Journal of Pregnancy The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Baird-Pattinson Aetiological Classification and Phases of Delay Contributing to Stillbirths in a Nigerian Tertiary Hospital Thu, 14 Jan 2016 15:58:25 +0000 Purpose. This study aims to identify triggers of stillbirth in the study setting and to make suggestions to reduce the prevalence. Method. A three-year retrospective case-control study of stillbirths at Ekiti State University Teaching Hospital. Results. The stillbirth rate was 33 per 1000 births. Based on Baird-Pattinson classification of the primary obstetric causes of stillbirth, adverse intrapartum events, hypertensive diseases, and unexplained intrapartum fetal deaths were topmost causes of stillbirths. In comparison with the controls, other identified predictors of SB were grand multiparity (), delays in seeking medical care and/or in receiving treatment (), wrong initial diagnosis (), inadequate intrapartum monitoring (), and inappropriate clinical management (). Conclusion. Stillbirth rate remains high in our setting. Elimination of obstacles to accessing care, effective management of hypertensive disorders in pregnancy, updated health facilities, improved dedication to duty, and retraining of health workers will reduce the prevalence. Jacob Olumuyiwa Awoleke and Abiodun Idowu Adanikin Copyright © 2016 Jacob Olumuyiwa Awoleke and Abiodun Idowu Adanikin. All rights reserved. Beliefs, Barriers, and Preferences of European Overweight Women to Adopt a Healthier Lifestyle in Pregnancy to Minimize Risk of Developing Gestational Diabetes Mellitus: An Explorative Study Thu, 14 Jan 2016 07:02:25 +0000 Introduction. We explored beliefs, perceived barriers, and preferences regarding lifestyle changes among overweight European pregnant women to help inform the development of future lifestyle interventions in the prevention of gestational diabetes mellitus. Methods. An explorative mixed methods, two-staged study was conducted to gather information from pregnant European women (BMI 25 kg/m2). In three European countries 21 interviews were conducted, followed by 71 questionnaires in six other European countries. Content analysis and descriptive and chi-square statistics were applied (). Results. Women preferred to obtain detailed information about their personal risk. The health of their baby was a major motivating factor. Perceived barriers for physical activity included pregnancy-specific issues such as tiredness and experiencing physical complaints. Insufficient time was a barrier more frequently reported by women with children. Abstaining from snacking was identified as a challenge for the majority of women, especially for those without children. Women preferred to obtain support from their partner, as well as health professionals and valued flexible lifestyle programs. Conclusions. Healthcare professionals need to inform overweight pregnant women about their personal risk, discuss lifestyle modification, and assist in weight management. Lifestyle programs should be tailored to the individual, taking into account barriers experienced by overweight first-time mothers and multipara women. Judith G. M. Jelsma, Karen M. van Leeuwen, Nicolette Oostdam, Christopher Bunn, David Simmons, Gernot Desoye, Rosa Corcoy, Juan M. Adelantado, Alexandra Kautzky-Willer, Jürgen Harreiter, Frans Andre van Assche, Roland Devlieger, Dirk Timmerman, David Hill, Peter Damm, Elisabeth R. Mathiesen, Ewa Wender-Ozegowska, Agnieszka Zawiejska, Pablo Rebollo, Annunziata Lapolla, Maria G. Dalfrà, Stefano del Prato, Alessandra Bertolotto, Fidelma Dunne, Dorte M. Jensen, Lise Lotte T. Andersen, Frank J. Snoek, and Mireille N. M. van Poppel Copyright © 2016 Judith G. M. Jelsma et al. All rights reserved. Australian Pregnant Women’s Awareness of Gestational Weight Gain and Dietary Guidelines: Opportunity for Action Wed, 06 Jan 2016 09:25:53 +0000 Background. Excessive gestational weight gain (GWG) can negatively impact on maternal and foetal health. Guidelines based on Institute of Medicine (IOM) encourage managing GWG by following healthy eating recommendations and increasing physical activity. This study investigated pregnant women’s knowledge of their optimal GWG and recommended dietary approaches for GWG management. Method. English-speaking pregnant women were recruited from five hospitals in New South Wales (Australia) and an online link. Prepregnancy Body Mass Index (BMI) was calculated from self-reported height and prepregnancy weight. Participants identified their recommended GWG. A survey assessed practical dietary knowledge and asked about broad dietary recommendations to prevent excessive GWG. Chi square and logistic regression analyses were used. Results. pregnant women completed the surveys; 49% entered pregnancy overweight (25.2%) or obese (23.6%); and knowledge of recommended GWG was lacking. Prepregnancy BMI was a significant predictor of GWG recommendation knowledge (). Pregnant women were highly knowledgeable about broad dietary recommendations but had poor knowledge of detailed recommendations. Conclusions. Limited knowledge of IOM’s GWG guidelines and of specific dietary recommendations for pregnancy should be addressed by health care providers and education initiatives to assist the high number of women who enter pregnancy overweight or obese. Khlood Bookari, Heather Yeatman, and Moira Williamson Copyright © 2016 Khlood Bookari et al. All rights reserved. Physiologic Course of Female Reproductive Function: A Molecular Look into the Prologue of Life Tue, 01 Dec 2015 09:31:36 +0000 The genetic, endocrine, and metabolic mechanisms underlying female reproduction are numerous and sophisticated, displaying complex functional evolution throughout a woman’s lifetime. This vital course may be systematized in three subsequent stages: prenatal development of ovaries and germ cells up until in utero arrest of follicular growth and the ensuing interim suspension of gonadal function; onset of reproductive maturity through puberty, with reinitiation of both gonadal and adrenal activity; and adult functionality of the ovarian cycle which permits ovulation, a key event in female fertility, and dictates concurrent modifications in the endometrium and other ovarian hormone-sensitive tissues. Indeed, the ultimate goal of this physiologic progression is to achieve ovulation and offer an adequate environment for the installation of gestation, the consummation of female fertility. Strict regulation of these processes is important, as disruptions at any point in this evolution may equate a myriad of endocrine-metabolic disturbances for women and adverse consequences on offspring both during pregnancy and postpartum. This review offers a summary of pivotal aspects concerning the physiologic course of female reproductive function. Joselyn Rojas, Mervin Chávez-Castillo, Luis Carlos Olivar, María Calvo, José Mejías, Milagros Rojas, Jessenia Morillo, and Valmore Bermúdez Copyright © 2015 Joselyn Rojas et al. All rights reserved. Implementation of the International Association of Diabetes and Pregnancy Study Groups Criteria: Not Always a Cause for Concern Mon, 30 Nov 2015 13:55:57 +0000 Background. Controversy surrounds the decision to adopt the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) as fears that disease prevalence rates will soar have been raised. Aims. To investigate the prevalence of pregnancy complicated with GDM before and after the introduction of the IADPSG 2010 diagnostic criteria. Materials and Methods. A prospective audit of all women who delivered from July 1, 2010, to June 30, 2014, in a predefined geographic region within the North Metropolitan Health Service of Western Australia. Women were diagnosed with GDM according to Australian Diabetes in Pregnancy Society (ADIPS 1991) criteria until December 31, 2011, and by the IADPSG 2010 criteria after this date. Incidence of GDM and predefined pregnancy outcomes were audited. Results. Of 10,296 women, antenatal oral glucose tolerance test (OGTT) results and follow-up data were obtained for 10,103 women (98%), of whom 349 (3.5%) were diagnosed with GDM. The rate of GDM utilising ADIPS criteria was 3.4% and the rate of utilising IADPSG criteria was 3.5% (). Conclusion. IADPSG diagnostic criteria did not significantly increase the incidence of GDM in this low prevalence region. Pooja Sibartie and Julie Quinlivan Copyright © 2015 Pooja Sibartie and Julie Quinlivan. All rights reserved. Early Detection of Fetal Malformation, a Long Distance Yet to Cover! Present Status and Potential of First Trimester Ultrasonography in Detection of Fetal Congenital Malformation in a Developing Country: Experience at a Tertiary Care Centre in India Mon, 23 Nov 2015 12:55:28 +0000 Background. Early detection of malformation is tremendously improved with improvement in imaging technology. Yet in a developing country like India majority of pregnant women are not privileged to get timely diagnosis. Aims and Objectives. To assess the present status and potential of first trimester ultrasonography in detection of fetal congenital structural malformations. Methodology. This was a retrospective observational study conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences. All pregnant women had anomaly scan and women with fetal structural malformations were included. Results. Out of 4080 pregnant women undergoing ultrasound, 312 (7.6%) had fetal structural malformation. Out of 139 patients who were diagnosed after 20 weeks, 47 (33.8%) had fetal structural anomalies which could have been diagnosed before 12 weeks and 92 (66.1%) had fetal malformations which could have been diagnosed between 12 and 20 weeks. Conclusion. The first trimester ultrasonography could have identified 50% of major structural defects compared to 1.6% in the present scenario. This focuses on the immense need of the hour to gear up for early diagnosis and timely intervention in the field of prenatal detection of congenital malformation. Namrata Kashyap, Mandakini Pradhan, Neeta Singh, and Sangeeta Yadav Copyright © 2015 Namrata Kashyap et al. All rights reserved. AngiomiRs: Potential Biomarkers of Pregnancy’s Vascular Pathologies Tue, 13 Oct 2015 14:52:50 +0000 In recent years, microRNAs (miRNAs) have been the focus of research for their role in posttranscriptional regulation and as potential biomarkers of risk for disease development. Their identification in specific physiological processes, like angiogenesis, a key pathway in placental vascular development in pregnancy, suggests an important role of miRNAs that regulate angiogenesis (angiomiRs). Many complications of pregnancy have in common placental vascular alterations, involving an imbalance in the angiogenesis process in the development of conditions such as preeclampsia, intrauterine growth restriction, and gestational diabetes, complications with the highest rates of morbimortality in pregnancy. Many studies have identified angiomiRs with differential expression profiles in each of these diseases; however, this evidence requires further studies focused on evaluating their potential as biomarkers of risk for the angiomiRs detected, to establish correlations between placental tissue and serum/plasma expression profiles. Therefore, the objective of this review is to highlight the best angiomiRs detected in placental tissue and serum/plasma in each of these three pathologies to show the current data available for potential biomarkers and to propose future research strategies on this topic. Laura María Rodríguez Santa, Laura Yuriko González Teshima, Jose Vicente Forero Forero, and Andres Orlando Castillo Giraldo Copyright © 2015 Laura María Rodríguez Santa et al. All rights reserved. Naegele Forceps Delivery and Association between Morbidity and the Number of Forceps Traction Applications: A Retrospective Study Thu, 03 Sep 2015 07:01:03 +0000 Objective. To present the method of Naegele forceps delivery clinically practiced by the lead author, its success rate, and morbidity and to evaluate the relationship between morbidity and the number of forceps traction applications. Methods. Naegele forceps delivery was performed when the fetal head reached station +2 cm, the forceps were applied in the maternal pelvic application, and traction was slowly and gently performed. In the past two years, Naegele forceps delivery was attempted by the lead author in 87 cases, which were retrospectively reviewed. Results. The numbers of traction applications were one in 64.7% of cases, two in 24.7%, and three or more in 10.7%. The success rate was 100%. No severe morbidity was observed in mothers or neonates. Neonatal facial injury occurred most commonly in cases with fetal head malrotation, elevated numbers of traction applications, and maternal complications. Umbilical artery acidemia most commonly occurred in cases with nonreassuring fetal status. The significant crude odds ratio for three or more traction applications was 20 in cases with malrotation. Conclusion. Naegele forceps delivery has a high success rate, but multiple traction applications will sometimes be required, particularly in cases with malrotation. Malrotation and elevated numbers of traction applications may lead to neonatal head damage. Naoki Matsumoto, Toshifumi Takenaka, Nobuyuki Ikeda, Satoshi Yazaki, and Yuichi Sato Copyright © 2015 Naoki Matsumoto et al. All rights reserved. Forceps, Actual Use, and Potential Cesarean Section Prevention: Study in a Selected Mexican Population Mon, 24 Aug 2015 07:36:09 +0000 Objective. Assessment of the frequency of complications observed with various forceps and operative vaginal delivery (OVD) techniques performed at the ABC Medical Center (Mexico City) to evaluate their safety, bearing in mind the importance of decreasing our country’s high cesarean section incidence. Methods. We reviewed 5,375 deliveries performed between the years 2007 and 2012, only 146 were delivered by OVD.  Results. Only 1.0% of the cases had a serious, life-threatening situation (uterine rupture). The Simpson forceps was the most favored instrument (46%) due to its simplicity of use, effectiveness, and familiarity. Prophylactic use was the most common indication (30.8%) and significant complications observed were vaginal lacerations (), relative risk (RR) of 3.4 (95% confidence interval [CI]: 1.15–10.04), and fourth degree perineal tear (), RR of 3.4 (95% CI: 1.15–10.04). Conclusions. Forceps use and other OVD techniques are a safe alternative to be considered, diminishing C-section incidence and its complications. Rodrigo Ayala-Yáñez, Paulette Bayona-Soriano, Arturo Hernández-Jimenez, Alejandra Contreras-Rendón, Paulina Chabat-Manzanera, and Roberto Nevarez-Bernal Copyright © 2015 Rodrigo Ayala-Yáñez et al. All rights reserved. Impaired Fertility Associated with Subclinical Hypothyroidism and Thyroid Autoimmunity: The Danish General Suburban Population Study Mon, 17 Aug 2015 14:10:32 +0000 Introduction. The aim of this study was to estimate the significance of TSH, thyroid peroxidase antibody (TPOAb), and mild (subclinical) hypothyroidism in women from The Danish General Suburban Population Study (GESUS) on the number of children born, the number of pregnancies, and the number of spontaneous abortions. Methods. Retrospective cross sectional study of 11254 women participating in GESUS. Data included biochemical measurements and a self-administrated questionnaire. Results. 6.7% had mild (subclinical) hypothyroidism and 9.4% prevalent hypothyroidism. In women with mild hypothyroidism TPOAb was significantly elevated and age at first child was older compared to controls. TSH and TPOAb were negatively linearly associated with the number of children born and the number of pregnancies in the full cohort in age-adjusted and multiadjusted models. TSH or TPOAb was not associated with spontaneous abortions. Mild (subclinical) hypothyroidism was associated with a risk of not having children and a risk of not getting pregnant in age-adjusted and multiadjusted models. Prevalent hypothyroidism was not associated with the number of children born, the number of pregnancies, or spontaneous abortions. Conclusion. Impaired fertility is associated with TSH, TPOAb, and mild (subclinical) hypothyroidism in a Danish population of women. Anne-Dorthe Feldthusen, Palle L. Pedersen, Jacob Larsen, Tina Toft Kristensen, Christina Ellervik, and Jan Kvetny Copyright © 2015 Anne-Dorthe Feldthusen et al. All rights reserved. Association between Prenatal One-Hour Glucose Challenge Test Values and Delivery Mode in Nondiabetic, Pregnant Black Women Mon, 25 May 2015 07:16:53 +0000 Objective. We examined the association between 1-hour glucose challenge test (GCT) values and risk of caesarean section. Study Design. A prospective cohort study recruited 203 pregnant Black women to participate. At ~28 weeks of gestation, participants underwent a routine 1-hour 50 g GCT to screen for gestational diabetes mellitus. Logistic regression was used to examine the association between 1-hour GCT value and delivery mode. Results. Of the 158 participants included, 53 (33.5%) delivered via C-section; the majority (; 54.7%) were nulliparous. Mean 1-hour GCT values were slightly, but not significantly, higher among women delivering via C-section; versus vaginally (107.8 ± 20.7 versus 102.4 ± 21.5 mg/dL, resp.; ). After stratifying by parity and adjusting for maternal age, previous C-section, and prepregnancy body mass index, 1-hour GCT value was significantly associated with increased risk of C-section among parous women (OR per 1 mg/dL increase in GCT value = 1.05; 95% CI OR: 1.00, 1.05; ). Conclusion. Even slightly elevated 1-hour 50 g GCT values may be associated with delivery mode among parous Black women. Jerel M. Ezell, Rosalind M. Peters, Jessica E. Shill, and Andrea E. Cassidy-Bushrow Copyright © 2015 Jerel M. Ezell et al. All rights reserved. Prevalence of Abortion and Contraceptive Practice among Women Seeking Repeat Induced Abortion in Western Nigeria Tue, 19 May 2015 12:43:53 +0000 Background. Induced abortion contributes significantly to maternal mortality in developing countries yet women still seek repeat induced abortion in spite of availability of contraceptive services. The aim of this study is to determine the rate of abortion and contraceptive use among women seeking repeat induced abortion in Western Nigeria. Method. A prospective cross-sectional study utilizing self-administered questionnaires was administered to women seeking abortion in private hospitals/clinics in four geopolitical areas of Ogun State, Western Nigeria, from January 1 to December 31 2012. Data were analyzed using SPSS 17.0. Results. The age range for those seeking repeat induced abortion was 15 to 51 years while the median age was 25 years. Of 2934 women seeking an abortion, 23% reported having had one or more previous abortions. Of those who had had more than one abortion, the level of awareness of contraceptives was 91.7% while only 21.5% used a contraceptive at their first intercourse after the procedure; 78.5% of the pregnancies were associated with non-contraceptive use while 17.5% were associated with contraceptive failure. The major reason for non-contraceptive use was fear of side effects. Conclusion. The rate of women seeking repeat abortions is high in Nigeria. The rate of contraceptive use is low while contraceptive failure rate is high. Mustafa Adelaja Lamina Copyright © 2015 Mustafa Adelaja Lamina. All rights reserved. Determinants and Outcomes of Emergency Caesarean Section following Failed Instrumental Delivery: 5-Year Observational Review at a Tertiary Referral Centre in London Mon, 11 May 2015 08:13:43 +0000 Objectives. To review the determinants for a failed operative vaginal delivery and to examine associated fetal and maternal morbidity. Design. Retrospective observational study. Setting. Large London Teaching Hospital. Method. A retrospective review of case notes during a 5-year period was carried out. Results. Overall 119 women (0.44%) out of 26,856 births had a caesarean section following a failed instrumental delivery, which comprised 5.1% of all operative vaginal births. 73% had a spontaneous onset of labour and 63% required syntocinon at some time prior to delivery. 71.5% of deliveries were complicated by malposition. Only 20% of deliveries were attended by a consultant obstetrician. Almost 50% of women and 8.4% of neonates sustained trauma at the time of either their failed instrumental delivery or the caesarean section. Conclusions. Emergency caesarean section during the second stage of labour is associated with maternal and fetal complications. A ‘failed instrumental delivery score’ (FIDS) may aid practitioners in predicting an increased likelihood of a failed operative vaginal birth and therefore to consider a trial of operative vaginal delivery in the theatre. Senior input should also be sought because a failed operative vaginal birth is associated with increased maternal and fetal morbidity. Sian McDonnell and Edwin Chandraharan Copyright © 2015 Sian McDonnell and Edwin Chandraharan. All rights reserved. Paradox of Modern Pregnancy: A Phenomenological Study of Women’s Lived Experiences from Assisted Pregnancy Sun, 03 May 2015 09:34:42 +0000 The purpose of our study was describing the meaning of pregnancy through Assisted Reproductive Technologies (ARTs). A qualitative design with hermeneutic phenomenology approach was selected to carry out the research. Semistructured in-depth interviews were conducted with 12 women who experienced assisted pregnancy. Three themes emerged from women’s experience including finding peace in life, paradoxical feelings, and struggling to realize a dream. We concluded that pregnancy is the beginning of a new and hard struggle for women with fertility problems. The findings of our study resulted in helpful implications for the health care professionals managing assisted pregnancies. Fahimeh Ranjbar, Mohammad-Mehdi Akhondi, Leili Borimnejad, Saeed-Reza Ghaffari, and Zahra Behboodi-Moghadam Copyright © 2015 Fahimeh Ranjbar et al. 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.