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International Journal of Gynaecology... Dec 1998Pregnancy among adolescents is an important problem in most developing countries. The phenomenon in Brazil seems numerically stable for the age group from 15 to 19 years... (Comparative Study)
Comparative Study Review
Pregnancy among adolescents is an important problem in most developing countries. The phenomenon in Brazil seems numerically stable for the age group from 15 to 19 years old, with a trend of increase in the first segment of adolescence, below 15. The majority of pregnancies are unwanted, with medical, psychological and mainly social repercussions. The disadvantages are clearer for multipara adolescents. The main immediate consequences of an unwanted pregnancy are: induced abortion, lack of prenatal care, personal and family disruption, adoption and abandonment. Some intervention policies are suggested for the reduction of this phenomenon through programs of sexual education, services for special care of adolescents, access to orientation and contraceptive methods, and support for the pregnancies to be carried on until term.
Topics: Adolescent; Brazil; Family Planning Services; Female; Humans; Pregnancy; Pregnancy in Adolescence; Pregnancy, Unwanted; Psychology; Quality of Life; Risk Assessment; Socioeconomic Factors
PubMed: 10075226
DOI: 10.1016/s0020-7292(98)00198-2 -
Discovery Medicine Oct 2023Pregnancy is often thought of as a time of happiness and anticipation, however, for some women, it can bring about significant emotional distress and feelings of... (Review)
Review
Pregnancy is often thought of as a time of happiness and anticipation, however, for some women, it can bring about significant emotional distress and feelings of vulnerability. The physiological changes that occur during pregnancy, including hormonal fluctuations and alterations to the immune and physical systems, can affect various parts of the body, including the central nervous system (CNS). As a result, existing conditions may be intensified or new ones, such as neurologic or psychiatric disorders, may arise, exposing women to increased risk of life-threatening conditions or suicide, in the worst-case scenarios. Given the impact of pregnancy on CNS diseases, it is crucial for healthcare providers and patients alike to be aware of these potential effects. By understanding how pregnancy may affect the CNS, clinicians can take appropriate steps to ensure that women receive the care and support they need to minimize any negative outcomes for both the mother and the baby. This paper aims to review the available evidence on the impact of pregnancy on CNS diseases, including mental health conditions, from both the clinical and biomolecular perspectives. By illuminating this crucial subject, this study fosters a delicate understanding within both patients and healthcare providers, thereby paving the way for enhanced outcomes for women throughout their pregnancy journey and beyond.
Topics: Pregnancy; Infant; Humans; Female; Central Nervous System; Immunity; Central Nervous System Diseases
PubMed: 37811609
DOI: 10.24976/Discov.Med.202335178.66 -
Journal of Applied Physiology... Apr 2021Pregnancy is recognized as a natural physiological stressor to the maternal cardiovascular system. Cardiovascular adaptation is markedly greater in twin pregnancy...
Pregnancy is recognized as a natural physiological stressor to the maternal cardiovascular system. Cardiovascular adaptation is markedly greater in twin pregnancy compared with singleton pregnancy; however, these changes are sparsely documented in triplet pregnancy. The aim of this case series was to compare maternal cardiac function, cardioautonomic regulation, and blood pressure reactivity in healthy singleton, twin, and triplet pregnancies. Resting cardiac structure and function (echocardiography), beat-by-beat blood pressure variability (BPV; photoplethysmography), and heart rate variability (HRV; electrocardiogram) were measured in two triplet, three twin, and three singleton pregnancies (matched for maternal age, prepregnancy body mass index, and gestational age). Hemodynamic responses to a 3-min cold pressor test were also recorded to assess blood pressure reactivity. Due to the small sample size of this case series, statistical comparisons were not made between groups. Compared with singleton and twin pregnancies, individuals pregnant with triplets had greater resting cardiac output but lower cardiac deformation (longitudinal strain, basal circumferential strain, and torsion), sympathetic dominance in cardioautonomic regulation (lower HRV and higher BPV), and elevated blood pressure reactivity in response to the cold pressor test. Taken together, these observations suggest that females with triplet pregnancies may have reduced cardiovascular function, which may contribute to the heightened risk of complications in multifetal pregnancies. Individuals with healthy triplet pregnancies had greater resting cardiac output but lower left ventricular mechanics when compared with singleton and twin pregnancies matched for gestational age. In addition, triplet pregnancies had greater blood pressure variability and lower overall heart rate variability compared with singleton pregnancies, as well as greater blood pressure reactivity to the cold pressor test. Healthy triplet pregnancies may have reduced cardiovascular function as well as a greater sympathetic contribution to cardiac control.
Topics: Female; Gestational Age; Humans; Pregnancy; Pregnancy, Triplet; Pregnancy, Twin; Triplets; Twins
PubMed: 33507851
DOI: 10.1152/japplphysiol.00998.2020 -
BMC Pregnancy and Childbirth Dec 2023Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births... (Review)
Review
OBJECTIVE
Multiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies.
METHODS
This study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing.
RESULTS
Out of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29-3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins.
CONCLUSION
The prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Infant; Premature Birth; Pregnancy, Twin; Cesarean Section; Retrospective Studies; Thailand; Pregnancy, Multiple; Pregnancy Outcome
PubMed: 38110899
DOI: 10.1186/s12884-023-06186-0 -
Reproduction, Fertility, and Development Dec 2022Beef cattle producers rely on each of their cows to produce a marketable calf each year to maintain a sustainable operation. Within the first month of gestation,...
Beef cattle producers rely on each of their cows to produce a marketable calf each year to maintain a sustainable operation. Within the first month of gestation, pregnancy failures have been recorded to be upwards of 40-50%. From fertilisation to birth, there are numerous factors contributing to pregnancy failure. From the beginning of gestation oocyte competence is often a large factor impacting fertility as the dam contributes all mRNA for initial embryo development. Other factors contributing to early embryonic infertility include hormonal concentration and heat stress. After the embryo enters the uterus, it becomes critical for the uterus to be receptive to the developing conceptus. The embryo then begins to elongate and secrete interferon-tau to initiate maternal recognition of pregnancy; a requirement to establish and maintain bovine pregnancies. After a pregnancy completes these steps, placentation actively begins around day 22 of pregnancy and lasts until organogenesis. The fetal phase follows the embryonic phase where disease and/or toxins are often the cause of pregnancy failure at this period. However, fetal mortality has been reported to occur in less than 10% of pregnancies. Understanding of the many factors influencing infertility needs to be further investigated to increase pregnancy success in beef cattle.
Topics: Pregnancy; Female; Humans; Cattle; Animals; Uterus; Placentation; Abortion, Spontaneous; Fertility; Infertility
PubMed: 36592980
DOI: 10.1071/RD22206 -
Journal of Midwifery & Women's Health 2003Recent exploration of the experiences of pregnant and parenting adolescents has uncovered the need to address the unique developmental, social, and cultural aspects of... (Review)
Review
Recent exploration of the experiences of pregnant and parenting adolescents has uncovered the need to address the unique developmental, social, and cultural aspects of adolescent pregnancy. Many adolescents, especially those from urban areas, live in communities with limited opportunities, poverty, violence, and a lack of support. Programs that help young women discover their inner strength, create environments for empowerment, and build community may help adolescents to achieve goals and parent successfully. Centering Pregnancy is a model of group prenatal care that provides for the assessment, education, and support of pregnant women and may be particularly useful in adolescent populations. The model is described and the ways adolescents may benefit from Centering Pregnancy's unique design is discussed.
Topics: Adolescent; Adolescent Health Services; Female; Health Education; Humans; Maternal Health Services; Midwifery; Models, Nursing; Nurse's Role; Nursing Assessment; Pregnancy; Pregnancy in Adolescence; Quality of Life; United States
PubMed: 12764308
DOI: 10.1016/s1526-9523(03)00062-x -
Fetal Diagnosis and Therapy 1993In the present study we summarized the world literature on first trimester multifetal pregnancy reduction between 1985 and 1992 and added our own experience. Our aim was... (Review)
Review
In the present study we summarized the world literature on first trimester multifetal pregnancy reduction between 1985 and 1992 and added our own experience. Our aim was to reach a comprehensive view on the survival rate of reduced high multifetal pregnancies, as the data in various studies are somewhat confusing, possibly as a result of the small number of cases. The data so gathered were classified by the number of fetuses. Of 94 triplet pregnancies reduced to twins 91.6% survived. Of 108 quadruplet pregnancies reduced to twins 92.6% survived. Of 40 quintuplet pregnancies 72.5% survived, and of 93 septuplets or more 87.1% survived. The outcome of pregnancies reduced to triplets did not differ from the outcome of pregnancies reduced to twins, with a survival rate of 85.7 and 72.5%, respectively. In our opinion, in view of the infertility history of many of these patients, the risk of pregnancy loss, the high survival rate of triplets and fetal reduction in triplet pregnancies in this group of patients may be unjustified. Accordingly, our policy in cases where the patients demand or when reduction is done early in pregnancy to reduce the triplets.
Topics: Abortion, Therapeutic; Ethics, Medical; Female; Fetal Death; Humans; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Survival Rate; Treatment Outcome
PubMed: 8240698
DOI: 10.1159/000263829 -
American Journal of Obstetrics and... Sep 2022This systematic review and meta-analysis aimed to compare the fetal survival rate and perinatal outcomes of triplet pregnancies after selective reduction to twin... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to compare the fetal survival rate and perinatal outcomes of triplet pregnancies after selective reduction to twin pregnancies vs singleton pregnancies.
DATA SOURCES
PubMed, Web of Science, Scopus, and Embase were systematically searched from the inception of the databases to January 16, 2022.
STUDY ELIGIBILITY CRITERIA
Studies comparing the survival and perinatal outcomes between reduction to twin pregnancies and reduction to singleton pregnancies were included. The primary outcomes were fetal survival, defined as a live birth at >24 weeks of gestation. The secondary outcomes were gestational age at birth, preterm birth at <32 and <34 weeks of gestation, early pregnancy loss (<24 weeks of gestation), low birthweight, and rate of neonatal demise (up to 28 days after birth).
METHODS
The random-effect model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. To provide a range of expected effects if a new study was conducted, 95% prediction intervals were calculated for outcomes presented in >3 studies.
RESULTS
Of note, 10 studies with 2543 triplet pregnancies undergoing fetal reduction, of which 2035 reduced to twin pregnancies and 508 reduced to singleton pregnancies, met the inclusion criteria. Reduction to twin pregnancies had a lower rate of fetal survival (odds ratio, 0.61; 95% confidence interval, 0.40-0.92; P=.02; 95% prediction interval, 0.36-1.03) and comparable rates of early pregnancy loss (odds ratio, 0.89; 95% confidence interval, 0.58-1.38; P=.61; 95% prediction interval, 0.54-1.48) and neonatal demise (odds ratio, 0.57; 95% confidence interval, 0.09-3.50; P=.55) than reduction to singleton pregnancies. Reduction to twin pregnancies had a significantly lower gestation age at birth (weeks) (mean difference, -2.20; 95% confidence interval, -2.80 to -1.61; P<.001; 95% prediction interval, -4.27 to -0.14) than reduction to singleton pregnancies. Furthermore, reduction to twin pregnancies was associated with lower birthweight and greater risk of preterm birth at <32 and <34 weeks of gestation.
CONCLUSION
Triplet pregnancies reduced to twin pregnancies had a lower fetal survival rate of all remaining fetuses, lower gestational age at birth, higher risk of preterm birth, and lower birthweight than triplet pregnancies reduced to singleton pregnancies; reduction to twin pregnancies vs reduction to singleton pregnancies showed no substantial difference for the rates of early pregnancy loss and neonatal death.
Topics: Abortion, Spontaneous; Birth Weight; Female; Gestational Age; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Pregnancy Reduction, Multifetal; Pregnancy, Triplet; Pregnancy, Twin; Premature Birth; Retrospective Studies
PubMed: 35351408
DOI: 10.1016/j.ajog.2022.03.050 -
Health Reports 1996Live births, induced abortions, and miscarriages/stillbirths are usually examined separately. This article combines the three outcomes to focus on pregnancy in Canada...
Live births, induced abortions, and miscarriages/stillbirths are usually examined separately. This article combines the three outcomes to focus on pregnancy in Canada from 1974 to 1992. An estimated 525,100 pregnancies ended in Canada during 1992. While this was a substantial increase from 438,300 in 1974, the pregnancy rate in 1992-77 pregnancies per 1,000 women aged 15 to 44-was actually lower than in 1974, when it had been 85 per 1,000. As the pregnancy rate declined, there was a shift in outcomes. The share of pregnancies that ended in live births fell from 79% to 76%, and the proportion ending in miscarriages/stillbirths went from 9% to 5%. A growing proportion of pregnancies ended in abortions: 19% in 1992, compared with 12% in 1974. Trends in pregnancies varied with the age of the women. Pregnancy rates rose among those in their thirties, but dropped at all other ages. Consequently, older women accounted for a larger share of pregnancies at the end of the period than they had at the beginning. Pregnancy outcomes also differed depending on the women's age. The proportion that ended in an abortion was relatively high among women under age 25 and age 40 and over. Throughout the 1974-1992 period, the proportion of pregnancies ending in miscarriages or stillbirths fell among women of all ages.
Topics: Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Canada; Female; Humans; Maternal Age; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Pregnancy in Adolescence; Pregnancy, High-Risk
PubMed: 8844176
DOI: No ID Found -
Current Opinion in Obstetrics &... Oct 2023Twin pregnancies are characterized by slower growth velocity compared with singletons, especially during the third trimester and, therefore, tend to be smaller than... (Review)
Review
PURPOSE OF REVIEW
Twin pregnancies are characterized by slower growth velocity compared with singletons, especially during the third trimester and, therefore, tend to be smaller than singletons. Growth surveillance is instrumental in the identification of twin pregnancies at risk of adverse outcomes. Whether the phenomenon of slow growth is an adaptive physiological response or represents pathological growth lag, is controversial. In this review, we focus on the evidence related to the types of growth charts employed for twin pregnancies.
RECENT FINDINGS
Consistent evidence has emerged over the past few years from large independent cohorts in different countries suggesting that twin-specific standards perform better in identifying growth-restricted twin pregnancies at risk of adverse perinatal outcomes, without resulting in an increase in interventions or iatrogenic prematurity.
SUMMARY
The current evidence supports the use of twin-specific reference charts. Concerted efforts should be made to derive prospective evidence from large multicentre studies on various aspects of the implementation of twin-specific standards.
Topics: Pregnancy; Female; Humans; Pregnancy, Twin; Prospective Studies; Ultrasonography, Prenatal; Parturition; Pregnancy Trimester, Third; Retrospective Studies
PubMed: 37560793
DOI: 10.1097/GCO.0000000000000898