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Trends in Immunology Nov 2023Pregnancy poses an immunological challenge, since the mother's immune system must adapt to tolerate the developing embryo until birth. The mechanisms governing this...
Pregnancy poses an immunological challenge, since the mother's immune system must adapt to tolerate the developing embryo until birth. The mechanisms governing this maternal-fetal dialogue have traditionally centered on the immune system. Yang et al. propose a new concept: immune-featured decidual stromal cells (DSCs), which emerge as pivotal players in mammalian maternal-fetal crosstalk.
Topics: Pregnancy; Female; Humans; Decidua; Stromal Cells
PubMed: 37867112
DOI: 10.1016/j.it.2023.09.009 -
Journal of National Black Nurses'... 1990Repeat pregnancy among adolescent mothers is a major problem facing healthcare providers today. Adolescents who experience multiple pregnancies often are subjected to... (Review)
Review
Repeat pregnancy among adolescent mothers is a major problem facing healthcare providers today. Adolescents who experience multiple pregnancies often are subjected to overwhelming physical, social, economic, and psychological outcomes. Research is needed to investigate the problem of repeat pregnancy and provide empirical support for intervention programs developed to reduce the incidence. This paper is a review of previous research. Major factors related to repeat pregnancy are examined. In addition, recommendations for future research are discussed.
Topics: Adolescent; Contraception Behavior; Educational Status; Female; Humans; Marriage; Parent-Child Relations; Parity; Pregnancy; Pregnancy in Adolescence
PubMed: 2198329
DOI: No ID Found -
Rheumatology International Jun 2014Little is known about the interactions between adult-onset Still's disease (AOSD) and pregnancy. In an attempt to clarify the link between these 2 conditions, we... (Review)
Review
Little is known about the interactions between adult-onset Still's disease (AOSD) and pregnancy. In an attempt to clarify the link between these 2 conditions, we retrospectively analyzed patients registered as suffering from AOSD seen in our university hospital. A total of 57 patients, among them 30 women, were diagnosed. Ten pregnancies in 8 women were identified. Three cases manifested AOSD in their first trimester, all treated with prednisone. Premature births and flares occurred in 2 patients. One patient developed a monocyclic AOSD during her second pregnancy's postpartum. In the 4 other cases, AOSD was known and quiescent before pregnancy. One patient had 2 pregnancies without any flare or complication. One patient experienced her first pregnancy while under treatment and presented a late flare 8 months after delivery. The third patient developed exacerbation in the first trimester of her second pregnancy which was treated with IgIV alone. The last one presented her first pregnancy 7 years after diagnosis. A prednisone-treated systemic flare occurred during the first trimester without later complication. Based on our own experience and the analysis of only two series of the literature, including, respectively, 4 and 5 patients, we suggest that two settings could be distinguished. First, AOSD can occur during pregnancy and can be responsible for obstetrical complications. Then, in patients with known AOSD, the second trimester and postpartum appear to be periods exposing to disease recurrence. Thus, we recommend a close multidisciplinary monitoring by a rheumatologist and an obstetrician prior to, during and after pregnancies.
Topics: Adult; Cohort Studies; Disease Progression; Female; Glucocorticoids; Humans; Prednisone; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Retrospective Studies; Still's Disease, Adult-Onset; Young Adult
PubMed: 23624554
DOI: 10.1007/s00296-013-2765-5 -
Global Health, Science and Practice Dec 2017In 2017, of the 22.5 million parenting adolescents (ages 15-19) in 60 countries, approximately 4.1 million gave birth to a second or higher-order child. Adolescent... (Review)
Review
BACKGROUND
In 2017, of the 22.5 million parenting adolescents (ages 15-19) in 60 countries, approximately 4.1 million gave birth to a second or higher-order child. Adolescent pregnancy in general, and rapid repeat pregnancies specifically, expose young mothers and their children to multiple health and socioeconomic risks. The purpose of this article is to review the impact of interventions designed to prevent unintended, rapid repeat pregnancies among adolescents, including those aimed at changing norms to postpone "intended" closely spaced pregnancies to promote healthy spacing.
METHODS
We searched PubMed and other databases for evaluations of interventions published in English from 1990 through 2016. We included evaluations that assessed a programmatic intervention specifically designed to prevent rapid repeat pregnancy (occurring less than 24 months after the index birth) or birth (occurring less than 33 months after the index birth), or that reported on contraceptive continuation for at least 2 years. We first assessed the quality of the evaluations, then ranked the interventions based on the quality of the evaluation and the level of impact on repeat pregnancy or birth (statistically significant impact, positive trends but not statistically significant, or no impact) to identify the most effective interventions. Finally, we extracted program design and implementation lessons from the interventions included in the high-quality evaluations.
RESULTS
Our search identified 2,187 articles, of which 40 evaluations met the inclusion criteria (24=high quality, 14=moderate quality, 2=less rigorous). We found 14 high-quality evaluations in which the intervention achieved a statistically significant impact on repeat pregnancy or birth. These interventions fell into 5 broad categories: (1) contraceptive services and information, with proactive monitoring of contraceptive use and outreach to families; (2) postpartum contraceptive counseling and services provided soon after delivery; (3) activities that help adolescents improve planning skills, including preparing contraceptive plans; (4) social and behavioral change activities that help adolescents understand the role contraception can play in determining positive life outcomes, and the implications of their reproductive health decisions for their future; and (5) activities that provide mentoring, goal setting, and motivation.
CONCLUSION
Effective interventions that prevent rapid adolescent childbearing link clinical contraceptive services with non-clinical activities that build planning skills, enhance understanding of the role that contraceptives can play in determining positive life outcomes, and provide mentoring and goal setting. Recognizing potentially synergistic effects, we recommend testing various combinations of these interventions, with access to contraception as the foundational activity.
Topics: Adolescent; Female; Humans; Pregnancy; Pregnancy in Adolescence; Pregnancy, Unplanned; Randomized Controlled Trials as Topic; Time Factors
PubMed: 29284694
DOI: 10.9745/GHSP-D-17-00131 -
International Journal of Gynaecology... Sep 2003To outline maternal and perinatal consequences of iatrogenic pregnancies. (Review)
Review
OBJECTIVES
To outline maternal and perinatal consequences of iatrogenic pregnancies.
METHODS
Review of recently published literature.
RESULTS
The problems of iatrogenic pregnancies derive from major changes in the lifestyle of women during the second half of the 20th century, whereby the age at which childbirth is desired has advanced. At the same time, the naturally reduced fecundity of advanced age, as well as involuntary infertility, were met by new, effective, and costly, treatments. The side-effect of attempts to maximize success rates of such treatments was a remarkable increase in the numbers of multiple gestations, which are invariably associated with serious maternal and perinatal complications.
CONCLUSIONS
The best method to reduce the impact of iatrogenic pregnancies is to re-define our concept of success after infertility therapy-from live birth (of any number of fetuses) to singleton live birth per treatment-and to adopt a conscientious and rational approach to achieve it.
Topics: Cerebral Palsy; Female; Global Health; Humans; Maternal Welfare; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Reproductive Techniques, Assisted; Women's Health
PubMed: 14499977
DOI: 10.1016/s0020-7292(03)00219-4 -
Autoimmunity Reviews Aug 2015Systemic vasculitis (SV) are uncommon diseases that rarely affect women during their reproductive age; little data, mainly retrospective, is available on this topic. The... (Review)
Review
OBJECTIVE
Systemic vasculitis (SV) are uncommon diseases that rarely affect women during their reproductive age; little data, mainly retrospective, is available on this topic. The aim of our study was to evaluate maternal/neonatal outcome and disease course before, during and after pregnancy.
METHODS
Sixty-five pregnancies in 50 women with SV were followed by a multispecialistic team in 8 institutions between 1995 and 2014. Clinical data on pregnancy, 1year before and 1year after delivery was retrospectively collected. The rate of pregnancy complications was compared to that of a General Obstetric Population (GOP) of 3939 women.
RESULTS
In 2 patients the diagnosis of SV was done during pregnancy; 59 out of the remaining 63 started when maternal disease was quiescent. We recorded 56 deliveries with 59 live births, 8 miscarriages and 1 fetal death. In SV, preterm, particularly early preterm (<34weeks) deliveries and cesarean sections appeared significantly more frequent than in GOP (11.3% vs 5.0%, p=0.049 and 48.2% vs 31.0%, p=0.009). Vasculitis-related complications occurred in 23 pregnancies (35.4%), with 5 severe events (7.7%) including 3 cases of transient ischemic attack (TIA). Data about the post-partum period were available for 56 pregnancies: 12 flares (21.4%) occurred, with 1 severe event (1.8%).
CONCLUSION
SV patients can have successful pregnancies (especially during a disease remission phase) despite an increased rate of preterm delivery. Severe flares were limited, but the occurrence of 3 TIA suggests that particular attention should be given to possible thrombotic complications in SV patients during pregnancy and puerperium.
Topics: Abortion, Spontaneous; Cesarean Section; Female; Fetal Death; Humans; Multicenter Studies as Topic; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Systemic Vasculitis
PubMed: 25858351
DOI: 10.1016/j.autrev.2015.03.009 -
Journal of Developmental and Behavioral... Dec 2021This study aims to characterize the association between maternal pregnancy intention and socioemotional developmental outcomes in a Brazilian sample of preschool-aged...
OBJECTIVE
This study aims to characterize the association between maternal pregnancy intention and socioemotional developmental outcomes in a Brazilian sample of preschool-aged children.
METHODS
Data from children aged 4 to 5 years and their primary caregivers in Embu das Artes, a Brazilian municipality in the state of São Paulo, were collected in 2016. Maternal pregnancy intention was defined as intended or unintended, which was then further stratified as mistimed or unwanted. Outcomes included socioemotional developmental delay, internalizing and externalizing behaviors, and school readiness. We estimated risk ratios (RRs) for unadjusted and inverse-probability-weighted regression adjustment (IPWRA) analyses using 2-level (intended vs unintended) and 3-level (intended vs mistimed vs unwanted) exposure definitions.
RESULTS
Of 1,034 total mothers, 40.7% reported their pregnancy as intended, 46.0% as mistimed, and 13.4% as unwanted. In both unadjusted and IPWRA analyses comparing intended and unintended pregnancies, all associations failed to reach statistical significance. In the IPWRA analysis using the 3-level exposure definition, unwanted pregnancies were associated with higher risk of socioemotional developmental delay (RR = 1.14; 95% confidence interval [CI], 1.01-1.28) and co-occurring internalizing and externalizing behaviors (RR = 1.11, 95% CI, 1.00-1.22), compared with intended pregnancies.
CONCLUSION
There was higher risk of poor child outcomes among unwanted compared with intended pregnancies, whereas mistimed pregnancies were not associated with poor outcomes. Further research using standardized definitions of pregnancy intention along with targeted interventions that increase access to family planning services and counseling for parents of children born after unintended pregnancies is needed.
Topics: Brazil; Child; Child, Preschool; Female; Humans; Intention; Mothers; Pregnancy; Pregnancy, Unplanned; Pregnancy, Unwanted
PubMed: 33859123
DOI: 10.1097/DBP.0000000000000951 -
BMC Pregnancy and Childbirth May 2023As the rate of multiple pregnancies increases, delayed interval delivery (DID) is increasingly being implemented to improve perinatal outcomes. But there are no... (Review)
Review
BACKGROUND
As the rate of multiple pregnancies increases, delayed interval delivery (DID) is increasingly being implemented to improve perinatal outcomes. But there are no international guidelines for DID in multiple pregnancies. We report a case of DID in a quadruplet pregnancy and review the relevant literature to summarize the management of DID in multiple pregnancies.
CASE PRESENTATION
A 22-year-old woman, 22 2/7 weeks' gestation, with quadruplets, was admitted to the hospital for a first cervical cerclage due to cervical dilation. Twenty-five days later, it was found that the cervix was dilated again, so after removing the cervical cerclage, the first quadruplet was delivered vaginally (25 6/7 weeks), and a second cervical cerclage was performed. Four days later, due to re-dilation of the cervix, after removal of the cervical cerclage, the second quadruplet was delivered vaginally (26 3/7 weeks), followed by a third cervical cerclage. Six days later, the pregnancy was terminated by cesarean section due to fetal distress, and the third and fourth quadruplets were delivered (27 2/7 weeks). The patient had no postoperative complications, and all four infants were treated in the neonatal intensive care unit and discharged successfully.
CONCLUSION
This case emphasizes that comprehensive management of delayed interval delivery can improve perinatal outcomes in multiple pregnancies, including anti-infection, tocolytic therapy, practice to promote fetal lung, and cervical cerclage.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Young Adult; Adult; Pregnancy, Quadruplet; Cesarean Section; Pregnancy, Multiple; Cervix Uteri; Cerclage, Cervical; Pregnancy Outcome
PubMed: 37189021
DOI: 10.1186/s12884-023-05647-w -
Journal of Reproductive Immunology Mar 2024Infertile couples' percentage is increasing all over the world, especially in Italy, with high number of children born in our country through assisted reproductive... (Review)
Review
INTRODUCTION
Infertile couples' percentage is increasing all over the world, especially in Italy, with high number of children born in our country through assisted reproductive techniques (ART). However, pregnancies obtained by ART have increased potential obstetrical risks which could be caused by fetus-placenta unit development, most of all due to placentation's evolution. These can be reassumed into miscarriage, chromosomal abnormalities, preterm delivery, multiple pregnancy, IUGR, placenta previa, abruptio placentae, preeclampsia and hypertensive disorders, postpartum hemorrhage.
METHODS
The aim of this article is to evaluate hypothetic mechanism involved in placentation process and in the etiopathology of ART pregnancies disorders, giving an updating overview of different etiopathogenetic pathways and features. On this scenario, we create an updated review about the etiopathogenesis of abnormal placentation in ART pregnancies.
RESULTS
Several features and different etiopathogenetic characteristic might impact differently such as advanced maternal age, poor ovarian reserve, oocyte quality and causes of subfertility themselves, and the ART techniques itself, as hormonal medical treatments and laboratory techniques such as gamete and embryo laboratory culture, cryopreservation versus fresh ET, number of embryos transferred.
CONCLUSION
To further explore the molecular mechanisms behind placentation in ART pregnancies, further studies are necessary to gain a better understanding of the various aspects involved, particularly those which are not fully comprehended. This could prove beneficial to clinicians in both ART care and obstetric care, as it could help to stratify obstetrical risk and decrease complications in women undergoing ART, as well as perinatal disorders in their children. Correct placentation is essential for a successful pregnancy for both mother and baby.
Topics: Pregnancy; Infant, Newborn; Child; Female; Humans; Placentation; Pregnancy Outcome; Reproductive Techniques, Assisted; Premature Birth; Pregnancy, Multiple; Infertility; Retrospective Studies
PubMed: 38219630
DOI: 10.1016/j.jri.2023.104191 -
Medicine Jan 2021Conjoined twins are a rare complication of monochorionic pregnancies and an extremely rare condition in spontaneous triplet pregnancies. We report a case of conjoined... (Review)
Review
RATIONALE
Conjoined twins are a rare complication of monochorionic pregnancies and an extremely rare condition in spontaneous triplet pregnancies. We report a case of conjoined twins in a spontaneous monochorionic triplet pregnancy. The conjoined twins might have suffered from twin anemia-polycythemia sequence, which was reported to be extremely rare.
PATIENT CONCERNS
A 26-year-old woman conceived spontaneously with an obstetric history of invasive mole 4 years ago.
DIAGNOSES
We initially misdiagnosed her as having monochorionic triamniotic triplets at 10 weeks of gestation. However, we confirmed conjoint twins with the monochorionic diamniotic triplet pregnancy at 12 weeks of gestation and classified them as omphalopagus.
INTERVENTIONS
As the woman decided to continue the pregnancy, regular and careful antenatal care was conducted.
OUTCOMES
Unexpectedly, she had a stillbirth 3 weeks later and had to terminate the pregnancy at 15 weeks of gestation. After abortion, the diagnosis of omphalopagus was confirmed in the induced fetuses. Moreover, the skin colors of the conjoined twins were different: one was plethoric, and the other was pale. Additionally, the parents agreed to examine the chromosome of the fetuses, and the results were normal.
CONCLUSION
Dichorionic triplet and monochorionic triplet pregnancies have a poorer prognosis than trichorionic triplet pregnancies. Surgery is the main therapy for conjoined twins; however, most conjoined twins in triplet pregnancies cannot survive, including omphalopagus twins. The conjoined twins may have suffered from twin anemia-polycythemia sequence, which could probably not be diagnosed intrauterine. Transvaginal probe and 3-dimensional ultrasound may be helpful for clarifying the diagnosis in early pregnancy.
Topics: Abortion, Eugenic; Adult; Female; Humans; Pregnancy; Pregnancy, Triplet; Stillbirth; Triplets; Twins, Conjoined; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal
PubMed: 33530268
DOI: 10.1097/MD.0000000000024490