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PloS One 2013Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications.
METHODS AND FINDINGS
Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00-5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42-13.97). For other obstetric complications the evidence was weak and inconsistent.
CONCLUSIONS
The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women.
Topics: Female; HIV Infections; Humans; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious
PubMed: 24124458
DOI: 10.1371/journal.pone.0074848 -
Medicine Nov 2023Subchorionic hemorrhage (SCH) or hematoma is one of the abnormal ultrasonic manifestations. At present, there are few studies on the pathogenesis of SCH, and its...
Subchorionic hemorrhage (SCH) or hematoma is one of the abnormal ultrasonic manifestations. At present, there are few studies on the pathogenesis of SCH, and its underlying mechanism is still unclear. It may be related to abnormal placenta formation and implantation, autoimmune dysfunction, and coagulation dysfunction. As a unique complication of pregnancy, SCH has a controversial effect on pregnancy outcome. The aim of the present study was to explore the possible etiology of SCH, especially its association with autoimmune dysfunctions, as well as the pregnancy outcomes of SCH patients. This retrospective cohort study was conducted at the Third Affiliated Hospital of Zhengzhou University. Patients with a singleton pregnancy of ≤14 weeks gestation from June 2021 to June 2022 were included. Patients with SCH detected by ultrasound were selected as the study group, while patients without SCH during the same period were chosen as the control group. Immunological indicators and pregnancy outcomes were primarily compared between the 2 groups. The decrease in protein S activity and antithrombin-III levels, the increase in homocysteine levels, and the presence of autoantibodies (such as lupus anticoagulant, anticardiolipin antibody, and antinuclear antibody spectrum) were found to be risk factors for SCH. SCH in the first trimester was associated with higher rates of premature rupture of membranes (13.5% vs 3.8%) and miscarriage (14.4% vs 6.4%). However, there were no significant differences in the rates of placental abruption, fetal distress, cesarean section, neonatal birth weight, and gestational age. The incidence of miscarriage was also significantly higher in patients with subchorionic hematoma (SCH) who tested positive for autoantibodies (28.2% vs 7.6%). There were no significant differences in other clinical characteristics and pregnancy outcomes between patients with SCH who had positive autoantibodies and those who did not. The occurrence of SCH may be related to maternal immune abnormalities. SCH may increase the risk of premature rupture of membranes and abortion. However, there is no correlation between the presence or absence of SCH and neonatal outcomes.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Pregnancy Outcome; Abortion, Spontaneous; Pregnant Women; Retrospective Studies; Cesarean Section; Placenta; Pregnancy Complications; Hematoma; Premature Birth; Risk Factors; Autoantibodies
PubMed: 38013360
DOI: 10.1097/MD.0000000000035874 -
Systematic Reviews Apr 2017Women in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman's...
BACKGROUND
Women in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman's pregnancies. Inter-pregnancy intervals <12 months are associated with risk for adverse pregnancy outcome, yet increased maternal age at delivery is linked with increased risk. The optimal inter-pregnancy interval for older mothers is uncertain. This systematic review will aim to assess the relation between inter-pregnancy interval and perinatal and maternal health outcomes in women who delay childbearing to age 30 and older.
METHODS
We will search MEDLINE, CINAHL, and EMBASE databases for peer-reviewed articles on the effects of inter-pregnancy interval on perinatal and maternal health outcomes among women over 29 years at the time of first birth, in high-income countries. To assess the quality of studies, the Cochrane's Collaboration tool for assessing risk of bias will be used for randomized controlled trials, and the Newcastle-Ottawa tool to assess quality of case control and cross-sectional studies. The quality of the findings on each outcome will be assessed across studies, using the GRADE approach. The decision to conduct meta-analyses will be based on the concordance in definitions used for inter-pregnancy intervals, age groups studied, or outcomes measured among selected studies. We will report odds ratios and/or relative risks and/or risk differences for different inter-pregnancy intervals and perinatal and maternal outcomes as well as pregnancy complications.
DISCUSSION
This systematic review will summarize existing data on the relation between inter-pregnancy interval and perinatal and maternal health outcomes among women who delay childbearing to age 30 and older. Findings will inform clinical best practices to assist mothers over age 30 to space their pregnancies appropriately.
SYSTEMATIC REVIEW REGISTRATION
Prospero CRD42015019057.
Topics: Adult; Birth Intervals; Female; Humans; Maternal Age; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Reproductive Behavior; Research Design; Systematic Reviews as Topic
PubMed: 28390435
DOI: 10.1186/s13643-017-0464-0 -
Ultrasound in Obstetrics & Gynecology :... Jun 2023Data are lacking on the impact on pregnancy outcome of the position of the abnormal fetus in a discordant twin pregnancy undergoing selective termination (ST). Tissue...
OBJECTIVE
Data are lacking on the impact on pregnancy outcome of the position of the abnormal fetus in a discordant twin pregnancy undergoing selective termination (ST). Tissue maceration post ST of the presenting twin may lead to early rupture of membranes, amnionitis and preterm labor. The aim of this study was to evaluate pregnancy complications and outcome following ST of the presenting vs non-presenting twin.
METHODS
This was a multicenter retrospective cohort study of dichorionic diamniotic twin pregnancies that underwent ST due to a discordant fetal anomaly (structural or genetic) between 2007 and 2021. The study population was divided into two groups according to the position of the reduced twin (presenting or non-presenting) and outcomes were studied accordingly. The primary outcome was a composite of early complications following ST, including infection, preterm prelabor rupture of membranes and pregnancy loss.
RESULTS
A total of 190 dichorionic twin pregnancies were included, of which 73 underwent ST of the presenting twin and 117 of the non-presenting twin. The groups did not differ in either baseline demographic characteristics or mean gestational age at the time of the procedure. ST of the presenting twin resulted in a significantly higher rate of early complications compared with the non-presenting twin (19.2% vs 7.7%; P = 0.018). Moreover, the rates of preterm delivery (75.3% vs 37.6%; P < 0.001) and neonatal intensive care unit admission (45.3% vs 17.1%; P < 0.001) were higher, and birth weight was lower (P < 0.001), in those pregnancies in which the presenting twin was reduced.
CONCLUSIONS
ST of the presenting twin resulted in a higher rate of adverse pregnancy outcome compared with that of the non-presenting twin. These findings should be acknowledged during patient counseling and, if legislation permits, taken into consideration when planning ST. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Retrospective Studies; Pregnancy Outcome; Twins; Pregnancy, Twin; Premature Birth; Pregnancy Complications; Gestational Age
PubMed: 37167535
DOI: 10.1002/uog.26170 -
Revista Espanola de Cardiologia 1998Arterial hypertension is a relatively common complication of pregnancy, affecting about 10% of all normal pregnancies. The American College of Obstetric and Gynecology... (Review)
Review
Arterial hypertension is a relatively common complication of pregnancy, affecting about 10% of all normal pregnancies. The American College of Obstetric and Gynecology established in 1972 four different forms of arterial hypertension during pregnancy: a) arterial hypertension related to pregnancy, the so-called pre-eclampsia; b) arterial hypertension unrelated to pregnancy or chronic arterial hypertension; c) Pre-eclampsia superimposed on chronic arterial hypertension, and d) Transient or late arterial hypertension (third trimester). Pre-eclampsia and arterial hypertension are two different illnesses with different approaches and treatments. The mechanisms involved in arterial hypertension and pre-eclampsia of pregnant women are presently very well known, including genetic causes, alterations on the renin-angiotensin system, imbalance between vasoconstrictor and vasodilator agents derived from endothelial activity of the spiral arteries of the placenta, such as; prostacyclins, thromboxane A2, nitric oxide, endothelin-1, etc. The placenta is the key factor in inducing pre-eclampsia, and its expulsion during delivery or cesarean section is the definite cure of the process. All hypertensive forms during pregnancy increase the risks on both the mother and the fetus. Maternal risk is based on renal, metabolic and haematologic disorders, leading in some cases to cerebral haemorrhage or hepatic rupture. In the fetus, pre-eclampsia significantly increases the risk of still-birth, abruptio placentae, hypocalvaria, intrauterine growth retardation, and prematurity. Clinical, biochemical and haematologic manifestations of pre-eclampsia are very typical, facilitating an early and easy diagnosis.
Topics: Circadian Rhythm; Female; HELLP Syndrome; Humans; Hypertension; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular
PubMed: 9883069
DOI: No ID Found -
Cell Stress & Chaperones May 2010Heat shock proteins (Hsps) are ubiquitous and phylogenetically conserved molecules. They are usually considered to be intracellular proteins with molecular chaperone and... (Review)
Review
Heat shock proteins (Hsps) are ubiquitous and phylogenetically conserved molecules. They are usually considered to be intracellular proteins with molecular chaperone and cytoprotective functions. However, Hsp70 (HSPA1A) is present in the peripheral circulation of healthy nonpregnant and pregnant individuals. In normal pregnancy, circulating Hsp70 levels are decreased, and show a positive correlation with gestational age and an inverse correlation with maternal age. The capacity of extracellular Hsp70 to elicit innate and adaptive proinflammatory (Th1-type) immune responses might be harmful in pregnancy and may lead to the maternal immune rejection of the fetus. Decreased circulating Hsp70 level, consequently, may promote the maintenance of immunological tolerance to the fetus. Indeed, elevated circulating Hsp70 concentrations are associated with an increased risk of several pregnancy complications. Elevated Hsp70 levels in healthy pregnant women at term might also have an effect on the onset of labor. In preeclampsia, serum Hsp70 levels are increased, and reflect systemic inflammation, oxidative stress and hepatocellular injury. Furthermore, serum Hsp70 levels are significantly higher in patients with the syndrome of hemolysis, elevated liver enzymes, and low platelet count (HELLP syndrome) than in severely preeclamptic patients without HELLP syndrome. In HELLP syndrome, elevated serum Hsp70 level indicates tissue damage (hemolysis and hepatocellular injury) and disease severity. Increased circulating Hsp70 level may not only be a marker of these conditions, but might also play a role in their pathogenesis. Extracellular Hsp70 derived from stressed and damaged, necrotic cells can elicit a proinflammatory (Th1) immune response, which might be involved in the development of the maternal systemic inflammatory response and resultant endothelial damage in preeclampsia and HELLP syndrome. Circulating Hsp70 level is also elevated in preterm delivery high-risk patients, particularly in treatment-resistant cases, and may be a useful marker for evaluating the curative effects of treatment for preterm delivery. In addition, increased circulating Hsp70 levels observed in asthmatic pregnant patients might play a connecting role in the pathomechanism of asthmatic inflammation and obstetrical/perinatal complications. Nevertheless, a prospective study should be undertaken to determine whether elevated serum Hsp70 level precedes the development of any pregnancy complication, and thus can help to predict adverse maternal or perinatal pregnancy outcome. Moreover, the role of circulating Hsp70 in normal and pathological pregnancies is not fully known, and further studies are warranted to address this important issue.
Topics: Female; HELLP Syndrome; HSP70 Heat-Shock Proteins; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Premature Birth
PubMed: 19821156
DOI: 10.1007/s12192-009-0146-5 -
BJOG : An International Journal of... May 2021To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV). (Observational Study)
Observational Study
OBJECTIVE
To evaluate pregnancy and neonatal outcomes, disease severity, and mother-to-child transmission of pregnant women with Chikungunya infection (CHIKV).
DESIGN
Retrospective observational study.
SETTING
Grenada.
POPULATION
Women who gave birth during a Chikungunya outbreak between January 2014 and September 2015 were eligible.
METHODS
This descriptive study investigated 731 mother-infant pairs who gave birth during a CHIKV outbreak. Women and infants underwent serological testing for CHIKV by ELISA.
MAIN OUTCOME MEASURES
Primary outcomes: composite pregnancy complication (abruption, vaginal bleeding, preterm labour/cervical incompetence, cesarean delivery for fetal distress/abruption/placental abnormality or delivery for fetal distress) and composite neonatal morbidity.
RESULTS
Of 416 mother-infant pairs, 150 (36%) had CHIKV during pregnancy, 135 (33%) had never had CHIKV, and 131 (31%) had CHIKV outside of pregnancy. Mean duration of joint pain was shorter among women infected during pregnancy (μ = 898 days, σ = 277 days) compared with infections outside of pregnancy (μ = 1064 days, σ = 244 days) (P < 0.0001). Rates of pregnancy complications (RR = 0.76, P = 0.599), intrapartum complications (RR = 1.50, P = 0.633), and neonatal outcomes were otherwise similar. Possible mother-to-child transmission occurred in two (1.3%) mother-infant pairs and two of eight intrapartum infections (25%).
CONCLUSION
CHIKV infection during pregnancy may be protective against long-term joint pain sequelae that are often associated with acute CHIKV infection. Infection during pregnancy did not appear to pose a risk for pregnancy complications or neonatal health, but maternal infection just prior to delivery might have increased risk of mother-to-child transmission of CHIKV.
TWEETABLE ABSTRACT
Chikungunya infection did not increase risk of pregnancy complications or adverse neonatal outcomes, unless infection was just prior to delivery.
Topics: Adult; Chikungunya Fever; Chikungunya virus; Delivery, Obstetric; Disease Outbreaks; Female; Fetal Distress; Grenada; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Serologic Tests; Severity of Illness Index
PubMed: 33040457
DOI: 10.1111/1471-0528.16562 -
Annals of African Medicine 2020Birth preparedness and complication readiness (BPCR) have been shown to increase knowledge of danger signs and enhance access to skilled obstetric care. Previous studies...
CONTEXT
Birth preparedness and complication readiness (BPCR) have been shown to increase knowledge of danger signs and enhance access to skilled obstetric care. Previous studies have focused on intermediate outcomes of BPCR such as utilization of skilled care for pregnancy and delivery.
AIMS
This study aims to determine the maternal and perinatal outcomes associated with birth preparedness and complication readiness.
SETTINGS AND DESIGN
A cross-sectional study involving 827 recently delivered women, attending selected health facilities in Ikenne, southwestern Nigeria.
MATERIALS AND METHODS
BPCR was determined from a set of eight indicators that were developed by the John Hopkin's Bloomberg School of Public Health.
STATISTICAL ANALYSIS
The data were analyzed using SPSS version 21. Bivariate analysis was done using Chi-square test, and binary logistic regression model was used to assess factors related to BPCR practice among respondents. The level of statistical significance was set to P < 0.05.
RESULTS
BPCR was observed in 470/827 (56.8%) of the participants. Only a minority had knowledge of financial - 125/827 (15.1%) and transportation assistance - 56/827 (6.8%). Knowledge of ≥ 5 danger signs of pregnancy was also low, 286/827 (34.6%). Institutional delivery was in only 331/827 (40%), and it depended on being birth prepared and complication ready (adjusted odds ratio [AOR] =0.534, 95% confidence interval [CI] =0.319-0.893). Significantly more perinatal deaths occurred to women who were not birth prepared (AOR = 2.951, 95% CI = 1.436-6.062), although no difference existed for perinatal (AOR = 1.202, 95% CI = 0.653-2.214) and maternal (AOR = 0.744, 95% CI = 0.452-1.226) morbidities.
CONCLUSION
The knowledge and practice of key indicators of BPCR that reflect utilization of community resources in Ikenne Local Government Area is very poor. BPCR was an important determinant of perinatal survival.
Topics: Adolescent; Adult; Cross-Sectional Studies; Delivery, Obstetric; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnant Women; Prenatal Care; Young Adult
PubMed: 32174617
DOI: 10.4103/aam.aam_29_19 -
Vojnosanitetski Pregled Aug 2010Thyroid disorders exert a great impact on pregnancy course and outcome. The aim of the study was to investigate impact of autoimmune thyroid disorders on pregnancy...
BACKGROUND/AIM
Thyroid disorders exert a great impact on pregnancy course and outcome. The aim of the study was to investigate impact of autoimmune thyroid disorders on pregnancy course and outcome, frequency of pregnancy complications and pregnancy loss.
METHODS
We followed 63 pregnancies prospectively during the period 1985-2007, 28 with hyperthyroid and 15 with hypothyroid autoimmune disorders, and 20 healthy pregnancies. Follow up included clinical, sonographic and laboratory investigations, including OGTT and postprandial glicemia.
RESULTS
There was no difference between previous preterm and term labor in the observed groups (chi2 = 2.309; p > 0.05). Analysis of previous early pregnancy loss showed no significance (chi2 = 4.918; p > 0.05), including varieties of spontaneous and missed abortion (Fisher, p < 0.05). The hypothyroid patients developed gestational diabetes more frequently than the controls (chi2 = 7.638; p = 0.022), which is not the case with hyperthyroid patients (chi2 = 1.078; p > 0.05), or between the groups with thyroid disorders (chi2 = 3.619; p > 0.05). There was no difference among the groups in developing pregnancy-induced hypertension (chi2 = 1.953; p > 0.05).
CONCLUSIONS
Controlling thyroid diseases reduces pregnancy complications. Development of gestational diabetes in hypothyroid patients requires controlling glycoregulation in all pregnant women with hypothyroidism.
Topics: Abortion, Spontaneous; Adult; Autoimmune Diseases; Diabetes, Gestational; Female; Humans; Hyperthyroidism; Hypothyroidism; Pregnancy; Pregnancy Complications; Premature Birth; Thyroid Diseases
PubMed: 20845662
DOI: 10.2298/vsp1008617g -
Obstetrics and Gynecology Jan 2020To evaluate disease presentation, diagnosis, treatment, and clinical outcomes in pregnancy-associated atypical hemolytic uremic syndrome (aHUS).
OBJECTIVE
To evaluate disease presentation, diagnosis, treatment, and clinical outcomes in pregnancy-associated atypical hemolytic uremic syndrome (aHUS).
DATA SOURCES
We searched PubMed, MEDLINE, Cochrane Library, ClinicalTrials.gov, Web of Science, EMBASE and Google Scholar, from inception until March 2018.
METHODS OF STUDY SELECTION
We included English-language articles describing aHUS in pregnancy or postpartum. The diagnosis of aHUS was characterized by hemolysis, thrombocytopenia, and renal failure and was distinguished from typical diarrhea-associated hemolytic uremic syndrome. Patients were excluded if individual data could not be obtained, the diagnosis was unclear, or an alternative etiology was more likely, such as thrombotic thrombocytopenic purpura or Shiga toxin-producing Escherichia coli. Reports were appraised by two reviewers, with disagreements adjudicated by a third reviewer.
TABULATION, INTEGRATION, AND RESULTS
The search identified 796 articles. After review of titles, abstracts, and full text, we identified 48 reports describing 60 unique cases of pregnancy-associated aHUS, with 66 pregnancies. Twelve cases involved pregnancy in women with known aHUS, and 54 cases involved first-episode pregnancy-associated aHUS. Women with known aHUS, particularly those with baseline creatinine at or above 1.5 mg/dL, had a high rate of adverse pregnancy outcomes. For first-episode pregnancy-associated aHUS, diagnosis most often occurred postpartum (94%), after a cesarean delivery (70%), in nulliparous women (58%). Preceding obstetric complications were common and included fetal death, preeclampsia, and hemorrhage. Diagnosis was usually made clinically, based on the triad of microangiopathic hemolysis, thrombocytopenia, and renal failure. Additional testing included renal biopsy, complement genetic testing, and ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) testing. Treatment modalities included corticosteroids, plasma exchange, dialysis, and eculizumab. More women with first-episode pregnancy-associated aHUS achieved disease remission when treated with eculizumab, compared with those not treated with eculizumab (88% vs 57%, P=.02).
CONCLUSION
Pregnancy-associated aHUS usually presents in the postpartum period, often after a pregnancy complication, and eculizumab is effective for achieving disease remission.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42019129266.
Topics: Antibodies, Monoclonal, Humanized; Atypical Hemolytic Uremic Syndrome; Complement Inactivating Agents; Female; Humans; Plasma Exchange; Postpartum Period; Pregnancy; Pregnancy Complications, Hematologic; Renal Dialysis
PubMed: 31809447
DOI: 10.1097/AOG.0000000000003554