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International Journal of Medical... 2013To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.
PURPOSE
To evaluate whether type and location of placenta previa affect risk of antepartum hemorrhage-related preterm delivery.
METHODS
We retrospectively studied 162 women with singleton pregnancies presenting placenta previa. Through observation using transvaginal ultrasound the women were categorized into complete or incomplete placenta previa, and then assigned to anterior and posterior groups. Complete placenta previa was defined as a placenta that completely covered the internal cervical os, with the placental margin >2 cm from the os. Incomplete placenta previa comprised marginal placenta previa whose margin adjacent to the internal os and partial placenta previa which covered the os but the margin situated within 2 cm of the os. Maternal characteristics and perinatal outcomes in complete and incomplete placenta previa were compared, and the differences between the anterior and the posterior groups were evaluated.
RESULTS
Antepartum hemorrhage was more prevalent in women with complete placenta previa than in those with incomplete placenta previa (59.1% versus 17.6%), resulting in the higher incidence of preterm delivery in women with complete than in those with incomplete placenta previa [45.1% versus 8.8%; odds ratio (OR) 8.51; 95% confidence interval (CI) 3.59-20.18; p < 0.001]. In complete placenta previa, incidence of antepartum hemorrhage did not significantly differ between the anterior and the posterior groups. However, gestational age at bleeding onset was lower in the anterior group than in the posterior group, and the incidence of preterm delivery was higher in the anterior group than in the posterior group (76.2% versus 32.0%; OR 6.8; 95% CI 2.12-21.84; p = 0.002). In incomplete placenta previa, gestational age at delivery did not significantly differ between the anterior and posterior groups.
CONCLUSION
Obstetricians should be aware of the increased risk of preterm delivery related to antepartum hemorrhage in women with complete placenta previa, particularly when the placenta is located on the anterior wall.
Topics: Adult; Cardiotocography; Cesarean Section; Female; Gestational Age; Humans; Infant, Newborn; Placenta; Placenta Previa; Pregnancy; Pregnancy Complications; Premature Birth; Risk Factors; Ultrasonography, Prenatal; Uterine Hemorrhage
PubMed: 24151440
DOI: 10.7150/ijms.6416 -
BMC Pregnancy and Childbirth Mar 2017Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates...
BACKGROUND
Despite impressive improvements in maternal survival throughout the world, rates of antepartum complications remain high. These conditions also contribute to high rates of perinatal deaths, which include stillbirths and early neonatal deaths, but the extent is not well studied. This study examines patterns of antepartum complications and the risk of perinatal deaths associated with such complications in rural Bangladesh.
METHODS
We used data on self-reported antepartum complications during the last pregnancy and corresponding pregnancy outcomes from a household survey (N = 6,285 women) conducted in Sylhet district, Bangladesh in 2006. We created three binary outcome variables (stillbirths, early neonatal deaths, and perinatal deaths) and three binary exposure variables indicating antepartum complications, which were antepartum hemorrhage (APH), probable infection (PI), and probable pregnancy-induced hypertension (PIH). We then examined patterns of antepartum complications and calculated incidence rate ratios (IRR) to estimate the associated risks of perinatal mortality using Poisson regression analyses. We calculated population attributable fraction (PAF) for the three antepartum complications to estimate potential risk reductions of perinatal mortality associated them.
RESULTS
We identified 356 perinatal deaths (195 stillbirths and 161 early neonatal deaths). The highest risk of perinatal death was associated with APH (IRR = 3.5, 95% CI: 2.4-4.9 for perinatal deaths; IRR = 3.7, 95% CI 2.3-5.9 for stillbirths; IRR = 3.5, 95% CI 2.0-6.1 for early neonatal deaths). Pregnancy-induced hypertension was a significant risk factor for stillbirths (IRR = 1.8, 95% CI 1.3-2.5), while PI was a significant risk factor for early neonatal deaths (IRR = 1.5, 95% CI 1.1-2.2). Population attributable fraction of APH and PIH were 6.8% and 10.4% for perinatal mortality and 7.5% and 14.7% for stillbirths respectively. Population attributable fraction of early neonatal mortality due to APH was 6.2% and for PI was 7.8%.
CONCLUSIONS
Identifying antepartum complications and ensuring access to adequate care for those complications are one of the key strategies in reducing perinatal mortality in settings where most deliveries occur at home.
Topics: Adult; Bangladesh; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Obstetric Labor Complications; Perinatal Mortality; Postpartum Hemorrhage; Pregnancy; Rural Population; Stillbirth; Young Adult
PubMed: 28270117
DOI: 10.1186/s12884-017-1264-1 -
Acta Obstetricia Et Gynecologica... Jan 2015To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for... (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate the occurrence of severe obstetric complications associated with antepartum and intrapartum hemorrhage among women from the Brazilian Network for Surveillance of Severe Maternal Morbidity.
DESIGN
Multicenter cross-sectional study.
SETTING
Twenty-seven obstetric referral units in Brazil between July 2009 and June 2010.
POPULATION
A total of 9555 women categorized as having obstetric complications.
METHODS
The occurrence of potentially life-threatening conditions, maternal near miss and maternal deaths associated with antepartum and intrapartum hemorrhage was evaluated. Sociodemographic and obstetric characteristics and the use of criteria for management of severe bleeding were also assessed in these women.
MAIN OUTCOME MEASURES
The prevalence ratios with their respective 95% confidence intervals adjusted for the cluster effect of the design, and multiple logistic regression analysis were performed to identify factors independently associated with the occurrence of severe maternal outcome.
RESULTS
Antepartum and intrapartum hemorrhage occurred in only 8% (767) of women experiencing any type of obstetric complication. However, it was responsible for 18.2% (140) of maternal near miss and 10% (14) of maternal death cases. On multivariate analysis, maternal age and previous cesarean section were shown to be independently associated with an increased risk of severe maternal outcome (near miss or death).
CONCLUSION
Severe maternal outcome due to antepartum and intrapartum hemorrhage was highly prevalent among Brazilian women. Certain risk factors, maternal age and previous cesarean delivery in particular, were associated with the occurrence of bleeding.
Topics: Adolescent; Adult; Brazil; Cause of Death; Confidence Intervals; Cost of Illness; Cross-Sectional Studies; Delivery, Obstetric; Female; Hospitals, Maternity; Humans; Logistic Models; Maternal Mortality; Middle Aged; Multivariate Analysis; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Prenatal Care; Risk Assessment; Severity of Illness Index; Socioeconomic Factors; Uterine Hemorrhage; Young Adult
PubMed: 25327163
DOI: 10.1111/aogs.12529 -
Iranian Journal of Public Health Apr 2017We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia,... (Review)
Review
BACKGROUND
We aimed to explore whether maternal asymptomatic hepatitis B (HB) infection effects on pre-term rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension, or antepartum hemorrhage.
METHODS
We searched the PubMed, Scopus, and ISI web of science from 1990 to Feb 2015. In addition, electronic literature searches supplemented by searching the gray literature (e.g., conference abstracts thesis and the result of technical reports) and scanning the reference lists of included studies and relevant systematic reviews. We explored statistical heterogeneity using the, I2 and tau-squared (Tau2) statistical tests.
RESULTS
Eighteen studies were included. Preterm rupture of membranous (PROM), stillbirth, preeclampsia, eclampsia, gestational hypertension and antepartum hemorrhage were considerable outcomes in this survey. The results showed no significant association between inactive HB and these complications in pregnancy. The small amounts of -value and chi-square and large amount of I2 suggested the probable heterogeneity in this part, which we tried to modify with statistical methods such as subgroup analysis.
CONCLUSION
Inactive HB infection did not increase the risk of adversely mentioned outcomes in this study. Further, well-designed studies should be performed to confirm the results.
PubMed: 28540262
DOI: No ID Found -
BMC Pregnancy and Childbirth Oct 2016Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy.
METHODS
An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared.
RESULTS
The search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities.
DISCUSSION
Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis.
CONCLUSIONS
It is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction.
Topics: Bipolar Disorder; Case-Control Studies; Delivery, Obstetric; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Infant, Small for Gestational Age; Parturition; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 27793111
DOI: 10.1186/s12884-016-1127-1 -
Acta Obstetricia Et Gynecologica... Feb 2016Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC...
Worldwide, 98% of stillbirths occur in low-income countries (LIC), where stillbirth rates are ten-fold higher than in high-income countries (HIC). Although most HIC stillbirths occur prenatally, in LIC most stillbirths occur at term and during labor/delivery. Conditions causing stillbirths include those of maternal origin (obstructed labor, trauma, antepartum hemorrhage, preeclampsia/eclampsia, infection, diabetes, other maternal diseases), and fetal origin (fetal growth restriction, fetal distress, cord prolapse, multiples, malpresentations, congenital anomalies). In LIC, aside from infectious origins, most stillbirths are caused by fetal asphyxia. Stillbirth prevention requires recognition of maternal conditions, and care in a facility where fetal monitoring and expeditious delivery are possible, usually by cesarean section (CS). Of major causes, only syphilis and malaria can be managed prenatally. Targeting single conditions or interventions is unlikely to substantially reduce stillbirth. To reduce stillbirth rates, LIC must implement effective modern antepartum and intrapartum care, including fetal monitoring and CS.
Topics: Delivery, Obstetric; Female; Fetal Death; Fetal Diseases; Humans; Maternal Mortality; Midwifery; Poverty; Pregnancy; Pregnancy Complications; Prenatal Care; Resuscitation; Risk Factors; Stillbirth
PubMed: 26577070
DOI: 10.1111/aogs.12817 -
BMC Women's Health Sep 2021Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The...
BACKGROUND
Abortion and stillbirths are the common obstetrics condition in Ethiopia and their effect on the next pregnancy was not well identified in resource limited settings. The aim of the study was to assess the effect of stillbirth and abortion on the next pregnancy.
METHODS
A prospective cohort study design was implemented. The study was conducted in Mecha demographic surveillance and field research center catchment areas. The data were collected from January 2015 to March 2019. Epi-info software was used to calculate the sample size. The systematic random sampling technique was used to select stillbirth and abortion women. Poison regression was used to identify the predictors of MCH service utilization; descriptive statistics were used to identify the prevalence of blood borne pathogens. The Kaplan Meier survival curve was used to estimate survival to pregnancy and pregnancy related medical disorders.
RESULTS
1091 stillbirth and 3,026 abortion women were followed. Hepatitis B was present in 6% of abortion and 3.2% of stillbirth women. Hepatitis C was diagnosed in 4.7% of abortion and 0.3% of stillbirth women. HIV was detected in 3% of abortion and 0.8% of stillbirth women. MCH service utilization was determined by knowledge of contraceptives [IRR 1.29, 95% CI 1.18-1.42], tertiary education [IRR 4.29, 95% CI 3.72-4.96], secondary education. [IRR 3.14, 95% CI 2.73-3.61], married women [IRR 2.08, 95% CI 1.84-2.34], family size [IRR 0.67, 95% CI 1.001-1.01], the median time of pregnancy after stillbirth and abortion were 12 months. Ante-partum hemorrhage was observed in 23.1% of pregnant mothers with a past history of abortion cases and post-partum hemorrhage was observed in 25.6% of pregnant mothers with a past history of abortion. PREGNANCY INDUCED DIABETES MELLITUS was observed 14.3% of pregnant mothers with a past history of stillbirth and pregnancy-induced hypertension were observed in 9.2% of mothers with a past history of stillbirth.
CONCLUSION
Obstetric hemorrhage was the common complications of abortion women while Pregnancy-induced diabetic Mellitus and pregnancy-induced hypertension were the most common complications of stillbirth for the next pregnancy.
Topics: Abortion, Induced; Abortion, Spontaneous; Female; Humans; Longitudinal Studies; Pregnancy; Prospective Studies; Stillbirth
PubMed: 34563190
DOI: 10.1186/s12905-021-01485-0 -
PLoS Medicine Feb 2023Existing data on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during late pregnancy is well established, providing assurance. However, the use of NSAIDs...
BACKGROUND
Existing data on the use of nonsteroidal anti-inflammatory drugs (NSAIDs) during late pregnancy is well established, providing assurance. However, the use of NSAIDs during early pregnancy remains inconclusive owing to conflicting findings on adverse neonatal outcomes as well as the limited data on adverse maternal outcomes. Therefore, we sought to investigate whether early prenatal exposure to NSAIDs was associated with neonatal and maternal adverse outcomes.
METHODS AND FINDINGS
We conducted a nationwide, population-based cohort study using Korea's National Health Insurance Service (NHIS) database with a mother-offspring cohort constructed and validated by the NHIS to include all live births in women aged 18 to 44 years between 2010 and 2018. We defined exposure to NSAIDs as at least two records of NSAID prescriptions during early pregnancy (first 90 days of pregnancy for congenital malformations and first 19 weeks for nonmalformation outcomes) and compared against three distinct referent groups of (1) unexposed, no NSAID prescription during the 3 months before pregnancy start to end of early pregnancy; (2) acetaminophen-exposed, at least two acetaminophen prescriptions during early pregnancy (i.e., active comparator); and (3) past users, at least two NSAID prescriptions before the start of pregnancy but no relevant prescriptions during pregnancy. Outcomes of interest were adverse birth outcomes of major congenital malformations and low birth weight and adverse maternal outcomes of antepartum hemorrhage and oligohydramnios. We estimated relative risks (RRs) with 95% CIs using generalized linear models within a propensity score (PS) fine stratification weighted cohort that accounted for various potential confounders of maternal sociodemographic characteristics, comorbidities, co-medication use, and general markers of burden of illness. Of 1.8 million pregnancies in the PS weighted analyses, exposure to NSAIDs during early pregnancy was associated with slightly increased risks for neonatal outcomes of major congenital malformations (PS-adjusted RR, 1.14 [CI, 1.10 to 1.18]) and low birth weight (1.29 [1.25 to 1.33]), and for maternal outcome of oligohydramnios (1.09 [1.01 to 1.19]) but not antepartum hemorrhage (1.05 [0.99 to 1.12]). The risks of overall congenital malformations, low birth weight, and oligohydramnios remained significantly elevated despite comparing NSAIDs against acetaminophen or past users. Risks of adverse neonatal and maternal outcomes were higher with cyclooxygenase-2 selective inhibitors or use of NSAIDs for more than 10 days, whereas generally similar effects were observed across the three most frequently used individual NSAIDs. Point estimates were largely consistent across all sensitivity analyses, including the sibling-matched analysis. Main limitations of this study are residual confounding by indication and from unmeasured factors.
CONCLUSIONS
This large-scale, nationwide cohort study found that exposure to NSAIDs during early pregnancy was associated with slightly higher risks of neonatal and maternal adverse outcomes. Clinicians should therefore carefully weigh the benefits of prescribing NSAIDs in early pregnancy against its modest, but possible, risk of neonatal and maternal outcomes, where if possible, consider prescribing nonselective NSAIDs for <10 days, along with continued careful monitoring for any safety signals.
Topics: Infant, Newborn; Female; Humans; Pregnancy; Acetaminophen; Cohort Studies; Oligohydramnios; Anti-Inflammatory Agents, Non-Steroidal; Republic of Korea; Live Birth; Obstetric Labor Complications; Hemorrhage
PubMed: 36848338
DOI: 10.1371/journal.pmed.1004183 -
Frontiers in Medicine 2023Primary postpartum hemorrhage is still the main cause of maternal death worldwide, especially in low-resource nations like Ethiopia where there are insufficient...
INTRODUCTION
Primary postpartum hemorrhage is still the main cause of maternal death worldwide, especially in low-resource nations like Ethiopia where there are insufficient healthcare facilities and a shortage of skilled medical personnel. Data on the prevalence of primary postpartum hemorrhage in the study population are scarce or non-existent.
OBJECTIVE
The aim of this study was to assess the prevalence of primary postpartum hemorrhage and its associated factors among delivering women in Gedeo Zone, Southern Ethiopia, in 2021.
METHODS
A facility-based cross-sectional study was carried out from January 1 to March 30, 2021, in public health facilities in the Gedeo Zone. A randomly selected 577 participants were involved in the study. Data were gathered using an interview-administered, pre-tested, structured questionnaire. The gathered information was imported into Epi Info 3.5.1 and analyzed with SPSS 23. Descriptive data was presented using tables and graphs. A logistic regression model was fitted. A bivariable and multivariable logistic regression model was computed to identify the presence and strength of association. To run multivariable logistic regression analyses, variables with -values of <0.2 were used. The odds ratio, a 95% confidence interval (CI), and a -value of <0.05 were used to identify variables that were associated with primary postpartum hemorrhage.
RESULTS
The magnitude of primary postpartum hemorrhage was 4.2% (95% CI: 2.4-6.0). Postpartum hemorrhage was significantly associated with current antepartum hemorrhage (AOR = 11.67; 95%CI: 7.17-16.17), twin delivery (AOR = 6.59, 95%CI: 1.48-11.70), uterine atony (AOR = 8.45, 95%CI: 4.35-12.55), and prolonged labor (AOR = 5.6, 95%CI: 2.9-8.50).
CONCLUSIONS
The prevalence of primary postpartum hemorrhages in the Gedeo Zone, Southern Ethiopia was 4.2%. Current ante partum hemorrhage, twin delivery, uterine atony, and prolonged labor were predictors of primary postpartum hemorrhage. The results back up the necessity for care in the early postpartum period so that clinicians may quickly identify any issues, prevent and start treating excessive blood loss early, and, taking into account the aforementioned factors, possibly reduce the frequency of primary postpartum hemorrhage.
PubMed: 36865062
DOI: 10.3389/fmed.2023.1096501 -
Journal of Affective Disorders Feb 2020Recent analyses have described metabolomic markers for depression and suicidal ideation in non-pregnant adults. We examined the metabolomic profile of antepartum...
BACKGROUND
Recent analyses have described metabolomic markers for depression and suicidal ideation in non-pregnant adults. We examined the metabolomic profile of antepartum depression and suicidal ideation during mid-pregnancy, a time of high susceptibility to mood disorders.
METHODS
We collected fasting blood from 100 pregnant Peruvian women and profiled 307 plasma metabolites using liquid chromatography-mass spectrometry. We used the Patient Health Questionnaire 9 to define antepartum depression (score ≥ 10) and suicidal ideation (having thoughts that you would be better off dead, or of hurting yourself). Logistic regression was used to calculate odds ratios (ORs).
RESULTS
Three triacylglycerol metabolites (C48:5 triacylglycerol [OR = =1.89; 95% confidence interval (CI): 1.14-3.14], C50:6 triacylglycerol [OR = =1.88; 95%CI: 1.13-3.14], C46:4 triacylglycerol [OR = =1.89; 95%CI: 1.11-3.21]) were associated with higher odds of antepartum depression and 4 metabolites (betaine [OR = =0.56; 95%CI:0.33-0.95], citrulline [OR = =0.58; 95%CI: 0.34-0.98], C5 carnitine [OR = =0.59; 95%CI: 0.36-0.99], C5:1 carnitine [OR = =0.59; 95%CI: 0.35-1.00]) with lower odds of antepartum depression. Twenty-six metabolites, including 5-hydroxytryptophan (OR = =0.52; 95%CI: 0.30-0.92), phenylalanine (OR = =0.41; 95%CI: 0.19-0.91), and betaine (OR = =0.53; 95%CI: 0.28-0.99) were associated with lower odds of suicidal ideation.
LIMITATIONS
Our cross-sectional study could not determine whether metabolites prospectively predict outcomes. No metabolites remained significant after multiple testing correction; these novel findings should be replicated in a larger sample.
CONCLUSIONS
Antepartum suicidal ideation metabolomic markers are similar to markers of depression among non-pregnant adults, and distinct from markers of antepartum depression. Findings suggest that mood disorder in pregnancy shares metabolomic similarities to mood disorder at other times and may further understanding of these conditions' pathophysiology.
Topics: 5-Hydroxytryptophan; Adult; Betaine; Biomarkers; Carnitine; Citrulline; Cross-Sectional Studies; Depression; Female; Humans; Logistic Models; Metabolomics; Odds Ratio; Patient Health Questionnaire; Peru; Phenylalanine; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Second; Pregnant Women; Prospective Studies; Risk Factors; Suicidal Ideation; Triglycerides; Young Adult
PubMed: 31744743
DOI: 10.1016/j.jad.2019.11.061