This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a ...predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.
To report the demographic characteristics and clinical morbidity of methamphetamine-exposed pregnancies compared with control patients in a tertiary care, urban, academic medical center.
A ...single-site chart review from 2000 to 2006 was conducted. International Classification of Diseases, 9th Revision code 648.3x was used to identify potential study participants. Specific inclusion criteria required either a positive urine drug screen for methamphetamine use or by patient statement of methamphetamine use during pregnancy. Data from 276 identified patients were then compared with the 34,055 in the general obstetric population during the same period for various demographic factors and perinatal outcomes.
Two hundred seventy-six patients responsible for 273 live births were identified between 2000 and 2006. Factors that were significantly associated with methamphetamine use were age younger than 20 years (9% methamphetamine compared with 16% control patients), non-Hispanic white ethnicity (55% compared with 71%), married (12% compared with 46%), preterm delivery (52% compared with 17%), low Apgar scores (6% compared with 1-2%), cesarean delivery (29% compared with 23%), and neonatal mortality (4% compared with 1%). Additionally, the maternal demographic characteristics suggested that these women were more likely to be unemployed, use other abusive substances, and have higher rates of domestic violence and adoption when compared with the control population.
Methamphetamine use in pregnancy is complicated by more morbid maternal and neonatal outcomes when compared with the general obstetric population. Because the patients in this study were in a variety of ways demographically distinct, attempts to identify these patients early and intervene in an effort to improve pregnancy-related outcomes appears possible and warranted.
II.
Management of pregnancy in women with cirrhosis Rahim, Mussarat N.; Pirani, Tasneem; Williamson, Catherine ...
United European gastroenterology journal,
February 2021, Volume:
9, Issue:
1
Journal Article
Peer reviewed
Open access
Although pregnancy is rare in women with cirrhosis, it is increasingly prevalent in an era of modern assisted conception techniques and improved awareness, monitoring and management of underlying ...liver disease. After overcoming the difficulties of subfertility and becoming pregnant, women undergo a ‘high‐risk’ pregnancy which can be complicated by variceal haemorrhage (≤50%) and hepatic decompensation (≤25%). Management of these complications are similar to non‐pregnant individuals. However, there are a few caveats to consider. These pregnancies are associated with adverse maternal and foetal outcomes, such as mortality (0%–8%) and prematurity (19%–67%) in the newborn, and mortality (0%–14%), pregnancy‐induced hypertension (5%–22%) and post‐partum haemorrhage (5%–45%) in the mother. Pre‐pregnancy counselling, use of predictive scores and appropriate variceal screening during pregnancy can stratify patients and improve outcomes. This review focusses on the complications that can occur during pregnancy in women with cirrhosis.
Interventions to prevent stillbirth Page, Jessica M; Silver, Robert M
Seminars in fetal & neonatal medicine,
06/2017, Volume:
22, Issue:
3
Journal Article
Peer reviewed
Abstract Stillbirth is one of the most distressing complications of pregnancy and still occurs far too frequently. The rate of stillbirth has been decreasing worldwide but room for improvement ...remains even in high-income countries. Risk factors for stillbirth have been identified in an effort to detect those women at increased risk. However, risk factors are non-specific and do not identify most stillbirths. Strategies employed to screen the general population such as assessment of fetal activity, fetal growth screening and biomarkers have also been used to identify increased risk for stillbirth. As with clinical risk factors, these methods are non-specific. Interventions to prevent stillbirth include antenatal testing of high-risk women, ultrasonographic assessments of fetal growth and Doppler velocimetry as well as iatrogenic preterm or term delivery. Additional research into the role of these interventions and better identification of those at high risk for stillbirth will help to achieve further stillbirth reduction.
Aim
High‐risk pregnant women with antenatal depression are prone to postpartum depression. The purpose of this study was to evaluate the effectiveness of an antenatal depression screening and ...intervention among Chinese high‐risk pregnant women with medically defined complications.
Methods
Using a randomized controlled trial design, we enrolled 352 pregnant women with obstetrical complications and an Edinburgh postnatal depression scale (EPDS) ≥9 or postpartum depression screen scale (PDSS) ≥60. These participants were randomly assigned into the intervention group (n = 176) and control group (n = 176). The intervention group underwent a six‐session group intervention with one session focused on the husbands; the control group received the usual care. Participants were assessed at baseline, late pregnancy (≥28 weeks), 3 days and 42 days after delivery with PDSS and EPDS.
Results
Analysis of variance of repeated measures showed significant differences at each time point between groups. Analysis of the Kruskal‐Wallis test showed that there was no statistically significant differences in the PDSS and EPDS scores at any time point among the high‐risk pregnant women who attended different frequencies of the maternal intervention sessions (P > 0.05). Analysis of the Mann‐Whitney U test showed that the PDSS and EPDS were also not impacted based on whether or not the husbands participated in Session 6 of the intervention (P > 0.05).
Conclusions
This study highlights the effectiveness of the screening and the targeted management of antenatal depression in Chinese high‐risk pregnant women.
BACKGROUND: It is well known that miscarriage risk increases with age. However, studies usually investigate only maternal age effects. We investigated both maternal age and paternal age effects on ...miscarriage risk to provide insight into this frequent reproductive failure. METHODS: The last planned pregnancies (n = 3174) that ended in a birth or miscarriage were analysed in a retrospective population-based study on women aged 25–44 years in Denmark, Germany, Italy and Spain. Maternal and paternal ages were analysed together, using a single variable `couple age' in a multivariate logistic regression analysis, with couples composed of a woman and a man both aged 20–29 years forming the reference group. RESULTS: After adjustment for various factors (e.g. reproductive history, country), we found that the risk of miscarriage was higher if the woman was aged ≥35 years, as has already been reported in a number of studies. However, the increase in risk was much greater for couples composed of a woman aged ≥35 years and of a man aged ≥40 years. Potential source of bias (especially `reproductive compensation') are discussed. CONCLUSIONS: The risk of an adverse pregnancy outcome is highest if both partners are advanced in age.
Please cite this paper as: Kelly J, Kohls E, Poovan P, Schiffer R, Redito A, Winter H, MacArthur C. The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in ...high‐risk women in rural Ethiopia. BJOG 2010;117:1377–1383.
Objective To describe maternal mortality and stillbirth rates among women admitted via a maternity waiting area (MWA) and women admitted directly to the same hospital (non‐MWA) over a 22‐year period.
Design Retrospective cohort study.
Setting Hospital in rural Ethiopia, which provided comprehensive emergency obstetric care and has an established MWA.
Population All women admitted for delivery between 1987 and 2008.
Methods Data on maternal deaths, stillbirths, caesarean section and uterine rupture were ed from routine hospital records. Sociodemographic characteristics, antenatal care and other data were collected for 2008 only. Rates and 95% confidence intervals were calculated for maternal mortality and stillbirth.
Main outcome measures Maternal mortality and stillbirth.
Results There were 24 148 deliveries over the study period, 6805 admitted via MWA and 17 343 admitted directly. Maternal mortality was 89.9 per 100 000 live births (95% CI, 41.1–195.2) for MWA women and 1333.1 per 100 000 live births (95% CI, 1156.2–1536.7) for non‐MWA women; stillbirth rates were 17.6 per 1000 births (95% CI, 14.8–21.0) and 191.2 per 1000 births (95% CI, 185.4–197.1), respectively; 38.5% of MWA women were delivered by caesarean section compared with 20.3% of non‐MWA women, and none had uterine rupture, compared with 5.8% in the non‐MWA group. For the 1714 women admitted in 2008, relatively small differences in sociodemographic characteristics, distance and antenatal care uptake were found between groups.
Conclusions Maternal mortality and stillbirth rates were substantially lower in women admitted via MWA. It is likely that at least part of this difference is accounted for by the timely and appropriate obstetric management of women using this facility.
The photographs were released ahead of Women Deliver, the largest gathering of advocates for girls and women in a decade, held in Copenhagen last week to tackle issues such as abortion, the effect of ...Zika virus, sexual and reproductive health and rights, and maternal health.
Abnormal umbilical cord coiling has been associated with adverse neonatal outcomes, but the etiology of these findings remains poorly characterized. This study was undertaken to examine associations ...between cord coiling and maternal iron (Fe) status and to identify potential determinants of hypo- and hypercoiling in 2 higher risk obstetric groups: pregnant adolescents (≤18 years, n = 92) and adult women carrying twins (n = 49), triplets (n = 11), or quadruplets (n = 1). Umbilical cords were classified as hypo-, normo-, or hypercoiled using digital photographs to assess gross appearance. Hypocoiling and hypercoiling were observed in 44% (n = 86/195) and 13% (n = 26/195) of the combined study population. The prevalence of hypocoiling among women carrying multiples was over 3-fold higher than the prevalence in singleton pregnancies based on the published data. Within the entire study population, hypocoiling was associated with a lower gestational age at birth when compared to normocoiling and hypercoiling (36.3 ± 3.6 weeks n = 86 vs 37.8 ± 2.7 n = 83, P < .01, and 38.2 ± 2.6 n = 26, P < .01, respectively), whereas hypercoiling was associated with significantly lower serum ferritin when compared to normocoiling (P < .01) and hypocoiling (P < .001). In the multiples cohort only, hypercoiling was significantly associated with multiparity (P < .01) and lower birth weight (P < .05). Further studies are needed to identify the determinants and consequences of cord coiling.
Polyhydramnios can lead to maternal and fetal complication during pregnancy, so diagnosis and management can decrease some perinatal complications.
One hundred and fourteen singleton pregnancies were ...diagnosed with idiopathic polyhydramnios in the department of obstetrics at Shiraz University of Medical Sciences between January 2000 and January 2011 and were compared with 114 normal pregnancies for their perinatal outcome. Variables include birth weight, admission to neonatal intensive care unit (NICU), meconium staining, respiratory distress, fetal death, neonatal death, low 1-min and 5-min APGAR score, primary cesarean section (C/S), preterm delivery (<37 weeks), postpartum bleeding, and placental abruption.
Low birth weight (<2500 g), macrosoma (>4000 g), NICU admission, fetal distress, fetal death, lower 1-min and 5-min APGAR score, preterm delivery, and neonatal death were higher in the case group. However, meconium staining and malpresentation were equal between the two groups. Except for prematurity and 1-min and 5-min APGAR scores, there were no significant differences in other maternal or fetal outcomes considering the severity of polyhydramnios.
Idiopathic polyhydramnios should be considered as a high-risk pregnancy that warrants close surveillance. More studies should be done to detect the best time and interval of fetal surveillance in these patients. Chromosomal and torch studies can determine the definite cause of polyhydramnios.
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