High risk pregnancy Research Papers (original) (raw)

2025

Objective: We aimed to evaluate myocardial performance in fetuses with increased nuchal translucency. Method: Cases with increased NT without any associated structural anomalies were enrolled in this study. The study group consisted of 53 pregnancies complicated with thickened NT > 3.5 mm. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled in the study as the control group. The TEI index was evaluated before performing CVS in the group with an increase in NT. Karyotype analysis was performed via CVS in all patients with increased NT. In both groups, detailed fetal sonographic examinations, including fetal echocardiograms, were performed between 18 and 24 weeks of gestation. Results: The differences between normal and increased NT groups in terms of isovolumetric relaxation time (IRT), ejection time (ET), and myocardial performance index (MPI) variables were found to be statistically significant (p values of 0.023, 0.004, and < 0.001, respectively). For IRT and MPI variables, the median values of the group with an increase in NT were found to be significantly higher than that of the normal NT group, whereas the median value of the ET variable of the group with increased NT was significantly lower than that of the normal NT group Conclusion: The MPI significantly increased in the group with increased NT, but no difference was observed between those with and without Down syndrome. This suggests that increased NT is caused by cardiac dysfunction, whether or not Down syndrome is present.

2025, Ultrasound in Obstetrics & Gynecology

Conclusions: A small transverse diameter of fetal thymus in women with preterm premature rupture of membranes might be a marker of the histological chorioamnionitis.

2025, Mola hidatiforme parcial con feto vivo sano a término

Resumen ANTECEDENTES: El embarazo molar parcial, con feto vivo sano coexistente, es una forma rara de las molas hidatiformes. Debido a los pocos casos reportados se carece de guías que marquen la pauta para la atención médica de estas pacientes. Si bien el riesgo de complicaciones obstétricas en estos casos es alto, un gran porcentaje de las pacientes puede llegar a tener un recién nacido sano. CASO CLÍNICO: Paciente de 29 años, primigesta, con embarazo espontáneo. A las 23.3 semanas se detectó, por ultrasonido, que la placenta tenía múltiples imágenes anecoicas en su interior, un patrón en "racimo de uvas" que sugería un posible embarazo molar. La paciente decidió continuar con el embarazo a pesar de haberle explicado los riesgos obstétricos. Durante el resto del embarazo cursó con hipertensión gestacional y trombocitopenia, quizá gestacional. Se decidió la finalización del embarazo por vía abdominal a las 38 semanas. El reporte histopatológico corroboró el diagnóstico de mola hidatiforme parcial. CONCLUSIÓN: El momento de finalización del embarazo se determina con base en las complicaciones de la madre o el feto. Es importante la adecuada comunicación con la paciente.

2025, BMC pregnancy and childbirth

Stillbirth is a major contributor to perinatal mortality and it is particularly common in low- and middle-income countries, where annually about three million stillbirths occur in the third trimester. This study aims to develop a prediction model for early detection of pregnancies at high risk of stillbirth. This retrospective cohort study examined 6,573 pregnant women who delivered at Federal Medical Centre Bida, a tertiary level of healthcare in Nigeria from January 2010 to December 2013. Descriptive statistics were performed and missing data imputed. Multivariable logistic regression was applied to examine the associations between selected candidate predictors and stillbirth. Discrimination and calibration were used to assess the model's performance. The prediction model was validated internally and over-optimism was corrected. We developed a prediction model for stillbirth that comprised maternal comorbidity, place of residence, maternal occupation, parity, bleeding in pregn...

2025, Ultrasound in Obstetrics & Gynecology

Methods A group of 118 high-risk women with bilateral notching of the uterine arteries underwent an echocardiographic examination to evaluate midwall mechanics (midwall shortening (mFS%) and stress-corrected midwall shortening (SCmFS%)) of the LV at 24 weeks' gestation and 6 months postpartum. Patients were followed until delivery and pregnancies were classified retrospectively as uneventful (uncomplicated outcome) or complicated. A control group of 54 low-risk women with uneventful pregnancies without bilateral notching was also enrolled. The pregnancy was uneventful in 74 (62.7%) women, whereas 44 (37.3%) developed complications. At 24 weeks' gestation, mFS% and SCmFS% were greater in the uncomplicated-outcome compared with the complicated-outcome group (25.9 ± 4.8 vs 18.8 ± 5.0%, P < 0.001 and 107.9 ± 18.4 vs 77.9 ± 20.7%, P < 0.001, respectively). At 6 months postpartum, SCmFS% remained greater in the uncomplicated-outcome compared with the complicated-outcome group (100.4 ± 21.6 vs 87.8 ± 19.1, P < 0.05). In the uncomplicatedoutcome group, SCmFS% was higher during pregnancy than it was postpartum, whereas in the complicatedoutcome group, it was lower during pregnancy than it was postpartum (P < 0.05). Conclusions Maternal cardiac midwall mechanics appear to be enhanced (SCmFS% increased compared with controls) during pregnancy compared with postpartum in high-risk patients with uncomplicated pregnancy, whereas midwall mechanics are depressed both during pregnancy and postpartum in patients with pregnancy complications.

2025, Acta obstetricia et gynecologica Scandinavica

To analyze mode of delivery and neonatal morbidity according to chorionicity in a hospital birth center with a policy of vaginal delivery for twins. Retrospective analysis over a 13-year period. Department of Obstetrics, University Hospital, Lille, France. In all, 1009 twin pregnancies were included, divided into 171 uncomplicated monochorionic pregnancies (17%) and 838 dichorionic pregnancies (83%). We compared the monochorionic and the dichorionic populations. Rate of cesarean section and neonatal outcome (umbilical artery pH, Apgar score and neonatal complications). The rate of cesarean sections was 45.7% with no difference found based on chorionicity. The reasons for elective cesarean section were mainly noncephalic presentation, which was more frequent in dichorionic than in monochorionic (48.8% vs. 37.2%, p = 0.025) pregnancies. Birthweight was lower in monochorionic twins (2249 ± 469 g vs. 2329 ± 478 g, p = 0.045). The rate of umbilical artery cord blood values with a pH <...

2025, Journal of Women's Health & Gender-Based Medicine

We conducted a study to elucidate factors influencing women's decisions regarding prenatal genetic screening for and diagnosis of chromosomal disorders and to learn about their expe- riences with these tests and with the medical system. Using focus group interviews and ques- tionnaire assessments, we obtained detailed impressions of a diverse group of 75 pregnant women. Participants varied with respect to race/ethnicity, religious background, and repro- ductive history, as well as in their decisions about use of prenatal screening and diagnostic testing. Substantial variation surfaced in attitudes toward testing. Factors influencing women's views included available resources, feelings about having a child with Down syn- drome, moral beliefs, family and social influences, perceptions of one's own health, the dif- ficulty of becoming pregnant, and willingness to put the fetus at elevated miscarriage risk. Such findings indicate that age-based policies regarding access to prenatal diagnoses that, among other reasons, are based on the balance of risks between bearing a child with a chro- mosomal abnormality versus procedure-related loss are incompatible with the range of con- cerns that women bring to this decision and the weight individual women may assign to the outcomes.

2025, Ultrasound in Obstetrics & Gynecology

To determine the prevalence of and the association between trisomy 21 and isolated fetal echogenic cardiac foci (FECF) identified in the second trimester in an unselected low-risk population. Methods All cases with isolated FECF were collected by reviewing the antenatal ultrasound database for 3 consecutive years. In order to include all trisomy 21 cases for the same period, the regional cytogenetics database and pediatric databases were examined. A 2 × 2table analysis was performed to establish the sensitivity, specificity and positive and negative predictive values of isolated FECF as a screening test for trisomy 21 in a low-risk unselected population. In the 3-year period of the study the total number of deliveries was 11 105, of which 10 769 (97%) had a routine detailed anomaly scan between 16 and 24 weeks' gestation. There were 311 cases (2.9%) of isolated FECF. Among these there was only one case (0.3%) of trisomy 21. In the same period, the total number of trisomy 21 cases was 14. Accordingly, the sensitivity of isolated FECF for detecting trisomy 21 was 7.1% and the specificity was 97.1%. Positive and negative predictive values of FECF were 0.3% and 99.9%, respectively. In an otherwise healthy pregnancy, the finding of isolated FECF on a routine second-trimester anomaly scan is normal and should not be considered as a risk factor for trisomy 21 in an unselected lowrisk population.

2025, Diabetes Care

OBJECTIVE—There is strong evidence that low birth weight is associated with glucose intolerance and diabetes in adults. We have carried out a twin study to distinguish among maternal influences, which affect both twins; fetoplacental influences, which are unique to each twin; and the genetic factors that may underlie this association. RESEARCH DESIGN AND METHODS—We identified a sample of 423 twin pairs (250 monozygotic and 173 dizygotic) from the East Flanders Prospective Twin Survey who were born between 1964 and 1982. Data collected in this study included the mother’s body composition and weight gain during pregnancy, the twins’ birth weights, and gestational age. The twins (aged 18–34 years) attended a research center for measurement of height, weight, and waist-to-hip ratio as well as fasting glucose, proinsulin, and insulin concentrations. RESULTS—Among twin pairs discordant for birth weight, we found little evidence that the lighter twin had abnormal glucose-insulin metabolism...

2025, Arquivos Brasileiros de Cardiologia

2025, European Heart Journal

To assess the natural history, risk factors for death and deterioration of patients with Eisenmenger Syndrome. The clinical course of 188 patients from three different cardiac centres specialized in adult congenital heart defects, followed for a median period of 31 years, was retrospectively analysed. According to the diagnosis, 64 males and 124 females, mean age at last follow-up 33•02 12•8 years, were divided into two groups: simple (128) and complex (60) congenital heart disease. Events analysed were: time variation of Ability Index, pulmonary and cerebral complications, non-cardiac surgery, urate metabolism and renal function, arrhythmias, pregnancy and contraception, medical therapy and transplantation, death from all causes and sudden death. Eighty-four percent of the overall population showed a satisfactory Ability Index (1 and 2) at the first attendance (median age 25 years). Patients with complex heart disease and Eisenmenger reaction had earlier clinical deterioration (18•6 11•3 vs 26•7 12•2) and shorter survival (25•8 7•9 vs 32•5 14•6 years). Thirty-eight (20•2%) patients had at least one episode of haemoptysis between 20 and 40 years of age but it did not modify overall survival; 25 (13•2%) had pulmonary thromboembolism at a mean age of 35•2 13•4 years. Fifteen (7•9%) had a stroke and 7 (3•7%) a cerebral abscess at a mean age of 31•4 15•7 and 24•1 4•9 years, respectively. Cerebral complications influenced the quality of life but did not modify survival. Patients who had venesection showed a 2•04 times greater hazard ratio for haemoptysis. Venesection did not reduce cerebral complications and in 20% caused anaemia and iron deficiency. Other non-cardiac surgery with general anaesthesia carried risks (23•5% of deaths). Significant maternal mortality (27%) in relation to pregnancy occurred with constant deterioration in physical status, high incidence of spontaneous abortions (35•8%) and cardiac abnormalities in offspring (20%). Sixty-one patients died during follow-up, mainly by sudden death (29•5%), heart failure (22•9%) and from haemoptysis (11•4%). Eight patients had heart and lung transplantation and five died 1 week to 4 years after transplant. Deterioration in Ability Index (worsening symptoms), age, complex defects, blood creatinine level, right ventricular dysfunction and noncardiac surgery were variables which affected the prognosis adversely with uni-and multivariate analysis. Conclusions patients with Eisenmenger syndrome can survive to the seventh decade with informed medical care and protection from special risks

2025

bunuh diri adalah fenomena yang dipengaruhi oleh berbagai faktor dan melibatkan interaksi kompleks antara aspek biologis, psikologis, sosial, serta lingkungan. Terdapat banyak faktor yang dapat memengaruhi tingginya angka kejadian bunuh diri. Adanya faktor yang mempengaruhi tingginya angka kejadian bunuh diri. Maka dari itu, perlu untuk melakukan penelitian guna mengidentifikasi faktor-faktor penyebab terjadinya tindakan ini. Penelitian ini menerapkan metode deskriptif kualitatif dalam pendekatan studi literatur yang bertujuan untuk mendeskripsikan hasil temuan dari sejumlah artikel jurnal yang telah ditinjau. Metode yang diterapkan dalam penelitian ini yaitu analisis literature review. Dari hasil telaah berbagai jurnal, dapat disimpulkan bahwa terdapat empat faktor utama penyebab bunuh diri, yaitu faktor ekonomi, sosial, putus cinta dan akademik. Dapat disimpulkan bahwa dari keempat faktor tersebut yang paling sering terjadi, Dimana masalah ekonomi atau keuangan, lapangan kerja yang semakin sempit, introvert atau sulit beradaptasi, terjebak dalam hubungan yang toxic serta tekanan akademik yang membuat seseorang merasa stress dan pada akhirnya memilih untuk mengakhiri hidupnya

2025

Penelitian ini bertujuan untuk mengkaji pengaruh media sosial terhadap tingkat kecemasan remaja di era digital dengan menggunakan metode literature review. Hasil analisis menunjukkan bahwa kecemasan dapat meningkat akibat penggunaan media sosial yang berlebihan, stres, depresi, perilaku menyakiti diri, serta perasaan isolasi sosial pada remaja. Faktor-faktor seperti paparan konten negatif, cyberbullying, serta Fear of Missing Out (FoMO) memainkan peran penting dalam memperburuk kondisi kesehatan mental remaja. Meski demikian, media sosial juga berpotensi memberikan dampak positif jika digunakan secara bijak, seperti meningkatkan rasa percaya diri dan mempererat hubungan sosial. Penelitian ini menyoroti pentingnya literasi digital dan pendekatan edukatif dalam mengelola penggunaan media sosial untuk menjaga kesehatan mental remaja di era digital.

2025, American Journal of Obstetrics and Gynecology

We sought to examine if 17-alpha-hydroxyprogesterone caproate (17OHPC) effectiveness is dependent on the earliest gestational age (GA) at prior spontaneous preterm birth (SPTB) when administered in the clinical setting. STUDY DESIGN: Women enrolled for outpatient services with current singleton gestation and Ն1 prior SPTB between 20-36.9 weeks were identified. Data were divided into 3 groups according to earliest GA of prior SPTB (20-27.9, 28-33.9, and 34-36.9 weeks). We compared GA at delivery of current pregnancy and incidence of recurrent SPTB between women enrolled in outpatient 17OHPC administration program (n ϭ 2978) and women receiving other outpatient services without 17OHPC (n ϭ 1260). RESULTS: Rates of recurrent SPTB for those with and without 17OHPC prophylaxis, respectively, according to GA at earliest SPTB were: 20-27.9 weeks at earliest SPTB, 32.2% vs 40.7%, P ϭ .025; 28-33.9 weeks at earliest SPTB, 34.1% vs 45.5%, P Ͻ .001; and 34-36.9 weeks at earliest SPTB, 29.3% vs 38.8%, P Ͻ .001. CONCLUSION: 17OHPC given to prevent recurrent SPTB is effective regardless of GA at earliest SPTB.

2025, PubMed

Objective: To assess the effect of metformin in controlling Gestational Diabetes Mellitus (GDM) in women with Polycystic Ovarian Syndrome (PCOS). Study design: Comparative cohort study. Place and duration of study: Gynecology Clinics of Mamji Hospital, Karachi, from 2008 to 2010. Methodology: Patients who had been diagnosed Polycystic Ovarian Syndrome (PCOS) with hyperinsulinemia and conceived and continued pregnancy, were divided in two groups; 50 patients received metformin throughout pregnancy and 32 did not. Development of GDM was ascertained in both groups. The patients were followed throughout pregnancy and in puerperium with OGTT as per WHO criteria. Primary outcome measure was development of gestational diabetes mellitus. Comparison of continuous variables was done using student 't' test. For categorical variables, frequency and percentages are reported while, odds ratio is also estimated for GDM during pregnancy. Results: A total of 82 women with PCOS were included in this study, out of whom, 50 patients received metformin treatment while 32 patients did not. Pregnant women with PCOS in both groups were comparable in age, weight, parity and BMI. Mean fasting insulin levels at beginning of study entry were 17.22 ± 2.3 mIU/L and 16.93 ± 2.28 mIU/L in metformin and no metformin group respectively (p=0.589). Mean fasting blood sugar levels were 94.54 mg/dl in metformin and 99.59 mg/dl in no metformin group p < 0.001. A total of 5 (10%) patients in metformin group developed GDM while 11 (34.37% OR 4.71, p = 0.01) developed GDM in no metformin group. Patients not receiving metformin were 4.7 times likely to have GDM (OR: 4.71) compared to those who received it. Conclusion: The frequency of gestational diabetes, was significantly higher in patients with PCOS who had not received metformin compared to those who did.

2025

Objective: To assess the effect of metformin in controlling Gestational Diabetes Mellitus (GDM) in women with Polycystic Ovarian Syndrome (PCOS).

2025, Revista argentina de reumatología

Introducción: El interferón (IFN) tipo I es una citoquina que juega un rol fundamental en la patogenia del Lupus Eritematoso Sistémico (LES). Diferentes niveles de esta citoquina podrían explicar la heterogeneidad de esta patología y ser útil para evaluar la actividad de la misma. Objetivos: determinar los niveles de IFN tipo I sérico en pacientes con LES y evaluar su utilidad como biomarcador de actividad. Material y Métodos: 16 pacientes con LES (ACR 1997) y 16 controles. Métodos: Actividad de la enfermedad (SLEDAI-2K), daño orgánico (SLICC), IFN tipo I (HEK-Blue-IFNα/β), anticuerpos anti-DNAdc (Inmunofluorescencia Indirecta), anticuerpos anti-ENA (ELISA), C3-C4 (Inmunoturbidimetría). Estadística: InfoStat/Instat/MedCalc. Valores de p<0,05 fueron considerados estadísticamente significativos. Resultados: Se observó un aumento de la concentración de IFN en el grupo LES con respecto al control (p<0,05). Los pacientes con valores de IFN superiores al punto de corte, se asociaron con la presencia de anticuerpos anti-DNAdc (OR:13,33;p<0,05). Pacientes con hipocomplementemia y aquellos con puntaje de SLEDAI-2K mayor a 8 presentaron mayores niveles de IFN comparados con pacientes con complemento normal y menor puntaje de índice, respectivamente (p<0,05). Conclusiones: Estos resultados sugieren la importancia que podría tener la determinación de IFN tipo I para el monitoreo de la actividad del LES.

2025

Objectives: Different retrospective growth charts for twin pregnancies
debates whether twin growth is similar to singletons. Recently, the fetal
medicine foundation (FMF) published a retrospective fetal growth
chart that indicated similar growth charts for twins and singleton if
only term delivery of both twins without major malformation are
included. A national Denish growth chart confirmed these finding.
We constructed prospective growth chart of estimated fetal weight
(EFW) throughout pregnancy of monochorionic diamniotic (MCDA)
and dichorionic (DC) twins using a multi-center, multi-national
cohort.
Study Design: Pregnancies with two live fetuses at 11-13 wks’
gestation were enrolled. Gestational age was determined from
crown-rump length of the larger twin in the first trimester. EFW
charts were made from fetal growth at 11-13, 20-22, 24-26, 28-30,
32-34, and 36-37 wks’ gestation using Hadlock-4 formula made of
biparietal diameter, head and abdominal circumference, and femur
length. Chorionicity specific charts were built for 376 DC and 158
MCDA live twins who were born at term, without malformations.
Centers included were from Montreal, Canada, Bonn and Tubingen,
Germany, Barcelona, Spain, Rome, Italy, and Zerifin, Israel. ANOVA
was used to compare ethnic and centers charts and functional fit to
were compared our charts to retrospective EFW charts of the FMF.
Results: Growth was slower in MCDA compared with DC twins
starting from 21st wks’ gestation and increased with advancing
gestation. Our charts were similar but marginally slower than the
FMF ones. Smaller EFW were in Barcelona and Rome compared to
the larger in Bonn and Tubingen, and fetuses of white women were
larger than those of other ethnicities
Conclusions: We developed a prospective growth chart for
pregnancies with two live DC and MCDA twins born at term without
malformations that are consistent with those of the FMF, with small
differences between countries and ethnicities.

2025, Statistics in Medicine

Most longitudinal growth curve models evaluate the evolution of each of the anthropometric measurements separately. When applied to a 'reference population', this exercise leads to univariate reference curves against which new individuals can be evaluated. However, growth should be evaluated in totality, that is, by evaluating all body characteristics jointly. Recently, Cole et al. suggested the Superimposition by Translation and Rotation (SITAR) model, which expresses individual growth curves by three subject-specific parameters indicating their deviation from a flexible overall growth curve. This model allows the characterization of normal growth in a flexible though compact manner. In this paper, we generalize the SITAR model in a Bayesian way to multiple dimensions. The multivariate SITAR model allows us to create multivariate reference regions, which is advantageous for prediction. The usefulness of the model is illustrated on longitudinal measurements of embryonic growth obtained in the first semester of pregnancy, collected in the ongoing Rotterdam Predict study. Further, we demonstrate how the model can be used to find determinants of embryonic growth.

2025, The Lancet

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1•5%] of 10 036 patients vs 191 [1•9%] of 9985 in the placebo group, risk ratio [RR] 0•81, 95% CI 0•65-1•00; p=0•045), especially in women given treatment within 3 h of giving birth (89 [1•2%] in the tranexamic acid group vs 127 [1•7%] in the placebo group, RR 0•69, 95% CI 0•52-0•91; p=0•008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3•6%] patients in the tranexamic acid group vs 351 [3•5%] in the placebo group, RR 1•02, 95% CI 0•88-1•07; p=0•84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5•3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5•5%] in the placebo group, RR 0•97, 95% CI 0•87-1•09; p=0•65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.

2025, Revista Información Científica

2025, Korean Journal of Adult Nursing

2025

Nursing practice necessitates the application of knowledge, skills, and values in various combinations, all
of which have undergone significant changes in recent decades. There is a greater emphasis on interprofessional
collaboration, as well as possible new and more independent roles for nurses, especially in the emergency units.
Therefore, the study aimed to assess the clinical competence of emergency nurses based on a self-assessment tool.
Methods: a descriptive study design was applied to 87 nurses enrolled in the emergency units at King Khaled and
King Salman Specialist Hospital. A demographic data sheet and clinical competency questionnaire were used for
collecting data. A descriptive statistic: frequency and percentage were carried out. Results reveal that the majority
of emergency nurses have a high level of clinical competency scores.
Keywords: Clinical Competence; Emergency units; Nursing Staff; Self-Assessment; Questionnaire; Hospitals.

2025

Patient satisfaction affects clinical processes and patients' outcomes, the quality of nursing care is crucial in determining how the patients are satisfied with their hospital stay. This study aimed to assess patients' satisfaction with the quality of nursing care provided at emergency departments of King Khalid Hospital and king Salman Specialist Hospital in Hail, Saudi Arabia. A descriptive cross-sectional research design was utilized. Sample included all clients who received nursing care at previous settings and who agreed to participate. A self-administered online questionnaire consisted of two parts: Socio-demographic data sheet of the study subjects & the patient satisfaction with nursing care quality questionnaire (PSNCQQ). Results revealed that more than three quarters of the study subjects had high satisfactory scores regarding total quality of nursing care, the overall quality of the nursing care the patients received during stay in hospital was excellent. In conclusion, the patients were satisfied toward the nursing care provided, they recommended the previous hospital for family and friends.

2025, International Urology and Nephrology

Background Little is known about pregnancy in women with Alport syndrome (AS), as only four cases have been reported in the literature. We herein describe the course of pregnancy in two sisters with overt forms of AS. Cases Both women were diagnosed as having autosomal recessive AS. Before pregnancy, their renal function and their blood pressure were normal, and proteinuria values were below 2 g/24 h. Both patients faced a progressive and remarkable increase in proteinuria during pregnancy, with subsequent hypoproteinemia. The clinical condition worsened, particularly in the first case, who was managed with some success with a combination of diuretics. She delivered at 32 weeks of pregnancy. The second patient was less challenging and she delivered at 36 weeks. Proteinuria returned to pre-pregnancy levels in both cases, after delivery. Conclusion Management of pregnant women with overt AS is challenging and worsening of renal disease has to be expected. The use of diuretic therapy may be of benefit.

2025, Bjog: An International Journal Of Obstetrics And Gynaecology

Objective To determine whether the higher levels of obstetric intervention and maternity service use among older women can be explained by obstetric complications. Design A retrospective analysis of routinely collected data from the Aberdeen Maternity and Neonatal Databank. Participants All residents of Aberdeen city district delivering singleton infants at the Maternity Hospital 1988-1997 (28,484 deliveries). Main outcome measures Odds ratios for each intervention in older maternal age groups compared with women aged 20-29. Interventions considered include obstetric interventions (induction of labour, augmentation, epidural use, assisted delivery, caesarean section) and raised maternity service use (more than two prenatal scans, amniocentesis, antenatal admission to hospital, admission at delivery of more than ®ve days, infant resuscitation, and admission to the neonatal unit). Methods Logistic regression was used to investigate the association between maternal age and the incidence of interventions. The odds ratios for each intervention were then adjusted for relevant obstetric complications and maternal socio-demographic characteristics. Results Levels of amniocentesis, caesarean section, assisted delivery, induction, and augmentation (in primiparae) are all higher among older women. Maternity service use also increases signi®cantly with age: older women are more likely to have an antenatal admission, more than two scans, a hospital stay at delivery of more than ®ve days, and have their baby admitted to a neonatal unit. Controlling for relevant obstetric complications reveals several examples of effect modi®cation, but does not eliminate the age effect for most interventions in most groups of women. Conclusions Higher levels of intervention among older women are not explained by the obstetric complications we considered.

2025, Fertility and Sterility

2025, High Risk Pregnancy

Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem. However, bleeding and/or pain can be a warning sign of a miscarriage or, less commonly, of other... more

2025, BJOG: An International Journal of Obstetrics & Gynaecology

ObjectiveTo externally validate two models from the USA (entry‐to‐care [ETC] and close‐to‐delivery [CTD]) that predict successful intended vaginal birth after caesarean (VBAC) for the Dutch population.DesignA nationwide registration‐based cohort study.SettingSeventeen hospitals in the Netherlands.PopulationSeven hundred and sixty‐three pregnant women, each with one previous caesarean section and a viable singleton cephalic pregnancy without a contraindication for an intended VBAC.MethodsThe ETC model comprises the variables maternal age, prepregnancy body mass index (BMI), ethnicity, previous vaginal delivery, previous VBAC and previous nonprogressive labour. The CTD model replaces prepregnancy BMI with third‐trimester BMI and adds estimated gestational age at delivery, hypertensive disease of pregnancy, cervical examination and induction of labour. We included consecutive medical records of eligible women who delivered in 2010. For validation, individual probabilities of women who ...

2025

oor birth outcomes can have negative consequences for children’s health and development and have been associated with increased risk for altreatment. Preterm and low birth weight (LBW) abies face an elevated chance of early mortality, ealth problems, and developmental delays. LBW nfants are twice as likely as their normal-weight peers o be placed in foster care and to be maltreated over heir early years of life. In response, Healthy People

2025

Objective: To review the clinical indications and different causes of first-trimester vaginal bleeding by ultrasound.
Study Design: Cross-sectional study.
Setting: Department of Radiology, Faisal Hospital, Faisalabad, Pakistan.
Period: March 2022 to June 2022.
Material & Methods: A total of 150 female patients aged between 16-45 years with vaginal bleeding in the first trimester (gestational age up to 12 weeks) were included in the study. Clinically tested patients were found to be sent for ultrasound examinations. Both clinical findings and ultrasound were related. The Chi-square test was used to measure the association between vaginal bleeding and gestational age.
Results: In a study of 150 patients, it was estimated that 105 patients (70%) were pregnant with an assisted ultrasound. However, 80 patients (76%) out of 105, showed a variety of abortions; 32 (40%) were threatened abortion, 28 (35%) were incomplete abortions, 12 patients (15%) had a complete abortion, and 8 patients (10%) had blighted ovum. However, 25 patients (23.8 %) out of 105 showed different
pregnancies; 15 (14%) patients were pregnant with ectopic and 10 patients (10%) were pregnant orally.
Conclusion: It was concluded from the study that most cases were in the age group of 21-30 years (39%) as compared to the others. However, 80 cases (76%) were various types of abortions and 105 patients (70%) were multigravida. This study found an association between vaginal bleeding (abortion and ectopic pregnancy) and gestational age (<10 weeks and >10 weeks) which was found to be statistically significant (p=0.005).

2025, Transplant Immunology

The occurrence of pregnancy in young female organ transplant recipients may sustain a high risk for prematurity and low rate of malformations in neonates. Therefore, it is necessary to counsel couples who want a child. In case of pregnancy, strict guidelines must be observed. Continuous exposure to CsA in utero seems to impair T-, B-and NK-cell development and function in neonates. This effect is prolonged throughout the first year of life. In addition, low levels of serum immunoglobulins occur at the same time. This leads to suggest a delayed administration of classical vaccinations (after the first 6 months of life) in view of the potential risks of both sub-optimal immunologic responses, and adverse events after the administration of live, attenuated vaccines in infants born from young female organ transplant recipients.

2025, Diabetes Technology & Therapeutics

Background: Advanced glycation end products (AGEs) are long-lived tissue proteins that accumulate in diabetes. Skin AGEs measured in biopsy specimens strongly correlated with complications of diabetes. AGEs can also be measured noninvasively by the AGE ReaderÔ (DiagnOptics B.V., Groningen, The Netherlands). The aim of this review was to systematically review all articles on the association between skin autofluorescence (SAF), measured by the AGE Reader, and complications of diabetes. Methods: We screened PubMed for studies on SAF and complications in diabetes mellitus type 1 and type 2. Seven articles met the inclusion criteria. Results: All studies showed positive associations of SAF with one or more complications (all-cause mortality, cardiovascular mortality, micro-and macrovascular complications, neuropathy, and nephropathy), except retinopathy. Only three studies were of prospective design, with a follow-up of 3-5 years; the other four studies were cross-sectional. Studies were of large clinical heterogeneity. Conclusions: This systematic review of literature showed an association of SAF with end-organ complications in diabetes, except retinopathy, in all seven studies. However, studies were of large clinical heterogeneity, only three studies had a prospective design, and five studies were from the same research group. More prospective studies, with a longer period of follow-up, larger group size, and strict definitions of complications and end points, are needed to demonstrate the potential role and benefit in clinical management before the widespread use of the AGE Reader can be recommended.

2025, Diabetes Technology & Therapeutics

2025, dspace.lcc.ufmg.br

A524p Amorim, Lúcia de Fátima Pais de Prevalência das cardiopatias congênitas diagnosticadas ao nasci-mento no Hospital das Clínicas da Universidade Federal de Minas Ge-rais. / Lúcia de Fátima Pais de Amorim. 2007. 100 f. ...... more

2025, Journal of the Dow University of Health Sciences

Objective: To find out the effectiveness of Admission Test (AT) in detecting fetal hypoxia already present at admission to predict hypoxia in labor and to correlate the results of the AT with the perinatal outcome. Study Design: Descriptive study. Patients and Method: A total of 100 women in labor both high and low risk groups were selected in the study. All of them were subjected to an admission test (AT) which is a 15-20 minutes recording of fetal heart rate and uterine contractions on cardiotocograph machine at the time of admission in labor. The results of AT were not revealed to the concerned obstetrician in labor room and the test were evaluated after delivery so as not to influence the clinical management. The results of the AT were 'reactive' in 75 (75%), 'equivocal' in 22 (22%) and 'ominous' in 3 (3%) women. Women with the reactive AT had low risk of intrapartum fetal distress, 1.3% as compared to 4.5 % in the equivocal and 66.6 % in the ominous group. Operative delivery for fetal distress was required in only 1 (1.3 %) woman of the reactive group, in 1 (4.5%) woman of the equivocal group and in 2 (66.6 %) women of the ominous AT group. Resuscitation was required in 2 (2.6 %) babies of the reactive group, in 4 (18.1%) babies of the equivocal group and in 1 (33.3%) baby of the ominous AT group. Nine babies required neonatal unit and NICU admission for neonatal sepsis 5 (6.6%) were from the reactive, 2 (4.5%) were from the equivocal and 2 (66.6%) were from the ominous AT group. The test was useful to detect fetal distress already present at admission and had the ability to propose fetal well being for the next few hours of labor. It is simple, convenient, non invasive and economical for screening purpose.

2025

Context: Hernias generally coexist with pregnancy; however, an incarcerated hernia with intestinal obstruction is rare at an advanced stage of gestation and requires urgent intervention. Case report: A multiparous woman with a known large incisal hernia presented at 18 weeks and 5 days of gestational age and prior to laparotomy 10 years ago The patient was diagnosed with intestinal obstruction secondary to an incarcerated hernia with complete occlusive syndrome caused by the cessation of materials and gases, nausea, vomiting and severe abdominal pain. She underwent betamimetics tocolysis throughout the clinical and therapeutic process, before during and after surgery. An obstetric ultrasound done 72 hours after surgery confirms the vitality of the fetus. Conclusion: Intestinal incarceration by incisional hernia can occur during pregnancy and lead to favorable maternal and neonatal results.

2025, BJOG: An International Journal of Obstetrics & Gynaecology

Objective To test the postulated preventive effects of dietary n‐3 fatty acids on pre‐term delivery, intrauterine growth retardation, and pregnancy induced hypertension.Design In six multicentre trials, women with high risk pregnancies were randomly assigned to receive fish oil (Pikasol) or olive oil in identically‐looking capsules from around 20 weeks (prophylactic trials) or 33 weeks (therapeutic trials) until delivery.Setting Nineteen hospitals in Europe.Samples Four prophylactic trials enrolled 232, 280, and 386 women who had experienced previous pre‐term delivery, intrauterine growth retardation, or pregnancy induced hypertension respectively, and 579 with twin pregnancies. Two therapeutic trials enrolled 79 women with threatening pre‐eclampsia and 63 with suspected intrauterine growth retardation.Interventions The fish oil provided 2.7 g and 6.1 g n‐3 fatty acids/day in the prophylactic and therapeutic trials, respectively.Main outcome measures Preterm delivery, intrauterine g...

2025, Fertility and Sterility

Objective: To evaluate the results of IVF in women Ն40 years of age using their own oocytes. Design: Retrospective study. Setting: Wolfson and Royal Masonic in vitro fertilization units, London, United Kingdom. Patient(s): A total of 1,087 IVF cycles were started in women Ն40 years of age. Intervention(s): Medical records of patient outcomes were reviewed. Main Outcome Measure(s): Clinical pregnancy, miscarriage, and delivery rates. Of the 1,087 cycles started in 471 women Ն40 years of age, 842 reached oocyte retrieval (77.5%) and 702 had embryos transferred (64.6%). The pregnancy rate (PR) was significantly lower in women Ն40 years of age than in a control group of women Ͻ40 years of age (11.3% versus 28.2%). It decreased sharply in women Ͼ42 years of age, and no women Ͼ45 years of age had a child. Women Ն40 years of age were more likely to miscarry (27% versus 12.7%). When only one embryo was available for transfer, the PR was 3.3%. When Ͼ2 embryos were available for transfer, the PR was similar whether 2 or 3 embryos were replaced. No triplet pregnancy occurred. Women Ն40 years of age achieved a cumulative PR of 30% after three cycles with a cumulative "take home baby" rate of 21%. In vitro fertilization is a reasonable treatment for women Ͻ45 years of age using their own gametes. Those with a "good response" in their first attempt may be encouraged to complete three cycles with an acceptable chance of conception.

2025, Revista Brasileira de Ginecologia e Obstetrícia

Resumo ObjetivO: avaliar a prevalência e os fatores de risco associados à morbidade materna grave numa maternidade terciária. MétOdOs: trata-se de um estudo de corte transversal dos casos de morbidade materna grave atendidos no Hospital e Maternidade Celso Pierro entre outubro de 2005 e julho de 2006, identificados a partir dos livros de controle das unidades de internação, pronto atendimento e centro obstétrico. Foram estudadas gestantes e puérperas que apresentavam condições definidoras de morbidade materna grave a partir dos diagnósticos clínicos segundo critérios propostos por Waterstone. Posteriormente, os casos de maior gravidade clínica, chamados de morbidade extremamente grave, foram reclassificados utilizando-se os critérios definidores de Mantel, baseados em disfunção orgânica e manejo. ResultadOs: foram identificadas 114 mulheres com morbidade materna grave entre 2.207 partos, com razão de outra morbidade grave e morbidade extremamente grave de 44,9 e 6,8 casos por 1.000 partos, respectivamente. A média da idade gestacional no parto foi de 35 semanas e 87% das mulheres vieram de área de cobertura da maternidade no município. A hipertensão (pré-eclâmpsia grave) representou 96% de outras morbidades graves e a hemorragia esteve presente em 60% dos casos de morbidade extremamente grave, seguida de hipertensão. A prevalência de morbidade extremamente grave entre os casos de morbidade grave não se associou com estado marital, escolaridade, idade materna, tipo de parto, gestações, idade gestacional e distrito de saúde de moradia. COnClusões: as outras morbidades graves foram 6,6 vezes mais freqüentes que os casos extremamente graves, sem diferenças entre os grupos por fatores de risco epidemiológicos.

2025, Archives of Gynecology and Obstetrics

Purpose Immediate neonatal outcome in pregnancies complicated by placenta previa is largely dependent on gestational age. We aimed to investigate whether placenta previa increases the risk for perinatal mortality and immediate morbidity of the offspring born at term. Methods A population-based cohort study included all singleton pregnancies, with and without placenta previa, delivered at term. Maternal and pregnancy characteristics as well as immediate neonatal morbidity and mortality were compared. Deliveries occurred between the years 1991-2013 in a tertiary medical center. Multiple pregnancies, and fetal congenital malformations were excluded. Results During the study period 233,123 consecutive term deliveries met the inclusion criteria; 0.2 % of the babies were born to mothers diagnosed with placenta previa. Women with placenta previa were significantly older and more likely to have had a previous cesarean section. Pregnancies were more likely to be complicated with pathological presentations and cesarean hysterectomies. Babies born at term following pregnancies with placenta previa were more likely to weigh less than 2500 g (OR 2.78 CI 1.9-3.9, p \ 0.001). However, 5 min Apgar score and perinatal mortality rates were comparable between the groups. Neonatal outcomes remained comparable between the groups in a sub-analysis of cesarean deliveries only. Conclusion Although placenta previa pregnancies involve higher maternal morbidity rates, term offsprings are not at an increased risk for immediate adverse outcome.

2025, European Journal of Obstetrics & Gynecology and Reproductive Biology

A series of seven women aged 50 years and over was studied over two years to analyse patient profile and pregnancy outcome. All were first-generation immigrant Asian multigravidae who were Muslims of low socio-economic status and who had never used contraception. The median age at booking was 52 (range 51-59 years) and the median parity was nine. One woman had gestational diabetes and one had an antepartum haemorrhage. There were few intrapartum or puerperal problems but an increased rate of Caesarean section (28.6%) was noted. There were no stillbirths, neonatal deaths or congenital anomalies in this series. The mean birth weight was 3.3 kg and the mean gestation at delivery was 39.2 weeks. There was no significant perinatal morbidity. Five of the seven women declined further family planning advice. A possible relationship between race, parity and age at menopause is discussed.

2025, BMC Pregnancy and Childbirth

Background: 15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC) has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery. At present, there are no data on the effectiveness of progesterone in the prevention of preterm birth in multiple pregnancies. Methods/Design: We aim to investigate the hypothesis that 17OHPC will reduce the incidence of the composite neonatal morbidity of neonates by reducing the early preterm birth rate in multiple pregnancies. Women with a multiple pregnancy at a gestational age between 15 and 20 weeks of gestation will be entered in a placebo-controlled, double blinded randomised study

2025, Obstetrical & Gynecological Survey

2025, Pakistan Journal of Medical and Health Sciences

Objective: To compare the efficacy of clomiphene citrate and clomiphene citrate with metformin in anovulatory infertility with PCOS (polycystic ovarian syndrome (PCOS). Study Design: Randomized controlled trial. Place and Duration of Study: This research took place in the Department of Gynecology and Obstetrics at the combined military hospital Bahawalpur. The study was carried out over a six-month period, starting on 1st November 2022 and concluding on 30 April 2023 Materials and Methods: The study comprised 176 married women aged between 18 and 40 years who had been experiencing anovulatory infertility and PCOS for more than 6 months. In group A, for a period of three menstrual cycles, patients received 500 mg of metformin three times a day consistently and 100 mg of clomiphene citrate daily from the fifth to the ninth day of their menstrual cycle. In contrast, patients in group B were given 100 mg of clomiphene citrate daily from the fifth to the ninth day of their menstrual cycl...

2025, Infectious diseases in obstetrics and gynecology

Objective: To test the hypothesis that our inner city obstetric patients who have been infected with sexually transmitted diseases (STDs) will have a higher prevalence of hepatitis C virus infection than the general population and to identify specific risk factors and high-risk groups. Methods: All patients in our prenatal clinic (July 1997-April 1999) who tested positive for one or more STDs were asked to return for hepatitis C antibody testing. Medical charts of all patients who returned for hepatitis C testing were reviewed. Results: A total of 106 patients with STDs were tested for hepatitis C. Positive screening tests for anti-hepatitis C antibody were found in 6.6% (7/106) of the patients (95% CI = 2.7-13.1%). This frequency is significantly higher than the hepatitis C prevalence (1.8%) in the general United States population (p = 0.006). Multiple logistic regression analysis confirmed only older age (p = 0.016) and positive HIV status (p = 0.023) to be significant predictors of hepatitis C infection. Conclusions: Inner city STD-infected obstetric patients are at high risk for hepatitis C infection compared with the general population. Increasing age and HIV-positive status are risk factors which are significantly associated with hepatitis C infection.

2025, Mpho G Tau

Perinatal morbidity is defined as presence of the disease which occurs as a result of side effect influences of treatment acting either on a fetus or neonate during the first week of life. In the developing countries, the risk of perinatal morbidity is 6 times greater than in the developed countries; in the least developed countries it is over 8 times higher. High perinatal morbidity rates cause sub-optimal outcomes, which are common, and may impair subsequent developmental milestones of children or sound function of families, and might increase health care cost. The study aimed at developing strategies to reduce high perinatal morbidity. The study was conducted at the two selected tertiary hospital. A quantitative, cross sectional and descriptive research design was used. The population comprised of eighty (80) midwives allocated in neonatal intensive care and labour units. Simple random sampling was used to select 66 respondents who participated in the study. Data were collected using a pre-tested and validated self-developed questionnaire. Descriptive and inferential statistics were used to analyse data. The study revealed that shortage of staff, overcrowding of patients, and work overload of staff, lack of equipment and supplies, absenteeism, resignation and prematurity were contributory factors. The strategies aimed at reducing high perinatal morbidity are a priority for public health policies around the world. The study recommends that all midwives working in maternity and neonatal units should be upgraded in terms of the management of pregnant woman and sick neonates.