scholarly journals Prediction and management model of preterm birth

2019 ◽  
Vol 74 (4) ◽  
pp. 221-228 ◽  
Author(s):  
Yuriy A. Semenov ◽  
Valentina F. Dolgushina ◽  
Marina G. Moskvicheva ◽  
Vasiliy S. Chulkov
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Adverse Pregnancy Outcomes ◽  
History Of ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Group 1

Background: It seems relevant to study the contribution of socio-demographic, somatic and obstetric-gynecological factors in the implementation of preterm birth. Aims: Assessment of the prognostic significance of socio-demographic, obstetric-gynecological and somatic factors in the prediction of preterm birth and associated adverse pregnancy outcomes with subsequent validation of the prognostic model. Materials and methods: Cohort study with a mixed cohort. A retrospective assessment of socio-demographic factors, harmful habits, obstetric and gynecological pathology, somatic diseases, course and outcomes of pregnancy was carried out with the assessment of the status of newborns in 1246 women with subsequent construction of a predictive model of preterm birth and adverse outcomes of pregnancy using Regression with Optimal Scaling and its prospective validation in 100 women. Results: The most significant predictors, that increase the chance of preterm birth and adverse pregnancy outcomes, were history of premature birth, irregular monitoring during pregnancy, history of pelvic inflammatory disease, smoking, obesity, the onset of sexual activity up to 16 years, cardiovascular and endocrine diseases. Intellectual job reduced the chance of preterm birth and adverse pregnancy outcomes This multivariate predictive model has a diagnostic value. The score of risk factors 25 points had a sensitivity of 73%, a specificity of 71%, the area under the ROC curve (AUC) 0.76 (good quality), p0.001. After stratification of high-risk groups by maternal and perinatal pathology the following list of diagnostic and therapeutic measures is introduced and actively implemented in antenatal clinics. To stratificate this model, we prospectively analyze the course and pregnancy outcomes of 100 women divided into 2 groups: group 1 ― 50 women with preterm delivery, group 2 ― 50 women with term delivery. A total score of 25 and above had 44% of women in group 1 and only 10% of women in group 2 (sensitivity 81.4%, specificity 61.6%, positive predictive value 44%, negative predictive value 90%, positive likelihood ratio 2.2 [1.53.0], negative likelihood ratio 0.3 [0.130.68]). Conclusions: We have proposed a model for predicting preterm birth and delivery and perinatal losses using the available characteristics of pregnant women from early pregnancy with moderate indicators of diagnostic value. Further validation of the model in the general population of pregnant women is required.

Role of biometric characteristics of the uterine junctional zone in fertility outcomes in patients with adenomyosis

2021 ◽  
Vol 70 (3) ◽  
pp. 41-50
Author(s):  
Ekaterina K. Orekhova ◽  
Olga A. Zhandarova ◽  
Igor Yu. Kogan
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Resonance Imaging ◽  
Junctional Zone ◽  
History Of ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Group 1

BACKGROUND: The uterine junctional zone is the inner part of the myometrium. Dysfunction of the zone may underlie the pathogenesis of adenomyosis and its clinical manifestations, while biometric characteristics of the zone are currently considered as promising early diagnostic criteria for this disease. Adenomyosis has traditionally been associated with parity and intrauterine interventions, primarily in older patients. However, modern imaging tools often allow diagnosing the disease in young patients with infertility and an unburdened gynecological history. It is assumed that the detection of changes in the structure and function of the uterine junctional zone in adenomyosis can be the basis for predicting fertility outcomes and complications of pregnancy, as well as for the development of promising therapeutic strategies at the pregravid stage. AIM: The aim of this study was to assess the influence of biometric characteristics of the uterine junctional zone on pregnancy outcomes, depending on the parity and intrauterine interventions in patients with adenomyosis. MATERIALS AND METHODS: This prospective study included 102 patients aged 2239 years old with ultrasound features of adenomyosis who were going to conceive. The patients were divided into two groups: Group 1 (n = 58) consisted of nulliparous patients with no history of previous intrauterine interventions, and Group 2 (n = 44) comprised multipara women with a history of labor and / or intrauterine interventions. Using magnetic resonance imaging, we evaluated minimal, average and maximal junctional zone thicknesses, junctional zone deferential and a ratio of junctional zone thickness to myometrium thickness. Thresholds of biometric characteristics of the uterine junctional zone for adverse pregnancy outcomes were estimated. RESULTS: The frequencies of pregnancy and retrochorial hematoma in patients of Groups 1 and 2 in the first trimester of pregnancy did not differ significantly and amounted to 43.1% and 38.6%, 13.8% and 22.7%, respectively, p 0.05. Adverse pregnancy outcomes were diagnosed in 63.8% of patients in Group 1 and in 68.2% of patients in Group 2, p 0.05. In Group 1, the frequency of retrochorial hematoma depended on the initial junctional zone deferential, as well as on the initial average and maximal junctional zone thicknesses, junctional zone deferentials and ratios of junctional zone thickness to myometrium thickness, which, with an adverse pregnancy outcome, were 1.72.5 times higher than those in patients with a favorable outcome, p 0.05. In Group 2, adverse pregnancy outcomes were recorded with significantly higher values of average and maximal junctional zone thicknesses and junctional zone deferential. ROC curves were constructed using data of logistic regression analysis based on biometric characteristics of the uterine junctional zone to predict spontaneous abortion and infertility in patients with adenomyosis. CONCLUSIONS: Fertility outcomes in patients with adenomyosis depend on a complex of biometric characteristics of the uterine junctional zone as determined by magnetic resonance imaging.

scholarly journals Interpregnancy Body Mass Index Changes: Distribution and Impact on Adverse Pregnancy Outcomes in the Subsequent Pregnancy

2018 ◽  
Vol 36 (05) ◽  
pp. 517-521 ◽  
Author(s):  
Whitney Bender ◽  
Adi Hirshberg ◽  
Lisa Levine
Keyword(s):  
Body Mass Index ◽  
Preterm Birth ◽  
Body Mass ◽  
Pregnancy Outcomes ◽  
Subsequent Pregnancy ◽  
Adverse Pregnancy Outcomes ◽  
Increased Risk ◽  
History Of ◽  
Index Changes ◽  
Adverse Pregnancy

Objective To examine the change in body mass index (BMI) categories between pregnancies and its effect on adverse pregnancy outcomes. Study Design We performed a retrospective cohort study of women with two consecutive deliveries from 2005 to 2010. Analysis was limited to women with BMI recorded at <24 weeks for both pregnancies. Standard BMI categories were used. Adverse pregnancy outcomes included preterm birth at <37 weeks, intrauterine growth restriction (IUGR), pregnancy-related hypertension, and gestational diabetes mellitus (GDM). Women with increased BMI category between pregnancies were compared with those who remained in the same BMI category. Results In total, 537 women were included, of whom 125 (23%) increased BMI category. There was no association between increase in BMI category and risk of preterm birth, IUGR, or pregnancy-related hypertension. Women who increased BMI category had an increased odds of GDM compared with women who remained in the same BMI category (6.4 vs. 2.2%; p = 0.018). The increased risk remained after controlling for age, history of GDM, and starting BMI (adjusted odds ratio: 8.2; 95% confidence interval: 2.1–32.7; p = 0.003). Conclusion Almost one-quarter of women increased BMI categories between pregnancies. This modifiable risk factor has a significant impact on the risk of GDM.

scholarly journals Rate of gestational weight gain trajectory is associated with adverse pregnancy outcomes

2020 ◽  
Vol 23 (18) ◽  
pp. 3304-3314
Author(s):  
Heng Yaw Yong ◽  
Zalilah Mohd Shariff ◽  
Geeta Appannah ◽  
Zulida Rejali ◽  
Barakatun Nisak Mohd Yusof ◽  
...  
Keyword(s):  
Weight Gain ◽  
Pregnancy Outcomes ◽  
Caesarean Delivery ◽  
Adverse Pregnancy Outcomes ◽  
Obese Women ◽  
Gestational Weight ◽  
Group 3 ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Group 1

AbstractObjective:To examine the gestational weight gain (GWG) trajectory and its possible association with pregnancy outcomes.Design:GWG trajectories were identified using the latent class growth model. Binary logistic regression was performed to examine the associations between adverse pregnancy outcomes and these trajectories.Setting:Negeri Sembilan, Malaysia.Participants:Two thousand one hundred ninety-three pregnant women.Results:Three GWG trajectories were identified: ‘Group 1 – slow initial GWG but followed by drastic GWG’, ‘Group 2 – maintaining rate of GWG at 0·58 kg/week’ and ‘Group 3 – maintaining rate of GWG at 0·38 kg/week’. Group 1 had higher risk of postpartum weight retention (PWR) (adjusted OR (AOR) 1·02, 95 % CI 1·01, 1·04), caesarean delivery (AOR 1·03, 95 % CI 1·01, 1·04) and having low birth weight (AOR 1·04, 95 % CI 1·02, 1·05) compared with group 3. Group 2 was at higher risk of PWR (AOR 1·18, 95 % CI 1·16, 1·21), preterm delivery (AOR 1·03, 95 % CI 1·01, 1·05) and caesarean delivery (AOR 1·02, 95 % CI 1·01, 1·03), but at lower risk of having small-for-gestational-age infants (AOR 0·97, 95 % CI 0·96, 0·99) compared with group 3. The significant associations between group 1 and PWR were observed among non-overweight/obese women; between group 1 and caesarean delivery among overweight/obese women; group 2 with preterm delivery and caesarean delivery were only found among overweight/obese women.Conclusions:Higher GWG as well as increasing GWG trajectories was associated with higher risk of adverse pregnancy outcomes. Promoting GWG within the recommended range should be emphasised in antenatal care to prevent the risk of adverse pregnancy outcomes.

scholarly journals Quality of life, depression and anxiety among pregnant women with previous adverse pregnancy outcomes

2009 ◽  
Vol 127 (4) ◽  
pp. 185-189 ◽  
Author(s):  
Evelyn Regina Couto ◽  
Egle Couto ◽  
Bruna Vian ◽  
Zoraide Gregório ◽  
Marcelo Luis Nomura ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Anxiety And Depression ◽  
Life Questionnaire ◽  
Depression And Anxiety ◽  
Adverse Pregnancy ◽  
Group 1

CONTEXT AND OBJECTIVE: Previous adverse pregnancy outcomes (recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death) can affect the quality of life of pregnant women. The objective of this study was to compare the quality of life and the prevalence of symptoms of anxiety and depression among pregnant women with and without these antecedents. DESIGN AND SETTING: An analytical cross-sectional study was performed in four settings (two high-risk and two low-risk prenatal clinics) in the city of Campinas, São Paulo, Brazil. METHODS: A total of 240 women were interviewed by a single investigator between the 18th and 24th weeks of gestation: 120 women with prior adverse pregnancy outcomes (group 1) and 120 women with no such history (group 2), matched according to their numbers of living children. Sociodemographic variables were collected and two questionnaires were used: the Short Form-36 quality-of-life questionnaire and the Depression and Anxiety Scale. RESULTS: The women in group 1 had lower scores in all the items on the quality-of-life questionnaire. Depression and anxiety were more frequent in group 1 (P < 0.0001). An inverse correlation was found between the Short Form-36 domains and anxiety and depression. CONCLUSIONS: Women with histories of recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death seem to have poorer quality of life and more symptoms of anxiety and depression during their subsequent pregnancy, compared with those without such antecedents.

scholarly journals Ultrasonographic assessment of lower uterine segment thickness and perinatal Outcomes in patients with a previous cesarean history

2021 ◽  
Vol 8 (3) ◽  
pp. 175-180
Author(s):  
Nezaket Kadıoğlu ◽  
Başak Güler ◽  
Ebru Aslan Patakoğlu ◽  
Eda Özkan ◽  
Umit Yasemin Sert ◽  
...  
Keyword(s):  
Pregnancy Outcomes ◽  
Perinatal Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Lower Uterine Segment ◽  
The Other ◽  
Group 3 ◽  
Group 2 ◽  
Adverse Pregnancy ◽  
Previous Cesarean ◽  
Group 1

Objective: The purpose of the study was to establish the validity of the abdominal evaluation of lower uterine segment (LUS) thickness in patients having a previous cesarean section (CS) in predicting uterine rupture, and to evaluate if there is any effect of the number of a previous surgeries on adverse maternal and perinatal outcomes. Materials and methods: A prospective case-control study was carried out between December 2017 and June 2018 in Dr. Zekai Tahir Burak Women’s Health Education and Research Hospital. 555 patients were classified into three groups; Group 1: patients having one previous CS, Group 2: patients having two previous CS, Group 3: patients having more than the two previous CS). Ultrasonographic measurements of the LUS, intraoperative findings and, adverse pregnancy outcomes were assessed. Results: LUS thickness of group 2 was significantly less than the LUS thickness of the other groups (p=0.022). The feeling of pain was significantly more in the patients of group 2, when compared with the other groups (p=0.019). Pregnancy interval was the only parameter that had significant predictivity for adverse pregnancy outcomes for group 1(#CS=2) and group 3 (#CS≥4) (p=0.042, and p=0.021, respectively). In group 2 (#CS=3), age, the thickness of LUS, and thickness of subcutaneous adipose tissue were found to have significantly high predictivity for adverse pregnancy outcomes (p=0.012, p≤0.001, and p=0.007, respectively). Conclusion: Measurement of LUS, in the patients who had previous CS, can be used for risk assessment and management. It is a non-invasive, reliable and, easily applicable method. Standardization of the measurement technique is a necessity.

scholarly journals Criminal of Adverse Pregnant Outcomes: A Perspective From Thyroid Hormone Disturbance Caused by SARS-CoV-2

2022 ◽  
Vol 11 ◽  
Author(s):  
Qiman Shi ◽  
Min Wu ◽  
Pei Chen ◽  
Bo Wei ◽  
Hailong Tan ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Thyroid Hormone ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Growth And Development ◽  
Thyroid Dysfunction ◽  
Perinatal Death ◽  
Adverse Pregnancy Outcomes ◽  
Adverse Pregnancy ◽  
Underlying Mechanisms

Nowadays, emerging evidence has shown adverse pregnancy outcomes, including preterm birth, preeclampsia, cesarean, and perinatal death, occurring in pregnant women after getting infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the underlying mechanisms remain elusive. Thyroid hormone disturbance has been unveiled consistently in various studies. As commonly known, thyroid hormone is vital for promoting pregnancy and optimal fetal growth and development. Even mild thyroid dysfunction can cause adverse pregnancy outcomes. We explored and summarized possible mechanisms of thyroid hormone abnormality in pregnant women after coronavirus disease 2019 (COVID-19) infection and made a scientific thypothesis that adverse pregnancy outcomes can be the result of thyroid hormone disorder during COVID-19. In which case, we accentuate the importance of thyroid hormone surveillance for COVID-19-infected pregnant women.

scholarly journals Isthmico-cervical insufficiency associated with cervicovaginal infections: features of the course of pregnancy and perinatal outcomes

2021 ◽  
Vol 20 (1) ◽  
pp. 23-29
Author(s):  
V. F. Dolgushina ◽  
E. S. Alikhanova ◽  
I. V. Kurnosenko ◽  
T. V. Nadvikova
Keyword(s):  
Preterm Birth ◽  
Pregnant Women ◽  
Perinatal Mortality ◽  
Perinatal Outcomes ◽  
Intrauterine Infection ◽  
Cervical Insufficiency ◽  
Cervical Remodeling ◽  
History Of ◽  
Group 2 ◽  
Group 1

Introduction. The formation of isthmic-cervical insufficiency (ICI) in 80% is associated with intraamnial inflammation, this is the subject of discussion of new mechanisms of the pathogenesis of premature cervical remodeling. In this regard, it is of interest to study the relationship of ICS with intrauterine and cervicovaginal infections during pregnancy and their impact on the course and outcomes of pregnancy, which was the purpose of our study.Methods. A prospective cohort study included 100 pregnant women with ICI, taken by a continuous sample. All patients at the time of ICI manifestation underwent a comprehensive clinical and laboratory examination aimed at diagnosing cervicovaginal infections, according to e results of which the pregnant women were divided into 2 groups: the first group consisted of 72 women with ICI and cervicovaginal infections, the second group — 28 women with ICI and normocenosis of the vagina.Results. There were no significant differences between the compared groups in terms of the history of miscarriage, extragenital pathology and the frequency of complications of this pregnancy. Intrauterine infection during pregnancy in patients of group 1 was observed 4 times more often, being 55.6% (40) versus 14.3% (4) in group 2 (RR = 3.9, 95% CI = 1.5-9.9, p <0.001). Preterm birth was significantly more frequent in women of group 1, accounting for 62.5% (45), in group 2 — 28.6% (8). Perinatal mortality cases were observed only in group 1, amounting to 97‰ (7). In children from women in group 1, complications of the early neonatal period were more common, primarily due to prematurity. In addition, IUI in newborns was diagnosed 10 times more often in group 1, reaching 38.8% (26) of cases, compared with group 2 — 3.6% (1) (RR = 10.87, 95% CI = 1.55–76.22, p <0.001).Discussion. Perinatal outcomes in ICI associated with cervicovaginal infections are characterized by the presence of perinatal mortality, a higher incidence of preterm birth and IUI of the newborn than in women with ICI without cervicovaginal infection.

scholarly journals A várandós nő parodontalis egészségi állapota és a terhességi komplikációk közötti kapcsolat

2018 ◽  
Vol 159 (25) ◽  
pp. 999-1007
Author(s):  
István Gera
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Periodontal Disease ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Clinical Studies ◽  
Adverse Pregnancy Outcomes ◽  
Periodontal Therapy ◽  
Adverse Pregnancy

Abstract: Data from epidemiological and clinical studies published in the past two decades indicate certain association between periodontal disease and increased risk for preterm birth or low birth weight. Although the strength of those observed associations is weak, periodontitis today is considered as one of the potentially modifiable risk factors for adverse pregnancy outcomes. The aims of the publication are to summarize the epidemiological and clinical evidence for the impact of periodontal disease on adverse pregnancy outcomes and to make an attempt to overview the potential biological mechanism behind this association. The majority of epidemiological and clinical studies found certain negative effect of poor maternal periodontal condition on the incidence of low birth weight, preterm birth, pre-eclampsy, restricted foetal growth or even stillbirth. Two possible biological pathways have so far been identified: 1) the direct dissemination of the periodontal pathogens or their toxic by-products which reach the foetal-placental unit, and 2) an indirect mechanism when the circulating systemic inflammatory mediators induced by the periodontal inflammation can provoke secondary inflammation and foetal damage in the amnion. The periodontal therapy applied during the second or third trimesters has not been proven to reduce the incidence of any adverse pregnancy outcomes in pregnant women. A much more prophylaxis-oriented approach in periodontal treatment is needed. The adequate periodontal therapy should be completed before the conception to provide benefit to the pregnant women and also the new born baby. Orv Hetil. 2018; 159(25): 999–1007.

scholarly journals Clinical significance of unexplained elevated maternal serum alpha feto-protein in second trimester of pregnancy

2018 ◽  
Vol 7 (6) ◽  
pp. 2245
Author(s):  
Urmila Karya ◽  
Sweta Kumari ◽  
Anupam Rani ◽  
Shakun Singh
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Predictive Value ◽  
Maternal Serum ◽  
Adverse Pregnancy Outcomes ◽  
Alpha Fetoprotein ◽  
Second Trimester ◽  
Serum Alpha Fetoprotein ◽  
Adverse Pregnancy

Background: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to measure maternal serum AFP levels in second trimester between 15-20 weeks of gestation and to determine whether unexplained elevated MSAFP levels is an effective predictor of adverse pregnancy outcome among Indian population.Methods: This study was a prospective observational study, carried out on 400 pregnant women. Maternal serum alpha-fetoprotein (MSAFP) was measured between 15 and 20 weeks of gestation after excluding congenital malformation or birth defects. MSAFP level was determined by using a radio-immunoassay technique. Women with MSAFP level >2.0 MoM was considered as abnormal while MSAFP level≤ 2.0 MoM was considered as normal. All women were followed up till delivery and pregnancy outcomes were noted and compared between two groups.Results: Women with elevated MSAFP had significantly higher adverse pregnancy outcomes (75.4%) compared to women with MSAFP ≤2.0 MoM (26.1%) (p<0.0001 with relative risk of 2.89, 95% confidence interval 2.276 -3.667).Conclusions: Unexplained elevated MSAFP has high sensitivity, specificity, positive predictive value and negative predictive value in predicting adverse pregnancy outcomes. It would, therefore be worthwhile screening pregnant women in second trimester for maternal serum alpha-fetoprotein levels as it would help to identify high risk pregnancies and allow close antenatal survillence for better pregnancy outcome.

scholarly journals Association of socioeconomic disparity of the pregnant women with adverse pregnancy outcomes

2021 ◽  
Vol 12 (2) ◽  
pp. 1667-1671
Author(s):  
Vineela Nekkanti ◽  
Githa Kishore
Keyword(s):  
Socioeconomic Status ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Government Health ◽  
Lower Segment Cesarean Section ◽  
The Government ◽  
Adverse Pregnancy ◽  
Nicu Admission

Socioeconomic status of the pregnant women is a key determinant of the pregnancy outcomes. The government of India has started several health schemes to provide appropriate antenatal care for the pregnant women. The present study aimed to assess the association of socioeconomic status of pregnant women with adverse pregnancy outcomes after the implementation of these schemes. The present study used Kuppuswamy scale to determine the socio-economic status of the study subjects and pregnant women of both upper and lower SES class without major pregnancy complications were recruited into the study. These subjects were followed up until delivery, and their adverse pregnancy outcomes such as lower segment cesarean section (LSCS) delivery, preterm birth, low birth weight (LBW) and neonatal intensive care unit (NICU) admission were reported. In the present study, the rate of LSCS, preterm birth, LBW and NICU admission was high among the lower SES group as compared to the upper SES group women. However, NICU admission had a statistically significant association with SES of pregnant women at p=0.038. The difference in the occurrence of adverse pregnancy outcomes among the upper and lower SES pregnant women is minimal, which could be attributed to the enrolment of lower SES pregnant women to the government health schemes. Hence, to overcome the economic disparities among the pregnant women, the implementation of government health schemes should be strengthened by promoting the role of the accredited social health activist (ASHA) worker.

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