Worse Pregnancy Outcomes Research Articles

Reproductive history does not compromise subsequent live birth and perinatal outcome following in-vitro fertilization: analysis of 25 329 first frozen-thawed embryo transfer cycles without preimplantation genetic testing for aneuploidy.

To investigate the effect of women's reproductive history on live-birth rate and perinatal outcome after first frozen-thawed embryo transfer (FET) without preimplantation genetic testing for aneuploidy. This was a retrospective cohort study of women who had undergone their first FET cycle between January 2014 and December 2020 at a university-affiliated fertility center. No transferred embryo underwent preimplantation genetic testing for aneuploidy. The women were categorized into five groups based on their reproductive history: no previous pregnancy; previous termination of pregnancy (TOP); previous pregnancy loss; previous ectopic pregnancy (EP); and previous live birth. The women with no previous pregnancy were considered as the reference group. The primary outcome was the live-birth rate and secondary endpoints included rates of positive pregnancy test, clinical pregnancy, pregnancy loss and EP as well as perinatal outcomes such as birth weight and preterm birth. Multivariable logistic regression analyses were used to control for a number of potential confounders, including age, body mass index, education level, duration and cause of infertility, insemination method, type of endometrial preparation, number of embryos transferred, embryo developmental stage, quality of the embryos transferred, year of treatment and endometrial thickness. Additionally, propensity score matching (PSM) was used to check the robustness of the main findings. In total, 25 329 women were included in the final analysis. On univariate analysis, each reproductive-history type except for previous EP was significantly associated with worse pregnancy outcome following in-vitro fertilization (IVF), including rates of positive pregnancy test, clinical pregnancy, pregnancy loss and live birth, when compared with the group of women with no previous pregnancy. However, after correcting for several potential confounders, the differences in rates of live birth, pregnancy loss, positive pregnancy test and clinical pregnancy were no longer significant between the study and control groups on multivariable regression models, while the risk of EP after embryo transfer was elevated among women with a previous TOP or EP. There was no increased risk of adverse perinatal outcome associated with reproductive history compared with the control group. Notably, similar results were obtained from the PSM models, confirming the robustness of the main findings. Relative to women without a previous pregnancy, those with a prior TOP, pregnancy loss, EP or live birth did not have compromised live-birth rate or perinatal outcomes following FET without preimplantation genetic testing for aneuploidy, with the exception of an increased risk of EP in those with prior TOP or EP. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Prenatal exposure to perceived stress, maternal asthma, and placental size

IntroductionPrenatal exposure to stress has been associated with poor pregnancy outcomes, yet evidence linking stress and placental size is limited. Asthma is associated with worse pregnancy outcomes and women with asthma may be more susceptible to stress. Using the asthma-enriched B-WELL-Mom cohort, we examined the association between perceived stress and placental size. MethodsPlacental measures of weight, length, width, and thickness were available for 345 women (262 with asthma) via placental pathology report. Perceived Stress Scale (PSS) scores were obtained in each trimester of pregnancy and categorized into quartiles (low quartile as reference). For associations between PSS and placental size, generalized estimating equations adjusted for maternal and infant factors were used to estimate regression coefficients (β) and 95% confidence intervals (95% CI). Full models and models stratified by asthma status were run. ResultsCompared to Quartile 1, high levels of stress (Quartile 4) were associated with smaller placental weight (−20.63 95% CI: -37.01,-4.26) and length (−0.55 95% CI: -0.96,-0.15), but not width or thickness. Results by asthma status show a stronger association between perceived stress and shorter placental length in those with asthma and a stronger association between perceived stress and smaller placental thickness in those without asthma. Findings were robust to sensitivity analyses DiscussionHigher levels of perceived stress were associated with smaller placental size. Additional research is warranted to understand the relationship between stress and placental size.

Neighborhood Income Mobility and Risk of Neonatal and Maternal Morbidity

Residing in a low-income neighborhood is generally associated with worse pregnancy outcomes. It is not known if moving from a low- to higher-income area between 2 pregnancies alters the risk of adverse birth outcomes in the subsequent birth compared with women who remain in low-income areas for both births. To compare the risk of adverse maternal and newborn outcomes among women who achieved upward area-level income mobility vs those who did not. This population-based cohort study was completed in Ontario, Canada, from 2002 to 2019, where there is universal health care. Included were all nulliparous women with a first-time singleton birth at 20 to 42 weeks' gestation, each residing in a low-income urban neighborhood at the time of the first birth. All women were then assessed at their second birth. Statistical analysis was conducted from August 2022 to April 2023. Movement from a lowest-income quintile (Q1) neighborhood to any higher-income quintile neighborhood (Q2-Q5) between the first and second birth. The maternal outcome was severe maternal morbidity or mortality (SMM-M) at the second birth hospitalization or up to 42 days post partum. The primary perinatal outcome was severe neonatal morbidity or mortality (SNM-M) within 27 days of the second birth. Relative risks (aRR) and absolute risk differences (aARD) were estimated by adjusting for maternal and infant characteristics. A total of 42 208 (44.1%) women (mean [SD] age at second birth, 30.0 [5.2] years) experienced upward area-level income mobility, and 53 409 (55.9%) women (age at second birth, 29.0 [5.4] years) remained in income Q1 between births. Relative to women who remained in income Q1 between births, those with upward mobility had a lower associated risk of SMM-M (12.0 vs 13.3 per 1000 births), with an aRR of 0.86 (95% CI, 0.78 to 0.93) and aARD of -2.09 per 1000 (95% CI, -3.1 to -0.9 per 1000 ). Likewise, their newborns experienced lower respective rates of SNM-M (48.0 vs 50.9 per 1000 live births), with an aRR of 0.91 (95% CI, 0.87 to 0.95) and aARD of -4.7 per 1000 (95% CI, -6.8 to -2.6 per 1000). In this cohort study of nulliparous women living in low-income areas, those who moved to a higher-income area between births experienced less morbidity and death in their second pregnancy, as did their newborns, compared with those who remained in low-income areas between births. Research is needed to determine whether financial incentives or enhancement of neighborhood factors can reduce adverse maternal and perinatal outcomes.

Effect of Gestational Weight Gain on Length of Induction of Labor [ID: 1377561

INTRODUCTION: Review of institutional data found an association between maternal obesity and increased cesarean delivery (CD) among nulliparous, term, single, vertex (NTSV) pregnancies. To identify modifiable risk factors for CD, we evaluated the relationship of gestational weight gain (GWG) to length of induction of labor. METHODS: From January 2020 to May 2021, NTSV inductions were identified via retrospective chart review (IRB#4954). Gestational weight gain according to prepregnancy body mass index (BMI) was categorized using ACOG standards as appropriate, insufficient, or excessive. Time of initial induction agent to delivery time equated to total induction time. Chi square, t test, and regression analyses were performed where appropriate. RESULTS: Of 1,031 inductions, 244 (24%) patients had appropriate, 160 (15%) had insufficient, and 627 (61%) had excessive GWG. 366 (36%) had prepregnancy BMI greater than 30. Average total induction times for appropriate, insufficient, and excessive GWG were 1,179, 1,072, and 1,286 minutes, respectively. Excessive GWG was a positive predictor of length of induction (P<.001). Additionally, those with excessive GWG labored significantly longer with ruptured membranes (84 minutes) than those with appropriate GWG (P=.006). CONCLUSION: Excessive GWG correlated with 107 additional minutes in the induction process and more time with ruptured membranes. These data emphasize the importance of appropriate GWG particularly in patients beginning pregnancy with obesity. Patients with obesity otherwise have worse pregnancy outcomes; therefore, nutrition and exercise counseling during prenatal care could be advantageous. These data also help inform counseling and preparation on labor units, particularly as inductions become more prevalent.

Maternal and Perinatal Outcomes of SARS-CoV-2 and Variants in Pregnancy

Abstract Pregnancy is a physiological state that predisposes women to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, a disease that can cause adverse maternal and perinatal outcomes. The severity of coronavirus disease 2019 (COVID-19) disease is known to vary by viral strain; however, evidence for the effects of this virus in pregnant women has yet to be fully elucidated. In this review, we describe maternal and perinatal outcomes, vaccination, and vertical transmission, among pregnant women infected with the different SARS-CoV-2 variants identified to date. We also summarize existing evidence for maternal and perinatal outcomes in pregnant women with specific information relating to SARS-CoV-2 variants. Our analysis showed that Omicron infection was associated with fewer severe maternal and perinatal adverse outcomes while the Delta variant was associated with worse pregnancy outcomes. Maternal deaths arising from COVID-19 were found to be rare (<1.0%), irrespective of whether the virus was a wild-type strain or a variant. Severe maternal morbidity was more frequent for the Delta variant (10.3%), followed by the Alpha (4.7%), wild-type (4.5%), and Omicron (2.9%) variants. The rates of stillbirth were 0.8%, 4.1%, 3.1%, and 2.3%, respectively, in pregnancies infected with the wild-type strain, Alpha, Delta, and Omicron variants, respectively. Preterm birth and admission to neonatal intensive care units were more common for cases with the Delta infection (19.0% and 18.62%, respectively), while risks were similar for those infected with the wild-type (14.7% and 11.2%, respectively), Alpha (14.9% and 13.1%), and Omicron variants (13.2% and 13.8%, respectively). As COVID-19 remains a global pandemic, and new SARS-CoV-2 variants continue to emerge, research relating to the specific impact of new variants on pregnant women needs to be expanded.

Comparative Study between Gestational and Chronic diabetic women: Incidence, Predictive Factors and Maternal and Fetal complications

Objective: The rate of Diabetes in Egypt has significantly increased, exceeding international rates. The International Diabetes Federation (IDF) listed Egypt among the world's top 10 countries in the number of patients with Diabetes. There are two primary subtypes of Diabetes in pregnancy. One of these is pregestational diabetes mellitus (PGDM), which occurs before a woman becomes pregnant. The second is hyperglycemia, which was first detected during pregnancy and should be classified as DM in pregnancy (DIP) or gestational DM according to WHO guidelines (GDM). DIP is a disease that may be diagnosed if typical DM criteria are reached during screening, while GDM is diagnosed when women satisfy at least one of the criteria during a 100g oral glucose tolerance test, according to current guidelines (OGTT). GDM is a condition that affects pregnant women who develop hyperglycemia but do not have a history of Diabetes. Method: This prospective study was conducted on ninety pregnant females with normal menstrual cycles before pregnancy. Patient’s demographics, urine and blood analysis, HbA1c and OGTT at 24 weeks gestation, as well as ultrasonic screening for early prediction of any congenital malformations were assayed. Results: There was a significant difference in terms of Oral glucose tolerance test at week 24 during fasting, Oral glucose tolerance test at week 24 after one hour, Oral glucose tolerance test at week 24 after two hours, Oral glucose tolerance test at week 24 after three hours using 100 gms glucose; p-value <0.05. Conclusion: The results of this study concluded that mothers with PGDM had worse pregnancy outcomes than those with GDM.

Maternal and Perinatal Outcomes During the COVID-19 Epidemic in Pregnancies Complicated by Gestational Diabetes.

Gestational diabetes (GDM) is one of the most common complications in pregnancy, with a prevalence that continues to rise. At the time of the COVID-19 epidemic, immediate reorganisation and adjustment of the system was needed. Telemedicine support was offered in order to provide high-quality treatment to pregnant women. However, the success of the treatment is unknown. We therefore aimed to evaluate COVID-19 epidemic effects on pregnancy outcomes in GDM. The maternal outcomes (insulin treatment, gestational weight gain, caesarean section, hypertensive disorders) and perinatal outcomes (rates of large and small for gestational age, preterm birth and a composite child outcome) of women visiting a university hospital diabetes clinic from March to December 2020 were compared with those treated in the same period in 2019. Women diagnosed with GDM during the COVID-19 epidemic (n=417), were diagnosed earlier (23.9 [11.7-26.0] vs. 25.1 [21.8-26.7] gestational week), had higher fasting glucose (5.2 [5.0-5.4] vs. 5.1 [4.8-5.3] mmol/l) and earlier pharmacological therapy initiation, and had achieved lower HbA1c by the end of followup (5.1% (32.2 mmol/mol) [4.9% (30.1 mmol/mol)-5.4% (35.0 mmol/mol)] vs. 5.2% (33.3 mmol/mol) [5.0% (31.1 mmol/mol) - 5.4%·(35.5 mmol/mol)], p<0.001) compared to a year before (n=430). No significant differences in perinatal outcomes were found. Although GDM was diagnosed at an earlier gestational age and higher fasting glucose concentration was present at the time of diagnosis, the COVID-19 epidemic did not result in worse glucose control during pregnancy or worse pregnancy outcomes in Slovenia.

Nutritional Status in a Patient with Gestational Diabetes Mellitus and Pregnancy Outcome

Introduction: Both maternal nutritional status and GDM have impact on pregnancy outcome. But, data from Bangladesh in this issue is still scarce. To design and utilize national obstetric health care, nutritional status of GDM women and its impact in the birth weight of babies should be evaluated and therefore, this study was designed. Methods: This prospective cohort study was conducted in the department of Obstetrics and Gynecology at BIRDEM General Hospital-2, Dhaka to evaluate the nutritional status of GDM women and its impact on pregnancy outcomes. Results: The mean age of the patients in the study was 29.71± 5.06 years. The mean age, Mid Upper Arm Circumference (MUAC,) and Body Mass Index (BMI) were significantly higher in GDM mothers (p &lt;0.05). Additionally, gestational weight gain between 28 weeks and before delivery was significantly higher in GDM mothers (p &lt;0.001). The mean birth weight of the newborns was also higher in the GDM group (3.23±0.46vs. 2.97±0.37 kg) (p &lt;0.05). Macrosomic neonates were observed only in the GDM group (4.36%). APGAR score was significantly better in non-GDM mothers’ babies (p &lt;0.05). Babies of GDM mothers had a significantly higher proportion of birth asphyxia, septicemia, pneumonia, Intrauterine Growth Retardation (IUGR), and Neonatal Intensive Care Unit (NICU) admissions (p &lt;0.05). Macrosomic mothers had significantly higher BMI and higher gestational weight gain (p&lt;0.05). Conclusion: Mothers with GDM had a higher rate of bad pregnancy outcomes and that macrosomia was linked to a higher BMI. J Bangladesh Coll Phys Surg 2023; 41: 63-74

Longitudinal maternal cardiac function in hypertensive disorders of pregnancy

Compared with gestational hypertension, preeclampsia has traditionally been considered the worse end of the spectrum of hypertensive disorders of pregnancy. It is associated with worse pregnancy outcomes and future cardiovascular morbidities. Both hypertensive disorders may be associated with cardiac maladaptation in pregnancy. However, previous studies were limited by small numbers and a paucity of longitudinal data and unaccounted for the contribution of maternal characteristics that can affect hemodynamics. This study aimed to assess, in an unselected population, the maternal cardiac adaptation in normotensive and hypertensive pregnancies after controlling for important maternal characteristics that affect maternal cardiac function and the interaction among these covariates. This was a prospective, multicenter longitudinal study of maternal hemodynamics, assessed by a noninvasive bioreactance technology, measured at 11 0/7 to 13 6/7, 19 0/7 to 24 0/7, 30 0/7 to 34 0/7, and 35 0/7 to 37 0/7 weeks of gestation in 3 groups of women. Group 1 was composed of women with preeclampsia (n=45), group 2 was composed of women with gestational hypertension (n=61), and group 3 was composed of normotensive women (n=1643). A multilevel linear mixed-effects model was performed to compare the repeated measures of hemodynamic variables controlling for maternal age, height, weight, weight gain, race, previous obstetrical history, and birthweight. After adjusting for confounders that significantly affect maternal hemodynamics, both group 1 and group 2, compared with group 3, had pathologic cardiac adaptation. Group 1, compared with group 3, demonstrated hyperdynamic circulation with significantly higher cardiac output driven by greater stroke volume in the first trimester of pregnancy. As the pregnancies progressed to after 20 0/7 weeks of gestation, this hyperdynamic state transitioned to hypodynamic state with low cardiac output and high peripheral vascular resistance. Group 2, compared with group 3, had no significant differences in cardiac output, stroke volume, and heart rate before 20 0/7 weeks of gestation but thereafter demonstrated a continuous decline in cardiac output and stroke volume, similar to group 1. Both groups 1 and 2, compared with group 3, had persistently elevated mean arterial pressure and uterine artery pulsatility index throughout pregnancy. After adjusting for confounders that affect maternal hemodynamics in an unselected pregnant population, women with preeclampsia and gestational hypertension, compared with normotensive women, demonstrated similar cardiac maladaptation. This pathologic profile was evident after 20 0/7 weeks of gestation and at least 10 weeks before the clinical manifestation of the disease.

Effect of maternal adverse childhood experiences (ACE) and cannabis use on pregnancy outcomes.

This study aimed to characterize the relationship between cannabis use, ACE score, and pregnancy outcomes. Pregnant patients in Baltimore, MD, completed the 17-point ACE checklist. Charts of the birth parent and neonate were reviewed for urine toxicology testing at initiation of care and delivery, prenatal care metrics, and birth statistics. Multivariable logistic regression analysis was performed to assess the relationship between ACE score, cannabis use, and pregnancy outcomes. Of 256 birth parents, 87 (34.0%) tested positive for cannabis at initial visit and 39 (15.2%) tested positive for cannabis at delivery. Testing positive for cannabis at initial visit or delivery was associated with higher ACE score (15.1 vs 13.7, p = 0.04; 16.2 vs 13.8, p = 0.01). Of those who tested positive for cannabis at initial visit, 39/87 (45.0%) tested positive at delivery. Continued cannabis use at delivery was associated with lower maternal weight gain (7.9kg vs 13.3kg, p = 0.003), fewer prenatal visits (7 vs 8, p = 0.010), and numerically higher mean ACE score. Cannabis use at delivery was associated with 10% lower birthweight (2665g vs 3014g p < 0.05) but not with pre-term birth. Total ACE score was not significantly associated with any birth outcome. Worse pregnancy outcomes were associated with cannabis use throughout pregnancy but not with cannabis use at prenatal care initiation. The interplay of ACE and continued cannabis use during pregnancy warrants further research on the physiologic effects of cannabis and interventions to decrease substance use during pregnancy.

Periodontitis to Placenta

Introduction: Surprising how a small part of our body, the mouth, can alter and result in a variety of systemic complications if not taken care of. The primary factor for maternal and newborn morbidity and mortality is thought to be periodontitis. Gynecologists have a crucial role in educating their patients about the need of keeping good dental health because it can improve the success of pregnancies and reduce mouth pain. Objective: The objective of this study was to understand the awareness of gynecologists practicing in Pune, Maharashtra, about periodontal status and its outcome in pregnant women. Materials and Methods: A questionnaire-based study was conducted on 60 gynecologists. We evaluated people's knowledge of the negative effects of female sex hormones on periodontal health. Results: Eighty percent were aware of the correlation between periodontal health and female sex hormones. 56.7% agreed that periodontal microorganisms can pass through the placenta and harm the fetus. 76.7% were unaware that the possibility of prenatal growth restriction has increased. Most participants did not motivate pregnant women for an oral health checkup. Conclusion: It can be inferred that gynecologists are not aware of the connection between mouth findings and worse pregnancy outcomes.

İlk Trimesterde Bradikardik Olan Fetuslar Terme Ulaşıyor Mu?

Amaç: İlk trimesterde bradikardi saptanan fetüslerin kontrol grubu ile kıyaslanarak obstetrik ve perinatal sonuçlarının değerlendirilmesi amaçlanmıştır.&#x0D; Gereç ve Yöntem: Retrospektif kohort dizayn edilen bu çalışmayla hastanemizde takip ve tedavisi yapılmış ilk trimesterde bradikardi tespit edilen 58 gebe ve 276 normal gebe kontrol grubu olarak alınarak çalışmaya dahil edildi. Her hasta için fetal kalp hızı, yaş, parite, abortus sayısı, gebelik haftası, vücut kitle indeksi (VKİ), yardımcı üreme teknikleri kullanılıp kullanılmadığı, 11-14 hafta arası ölçülen nukal translusensi (NT) değeri, gebeliğin nasıl sonuçlandığı, doğum haftası, doğum şekli, yenidoğan yoğun bakım ünitesinde kaç gün yatış olduğu, fetal cinsiyet not alındı ve bu iki grubun perinatal sonuçları karşılaştırıldı.&#x0D; Bulgular: Ortalama yaş bradikardik grupta 27.8 ± 6.1 olup, kontrol grubunda 28.2±6.0 idi. İlk trimester NT ortalaması bradikardik grupta 1.56 ± 0.61 olup, kontrol grubunda 1.26 ± 0.34 ölçüldü. Bradikardik grubun NT’si istatistiksel olarak anlamlı düzeyde kontrol grubundan daha fazla idi (p

Advanced Maternal Age Impairs Uterine Artery Adaptations to Pregnancy in Rats.

Advanced maternal age (≥35 years) is associated with pregnancy complications. Aging impairs vascular reactivity and increases vascular stiffness. We hypothesized that uterine artery adaptations to pregnancy are impaired with advanced age. Uterine arteries of nonpregnant and pregnant (gestational day 20) young (4 months) and aged (9 months; ~35 years in humans) Sprague-Dawley rats were isolated. Functional (myogenic tone, n = 6–10/group) and mechanical (circumferential stress-strain, n = 10–24/group) properties were assessed using pressure myography and further assessment of elastin and collagen (histology, n = 4–6/group), and matrix metalloproteinase-2 (MMP-2, zymography, n = 6/group). Aged dams had worse pregnancy outcomes, including smaller litters and fetal weights (both p < 0.0001). Only in arteries of pregnant young dams did higher pressures (>100 mmHg) cause forced vasodilation. Across the whole pressure range (4–160 mmHg), myogenic behavior was enhanced in aged vs. young pregnant dams (p = 0.0010). Circumferential stress and strain increased with pregnancy in young and aged dams (p < 0.0001), but strain remained lower in aged vs. young dams (p < 0.05). Arteries from young nonpregnant rats had greater collagen:elastin ratios than the other groups (p < 0.05). In aged rats only, pregnancy increased MMP-2 active capacity. Altered functional and structural vascular adaptations to pregnancy may impair fetal growth and development with advanced maternal age.

The prevalence of metabolic dysfunction–associated fatty liver disease and its association on adverse pregnancy outcomes in women with gestational diabetes mellitus

AimsTo determine the prevalence of metabolic dysfunction–associated fatty liver disease (MAFLD) and its association on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM). Methods380 women with GDM had a FibroScan® performed between 24 and 32 weeks. A Controlled Attenuation Parameter (CAP) ≥ 233.5 dB/m signified MAFLD. Gestational hypertension, pre–eclampsia and eclampsia contributed to a composite of adverse maternal outcomes. A composite of adverse neonatal outcomes included pre–term birth, hypoglycaemia, small/large–for–gestational age and admission to neonatal high dependency. Multiple logistic regression was used to determine independent associations with MAFLD. Results147 (38.7 %) women had MAFLD. Higher pre–pregnancy BMI (median 28.4, IQR 24.7–33.0 kg/m2 vs median 24.0, IQR 21.7–26.5 kg/m2, p < 0.01) and rates of insulin therapy (62.2 % vs 40.7 %, p < 0.01) occurred in MAFLD over non–MAFLD women. MAFLD was independently associated with obesity (aOR 4.73 [95 % CI 2.53–8.86]) and insulin therapy (aOR 1.79 [95 % CI 1.12–2.85]). MAFLD and non–MAFLD women had comparable rates of adverse maternal (7.7 % vs 9.5 %, p = 0.56) and neonatal outcomes (75.4 % vs 68.8 %, p = 0.18). ConclusionsWithin this GDM cohort, almost 40% had FibroScan®–detected MAFLD in mid–to–late gestation. MAFLD was not associated with worse pregnancy outcomes.

Fetal and Neonatal Middle Cerebral Artery Hemodynamic Changes and Significance under Ultrasound Detection in Hypertensive Disorder Complicating Pregnancy Patients with Different Severities.

Colour Doppler ultrasound was applied for monitoring the hemodynamic parameters of fetal uterine artery (UtA), umbilical artery (UA), and middle cerebral artery (MCA) during pregnancy. In hypertension disease complicating pregnancy, these hemodynamic measures and their therapeutic applicability value were reviewed (HDCP). 120 singleton pregnant women were chosen, with 40 cases of mild preeclampsia (mild group), 40 cases of severe preeclampsia (severe group), and 40 normal control pregnant women (control group). The hemodynamic parameters of UtA, MCA, and UA were monitored in the three groups, including pulsatility index (PI), resistance index (RI), and the systolic/diastolic velocity (S/D). The parameters PI, RI, S/D, and venous catheter shunt rate (Qdv/Quv) of UtA and UA in the severe group were higher than those in the normal group and the mild group, showing the differences statistically significant (P < 0.05). The PI, RI, and S/D of MCA in the severe group were lower than those in the normal group and the mild group (P < 0.05). The changing trends of PI, RI, and S/D in the severe group were all first increased and then decreased in the early, middle, and later pregnancy (P < 0.05). The area under the curve (AUC) was 0.98 in the receiver operating characteristic (ROC) curve created using a combination of hemodynamic measures and pregnancy outcomes, and the sensitivity and specificity for predicting bad outcomes were 94.7 percent and 96.4 percent, respectively. Colour Doppler ultrasound may accurately detect changes in the PI, RI, and S/D of UtA, MCA, and UA in pregnant women and serve as a reference for determining the intrauterine state of the fetuses and predicting bad pregnancy outcomes. In particular, the parameters in later pregnancy were higher worthy of diagnostic value for adverse pregnancy outcomes. The combination of various parameters could make an improvement of the diagnostic accuracy and provide a basis for guiding treatment as well as determining the optimal timing of delivery.

Risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan: results from the Women ASPIRE cross-sectional study

BackgroundSyrian refugee women face health care disparities and experience worse pregnancy outcomes, including miscarriage. We investigated risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan to identify targets for interventions.MethodsWe analyzed data from Women ASPIRE, a cross-sectional study of gendered physical and mental health concerns of 507 Syrian refugee women (≥ 18 years old) living in non-camp settings in Jordan. We recruited women using systematic clinic-based sampling from four clinics. We limited our analyses to women who had a history of pregnancy and whose most recent pregnancy was single, took place in Jordan, and ended in term live birth or miscarriage (N = 307). We grouped the women by the primary outcome (term live birth or miscarriage) and compared the sociodemographic and clinical characteristics of the two groups. We used Pearson’s χ2 test or the Mann–Whitney U test to obtain unadjusted estimates and multivariable binomial logistic regression to obtain adjusted estimates.ResultsThe most recent pregnancies of 262 women (85%) ended in term live birth and another 45 (15%) ended in miscarriage. Since crossing into Jordan, 11 women (4%) had not received reproductive health services. Of 35 women who were ≥ 35 years old, not pregnant, and did not want a (or another) child, nine (26%) did not use contraception. Of nine women who were ≥ 35 years old and pregnant, seven (78%) did not plan the pregnancy. The adjusted odds of miscarriage were higher in women who had been diagnosed with thyroid disease (aOR, 5.54; 95% CI, 1.56–19.07), had been of advanced maternal age (aOR, 5.83; 95% CI, 2.02–16.91), and had not received prenatal care (aOR, 36.33; 95% CI, 12.04–129.71). Each additional previous miscarriage predicted an increase in the adjusted odds of miscarriage by a factor of 1.94 (1.22–3.09).ConclusionsWe identified several risk factors for miscarriage in Syrian refugee women living in non-camp settings in Jordan. The risk factors may be amenable to preconception and prenatal care.

Prevalence of Vitamin D Deficiency Among Antenatal Cases Between Vitamin D Levels and the Possibility of Adverse Pregnancy Outcome

Background: From the beginning till delivery, the embryo relies solely on its mother for all of its nutritional needs. There is a direct link between 25-OHD insufficiency and bad pregnancy outcomes, including preterm and congenital abnormalities. The study's goals were to find out how common deficiencies are among pregnant women at Indus Medical Hospital and to see if there's a link between those deficiencies and pregnancy difficulties. Material and Methods: Over six months, researchers examined the 25(OH)D levels and obstetrical problems, and risk-factors of 90 women. I observed 25-OHD deficiency in 43 pregnant women, according to the results. Results: A total of 90 pregnant women were enrolled, of these, 43 (47.77%) women had vitamin D deficiency. 34 (37.77%) of the females did not ate non-vegetarian foods and 20 (22.22%) ate non-vegetarian meals every other day. Milk intake was likewise low, with 37 (41.11%) drinking it every other day or fewer; the normal serving size of milk was 150 ml. Women below 30 years of age of 23 (53.48%), housewives of 22 (51.16%), and low-income households of 20 (46.51%) showed significantly lower vitamin D levels than women with higher socioeconomic status. Women with low 25(OH)D levels and pregnancies that resulted in over 34 (79.06%) low birth weight babies (&lt;2.5kg) were more likely to experience growth restriction. The baby's growth in utero appears to be being affected by maternal deficiencies. Conclusions: In conclusion, we observed that the frequency of 25(OH)D insufficiency was quite high. keywords: Vitamin d deficiency, antenatal cases, adverse pregnancy outcome

Which type of chromosomal mosaicism is compatible for embryo transfer: a systematical review and meta-analysis.

Chromosomal mosaicism becomes a common phenomenon in Preimplantaion genetic testing (PGT). This meta-analysis was conducted to study which feature of chromosomal mosaicism was compatible for embryo transfer. After searching the database PubMed, Embase, CCTR and related reviews up until May 2021. Two reviewers extracted relevant information and assessed study quality by the Newcastle-Ottawa scale independently. Summary Odd Radios(OR) were calculated using fixed- or random-effects models for clinical outcomes. A network meta-analysis compared the clinical outcomes of different chromosomes. A total of six studies with 1,106 cycles of single mosaic embryo transferred were included. Significant results of implantation rate(IR), miscarriage rate (MR), andongoing pregnancy/live birth rate (OP/LBR) were observed when comparing embryos with mosaicism level < 50% and ≥ 50% [OR 1.42, 95% CI (1.06, 1.89); OR 0.45, 95% CI (0.27, 0.75); OR 1.74, 95% CI (1.28, 2.37)], and embryos with mosaicism with only affecting segmental chromosome(s) and only involving whole chromosome(s) [OR 1.31, 95% CI (1.01, 1.71); OR 0.57, 95% CI (0.36, 0.93); OR 1.51, 95% CI (1.15, 2.00)]. Embryos with only mosaic gains or losses had significant higher IR and OP/LBR than complex mosaicism [Gains vs complex: OR 1.75, 95% CI (1.20, 2.54); OR 1.73, 95% CI (1.16, 2.58). Losses vs complex: OR 1.90, 95% CI (1.34, 2.71); OR 2.10, 95% CI (1.44, 3.07)]. Mosaic embryos with only one chromosome involved had significant favorable outcomes of IR and OP/LBR than with three or more chromosomes involved [OR 1.76, 95% CI (1.23, 2.52); OR 1.86, 95% CI (1.25,2.78)]. Chr. 7, Chr. 2, Chr. 1, Chr. 18, Chr. 11, Chr. X, Chr. 13, Chr. 14, Chr. 12, and Chr. 9 were considered as prioritized chromosomes of mosaic embryos for transfer. This analysis support the embryos with mosaicism level ≥ 50%, whole chromosome(s) involved, multiple mosaic abnormalities were associated with worse pregnancy outcomes. Mosaicism level of 50% could be used as a threshold to assess the mosaic embryos.

Severity of maternal infection and perinatal outcomes during periods of SARS-CoV-2 wildtype, alpha, and delta variant dominance in the UK: prospective cohort study

ObjectiveTo compare the severity of maternal infection and perinatal outcomes during periods in which wildtype, alpha variant, and delta variant of SARS-CoV-2 were dominant in the UK.DesignProspective cohort study.Setting194 obstetric...

Didelphys uterus: a successful induction of labor in a case of intrauterine fetal death near term

Abstract Objectives Müllerian anomalies are associated with infertility and worse pregnancy outcomes. Case presentation A 34-years-old primigravida patient affected by didelphys uterus and type 2 diabetes mellitus was admitted at 36.4 weeks with intrauterine fetal death. Labor was induced with oral Mifepristone and vaginal Dinoprostone. She had an uneventful vaginal delivery. Conclusions Pre-gestational evaluation should be recommended in each woman, in order to optimize clinical conditions in case of a chronic disease; moreover, if the patient is infertile Müllerian malformations should be excluded. In a didelphys uterus, the combination of Mifepristone and Dinoprostone could be a safe option for labor induction.