Maternal Perinatal Characteristics in Patients with Severe Preeclampsia: A Case-Control Nested Cohort Study

Preeclampsia is one of the most worrisome complications during pregnancy, affecting approximately 1 out of 20 women worldwide. Preeclampsia is mainly characterized by a sustained hypertension, proteinuria, also involving a significant organ dysfunction. Moreover, 25% of the cases could be classified as severe preeclampsia (SP), a serious condition that could be life-threatening for both the mother and fetus. Although there are many studies focusing on preeclampsia, less efforts have been made in SP, frequently limited to some specific situations. Thus, the present study aims to conduct a comparative analysis of risk factors, maternal characteristics, obstetric and neonatal outcomes and maternal complications in patients with severe preeclampsia versus patients without severe preeclampsia. Hence, 235 cases and 470 controls were evaluated and followed in our study. We described a set of variables related to the development of severe preeclampsia, including maternal age > 35 years (69.8%), gestational (26.8%) or chronic arterial hypertension (18.3%), obesity (22.6%), use of assisted reproduction techniques (12.3%), prior history of preeclampsia (10.2%) and chronic kidney disease (7.7%) All patients had severe hypertension (>160 mmHg) and some of them presented with additional complications, such as acute renal failure (51 cases), HELLP syndrome (22 cases), eclampsia (9 cases) and acute cerebrovascular accidents (3 cases). No case of maternal death was recorded, although the SP group had a higher cesarean section rate than the control group (60% vs. 20.9%) (p < 0.001), and there was a notably higher perinatal morbidity and mortality in these patients, who had a prematurity rate of 58.3% (p < 0.001) and 14 perinatal deaths, compared to 1 in the control group. Overall, our study recognized a series of factors related to the development of SP and related complications, which may be of great aid for improving the clinical management of this condition.

Characteristics of Newborns from Mothers with SARS-CoV-2 Infection in a Portuguese Hospital

Introduction: Guidance for pregnant women has been particularly problematic since the beginning of the COVID-19 pandemic. The aim of this study was to describe the characteristics and outcomes of pregnant women with SARS-CoV-2 infection and their newborns.Material and Methods: Case review of clinical records of pregnant women with SARS-CoV-2 infection admitted for delivery and their newborns from April to December 2020 at a hospital in the Lisbon metropolitan area.Results: From 1755 births, 81 (4.6%) were from SARS-CoV-2 positive mothers. Most (83.9%) were term newborns. Almost 16% were preterm, while there was an overall prematurity rate of 9.9%. Most women (88.6%) were asymptomatic. Rooming-in occurred in 80.8% cases and 19.2% newborns were admitted to the Neonatal Intensive Care Unit. From the total, 56.7% newborns were breastfed from birth and 43% had mixed feeding. None of the newborns had symptoms related to COVID-19 infection, and all had negative rt-PCR for SARS-CoV-2 at birth and at 48 hours of life. The majority (85.2%) was discharged home with their mothers.Discussion: Pregnant women with COVID-19 have shown immune characteristics resembling healthy pregnancies, and it is not yet clear if SARS-CoV-2 can be vertically transmitted. Recent updates on neonatal guidance now recommend rooming-in and support the relative safety of breastfeeding.Conclusion: This study supports other published articles regarding maternal and neonatal outcomes of SARS-CoV-2 infected pregnant women, including the absence of short-term adverse outcomes with rooming-in and breastfeeding.

Textronic Solutions Used for Premature Babies: A Review

Premature birth is considered to be a substantial problem in perinatal medicine, which in the vast majority of cases (>60%), concerns African and South Asian countries. Nevertheless, prematurity is a global problem and is faced by both less-developed (where 12% of babies are prematurely born) and well-developed countries (with 9% prematurity rate) [1, 2]. The percentage of children born prematurely, i.e., before the 37th week of pregnancy, was 8.7% in Europe, while, in Poland, it was 7.34% [3]. Care of prematurely born babies is a huge challenge for parents and medical staff in the neonatal intensive care unit. Preterm infants, because of their low weight and gestational age, are prone to health problems and even death. For this reason, continuous monitoring of health parameters plays an important role. It is achieved by the use of various sensors that are inserted in infants’ garments. Sensor systems monitor an infant’s health condition, and then the data are transmitted to doctors or parents. This article is for illustrative purposes, aimed at presenting solutions such as the use of sensors for monitoring infants’ physiological parameters.

Program for Prevention of a Considerable Number of Premature Births

Objective Prevention of prematurity by a prematurity-preventionprogram, including “Self-Care”-measures for the pregnant women. Introduction Prevention of early prematurity (< 32 gest.w.) and of very low birthweight infants (< 1500 g) is one of the most urgent tasks of perinatal medicine. Particularly ascending genital infection is the most important avoidable cause of early prematurity. For the prevention of these infections the “protective lactobacillus system” plays a crucial role. Bacterial vaginosis and/or ascending genital infection start mostly with a disturbance of this vaginal milieu–which we consider as a “precursor”. Our program is based on an anamnestic assessment of prematurity risk, the early detection of warning signs (including screening for preinfection respectively infection signs by regular measurement of the vaginal pH) and, if necessary, the appropriate therapeutic measures. The program includes “Self-Care”-measures by the women themselves (preferably for all pregnant women) and additional special measures for women at risk, for example, the ETCO for women with recurrent premature births. Design and method The Self-Care—measures for pregnant women are an additional measure to regular prenatal care. In our own study, we had 1120 multiparae and we compared the outcome of the pregnancy with self-care activities with the outcome of the immediate previous pregnancy. Our program was then used in the entire state of Thuringia (Germany). In the second half of the year 2000, the Self- Care Program was employed and the statistically evaluated results for the entire state were compared with those from the first half of 2000 without the program (in each half-year there have been more than 8.000 births). After that, several German health insurance companies used our prenatal-care self-examination program in a pilot project to their pregnant members. The early total cervix occlusion (ETCO) is a preventive measure particularly for cases with two or more late abortions (> 12 + 0 gw) or early premature births (< 32 + 0 gw) in the patient's history with either infection as cause for these events or when no other cause has been found, but when for instance premature rupture of membranes occurred. The Total Cervix Occlusion creates a complete barrier against ascending infections within the cervical canal (as opposed to the cerclage). Results With regards to the Self-Care—measures: In all studies the rate of premature births could be considerably reduced. Most interesting are the results of the prematures at particularly high risk. In our collective, the rate of very low birthweight infants (< 1500 g) could be reduced from 7.8% in the immediate previous pregnancy to 1.3%. In Thuringia, the rate of infants born < 32 + 0 gw was reduced from 1.36 to 0.94% respectively in infants < 1000 g from 0.61 to 0.38%. After the campaign in Thuringia had been finished, the prematurity rates monitored in 2002 were again as high as before. The first evaluation of a health insurance company in the German state North-Rhine-Westfalia (NRW) shows that the insured patients had a prematurity rate of 7% compared with the overall prematurity rate in NRW of 9.6%. After an ETCO the rate of surviving infants was about 80% in our own population (as opposed to 17% in the pregnancies before the ETCO in the same group). Similar good results have been obtained by other clinicians. With ETCO in multiple pregnancies Schulze (2008) was able to achieve a prematurity rate of only 17% as against a rate of 29% in cases without ETCO. Conclusion The Self-Care Program for pregnant women proved to be a very efficient method for the prevention of prematurity and should be recommended to every pregnant woman. In cases where this is not possible, at least doctors and midwives should measure the vaginalpH at each prenatal care examination. The Early Total Cervix Occlusion is an effective preventive measure for women with recurrent late abortions or prematures births and it seems to be also a good measure to prevent premature births in multiple pregnancies. More research in this area is necessary.

Integrating Psychotherapy with Obstetrics and Gynaecology

As a specialist Obstetrics and Gynaecology I then became a specialist also in psychotherapy, including: psychodynamic therapy, group therapy, hypnotherapy, and body-therapy. In the last nineteen years I have been working to integrate the medical and psychotherapeutic approach, including attention to psychosocial factors. After some years, I found our German rate of premature birth to be 7%. This amazed me because prematurity very rarely occurred in my patients, which was down to about 1%. In France they did some surveys and studies. By informing the mothers how to live, and reducing smoking and drugs, they reduced their prematurity rate to about half, but still much above my rate of 1%. I have described my method in articles. This is vital work, because serious prematurity is responsible for most damage and death amongst the children. A mother's complaint may be an early suggestion of danger. We then check it with the regular obstetric assessments. Even before birth symptoms can indicate a problem, such as premature labour, much as postnatal problems while breast feeding are indicated by symptoms. And before birth, as well as after birth stress and emotional problems can be the cause for serious somatic illness. It is really an effect of one relationship on the other. The way a woman relates to her child depends on her feeling of security among all who support her. All her relationships are important: how she grew up with her parents; her work; her other children. Further problems that experience of psychotherapy can help to reduce are: exceeding the estimated date of delivery; pre-eclampsia; HELLP-syndrome (Hemolysis, Elevated Liver enzymes and Low Platelets). The lectures we offer on the subject are also relevant to psychotherapeutic understanding and in guiding to treatment.

Management and Outcomes of 65 Quadruplet Pregnancies: Sixteen Years' Experience in France

Objective: data on the prognosis and management of multifetal pregnancies are of vital importance, particularly when the option of selective termination is considered. The present study details the obstetric management, neonatal outcome, and follow-up data of 65 quadruplet pregnancies in France.Methods: to conduct the study, a questionnaire was sent to families registered with the National Association Helping Parents of Multiple Births (Association National d'Entraide des Parents de Naissance Multiples, A.N.E.P.N.M.).Results: of 116 questionnaires sent to families of quadruplets born between 1972 and 1988, 65 were received. Of these pregnancies, 58 were obtained with ovulation induction agents, 2 with IVF (in vitro fertilization) and GIFT (gamete intrafallopian transfer) and 5 were spontaneous. Diagnosis was made prior to 13 weeks gestation in 87.2% of cases. Most mothers were hospitalized prior to delivery – mean duration of 47 days. The mean gestational age at delivery was 31.2 ± 3 weeks with a prematurity rate of 97%. Cesarean sections were performed in 51 cases and vaginal deliveries in 14. Neonatal and perinatal mortality rates were 68 and 104 per 1000, respectively. Birthweights of quadruplets ranged from 760 to 2455g with a mean of 1615 g.Conclusion: management of quadruplet pregnancies in France consists of early diagnosis, echographical and clinical monitoring, early reduction of maternal activity and cesarean deliveries. Our management of such pregnancies is of high quality as reflected by our obstetrical results. Lack of adequate management, as perceived by families of quadruplets, exists at two levels: a psychological (lack of psychological support) and a financial (lack of specific help).