluntary interruption of pregnancy. The final sample included 536 women. 68.6% of women requested a low care complexity, 22.8% a medium one, and 8.6% a high care complexity. Among the obstetric women population, the majority (70.6%) showed a high obstetric risk. The COVID-19 cohort of women required different levels of care with various care complexity and levels of obstetric risk. The model adopted allowed the acquisition of new technical and professional skills as well as the sharing of responsibilities and competences according to the care model of the Buddy System. Future studies could investigate COVID-related care models adopted internationally, but also deepen the technical and professional skills developed by midwives during the pandemic in order to enrich, improve and support midwifery profession.

A continuous quality improvement strategy to strengthen screening practices and facilitate the routine use of intravenous iron for treating anaemia in pregnant and postpartum women in Nigeria: a study protocol

BackgroundPregnancy-related anaemia is a public health challenge across Africa. Over 50% of pregnant women in Africa get diagnosed with this condition, and up to 75% of these are caused by iron deficiency. The condition is a significant contributor to the high maternal deaths across the continent and, in particular, Nigeria, which accounts for about 34% of global maternal deaths. Whereas oral iron is the mainstay treatment for pregnancy-related anaemia in Nigeria, this treatment is not very effective given the slow absorption of the medication, and its gastrointestinal adverse effects which lead to poor compliance by women. Intravenous iron is an alternative therapy which can rapidly replenish iron stores, but fears of anaphylactic reactions, as well as several misconceptions, have inhibited its routine use. Newer and safer intravenous iron formulations, such as ferric carboxymaltose, present an opportunity to overcome some concerns relating to adherence. Routine use of this formulation will, however, require addressing misconceptions and systemic barriers to adoption in the continuum of care of obstetric women from screening to treatment. This study aims to test the options to strengthen routine screening for anaemia during and immediately after pregnancy, as well as evaluate and improve conditions necessary to deliver ferric carboxymaltose to pregnant and postpartum women with moderate to severe anaemia.MethodsThis study will be conducted in a cluster of six health facilities in Lagos State, Nigeria. The study will employ continuous quality improvement through the Diagnose-Intervene-Verify-Adjust framework and Tanahashi’s model for health system evaluation to identify and improve systemic bottlenecks to the adoption and implementation of the intervention. Participatory Action Research will be employed to engage health system actors, health services users, and other stakeholders to facilitate change. Evaluation will be guided by the consolidated framework for implementation research and the normalisation process theory.DiscussionWe expect the study to evolve transferable knowledge on barriers and facilitators to the routine use of intravenous iron that will inform scale-up across Nigeria, as well as the adoption of the intervention and strategies in other countries across Africa.

Maternal Deaths from COVID-19 in Brazil: Increase during the Second Wave of the Pandemic.

To compare death rates by COVID-19 between pregnant or postpartum and nonpregnant women during the first and second waves of the Brazilian pandemic. In the present population-based evaluation data from the Sistema de Informação da Vigilância Epidemiológica da Gripe (SIVEP-Gripe, in the Portuguese acronym), we included women with c (ARDS) by COVID-19: 47,768 in 2020 (4,853 obstetric versus 42,915 nonobstetric) and 66,689 in 2021 (5,208 obstetric versus 61,481 nonobstetric) and estimated the frequency of in-hospital death. We identified 377 maternal deaths in 2020 (first wave) and 804 in 2021 (second wave). The death rate increased 2.0-fold for the obstetric (7.7 to 15.4%) and 1.6-fold for the nonobstetric groups (13.9 to 22.9%) from 2020 to 2021 (odds ratio [OR]: 0.52; 95% confidence interval [CI]: 0.47-0.58 in 2020 and OR: 0.61; 95%CI: 0.56-0.66 in 2021; p < 0.05). In women with comorbidities, the death rate increased 1.7-fold (13.3 to 23.3%) and 1.4-fold (22.8 to 31.4%) in the obstetric and nonobstetric groups, respectively (OR: 0.52; 95%CI: 0.44-0.61 in 2020 to OR: 0.66; 95%CI: 0.59-0.73 in 2021; p < 0.05). In women without comorbidities, the mortality rate was higher for nonobstetric (2.4 times; 6.6 to 15.7%) than for obstetric women (1.8 times; 5.5 to 10.1%; OR: 0.81; 95%CI: 0.69-0.95 in 2020 and OR: 0.60; 95%CI: 0.58-0.68 in 2021; p < 0.05). There was an increase in maternal deaths from COVID-19 in 2021 compared with 2020, especially in patients with comorbidities. Death rates were even higher in nonpregnant women, with or without comorbidities.

Labor dystocia and oxytocin augmentation before or after six centimeters cervical dilatation, in nulliparous women with spontaneous labor, in relation to mode of birth

BackgroundThe effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and women’s birthing experience.MethodsA retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (≤ 5 cm, 6–10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women´s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward).ResultsThe cesarean section rate differed between the groups (p < 0.001); 12% in the ≤ 5 cm group, 6% in the 6–10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the ≤ 5 cm group compared to the 6–10 cm group, adjusted OR 1.28 95%CI (0.78–2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27–0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the ≤ 5 cm group compared with the 6–10 cm group, adjusted OR 1.76 95%CI (1.05–2.95).ConclusionsAlthough no difference in the risk of operative birth was found between the ≤ 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at ≤ 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the ≤ 5 cm group should be kept in mind to improve labor care.

Analysis of clinical application effects and challenges of early warning system for the high-risk obstetric women of China: A scoping review.

Obstetric critical illness is an important factor that leads to an increase in maternal mortality. Early warning assessment can effectively reduce maternal and neonatal mortality and morbidity. However, there are multiple early warning systems, and the effect and applicability of each system in China still need to be explored. To elaborate on the application, effectiveness and challenges of the existing early warning systems for high-risk obstetric women in China and to provide a reference for clinical practice. A scoping review guided by the Arksey and O'Malley framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. We included original studies related to early warning and excluded those that were guidelines, consensus and reviews. The included studies were published in Chinese or English by Chinese scholars as of June 2021. CNKI, Wanfang, VIP, Cochrane, CINAHL, Embase, PubMed and Web of Science databases were searched systematically, and the reference sections of the included papers were snowballed. In total, 598 articles were identified. These articles were further refined using keyword searches and exclusion criteria, and 17 articles met the inclusion criteria. We extracted data related to each study's population, methods and results. Early warning tools, outcome indices, effects and challenges are discussed. Although all studies have shown that early warning systems have good application effects, the use of early warning systems in China is still limited, with poor regional management and poor sensitivity for specific obstetric women. Future research needs to develop more targeted early warning tools for high-risk obstetric women and address the current challenges in clinical applications.

Evaluation of risk stratification and adherence to venous thromboembolism prophylaxis among hospitalized obstetric women: Retrospective case file review at East Jeddah Hospital during 2018-2019.

BACKGROUND:Venous thromboembolism (VTE) is associated with substantial mortality as well as morbidity and is largely preventable among hospitalized obstetric women. However, thromboprophylaxis is underutilized in most hospitalized patients.OBJECTIVES:To evaluate VTE risk and adherence to local thromboprophylaxis protocol among hospitalized pre- and postnatal women.METHODS:This retrospective study was conducted at East Jeddah Hospital, Jeddah, Saudi Arabia, in 2020. The electronic record database of the hospitalized pregnant Saudi women during the years 2018 and 2019 was reviewed. Based on the local hospital protocol, the risk stratification was reassessed by researchers, and the hospital adherence to the prophylaxis was reviewed separately for antenatal and postnatal women.RESULTS:One thousand and ninety-five electronic records (539 antenatal and 556 postnatal) were reviewed. The postnatal group showed a significantly higher risk compared with an antenatal group (62.2% vs. 11.7%) (P = 0.000). There was a highly significant difference between risk categories assessment by the physicians and the researchers in both groups (P = 0.000). Thromboprophylaxis was overutilized in the low risk (5% heparin and 41.4% heparin and mechanical devices for antenatal and 17.08% heparin and 6.1% heparin and a mechanical device for the postnatal group) and underutilized in intermediate groups (50% no prophylaxis in antenatal and 51.5% mechanical devices in the postnatal group). There was less adherence to documentation in postnatal as compared to antenatal group (83.6% vs. 95%, P = 0.000) for risk documentation and 85.3% versus 91.5% for physician signature (P = 0.001). Thromboprophylaxis was ordered for 21.3% of antenatal (12.2 heparin, 3.5% mechanical, and 5.6% both) and 23.7% of postnatal patients (16.5 heparin, 2% mechanical, and 5.2% both). There were no reported VTE events or bleeding complications.CONCLUSION:There was a considerable VTE risk among hospitalized obstetric patients which peaked during the postnatal period. Physicians showed good compliance to local VTE protocol with no reported VTE events or drug-induced bleeding. However, the implementation of prophylaxis is associated with both under and overutilization. There is a need for increasing the physicians’ awareness of optimizing VTE risk assessment and documentation for hospitalized obstetric patients.

A study on impact and outcomes of clinical pharmacist in assessment and improvement of kap (knowledge, attitude, practice) in safe and effective practices of breast feedings among pregnant women in obstetrics and gynaecology department

The Present study was conducted in order to study the Role, Impact and outcomes of Clinical Pharmacist in assessing and improving KAP (Knowledge, Attitude, Practice) in safe and effective practices of breast feedings among Pregnant women in Obstetrics and Gynaecology departments. It is designed as Prospective, observational and interventional study which was conducted for a period of 3 months (from December 2019 to February 2020) with 357 People in ESI Hospital, Bangalore, and Karnataka, India. People with and aging above 18 years and are confirmed as positive for pregnancy and who are willing to participate in the Present Study were included and People who are not willing to participate in the Present Study were excluded. necessary information for statistical analysis was collected through Personal Interviews and Counselling Forms and Feedback Back forms on leaflets .Microsoft excel was used to record and calculate the data of Recruited Subjects in the present study and mean while Descriptive Statistics like Mean, Standard Deviations were used. 354 out of 357 of 99.15percent out of 100 expressed their positive feedbacks after counselling’s and P-Value was calculated by using Prism Graph Pad Software which is 0.001 which states the present study is highly significant . In India there is lack of proper guidance regarding counselling’s for safe and effective breast feeding practices among pregnant women. So as a responsible health care professional I took it as responsibility to create awareness among them by advanced counselling tips and practices. I definitely hope that the present study will also trigger and acts as catalyst for future researchers to carry out the research towards the present issue.

Maternal and neonatal outcomes in covid negative and covid probable obstetric women presenting with covid like symptoms

Maternal and neonatal outcomes in covid negative and covid probable obstetric women presenting with covid like symptoms

P.67 A review of fluid balance documentation in high-risk obstetric women on our maternal high dependency unit

P.67 A review of fluid balance documentation in high-risk obstetric women on our maternal high dependency unit

Community-based bilingual doulas for migrant women in labour and birth \u2013 findings from a Swedish register-based cohort study

BackgroundCommunity-based bilingual doula (CBD) services have been established to respond to migrant women’s needs and reduce barriers to high quality maternity care. The aim of this study was to compare birth outcomes for migrant women who received CBD support in labour with birth outcomes for (1) migrant women who experienced usual care without CBD support, and (2) Swedish-born women giving birth during the same time period and at the same hospitals.MethodsRegister study based on data retrieved from a local CBD register in Gothenburg, the Swedish Medical Birth Register and Statistics Sweden. Birth outcomes for migrant women with CBD support were compared with those of migrant women without CBD support and with Swedish-born women. Associations were investigated using multivariable logistic regression, reported as odds ratios (aORs) with 95% confidence intervals (CI), adjusted for birth year, maternal age, marital status, hypertension, diabetes, BMI, disposable income and education.ResultsMigrant women with CBD support (n = 880) were more likely to have risk factors for adverse pregnancy outcomes than migrant women not receiving CBD support (n = 16,789) and the Swedish-born women (n = 129,706). In migrant women, CBD support was associated with less use of pain relief in nulliparous women (epidural aOR 0.64, CI 0.50–0.81; bath aOR 0.64, CI 0.42–0.98), and in parous women with increased odds of induction of labour (aOR 1.38, CI 1.08–1.76) and longer hospital stay after birth (aOR 1.19, CI 1.03–1.37). CBD support was not associated with non-instrumental births, perineal injury or low Apgar score. Compared with Swedish-born women, migrant women with CBD used less pain relief (nulliparous women: epidural aOR 0.50, CI 0.39–0.64; nitrous oxide aOR 0.71, CI 0.54–0.92; bath aOR 0.55, CI 0.36–0.85; parous women: nitrous oxide aOR 0.68, CI 0.54–0.84) and nulliparous women with CBD support had increased odds of emergency caesarean section (aOR 1.43, CI 1.05–1.94) and longer hospital stay after birth (aOR 1.31, CI 1.04–1.64).ConclusionsCBD support appears to have potential to reduce analgesia use in migrant women with vulnerability to adverse outcomes. Further studies of effects of CBD support on mode of birth and other obstetric outcomes and women’s experiences and well-being are needed.

SIGNIFICANT ASSOCIATION BETWEEN ANTI-THYROID PEROXIDASE (ANTI-TPO) ANTIBODIES AND LOW BIRTH WEIGHT IN EUTHYROID PREGNANT WOMEN

Background: Maternal and perinatal morbidities are well-documented complications of pregnancy in women with thyroid dysfunction, both clinical and subclinical. About 2–5% of pregnant women suffer from thyroid disorders and timely intervention can be done if detected early. The presence of anti-TPO Ab is associated with increased rate of pregnancy complications such as miscarriage, preterm delivery, placental abruption, pregnancy-induced hypertension, intrauterine death and low birth weight.&#x0D; Objectives: Study the effect of anti-TPO Ab positivity on pregnancy outcome especially birth weight and estimate the prevalence of anti-TPO Ab in euthyroid pregnant women.&#x0D; Methods: This observational study enrolled 500 euthyroid pregnant women, age 20-35 years, up to 20 weeks gestation. Venous blood samples collected and analyzed for the anti-TPO Ab levels. On the basis of Ab positivity they were divided into anti-TPO Ab positive and Ab negative group. These two groups were followed up till delivery and compared fetal outcomes for birth weight.&#x0D; Result: Prevalence of anti-TPO Ab positivity was 5.2% in euthyroid obstetric women. Most of anti-TPO Ab positive women were overweight. Incidence of low birth weight babies was 4 fold higher in anti-TPO Ab positive women.&#x0D; Conclusion: Anti-TPO Ab positivity significantly associated with prepregnancy BMI and low birth weight of newborns.&#x0D; Keywords: Thyroid peroxidase antibodies, Anti-TPO Ab, Euthyroid, Low birth weight.

Application of psychological suggestion therapy in induced labor of mid-late pregnant women in obstetrics.

Application of psychological suggestion therapy in induced labor of mid-late pregnant women in obstetrics.

Age-period-cohort effects in pre-existing and pregnancy-associated diseases amongst primiparous women

BackgroundThe average age at first birth is steadily increasing in developed countries; however, demographic shifts in maternal age at childbearing have not occurred in isolation. While temporal increases in adverse pregnancy outcomes are typically attributed to increases in maternal age, little is known about how maternal health status has changed across maternal age, period of delivery, and birth cohort.MethodsNatality files were used to identify primiparous women delivering liveborn, singleton infants in the USA in 1989, 1994, 1999, 2004, 2009, and 2014 (n = 6,857,185). Age-period-cohort models using the intrinsic estimator adjusted for temporal trends in smoking and gestational weight gain were used to quantify temporal changes in the rates of pre-existing (chronic hypertension, pre-existing diabetes) and pregnancy-associated (pregnancy-associated hypertension, gestational diabetes, eclampsia) diseases. Log-linear models were used to model the impact of temporal changes on preterm birth, small, and large for gestational age (SGA/LGA) births.ResultsSignificant period effects resulted in temporal increases in the rate of chronic hypertension, pregnancy-associated hypertension, and gestational diabetes, and a significant decrease in the rate of eclampsia. These observed period effects were associated with a 10.6% increase in the rate of SGA and a 7.1% decrease in LGA. Had the rate of pre-existing and pregnancy-associated diseases remained static over this time period, the rate of preterm birth would have increased by 5.9%, but instead only increased by 4.4%.ConclusionsIndependent of changes in the incidence of pre-existing and pregnancy-associated diseases as women age, the obstetric population is becoming less healthy over time. This is important, as these changes have a direct negative impact on short-term obstetric outcomes and women’s long-term health.

OP05.06: Genetic polymorphism in high‐risk obstetric and infertility populations

To assess the incidence and outcomes of genetic polymorphism in high-risk obstetric and subfertile populations. From January 2017 to February 2019, 78 patients were detected to have genetic polymorphisms. 35% are high-risk obstetric women who were followed up until their outcomes and 65% are from the subfertile group who are currently being followed up with assisted reproductive techniques. Out of the pregnancies 89% delivered, 4% had miscarriages and 7% are being followed up with high-risk fetomaternal surveillance. Polymorphisms identified in only the subfertile population include Yqh+, Iqh+, 9qh-, Pstk+, 47XXY[1]/46XY[19] and 45XX, t(13, 14)(q12.1, q11.2).The incidence of detected aberrations in this group are Yqh+(4%), Yqh-(12%), Iqh+(2%), 9qh+(32%), 9qh-(4%), Pstk+(8%), 13pstk+(46%), 14pstk+(40%), 15pstk+(50%), 21pstk+(58%), 22pstk+(42%), 14PSQ(2%), 47XXY[1]/46XY[19](2%) and 45XX, t(13, 14)(q12.1, q11.2)(2%). The incidence of genetic abnormalities in the subfertile population consists of Yqh+(4%), Yqh-(10%), 9qh+(24%), 9qh-(4%), Pstk+(8%), 13pstk+(26%), 14pstk+(24%), 15pstk+(34%), 21pstk+(36%), 22pstk+(26%), 47XXY(1)/46XY(19)(2%) and 45XX, t(13, 14)(q12.1, q11.2)(2%). The commonest abnormalities identified in the high risk obstetric group include 9qh+, 13pstk+, 14pstk+, 15pstk+, 21pstk+ and 22pstk+. The incidence of genetic abnormalities consists of Yqh-(4%), 9qh+(15%), 13pstk+(48%), 14pstk+(30%), 15pstk+(30%), 21pstk+(41%), 22pstk+(26%), and 14PSQ(4%). Genetic abnormalities associated with delivery of a low birth weight neonate are 9qh+, 13pstk+, 14pstk+, 15pstk+, 21pstk+ and 22pstk+. Incidence of recurrent miscarriages in this high risk population had underlying genetic abnormalities of Yqh+, Yqh-, 1qh+, 9qh+, pstk+, 13pstk+, 14pstk+, 15pstk+, 21pstk+, 22pstk+ and 14PSQ. Genetic polymorphism is responsible for bad pregnant and fertility outcome in high risk population. Further studies are needed to identify genetic variations and their contribution to bad outcomes. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The inception of a group psychotherapeutic intervention in infertile women – difficulties and obstacles through the constitution of a group setting in a maternity hospital

Several cases of infertility without the presence of a known medical cause and with a spontaneous remission have been studied from the psychological point of view. A look at infertility, in a psychodynamic way, suggests that it is the result of a defensive activation, aimed at promoting emotional protection, seen in pregnant women in high-risk obstetrics, in infertile couples waiting for infertility appointments and in pregnant women waiting for amniocentesis examination outcome. Thus, a spontaneous remission may be seen as a translation that the psychological impasse would have been overcome. This article intends to present a research project that has been held at the Maternity Hospital Dr. Alfredo da Costa (MAC), in Lisbon, and which participants are women followed in the MAC infertility consultation, unable to conceive or lead to good fruition a pregnancy after at least one year of regular sexual intercourse without resorting to contraceptive methods. In this article we intend to reflect the hindrances, difficulties and obstacles felt through the inception of a group psychotherapeutic setting in a Maternity Hospital. After all the bureaucratic issues have been solved out, the psychological resistance of the participants emerged, revealing to be a pattern.

Impact du genre sur le choix de carrière parmi les internes de gynécologie-obstétrique : comparaison Lille/Paris

ObjectiveCompare the professional aspiration and obstacles in gynecology and obstetrics residents careers between Lille and Paris. MethodsWe conducted a cross-sectional survey, using questionnaires sent by e-mail to residents in obstetrics and gynecology in Lille. An analysis by genre was made, and those results were compared to results obtained in a same study with Parisian residents. ResultsAmong the 73 residents in training in Lille, 63 responded (86.3%), of them 53 those were women and 10 were men. No woman answered wanting to start an academic career, however 50% of men did (P=0.001). The global analysis found obstacles to an academic career in defined areas such as: lack of mentors, lack of identification in a same sex role model or women doubting more than men in their abilities to achieve this career. The comparison between the two cities shown a greater gap between women and men in Lille: women in Lille were most reluctant to engage in academic careers and have not the prerequisites (diplomas, mobility or publications) that seem necessary for this type of career. ConclusionsWomen were less expecting to have academic careers in Lille than in Paris. Many barriers have been identified as difficulties for them to follow this career path. It is important to develop strategies to encourage women in gynecology and obstetrics to find their place in research and teaching, since they are most present in this specialty.

Management of Major Obstetric Haemorrhage using ROTEM Point-of-Care Haemostasis Analysers Can Reduce Blood Product usage Without Increasing Fibrinogen Replacement Therapy

Major obstetric haemorrhage (MOH) is a leading cause of maternal death and morbidity, with the majority of deaths occurring within four hours of delivery. Therefore, prompt identification of women at risk of MOH is crucial for the rapid assessment and management of blood loss to urgently restore haemodynamic stability. Furthermore, as the rate of blood loss during MOH can increase rapidly in the time when laboratory results are awaited, the management of MOH could benefit from point-of-care coagulation testing by the ROTEM analyser which has a quicker turnaround time compared to standard laboratory coagulation tests. A number of studies indicate that ROTEM-based management of MOH has resulted in a significant reduction in massive transfusions and decreased transfusion of concentrated red cells (CRC) and fresh frozen plasma (FFP) due to a reduction in total blood loss. Several reports which have linked MOH to the depletion of fibrinogen reserves indicate that the reduction in CRC and FFP transfusions is largely due to an increase in early fibrinogen replacement therapy which corrects hypofibrinogenemia. This short report discusses preliminary findings on the impact of ROTEM point-of-care haemostasis analyser on the transfusion of various blood products to obstetric women experiencing MOH at the Royal Gwent Hospital in South wales. The number of blood products transfused following decisions based on the ROTEM analyser measurements (ROTEM group) was compared to historical transfusion data before the ROTEM analyser became available (Pre-ROTEM group). Blood product transfusion in the Pre-ROTEM group was guided by measurements of standard laboratory coagulation tests in conjunction with the established major haemorrhage protocols at the time. The findings indicate that the ROTEM analyser was effective in managing MOH at point-of-care and led to a reduction in the transfusion of CRC, FFP and platelets. However, contrary to published studies, the reduction in blood product usage was not accompanied by an increase in fibrinogen replacement transfusion therapy, suggesting that the ROTEM’s FIBTEM assay accurately quantified fibrinogen levels based on fibrin-clot firmness to enable an early diagnosis of hypofibrinogenemia. Early establishment of the absence of hypofibrinogenemia helped to prevent unnecessary transfusion of fibrinogen concentrate in this study. These findings support the adoption of routine use of ROTEM analysers at point-of-care on labour wards to manage MOH and reduce fibrinogen replacement therapy. The ease of use and rapidity of ROTEM tests could enable departure from globally directed correction of coagulopathy during MOH to a more focussed and precise target transfusion therapy, which will ultimately reduce blood product wastage (including fibrinogen concentrate) whilst minimising transfusion-associated side effects such as alloimmunisation, circulatory overload and dilutional coagulopathy.