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Abstract Background Rheumatic heart disease (RHD) remains prevalent in the developing world and reproductive-age women are disproportionately affected. It is among the common est cardiac diseases during pregnancy and is associated with poor pregnancy outcomes. Despite its importance among reproductive-age women, there are no local studies that characterize the clinical characteristics, risk of poor pregnancy outcomes and contraception which represents one effective way to prevent unplanned pregnancies in this population. Methods This was a hospital-based descriptive cross-sectional study. Non-pregnant reproductive-age women with echocardiographically diagnosed RHD were consecutively recruited from in- and out-patients units of the Jakaya Kikwete Cardiac Institute (JKCI). A clinical research form was used to gather socio-demographic, clinical characteristics, contraception status and echocardiographic information. The maternal/pregnancy risk class was determined using the modified World Health Organization (WHO) classification of maternal risk. Results Two hundred thirty-eight women of reproductive age with RHD were recruited. The median age (range) was 36 years (15–49). Two-thirds were dyspneic on moderate exertion and 17.2% had New York Heart Association class IV heart failure. A quarter had atrial fibrillation/flutter. On echocardiography, mitral regurgitation was the most common valvular lesion (68.1%), followed by mitral stenosis (66.8%), and 12.2% of participants had reduced left ventricular ejection fraction. Two-thirds (66%) had a high pregnancy risk (class IV) based on the modified WHO classification system. The proportion of participants using contraception was 7.1% and common methods were: bilateral tubal ligation 5 of 17 (29.4%) and hormonal implant (4 of 17). The most common reason for the choice of a method was safety, 10 out of 17 (58.8%). Conclusion The majority of women of reproductive age with RHD in our hospital cohort are at the highest pregnancy risk based on the modified WHO classification and a very small proportion of them are on contraception. These results call for action among clinicians to offer counselling to these patients, educating them on their risk and offering appropriate contraception advice while waiting for definitive interventions.

East Lombok Regency, despite implementing pregnancy health programs, grapples with a persistently high pregnancy risk. This study investigates the disparity between medical and Sasak cultural perspectives on young mothers’ pregnancy risks. Qualitative case study research reveals a conflict between community sociocultural narratives and medical viewpoints. Cultural norms normalize medical narratives, shaping pre-marital reproductive arrangements, body perceptions, and idealized pregnancy concepts. Young mothers, influenced by cultural values, accept pregnancy as a collective social process within the family. The study emphasizes the impact of cultural determinism on shaping perceptions and preferences for young mothers’ pregnancy health, highlighting the need for an integrated approach that bridges medical and cultural perspectives to address and mitigate pregnancy risks effectively.

Summary: Background: Despite substantial progress in improving maternal and newborn health, India continues to experience high rates of newborn mortality and stillbirths. One reason may be that many births happen in health facilities that lack advanced services—such as Caesarean section, blood transfusion, or newborn intensive care. Stratification based on pregnancy risk factors is used to guide ‘high-risk’ women to advanced facilities. To assess the utility of risk stratification for guiding the choice of facility, we estimated the frequency of adverse newborn outcomes among women classified as ‘low risk’ in India. Methods: We used the 2019–21 Fifth National Family Health Survey (NFHS-5)—India’s Demographic and Health Survey—which includes modules administered to women aged 15–49 years. In addition to pregnancy history and outcomes, the survey collected a range of risk factors, including biomarkers. We used national obstetric risk guidelines to classify women as ‘high risk’ versus ‘low risk’ and assessed the frequency of stillbirths, newborn deaths, and unplanned Caesarean sections for the respondent’s last pregnancy lasting 7 or more months in the past five years. We calculated the proportion of deliveries occurring at non-hospital facilities in all the Indian states. Findings: Using data from nearly 176,699 recent pregnancies, we found that 46.6% of India’s newborn deaths and 56.3% of stillbirths were among women who were ‘low risk’ according to national guidelines. Women classified as ‘low risk’ had a Caesarean section rate of 8.4% (95% CI 8.1–8.7%), marginally lower than the national average of 10.0% (95% CI 9.8–10.3%). In India as a whole, 32.0% (95% CI 31.5–32.5%) of deliveries occurred in facilities that were likely to lack advanced services. There was substantial variation across the country, with less than 5% non-hospital public facility deliveries in Punjab, Kerala, and Delhi compared to more than 40% in Odisha, Madhya Pradesh, and Rajasthan. Newborn mortality tended to be lower in states with highest hospital delivery rates. Interpretation: Individual risk stratification based on factors identified in pregnancy fails to accurately predict which women will have delivery complications and experience stillbirth and newborn death in India. Thus a determination of ‘low risk’ should not be used to guide women to health facilities lacking key life saving services, including Caesarean section, blood transfusion, and advanced newborn resuscitation and care. Funding: Bill and Melinda Gates Foundation and the World Bank. The findings, interpretations and conclusions expressed in the paper are entirely those of the authors, and do not represent the views of the Gates Foundation or of the World Bank, its Executive Directors, or the countries they represent.

Development of bovine estrus synchronization protocols started in the 1970’s. The aim of these protocols has changed progressively from synchronizing estrus to synchronizing ovulation with main goal of performing insemination without heat detection (Timed artificial insemination). The present paper discusses the physiology behind development of these synchronization protocols and reviews of the main protocols used nowadays in dairy herd reproductive management.

Abstract Background In India, where men take most decisions in the family, it is useful that they have adequate knowledge about pregnancy risks during women’s menstrual cycles. Since traditional contraceptive methods are still employed by a large population in India, the knowledge regarding the pregnancy risk during the menstrual cycle is indispensable. This research paper attempts to assess the knowledge among urban men in Uttar Pradesh, India about the fertile window of the menstrual cycle; it also attempts to discover the rationales behind the misconceptions about the concept. Methods This study utilizes the baseline data of the Measurement, Learning, and Evaluation project for the Urban Reproductive Health Initiative in Uttar Pradesh. Descriptive Statistics has been used to assess the prevalence of knowledge among urban men regarding the concept. Using the Discriminant Analysis, we also investigate the rationales behind the misconceptions among urban men about the concept. Results Only one-fifth of the men have the correct knowledge about the concept. Further, we find that education, societal perception, caste, and spousal discussion about the reproductive issues are the primary factors affecting the knowledge about the pregnancy risk during the menstrual cycle. Conclusions There is an urgent need for sex education in the region to make the urban men more educated about the reproductive process of women; this may reduce unwanted births and abortion due to an unwanted pregnancy as well. The study promotes the higher education and motivates couples to discuss the reproductive health issues among them. In this manner, we can provide better reproductive health to the women of urban India.

Estuda-se conhecimentos, atitudes e práticas em relação à assistência pré-natal de 404 mulheres internadas no Serviço de Obstetrícia de um hospital do município de São Paulo (Brasil). Descreve-se o trimestre da gestação em que a assistência pré-natal teve início, de acordo com o risco gravídico medido através do sistema de avaliação de Perkin. Apresentam-se as razões que impediram o comparecimento no primeiro trimestre de gravidez ou levaram ao não-comparecimento a esse serviço, assim como inconsistências entre atitudes e práticas da população em estudo.The knowledge, attitudes and practices, in relation to prenatal care, of 404 women patients in the Obstetrics Clinic of a hospital in the municipality of S. Paulo (Brazil) were studied. The period of gestation in which prenatal care started is described in accordance with pregnancy risk as measured by Perkin's method of assessment. This study sets out the reasons with hindered the patients' taking advantage of the services offered by this Clinic during the first trimester of pregnancy or at any time during pregnancy, as well as the inconsistencies between the attitudes and practices of the population sample under review.

Estudou-se, através de dados oficiais, a mortalidade materna no Brasil, em suas regiões geográficas e em São Paulo (Brasil). Escolheu-se o ano de 1980 por oferecer possibilidade de se trabalhar com informações sobre nascimentos verificados naquele ano, divulgados no Censo Demográfico realizado naquele ano. Verificou-se que as principais causas de óbito por causas maternas no Brasil, pela ordem, são os estados hipertensivos, as hemorragias, as infecções puerperais, seguidas do aborto. Para São Paulo, onde se dispôs do 4º digito da Classificação Internacional de Doenças, a primeira causa de óbito materno foi a eclâmpsia, a segunda as hemorragias e a terceira as infecções, quer próprias ou associadas à gravidez. Quanto à idade, pode-se observar que o menor coeficiente de mortalidade materna ocorreu na faixa etária de 20 a 29 anos, sendo um pouco maior nas idades de 15 a 19 anos e aumentando gradativamente nas idades de 30 a 39 anos e 40 a 49 anos. Cabe ressaltar que não foi possível analisar este coeficiente para as faixas de 10 a 14 anos e de 50 e mais, por falta de dados sobre nascidos vivos, porém ocorreram 18 e 4 óbitos respectivamente nestas faixas, o que mostrou que nos extremos do período reprodutivo existe contingente não desprezível de mortes maternas. Estas mulheres deveriam, pelas suas condições, merecer melhor assistência de saúde, evitando-se perdas desnecessárias de vida, principalmente as adolescentes que não são até o momento contempladas por ações de saúde nos programas ora vigentes. Ao se comparar estes dados com os de outros países pôde-se observar que a maioria dos óbitos por complicações de gravidez, parto e puerpério são evitáveis e que seria possível reduzi-los de maneira considerável por meio de melhor assistência à mulher, com a utilização de técnicas e recursos disponíveis em nosso meio.Brazilian maternal mortality is studied on the basis of official statistics from the country's various geographical regions, including especially the State of S. Paulo (Brazil). 1980 was chosen because of the possibility of working with data from the Population Census of that year. The principal causes of death in Brazil were found to be, in the following order: hypertensive states, haemorrhage, puerperal infections and abortion. In S. Paulo, where the fourth digit of the IDC is used, the first cause of death was eclampsia. The second was haemorrhage and the third the infections, whether due to or associated with pregnancy. As for age, one observed that the lowest maternal mortality rate occurred in the 20 to 29-year-old age group, the rate for 15-19 being slightly higher and increasing gradually in the age groups 30-39 and 40-49 years of age. It must be stated that it was not possible to analyse the rates for the 10 to 14 and over 50 age groups because of the lack of data on livebirths. However, there were 18 and 4 deaths respectively in those two groups which shows that at the extreme limits of the reproductive age there exists a not inconsiderable loss of life, mainly in the case of girls (adolescents) who are not taken into consideration at the present time in the prevailing health programs. On comparing these data with those of other countries it was found that the majority of deaths are avoidable and that it should be possible to reduce the number considerably by means of better assistance to women, and by the use of the techniques and resources which are already available.

Foram estudados dois grupos de gestantes, sendo um de grávidas normais e outro de obesas, com a finalidade de reconhecer algumas características da evolução da gravidez, em mulheres obesas, e suas repercussões sobre o concepto. Foram relacionadas as seguintes variáveis: status sócio-econômico familiar, idade, altura, perímetro braquial, peso habitual, número de gestações anteriores, paridade materna, ganho de peso durante a gestação, idade gestacional, intercorrências durante a gestação, peso ao nascer e vitalidade do recém-nascido. Pelos resultados concluiu-se que as gestantes obesas são diferentes das normais e apresentam maior incidência de complicações obstétricas. Os recém-nascidos, filhos de obesas, registraram índice maior de mortalidade, principalmente no período perinatal. Houve maior incidência de prematuridade e de fetos macrossômicos, sendo a curva de distribuição de peso ao nascer diferente da dos recém-nascidos das gestantes normais. A média de peso ao nascer das crianças das gestantes obesas é maior que o das normais. Concluiu-se ainda que toda vez que a gestante obesa sofre restrição alimentar, com ganho de peso inadequado, o crescimento intra-uterino é afetado; não sendo, portanto, a época da gravidez a melhor para a obesa perder peso, mas, ao contrário, ela deveria receber uma orientação alimentar adequada. A obesidade é pois um fator de aumento do risco gravídico, que pode afetar tanto a mãe como o concepto.Characteristics of the evolution of pregnancy in obese women were studied for their effect on newborn infants. Two control groups were observed - one of normal weight pregnant women, one of obese. The variables selected were: the socio-economic status of the family and the mother's age, height, arm circunference, prepregancy weight, total number of pregnancies, parity, weight gain during pregnancy, obstetric complications, birth weight, and fetal vitality. Results showed that pregnancy in obese women differs from that in normal weight women and that they show a larger incidence of obstetric complications. Children of obese mothers had a higher mortality rate principally in the perinatal period; moreover, there was also a higher rate of prematurity and a higher proportion of overweight babies among obese mothers. As a result, the distribution of the curve of the birth weight of infants of obese morthers was higher than that of infants of normal weight mothers. The conclusion reached was that whenever a pregnant obese woman reduced foot intake, with resultant insufficient weight gain, intrauterine growth was affected. Thus, it follows that pregnancy is not the best time for the obese mother to lose weight; for this reason, it is important that she receive adequate guidance in regard to diet. Obesity, therefore, is a factor contributing to high-risk pregnancy which can affect both mother and child.