Journal of Pregnancy The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Using Community Informants to Estimate Maternal Mortality in a Rural District in Pakistan: A Feasibility Study Mon, 09 Feb 2015 13:31:29 +0000 Background. We aimed to assess the feasibility of using community-based informants’ networks to identify maternal deaths that were followed up through verbal autopsies (MADE-IN MADE-FOR technique) to estimate maternal mortality in a rural district in Pakistan. Methods. We used 4 community networks to identify deaths in women of reproductive age in the past 2 years in Chakwal district, Pakistan. The deaths recorded by the informants were followed up through verbal autopsies. Results. In total 1,143 Lady Health Workers (government employees who provide primary health care), 1577 religious leaders, 20 female lady councilors (elected representatives), and 130 nikah registrars (persons who register marriages) identified 2001 deaths in women of reproductive age. 1424 deaths were followed up with verbal autopsies conducted with the relatives of the deceased. 169 pregnancy-related deaths were identified from all reported deaths. Through the capture-recapture technique probability of capturing pregnancy-related deaths by LHWs was 0.73 and for religious leaders 0.49. Maternal mortality in Chakwal district was estimated at 309 per 100,000 live births. Conclusion. It is feasible and economical to use community informants to identify recent deaths in women of reproductive age and, if followed up through verbal autopsies, obviate the need for conducting large scale surveys. Ali Mohammad Mir, Mohammad Saleem Shaikh, Siti Nurul Qomariyah, Gul Rashida, Mumraiz Khan, and Irfan Masood Copyright © 2015 Ali Mohammad Mir et al. All rights reserved. Knowledge of Pregnant Women on Mother-to-Child Transmission of HIV in Meket District, Northeast Ethiopia Mon, 09 Feb 2015 13:27:55 +0000 Knowledge of pregnant women on the three periods of mother-to-child transmission (MTCT) of HIV has implication for child HIV acquisition. This study aims to assess the knowledge of pregnant women on mother-to-child transmission of HIV and to identify associated factors in Meket district, northeast Ethiopia. Logistic regression models were fitted to identify associated factors. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were used to determine the presence and strength of association. About one-fifth (19%) of women were knowledgeable on mother-to-child transmission of HIV (95% CI: 15.5%, 22.4%). Being urban resident (AOR: 2.69, 95% CI: 1.48, 4.87), having primary education (AOR: 2.41, 95% CI: 1.03, 5.60), reporting receiving information on HIV from health care providers (AOR: 3.24, 95% CI: 1.53, 6.83), having discussion with partner about mother-to-child transmission of HIV (AOR: 2.64, 95% CI: 1.59, 4.39), and attending antenatal care (AOR: 5.80, 95% CI: 2.63, 12.77) were positively associated with increased maternal knowledge of mother-to-child transmission of HIV. Knowledge of mother-to-child transmission of HIV among pregnant women was low. Providing information, especially for rural women and their partners, is highly recommended. Tesfaye Birhane, Gizachew Assefa Tessema, Kefyalew Addis Alene, and Abel Fekadu Dadi Copyright © 2015 Tesfaye Birhane et al. All rights reserved. Posttraumatic Stress and Posttraumatic Stress Disorder after Termination of Pregnancy and Reproductive Loss: A Systematic Review Thu, 05 Feb 2015 09:00:26 +0000 Objective. The aims of this systematic review were to integrate the research on posttraumatic stress (PTS) and posttraumatic stress disorder (PTSD) after termination of pregnancy (TOP), miscarriage, perinatal death, stillbirth, neonatal death, and failed in vitro fertilisation (IVF). Methods. Electronic databases (AMED, British Nursing Index, CINAHL, MEDLINE, SPORTDiscus, PsycINFO, PubMEd, ScienceDirect) were searched for articles using PRISMA guidelines. Results. Data from 48 studies were included. Quality of the research was generally good. PTS/PTSD has been investigated in TOP and miscarriage more than perinatal loss, stillbirth, and neonatal death. In all reproductive losses and TOPs, the prevalence of PTS was greater than PTSD, both decreased over time, and longer gestational age is associated with higher levels of PTS/PTSD. Women have generally reported more PTS or PTSD than men. Sociodemographic characteristics (e.g., younger age, lower education, and history of previous traumas or mental health problems) and psychsocial factors influence PTS and PTSD after TOP and reproductive loss. Conclusions. This systematic review is the first to investigate PTS/PTSD after reproductive loss. Patients with advanced pregnancies, a history of previous traumas, mental health problems, and adverse psychosocial profiles should be considered as high risk for developing PTS or PTSD following reproductive loss. Viltė Daugirdaitė, Olga van den Akker, and Satvinder Purewal Copyright © 2015 Viltė Daugirdaitė et al. All rights reserved. Reference Ranges of Amniotic Fluid Index in Late Third Trimester of Pregnancy: What Should the Optimal Interval between Two Ultrasound Examinations Be? Thu, 15 Jan 2015 14:11:44 +0000 Background. Amniotic fluid index (AFI) is one of the major and deciding components of fetal biophysical profile and by itself it can predict pregnancy outcome. Very low values are associated with intrauterine growth restriction and renal anomalies of fetus, whereas high values may indicate fetal GI anomalies, maternal diabetes mellitus, and so forth. However, before deciding the cut-off standards for abnormal values for a local population, what constitutes a normal range for specific gestational age and the ideal interval of testing should be defined. Objectives. To establish reference standards for AFI for local population after 34 weeks of pregnancy and to decide an optimal scan interval for AFI estimation in third trimester in low risk antenatal women. Materials and Methods. A prospective estimation of AFI was done in 50 healthy pregnant women from 34 to 40 weeks at weekly intervals. The trend of amniotic fluid volume was studied with advancing gestational age. Only low risk singleton pregnancies with accurately established gestational age who were available for all weekly scan from 34 to 40 weeks were included in the study. Women with gestational or overt diabetes mellitus, hypertensive disorders of the pregnancy, prelabour rupture of membranes, and congenital anomalies in the foetus and those who delivered before 40 completed weeks were excluded from the study. For the purpose of AFI measurement, the uterine cavity was arbitrarily divided into four quadrants by a vertical and horizontal line running through umbilicus. Linear array transabdominal probe was used to measure the largest vertical pocket (in cm) in perpendicular plane to the abdominal skin in each quadrant. Amniotic fluid index was obtained by adding these four measurements. Statistical analysis was done using SPSS software (Version 16, Chicago, IL). Percentile curves (5th, 50th, and 95th centiles) were constructed for comparison with other studies. Cohen’s coefficient was used to examine the magnitude of change at different time intervals. Results. Starting from 34 weeks till 40 weeks, 50 ultrasound measurements were available at each gestational age. The mean (standard deviation) of AFI values (in cms) were 34 W: 14.59 (1.79), 35 W: 14.25 (1.57), 36 W: 13.17 (1.56), 37 W: 12.48 (1.52), 38 W: 12.2 (1.7), and 39 W: 11.37 (1.71). The 5th percentile cut-off was 8.7 cm at 40 weeks. There was a gradual decline of AFI values as the gestational age approached term. Significant drop in AFI was noted at two-week intervals. AFI curve generated from the study varied significantly when compared with already published data, both from India and abroad. Conclusion. Normative range for AFI values for late third trimester was established. Appreciable changes occurred in AFI values as gestation advanced by two weeks. Hence, it is recommended to follow up low risk antenatal women every two weeks after 34 weeks of pregnancy. The percentile curves of AFI obtained from the present study may be used to detect abnormalities of amniotic fluid for our population. Shripad Hebbar, Lavanya Rai, Prashant Adiga, and Shyamala Guruvare Copyright © 2015 Shripad Hebbar et al. All rights reserved. Prevalence of Musculoskeletal Dysfunctions among Indian Pregnant Women Tue, 06 Jan 2015 09:18:23 +0000 Background and Objectives. Pregnancy triggers a wide range of changes in a woman’s body leading to various musculoskeletal dysfunctions. Most commonly reported musculoskeletal discomforts by pregnant women are low back pain and symphysis pubis pain. The culture and the environmental factors may influence the discomforts experienced by a pregnant woman. There is a dearth of literature in India, regarding the common musculoskeletal dysfunctions experienced by a pregnant woman, and hence this study. Method. A questionnaire to identify the musculoskeletal dysfunction was developed; content was validated and was translated to local languages through parallel back translation. 261 primiparous pregnant women participated in the study and filled the questionnaire in their native language. Results. Among the musculoskeletal dysfunctions reported by the pregnant women, 64.6% reported calf muscle cramps, 37.1% reported foot pain, and 33.7% experienced low back pain in their third trimester. In the second trimester, common musculoskeletal dysfunctions experienced by the women were that of calf pain (47.8%), low back pain (42%), and pelvic girdle pain (37%). Conclusion. Musculoskeletal dysfunctions and general discomforts very commonly affect the activities of daily living of pregnant women. Understanding the common discomforts during various trimesters of pregnancy will help to develop a comprehensive program for prevention and cure. Preetha Ramachandra, Arun G. Maiya, Pratap Kumar, and Asha Kamath Copyright © 2015 Preetha Ramachandra et al. All rights reserved. Gastroschisis: Antenatal Sonographic Predictors of Adverse Neonatal Outcome Mon, 22 Dec 2014 00:10:07 +0000 Objectives. The aim of this review was to identify clinically significant ultrasound predictors of adverse neonatal outcome in fetal gastroschisis. Methods. A quasi-systematic review was conducted in PubMed and Ovid using the key terms “gastroschisis,” “predictors,” “outcome,” and “ultrasound.” Results. A total of 18 papers were included. The most common sonographic predictors were intra-abdominal bowel dilatation (IABD), intrauterine growth restriction (IUGR), and bowel dilatation not otherwise specified (NOS). Three ultrasound markers were consistently found to be statistically insignificant with respect to predicting adverse outcome including abdominal circumference, stomach herniation and dilatation, and extra-abdominal bowel dilatation (EABD). Conclusions. Gastroschisis is associated with several comorbidities, yet there is much discrepancy in the literature regarding which specific ultrasound markers best predict adverse neonatal outcomes. Future research should include prospective trials with larger sample sizes and use well-defined and consistent definitions of the adverse outcomes investigated with consideration given to IABD. Rachael Page, Zachary Michael Ferraro, Felipe Moretti, and Karen Fung Kee Fung Copyright © 2014 Rachael Page et al. All rights reserved. IUGR Management: New Perspectives Tue, 09 Dec 2014 06:31:44 +0000 Aim of the Study. Analyzing velocimetric (umbilical artery, UA; ductus venosus, DV; middle cerebral artery, MCA) and computerized cardiotocographic (cCTG) (fetal heart rate, FHR; short term variability, STV; approximate entropy, ApEn) parameters in intrauterine growth restriction, IUGR, in order to detect early signs of fetal compromise. Population Study. 375 pregnant women assisted from the 28th week of amenorrhea to delivery and monitored through cCTG and Doppler ultrasound investigation. The patients were divided into three groups according to the age of gestation at the time of delivery, before the 34th week, from 34th to 37th week, and after the 37th week. Data were analyzed in relation to the days before delivery and according to the physiology or pathology of velocimetry. Statistical analysis was performed through the t-test, chi-square test, and Pearson correlation test . Our results evidenced an earlier alteration of UA, DV, and MCA. The analysis between cCTG and velocimetric parameters (the last distinguished into physiological and pathological values) suggests a possible relation between cCTG alterations and Doppler ones. The present study emphasizes the need for an antenatal testing in IUGR fetuses using multiple surveillance modalities to enhance prediction of neonatal outcome. N. Giuliano, M. L. Annunziata, S. Tagliaferri, F. G. Esposito, O. C. M. Imperato, M. Campanile, M. G. Signorini, and A. Di Lieto Copyright © 2014 N. Giuliano et al. All rights reserved. Effects of Continuous Use of Entonox in Comparison with Intermittent Method on Obstetric Outcomes: A Randomized Clinical Trial Sun, 30 Nov 2014 09:45:37 +0000 Background. Entonox (N2O2) which is an inhalational gas for relieving labor pain is commonly used intermittently; however some women are interested in continuous breathing in face mask. So we decided to compare the complications induced by two methods to find out whether it is safe to permit the mothers to use Entonox continuously or not. Patients and Methods. This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. 50 parturients used Entonox intermittently and 50 cases used it continuously during labor. Then obstetrical outcomes were analyzed in two groups by spss 17 software, -test, and Chi2 while was considered significant. Results. This study showed the mean duration of second stage of labor had no significant difference (). Perineal laceration was less in continuous group significantly (). Assisted vaginal birth was not different significantly (). Uterine atony had no significant difference in two groups (). Maternal collaboration in pushing and satisfaction were higher in continuous group significantly (), (). Apgar score of neonates at first and fifth minute was acceptable and not different significantly in two groups (). Conclusions. Our study demonstrated continuous method is also safe. So, it seems reasonable to set mothers free to choose the desired method of Entonox usage. Jila Agah, Roya Baghani, Seid Hossein Safiabadi Tali, and Yaser Tabarraei Copyright © 2014 Jila Agah et al. All rights reserved. A Prospective Study of Villous Capillary Lesions in Complicated Pregnancies Mon, 24 Nov 2014 13:39:15 +0000 The vascularity of placental tissue is dependent on various factors of which fetomaternal hypoxia plays a major role. Hypoxia can be of different types and each type influences the vascularity of the villi, especially terminal villi, in its own way. In this study, we attempted to identify villous vascular changes in a group of term placentae from mothers with diseases complicating pregnancy. Chorangiosis was the most frequently identified lesion while chorangioma was found in only 2 cases. There were no cases of chorangiomatosis. A few cases had normal villous vasculature. Maternal diseases have a major role in disrupting the placental vasculogenesis and angiogenesis by creating a hypoxic environment that may affect the fetus adversely. Hence, such conditions need to be identified early in pregnancy and managed appropriately as it is possible to maintain a normal vasculature and prevent neonatal mortality and morbidity if prompt intervention is done. Anu Priyadharshini Srinivasan, B. O. Parijatham Omprakash, Kandhimalla Lavanya, Priyadharshini Subbulakshmi Murugesan, and Saraswathi Kandaswamy Copyright © 2014 Anu Priyadharshini Srinivasan et al. All rights reserved. 11-Year Trends in Pregnancy-Related Health Indicators in Maine, 2000–2010 Thu, 13 Nov 2014 10:35:06 +0000 The objective of this study is to understand health and demographic trends among mothers and infants in Maine relative to the goals of Healthy People 2020. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine yearly values of pregnancy-related variables. Means (for continuous variables) and percentages (for categorical variables) were calculated using the survey procedures in SAS. Linear trend analysis was applied with study year as the independent variable. The slope and significance of the trend were then calculated. Over the study period, new mothers in Maine became better educated but the fraction of households with incomes <$20,000/year remained stagnant. Maternal prepregnancy BMI increased. Average pregnancy weight gain decreased but the number of women whose pregnancy weight gain was within the recommended range was unchanged. The rates of smoking and alcohol consumption (before and during pregnancy) increased. The Caesarean section rate rose and the fraction of infants born premature (<37 wks gestation) or underweight (<2500 gms) remained unchanged. The fraction of infants who were breast-fed increased. These results suggest that, despite some positive trends, Maine faces significant challenges in meeting Healthy People 2020 goals. David E. Harris, AbouEl-Makarim Aboueissa, Nancy Baugh, Cheryl Sarton, and Erika Lichter Copyright © 2014 David E. Harris et al. All rights reserved. Mild Anemia and Pregnancy Outcome in a Swiss Collective Thu, 13 Nov 2014 07:07:34 +0000 Background. Over half of all women in the world experience anemia during their pregnancy. Our aim was to investigate the relation between hemoglobin and iron status examined in second trimester and pregnancy outcome. Methods. In a prospective longitudinal study, 382 pregnant women were included. Blood samples were examined for hematological status and serum ferritin between 16 and 20 weeks and for hemoglobin before delivery. The adverse maternal and perinatal outcomes were determined. Regression analysis was performed to establish if anemia and low serum ferritin are risk factors for pregnancy complications. Results. There was no increase of complications in women with mild anemia and in women with depleted iron stores. The finding showed that mild iron deficiency anemia and depleted iron stores are not risk factors for adverse outcomes in iron supplemented women. Conclusions. Mild anemia and depleted iron stores detected early in pregnancy were not associated with adverse maternal and perinatal outcomes in iron supplemented women. Gabriela Bencaiova and Christian Breymann Copyright © 2014 Gabriela Bencaiova and Christian Breymann. All rights reserved. Factor XII (Hageman) Levels in Women with Recurrent Pregnancy Loss Wed, 12 Nov 2014 00:00:00 +0000 Objective. To evaluate factor XII levels in women with recurrent pregnancy loss (RPL) in a tertiary referral hospital. Methods. Women who were referred to our hospital for two consecutive abortions or three abortions in between 2007 and 2013 were included in this retrospective observational study. Women were further grouped according to factor XII levels, as <60% and ≥60%. Results. Mean factor XII level was 109.1 ± 35.7% (range: 9–200). Ninety-three (7.4%) women had factor XII levels < 60%. Mean factor XII level was 44.8 ± 13.1, and levels ranged between 9 and 60 in this group. Only one woman had factor XII level < 10 %. Remaining 1164 (92.6%) women had factor XII levels ≥ 60%. Mean factor XII level was 114.3 ± 31.7, and levels ranged between 60.3 and 200 in this group, while 1015 (72.4%) women had factor XII levels within the normal range (60%–150% [100% = 30 μg/mL]). Conclusion. Decreased activity of F-XII was diagnosed in 7.4% of women with RPL. We concluded factor XII deficiency that might be a rare but significant factor for RPL, and should be evaluated in women who are investigated for recurrent pregnancy loss. A. Seval Ozgu-Erdinc, Cihan Togrul, Ayla Aktulay, Umran Buyukkagnici, Elif Gul Yapar Eyi, and Salim Erkaya Copyright © 2014 A. Seval Ozgu-Erdinc et al. All rights reserved. Using Celecoxib for the Suppression of Preterm Labor Instead of Magnesium Sulfate Thu, 23 Oct 2014 06:29:13 +0000 We aimed to use celecoxib to suppress preterm labor instead magnesium sulfate (MgSO4) to prevent preterm labor. Methods. It was a randomized clinical trial study, which was done on 600 pregnant women. All subjects were divided into two groups by simple random sampling. One group was given 4 grams of MgSO4 intravenously and second group was given 100 mg of celecoxib orally every 12 hours for at least 2 days. The data were entered and analyzed using SPSS 11 and performed using -test and chi-square test. Results. The finding of this study has shown that preterm labor may be prevented in 75.7% of subjects who had received celecoxib and there were no significant difference between two groups in frequency of history of preterm labor (), frequencies of nulliparity (), duration of drug use and arrest contraction (), delivery before 48 hours (), and mean gestational age in lack of response to treatment (). Conclusions. Result has shown that celecoxib was similar to MgSO4 as a medication to prevent preterm labor; it was recommended to be prescribe to prevent preterm labor, because it was cheaper than magnesium sulfate. Najmieh Saadati, Farideh Moramezi, Maria Cheraghi, and Laila Sokhray Copyright © 2014 Najmieh Saadati et al. All rights reserved. Can Preterm Labour Be Predicted in Low Risk Pregnancies? Role of Clinical, Sonographic, and Biochemical Markers Wed, 22 Oct 2014 06:26:46 +0000 Background and Objectives. This is a prospective nested cohort study conducted over a period of 3 years. 2644 women were recruited, out of which final analysis was done for 1884 women. Methods. Cervicovaginal and blood samples were collected for all recruited women. Out of these, 137 women who delivered before 35 weeks were treated as cases and equal number of matched controls were chosen. Analysis of samples for serum G-CSF, AFP, ferritin, and cervicovaginal interleukin-6 and IGFBP-1 was done. Results. Poor orodental hygiene, which can be a social marker, was significantly more common in women who delivered preterm (). Serum alkaline phosphatase and serum ferritin were found to be significantly associated with preterm deliveries. The 90th percentile value of these parameters was considered as cut-off as there is no specific cut-off. Conclusions. Our study did not prove usefulness of any predictive marker. Serum ferritin and alkaline phosphatase were found to have correlation but their values are affected in many conditions and need to be elucidated with caution. Larger studies are needed for predicting preterm labour in asymptomatic women. Reva Tripathi, Shakun Tyagi, Nilanchali Singh, Yedla Manikya Mala, Chanchal Singh, Preena Bhalla, and Siddhartha Ramji Copyright © 2014 Reva Tripathi et al. All rights reserved. Visual Acuity Changes during Pregnancy and Postpartum: A Cross-Sectional Study in Iran Sun, 28 Sep 2014 11:35:15 +0000 In this research, we represent the changes in visual acuity during pregnancy and after delivery. Changes as myopic shift start during second trimester and will be stopped after delivery; however it is obtained that women will have the same refractive error as what they had in the first trimester, after postpartum. So, any change in their spectacle prescription during this period is forbidden. As a result, not only changing in hormones can cause myopic shift in vision, but also overweight has its retributive role. What we are trying to do is to notify gynecologists and optometrists to be aware of these changes, so as to leave spectacle prescription writing to the session after postpartum period. Khashayar Mehdizadehkashi, Shahla Chaichian, Abolfazl Mehdizadehkashi, Ebrahim Jafarzadepour, Zeinab Tamannaie, Bahram Moazzami, and Mohaddeseh Pishgahroudsari Copyright © 2014 Khashayar Mehdizadehkashi et al. All rights reserved. The Relationship of Objectively Measured Physical Activity and Sedentary Behaviour with Gestational Weight Gain and Birth Weight Sun, 21 Sep 2014 00:00:00 +0000 Objective. To evaluate the relationship of physical activity (PA) and sedentary behaviour with gestational weight gain (GWG) and birth weight. Design. Combined data from two prospective studies: (1) nulliparous pregnant women without BMI restrictions and (2) overweight and obese pregnant women at risk for gestational diabetes. Methods. Daily PA and sedentary behaviour were measured with an accelerometer around 15 and at 32–35 weeks of gestation. The association between time spent in moderate-to-vigorous PA (MVPA) and in sedentary activities with GWG and birth weight was determined. Main outcome measures were GWG between 15 and 32 weeks of gestation, average GWG per week, and birth weight. Results. We studied 111 women. Early in pregnancy, 32% of women spent ≥30 minutes/day in at least moderate PA versus 12% in late pregnancy. No significant associations were found between time spent in MVPA or sedentary behaviour with GWG or birth weight. Conclusions. We found no relation between MVPA and sedentary behaviour with GWG or birth weight. The small percentage of women meeting the recommended levels of PA indicates the need to inform and support pregnant women to maintain regular PA, as there seems to be no adverse effect on birth weight and maintaining PA increases overall health. Anneloes E. Ruifrok, Ellen Althuizen, Nicolette Oostdam, Willem van Mechelen, Ben Willem Mol, Christianne J. M. de Groot, and Mireille N. M. van Poppel Copyright © 2014 Anneloes E. Ruifrok et al. All rights reserved. Maternal Opioid Drug Use during Pregnancy and Its Impact on Perinatal Morbidity, Mortality, and the Costs of Medical Care in the United States Thu, 28 Aug 2014 13:14:25 +0000 Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. Women who used opioids during pregnancy experienced higher rates of depression, anxiety, and chronic medical conditions. After adjusting for confounders, opioid use was associated with increased odds of threatened preterm labor, early onset delivery, poor fetal growth, and stillbirth. Users were four times as likely to have a prolonged hospital stay and were almost four times more likely to die before discharge. The mean per-hospitalization cost of a woman who used opioids during pregnancy was $5,616 (95% CI: $5,166–$6,067), compared to $4,084 (95% CI: $4,002–$4,166) for nonusers. Conclusion. Opioid use during pregnancy is associated with adverse perinatal outcomes and increased healthcare costs. Valerie E. Whiteman, Jason L. Salemi, Mulubrhan F. Mogos, Mary Ashley Cain, Muktar H. Aliyu, and Hamisu M. Salihu Copyright © 2014 Valerie E. Whiteman et al. All rights reserved. Comparison of the Effects of Maternal Supportive Care and Acupressure (BL32 Acupoint) on Pregnant Women’s Pain Intensity and Delivery Outcome Tue, 19 Aug 2014 08:20:49 +0000 Delivery is considered as one of the most painful experiences of women’s life. The present study aimed to compare the effects of supportive care and acupressure on the pregnant women’s pain intensity and delivery outcome. In this experimental study, 150 pregnant women were randomly divided into supportive care, acupressure, and control groups. The intensity of pain was measured using Visual Analogue Scale (VAS). The supportive care group received both physical and emotional cares. In the acupressure group, on the other hand, BL32 acupoint was pressed during the contractions. Then, the data were analyzed using descriptive and inferential statistics. The results revealed significant difference among the three groups regarding the intensity of pain after the intervention (). Besides, the highest rate of natural vaginal delivery was observed in the supportive care group (94%) and the acupressure group (92%), while the highest rate of cesarean delivery was related to the control group (40%) and the difference was statistically significant (). The results showed that maternal supportive care and acupressure during labor reduced the intensity of pain and improved the delivery outcomes. Therefore, these methods can be introduced to the medical team as effective strategies for decreasing delivery pain. This trial is registered with the Iranian Registry of Clinical Trial Code IRCT2014011011706N5. Marzieh Akbarzadeh, Zahra Masoudi, Mohammad Javad Hadianfard, Maryam Kasraeian, and Najaf Zare Copyright © 2014 Marzieh Akbarzadeh et al. All rights reserved. Latency after Preterm Prelabor Rupture of the Membranes: Increased Risk for Periventricular Leukomalacia Thu, 17 Jul 2014 08:14:27 +0000 Objective. To identify the risk factors for cystic periventricular leukomalacia (cPVL) and their implications for deciding between immediate delivery and conservative management of preterm prelabor rupture of the membranes (pPROM). Methods. The following risk factors were compared between cPVL infants and 6440 controls: chorioamnionitis, sex, gestational age (GA), birth weight, pPROM, and pPROM-delivery interval. Factor impact on cPVL risk and clinical decision-making was determined by multivariate logistic regression. Results. Overall cPVL prevalence () was 0.99/1000 births. All cPVL infants but one were born <34 weeks of gestation and were <2500 g; 56% had histological chorioamnionitis versus 1.1% of controls (OR 35.9; 95%-CI 12.6–102.7). Because chorioamnionitis is a postnatal diagnosis, logistic regression was performed with prenatally available factors: pPROM-delivery interval >48 hours (OR 9.0; 95%-CI 4.1–20.0), male gender (OR 3.2; 95%-CI 1.4–7.3). GA was not a risk factor if birth weight was included. Risk decreased with increasing fetal weight despite a prolonged pPROM-delivery interval. Conclusion. pPROM-delivery interval is the single most important prenatally available risk factor for the development of cPVL. Immediate delivery favors babies with chorioamnionitis but disfavors those with non infectious pPROM. In the absence of clinical chorioamnionitis fetal weight gain may offset the inflammatory risk of cPVL caused by a prolonged pPROM-delivery interval. Annick Denzler, Tilo Burkhardt, Giancarlo Natalucci, and Roland Zimmermann Copyright © 2014 Annick Denzler et al. All rights reserved. A New Model for Providing Cell-Free DNA and Risk Assessment for Chromosome Abnormalities in a Public Hospital Setting Wed, 02 Jul 2014 00:00:00 +0000 Objective. Cell-free DNA (cfDNA) offers highly accurate noninvasive screening for Down syndrome. Incorporating it into routine care is complicated. We present our experience implementing a novel program for cfDNA screening, emphasizing patient education, genetic counseling, and resource management. Study Design. Beginning in January 2013, we initiated a new patient care model in which high-risk patients for aneuploidy received genetic counseling at 12 weeks of gestation. Patients were presented with four pathways for aneuploidy risk assessment and diagnosis: (1) cfDNA; (2) integrated screening; (3) direct-to-invasive testing (chorionic villus sampling or amniocentesis); or (4) no first trimester diagnostic testing/screening. Patients underwent follow-up genetic counseling and detailed ultrasound at 18–20 weeks to review first trimester testing and finalize decision for amniocentesis. Results. Counseling and second trimester detailed ultrasound were provided to 163 women. Most selected cfDNA screening (69%) over integrated screening (0.6%), direct-to-invasive testing (14.1%), or no screening (16.6%). Amniocentesis rates decreased following implementation of cfDNA screening (19.0% versus 13.0%, ). Conclusion. When counseled about screening options, women often chose cfDNA over integrated screening. This program is a model for patient-directed, efficient delivery of a newly available high-level technology in a public health setting. Genetic counseling is an integral part of patient education and determination of plan of care. Robert Wallerstein, Andrea Jelks, and Matthew J. Garabedian Copyright © 2014 Robert Wallerstein et al. All rights reserved. Previous Early Antenatal Service Utilization Improves Timely Booking: Cross-Sectional Study at University of Gondar Hospital, Northwest Ethiopia Tue, 01 Jul 2014 07:55:29 +0000 Background. Early booking of antenatal care (ANC) is regarded as a cornerstone of maternal and neonatal health care. However, existing evidence from developing countries indicate that lots of pregnant woman begin ANC booking lately. Objective. It was aimed to assess timing of ANC booking and associated factors among pregnant women attending ANC clinic at University of Gondar Hospital, 2013. Methods. An institution based cross-sectional study design was used to collect data with a face-to-face interview technique. Bivariate and multivariate analysis was used to identify associated factors for early ANC visit using SPSS version 20. Results. From total women (N = 369) interviewed, 47.4% were timely booked. Mothers with younger age (AOR = 3.83, 95% CI: 1.89, 10.53), formal education (AOR = 1.06, 95% CI: 1.03, −7.61), previous early ANC visit (AOR = 2.39, 95% CI: 2.23, 9.86), and perceived ANC visit per pregnancy of four and greater were significantly associated with early ANC visit. Conclusions. Although late booking is a problem in this study, previous early utilization of ANC visit favors current timely booking. This indicates that the importance of early booking was appropriately addressed from previous visits. Counseling of timely booking during ANC visit should be strengthened. Moreover, empowering through education is also recommended. Tadesse Belayneh, Mulat Adefris, and Gashaw Andargie Copyright © 2014 Tadesse Belayneh et al. All rights reserved. Predictors of Perinatal Mortality Associated with Placenta Previa and Placental Abruption: An Experience from a Low Income Country Wed, 04 Jun 2014 11:19:12 +0000 A retrospective cohort study design was used to assess predictors of perinatal mortality in women with placenta previa and abruption between January 2006 and December 2011. Four hundred thirty-two women (253 with placenta previa and 179 with placental abruption) were eligible for analysis. Binary logistic regression, Kaplan-Meier survival curve, and receiver operating characteristic (ROC) curve were used. On admission, 77% of the women were anaemic (<12 gm/dL) with mean haemoglobin level of 9.0 ± 3.0 gm/dL. The proportion of overall severe anaemia increased from about 28% on admission to 41% at discharge. There were 50% perinatal deaths (neonatal deaths of less than seven days of age and fetal deaths after 28 weeks of gestation). In the adjusted odds ratios, lengthy delay in accessing hospital care, prematurity, anaemia in the mothers, and male foetuses were independent predictors of perinatal mortality. The haemoglobin level at admission was more sensitive and more specific than prematurity in the prediction of perinatal mortality. The proportion of severe anaemia and perinatal mortality was probably one of the highest in the world. Yifru Berhan Copyright © 2014 Yifru Berhan. All rights reserved. Genetic Aspects of Preeclampsia and the HELLP Syndrome Mon, 02 Jun 2014 07:18:35 +0000 Both preeclampsia and the HELLP syndrome have their origin in the placenta. The aim of this study is to review genetic factors involved in development of preeclampsia and the HELLP syndrome using literature search in PubMed. A familial cohort links chromosomes 2q, 5q, and 13q to preeclampsia. The chromosome 12q is coupled with the HELLP syndrome. The STOX1 gene, the ERAP1 and 2 genes, the syncytin envelope gene, and the −670 Fas receptor polymorphisms are involved in the development of preeclampsia. The ACVR2A gene on chromosome 2q22 is also implicated. The toll-like receptor-4 (TLR-4) and factor V Leiden mutation participate both in development of preeclampsia and the HELLP syndrome. Carriers of the TT and the CC genotype of the MTHFR C677T polymorphism seem to have an increased risk of the HELLP syndrome. The placental levels of VEGF mRNA are reduced both in women with preeclampsia and in women with the HELLP syndrome. The BclI polymorphism is engaged in development of the HELLP syndrome but not in development of severe preeclampsia. The ACE I/D polymorphism affects uteroplacental and umbilical artery blood flows in women with preeclampsia. In women with preeclampsia and the HELLP syndrome several genes in the placenta are deregulated. Preeclampsia and the HELLP syndrome are multiplex genetic diseases. Kjell Haram, Jan Helge Mortensen, and Bálint Nagy Copyright © 2014 Kjell Haram et al. All rights reserved. Revisiting the Role of First Trimester Homocysteine as an Index of Maternal and Fetal Outcome Mon, 05 May 2014 07:10:10 +0000 Aim. To revisit the role of first trimester homocysteine levels with the maternal and fetal outcome. Methods. This was a cohort study comprising 100 antenatal women between 8 and 12 weeks of gestation. Serum homocysteine levels were checked after overnight fasting. Results. There were significantly elevated homocysteine levels among women with prior history of hypertensive disorders of pregnancy and prior second or third trimester pregnancy losses. There was no significant difference in homocysteine levels among women with previous gestational diabetes mellitus, preterm deliveries, or fetal malformations. Homocysteine levels were significantly elevated in those who developed hypertensive disorder of pregnancy, oligohydramnios, and meconium stained amniotic fluid, had a pregnancy loss, or delivered a low birth weight baby. There was no significant difference in homocysteine levels for those who developed gestational diabetes mellitus. Conclusions. Increased first trimester serum homocysteine is associated with history of pregnancy losses, hypertensive disorders of pregnancy, and preterm birth. This is also associated with hypertensive disorders of pregnancy, pregnancy loss, oligohydramnios, meconium stained amniotic fluid, and low birth weight in the current pregnancy. This trial is registered with CTRI/2013/02/003441. Mariano Mascarenhas, Syed Habeebullah, and M. G. Sridhar Copyright © 2014 Mariano Mascarenhas et al. All rights reserved. Effects of a New Patient Safety-Driven Oxytocin Dosing Protocol on Postpartum Hemorrhage Sun, 27 Apr 2014 00:00:00 +0000 Objective. To determine if there was an increase in postpartum (PP) hemorrhage after decreasing the PP oxytocin dose from 40 to 30 units. Study Design. Retrospective cohort study comparing 8 months before to 8 months after the change. PP day 1 hemoglobin was subtracted from admission hemoglobin. Mean change was compared by Student’s -test. The best fit polynomial was analyzed for trends between the two time frames. Women who received blood transfusions were excluded. Results. 73/3564 (2.0%) women received blood transfusions in the pre group and 64/3295 (1.9%) women in the post group, . Mean hemoglobin change ± standard deviation was  g/dL for pre versus  g/dL for post, . 1003/3114 (32.2%) in the pre group had a hemoglobin decrease of ≥2 g/dL compared to 918/2895 (31.7%) in the post group, . 261/3114 (8.4%) in the pre group had a hemoglobin decrease of ≥3 g/dL compared to 252/2895 (8.7%), . There were no significant trends between the two time frames. Conclusion. The change in the dose of PP oxytocin did not result in an increase in postpartum hemorrhage or an increase in the need for blood transfusion. David S. McKenna, Kari Rudinsky, and Jiri Sonek Copyright © 2014 David S. McKenna et al. All rights reserved. Expectant Management of Miscarriage in View of NICE Guideline 154 Sun, 27 Apr 2014 00:00:00 +0000 Objective. To find out the success rate of conservative management of complete two weeks for miscarriage in view of NICE Guideline 154. Design. Prospective observational study. Setting. Early pregnancy assessment units of District General Hospital in the United Kingdom. Participants. Women of less than 14 weeks’ gestation, with a diagnosis of miscarriage (missed miscarriage/anembryonic or incomplete miscarriage). Interventions. Expectant management for two weeks. Main Outcome Measure. (1) Efficacy of 2-week expectant management, that is, complete resolution of miscarriage based either on self-reporting of patient after passing products of conception at home between D0 and D14 of expectant management or confirmation on scan at D14, and (2) short-term complications needing strong analgesia, blood transfusion, and antibiotics. Results. Expectant management of miscarriage for 2 weeks from the day of diagnosis was successful in 58% (64 /111) and failed in 42% (47/111). Conclusions. Expectant management success rate is consistent with the results from the longitudinal studies and RCTs published in the past. It is a safe option as none of the patients on expectant/medical management needed strong analgesia/antibiotics or blood transfusion. Junaid Rafi and Haroona Khalil Copyright © 2014 Junaid Rafi and Haroona Khalil. All rights reserved. Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section under Either General Or Spinal Anesthesia Thu, 17 Apr 2014 14:09:48 +0000 This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5%) patients underwent spinal anesthesia (SA) and 27 (15.5%) patients had general anesthesia (GA). Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; ). Patients receiving GA had a higher mortality (25.9% versus 1.4%; ). The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; ) and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; ). To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia. Suman Chattopadhyay, Ashok Das, and Subrata Pahari Copyright © 2014 Suman Chattopadhyay et al. All rights reserved. Maternofoetal Complications and Their Association with Proteinuria in a Tertiary Care Hospital of a Developing Country Mon, 14 Apr 2014 00:00:00 +0000 Objective. To investigate association between maternofoetal complications and the amount of proteinuria measured by spot urine protein creatinine ratio in patients with preeclampsia. Methods. 200 consecutive patients with preeclampsia were recruited in the study. The complications like first episode of severe hypertension, renal insufficiency, raised level of aspartate transaminase, signs of neurological involvement, thrombocytopenia, eclampsia, and need to shift in intensive care units were studied. The maternal outcome was studied in terms of type of labour, outcome of pregnancy, mode of delivery, indication of cesarean section, and maternal mortality. The foetal complications and outcome parameters were birth weight, Apgar score at the time of birth and at five minutes, need of high dependency unit care, and perinatal mortality. Result. The frequency of various maternal and foetal complications was between 14–53% and 22–92%, respectively. Maternal mortality was 3%, whereas perinatal mortality was 23%. Statistically significant association was found between the frequencies of various complications in mother and newborn and spot UPCR. Conclusion. The rate of various maternofoetal complications in preeclampsia is higher in developing countries than in developed world. Maternofoetal complications and outcome correlate with maternal spot UPCR. Archana Kumari, Avinash Chakrawarty, Abha Singh, and Ritu Singh Copyright © 2014 Archana Kumari et al. All rights reserved. Manual Removal of the Placenta after Vaginal Delivery: An Unsolved Problem in Obstetrics Wed, 09 Apr 2014 11:57:25 +0000 The third stage of labor is associated with considerable maternal morbidity and mortality. The major complication is postpartum hemorrhage (PPH), which is the leading cause of maternal morbidity and mortality worldwide. Whereas in the event of PPH due to atony of the uterus there exist numerous treatment guidelines; for the management of retained placenta the general consensus is more difficult to establish. Active management of the third stage of labour is generally accepted as standard of care as already its duration is contributing to the risk of PPH. Despite scant evidence it is commonly advised that if the placenta has not been expelled 30 minutes after delivery, manual removal of the placenta should be carried out under anaesthesia. Pathologic adhesion of the placenta in the low risk situation usually is diagnosed at the time of delivery; therefore a pre- or intrapartum screening opportunity for placenta accreta would be desirable. But diagnosis of abnormalities of placentation other than placenta previa remains a challenge. Nevertheless the use of ultrasound and doppler sonography might be helpful in the third stage of labor. An improvement might be the implementation of standardized operating procedures for retained placenta which could contribute to a reduction of maternal morbidity. Fiona Urner, Roland Zimmermann, and Alexander Krafft Copyright © 2014 Fiona Urner et al. All rights reserved. Induced Abortion and Associated Factors in Health Facilities of Guraghe Zone, Southern Ethiopia Sun, 30 Mar 2014 17:11:25 +0000 Unsafe abortion is one of the major medical and public health problems in developing countries including Ethiopia. However, there is a lack of up-to-date and reliable information on induced abortion distribution and its determinant factors in the country. This study was intended to assess induced abortion and associated factors in health facilities of Guraghe zone, Southern Ethiopia. Institution based cross-sectional study was conducted in eight health facilities in Guraghe zone. Client exit interview was conducted on 400 patients using a structured questionnaire. Bivariate and multivariate logistic regression analysis was performed to identify factors associated with induced abortion. Out of 400 women, 75.5% responded that the current pregnancy that ended in abortion is unwanted. However, only 12.3% of the respondents have admitted interference to the current pregnancy. Having more than four pregnancies (AOR = 4.28, CI: (1.24–14.71)), age of 30–34 years (AOR = 0.15, CI: (0.04–0.55)), primary education (AOR = 0.26, CI: (0.13–0.88)), and wanted pregnancy (AOR = 0.44, CI: (0.14–0.65)) were found to have association with induced abortion. The study revealed high level of induced abortion which is underpinned by high magnitude of unwanted pregnancy. There is requirement for widespread expansion of increased access to high quality family planning service and post-abortion care. Gezahegn Tesfaye, Mitiku Teshome Hambisa, and Agumasie Semahegn Copyright © 2014 Gezahegn Tesfaye et al. All rights reserved.