Search

Background: To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM), its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective: This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. Design: A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. Results: The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-)screening, difficulties with reaching women for testing in the fasting state, time consuming nature of the tests, intolerance to high glucose load due to nausea, needfor repeat tests, issues with scarcity of test consumables and lack of equipment making some procedures impossible to follow. Conclusion: Though an international consensus on screening and diagnosis for GDM is welcome, it should ensure that the recommendations take into account feasibility and applicability in low resource settings to ensure wider usage. We need to move away from purely academic discussions focusing on sensitivity and specificity to also include what can actually be done at the basic care level. [ABSTRACT FROM AUTHOR]

Objective: To examine the use of the modified Wells score in pregnancy as a risk stratification tool in the diagnosis of pulmonary embolism (PE). Methods: All pregnant or post-partum patients who were referred for CT Pulmonary Angiography (CTPA) to evaluate suspected PE over a 5-year period were included in the study. Patient records were used to apply the modified Wells score (MWS) and analyze their risk of PE. Results: A total of 125 women were referred for CTPA over 5 years. A MWS of 6 or greater ('High Risk') was 100% sensitive and 90% specific with a positive predictive value of 36% for PE on CTPA. No patients with a low MWS (less than 6) had a PE, giving a negative predictive value of 100%. p ≤ 0.001. D-dimers, chest X-ray, blood gases and EKG were significantly less effective than the MWS in aiding the diagnosis of PE. Conclusion: Current methods employed for the diagnosis of PE are inadequate. Risk stratification using the MWS may allow safe exclusion of PE before resorting to CTPA. To the best of our knowledge this is the first study to have used the MWS in a pregnant patient group. [ABSTRACT FROM AUTHOR]

Pelvic girdle pain (PGP) is a term used specifically to pregnancy-related pain in the lumbosacral, sacroiliac and symphysis pubis joints. Pregnancy-induced hormonal and physical changes increase the risk of musculoskeletal problems in pregnancy. The severity of these conditions varies from mild self-limiting pain to a severe disabling condition. PGP is common in pregnancy and while most can be managed as outpatients, a few patients require inpatient admission for further investigations and management. Prompt identification of these conditions is essential to avoid serious disability. Lack of awareness and failure of recognition not only results in women feeling isolated, but may also result in long-term morbidity. In this review, we explore the aetiology, presentation, risk factors, risk of recurrence, differential diagnosis and multidisciplinary management of these conditions. We also enclose obstetric guidelines to increase the awareness of the health professionals. [ABSTRACT FROM AUTHOR]

Objective. A model construction for classification of women with normal, hypertensive and preeclamptic pregnancy in different gestational ages using maternal heart rate variability (HRV) indexes. Method and patients. In the present work, we applied the artificial neural network for the classification problem, using the signal composed by the time intervals between consecutive RR peaks (RR) ( n == 568) obtained from ECG records. Beside the HRV indexes, we also considered other factors like maternal history and blood pressure measurements. Results and conclusions. The obtained result reveals sensitivity for preeclampsia around 80%% that increases for hypertensive and normal pregnancy groups. On the other hand, specificity is around 85-90%%. These results indicate that the combination of HRV indexes with artificial neural networks (ANN) could be helpful for pregnancy study and characterization. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was the analysis of the umbilical cord serum sP-selectin levels in pregnancies complicated by severe preeclampsia with and without intrauterine growth restriction and in normotensive pregnancies. Patients and methods. The study was carried out on 18 patients with singleton pregnancies complicated by severe preeclampsia with appropriate-for-gestational-age weight infants (group P) and 18 pregnant patients with severe preeclampsia complicated by intrauterine fetal growth restriction (IUGR) (group PI). The control group consisted of 34 patients with singleton uncomplicated pregnancies (group C). Umbilical serum sP-selectin concentrations were estimated using a sandwich ELISA assay according to the manufacturer's instruction (ELISA kit Bender MedSystems Vienna, Austria). Results. Our study revealed different concentrations of soluble P-selectin in the umbilical cord in our both studied groups of preeclamptic women with and without IUGR. The umbilical cord levels of sP-selectin were decreased in the group with preeclampsia complicated by IUGR and increased in the preeclamptic women with the normal intrauterine fetal growth. The mean values of umbilical sP-selectin were 839.008 ±± 625.703 ng/ml in group P, 275.873 ±± 174.339 ng/ml in group PI, and 288.719 ±± 199.039 ng/ml in the control group, respectively. Conclusions. Higher levels of the umbilical sP-selectin may confirm the presence of platelet and endothelial cell activation and confirm a hypercoagulant state in preeclamptic disorder, especially in preeclampsia without IUGR. [ABSTRACT FROM AUTHOR]

Since the birth of the first baby through in  vitro fertilisation over 30 years ago, there has been a rapid increase in the number of women using assisted reproductive technologies. New techniques are constantly being introduced and are evolving rapidly. Understanding the long-term impact of these treatments, which have been linked with several potential complications affecting the mother and the child, poses a constant challenge for the scientific community. The main complications discussed in this review include the rare but serious risk of thromboembolic disease particularly in the upper half of the body and a higher risk of pregnancy complications including abnormal placentation, miscarriage, gestational diabetes and hypertensive disorders. A link between assisted conception and a number of genital cancers particularly of the breast, ovary and endometrium has also been suggested, but the evidence is currently inconclusive. A number of foetal and neonatal complications including imprinting disorders, low birth weight, congenital malformations and growth disorders are also discussed. [ABSTRACT FROM AUTHOR]

Objective. To investigate time trends and risk factors for peripartum cesarean hysterectomy. Methods. A population-based study comparing all deliveries that were complicated with peripartum hysterectomy to deliveries without this complication was conducted. Deliveries occurred during the years 1988--2007 at a tertiary medical center. A multiple logistic regression model was constructed to find independent risk factors associated with peripartum hysterectomy. Results. Emergency peripartum cesarean hysterectomy complicated 0.06%% ( n == 125) of all deliveries in the study period ( n == 211,815). The incidence of peripartum hysterectomy increased over time (1988--1994, 0.04%%; 1995--2000, 0.05%%; 2001--2007, 0.095%%). Independent risk factors for emergency peripratum hysterectomy from a backward, stepwise, multivariable logistic regression model were: uterine rupture (OR == 487; 95%% CI 257.8--919.8, p < 0.001), placenta previa (OR == 66.4; 95%% CI 39.8--111, p < 0.001), postpartum hemorrhage (PPH) (OR == 40.8; 95%% CI 22.4--74.6, p < 0.001), cervical tears (OR == 22.3; 95%% CI 10.4--48.1, p < 0.001), second trimester bleeding (OR == 6; 95%% CI 1.8--20, p == 0.003), previous cesarean delivery (OR == 5.4; 95%% CI 3.5--8.4, p < 0.001), placenta accreta (OR == 4.7; 95%% CI 1.9--11.7, p == 0.001), and grand multiparity (above five deliveries, OR == 4.1; 95%% CI 2.5--6.6, p < 0.001). Newborns of these women had lower Apgar scores (<7) at 1 and 5 min (32.7%% vs.4.4%%; p < 0.001, and 10.5%% vs. 0.6%%; p < 0.001, respectively), and higher rates of perinatal mortality (18.4%% vs. 1.4%%; p < 0.001) as compared to the comparison group. Conclusion. Significant risk factors for peripartum hysterectomy are uterine rupture, placenta previa, PPH, cervical tears, previous cesarean delivery, placenta accreta, and grand multiparity. Since the incidence rates are increasing over time, careful surveillance is warranted. Cesarean deliveries in patients with placenta previa-accreta, specifically those performed in women with a previous cesarean delivery, should involve specially trained obstetricians, following informed consent regarding the possibility of peripartum hysterectomy. [ABSTRACT FROM AUTHOR]

Objective. There is limited data on pregnancy outcome in inflammatory bowel diseases (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]) from Eastern Europe. The aim of our multicenter study was to compare the pregnancy outcomes and the data of infants in pregnancies before and after the diagnosis of IBD. Patients and methods. 97 pregnancies in women with IBD (36 CD and 61 UC) and 70 pregnancies in the same women before the diagnosis of IBD (24 CD and 46 UC) were compared. The influence of disease activity and medical treatment during pregnancy on gestational age at birth, birth weight, health status of the newborns and the frequency of childhood diseases were analyzed. Results. Preterm birth and low birth weight were more common in IBD compared to those pregnancies delivered before the diagnosis of the disease ( p = 0.008, p = 0.048). The occurrence of congenital abnormalities was not influenced by IBD, whereas childhood diseases occurred more frequently in the offspring of mothers with active UC. Disease activity in CD and UC during pregnancy did not predispose to abnormal birth outcome, compared to inactive disease. The type of medical treatment did not affect the pregnancy outcome in IBD. Conclusion. Preterm birth and low birth weight were more common in IBD. The medical treatment of the active disease during pregnancy did not increase the frequency of abnormal birth outcomes. Medical maintenance treatment should be continued during pregnancy to avoid relapses, although IBD seems to be an independent risk factor for low birth weight and preterm birth. [ABSTRACT FROM AUTHOR]

Objective. Pentraxin 3 (PTX3) is an acute-phase protein that has an important role in the regulation of the innate immune response. The aim of this study was to determine if maternal plasma PTX3 concentration changes in the presence of intra-amniotic infection and/or inflammation (IAI) in women with preterm labor (PTL) and intact membranes, as well as those with preterm prelabor rupture of membranes (preterm PROM). Study design. This cross-sectional study included women in the following groups: (1) nonpregnant ( n = 40); (2) uncomplicated pregnancies in the first ( n = 22), second ( n = 22) or third trimester ( n = 71, including 50 women at term not in labor); (3) uncomplicated pregnancies at term with spontaneous labor ( n = 49); (4) PTL and intact membranes who delivered at term ( n = 49); (5) PTL without IAI who delivered preterm ( n = 26); (6) PTL with IAI ( n = 65); (7) preterm PROM without IAI ( n = 25); and (8) preterm PROM with IAI ( n = 77). Maternal plasma PTX3 concentrations were determined by ELISA. Results. (1) Maternal plasma PTX3 concentrations increased with advancing gestational age ( r = 0.62, p < 0.001); (2) women at term with spontaneous labor had a higher median plasma PTX3 concentration than those at term not in labor (8.29 ng/ml vs. 5.98 ng/ml, p = 0.013); (3) patients with an episode of PTL, regardless of the presence or absence of IAI and whether these patients delivered preterm or at term had a higher median plasma PTX3 concentration than normal pregnant women ( p < 0.001 for all comparisons); (4) similarly, patients with preterm PROM, with or without IAI had a higher median plasma PTX3 concentration than normal pregnant women ( p < 0.001 for both comparisons); and (5) among patients with PTL and those with preterm PROM, IAI was not associated with significant changes in the median maternal plasma PTX3 concentrations. Conclusions. The maternal plasma PTX3 concentration increases with advancing gestational age and is significantly elevated during labor at term and in the presence of spontaneous preterm labor or preterm PROM. These findings could not be explained by the presence of IAI, suggesting that the increased PTX3 concentration is part of the physiologic or pathologic activation of the pro-inflammatory response in the maternal circulation during the process of labor at term or preterm. [ABSTRACT FROM AUTHOR]

This retrospective, cost consequence analysis examined three distinct outreach strategies used by a community-based public health agency to enroll uninsured, low-income pregnant women in perinatal health care services. The three strategies included outreach workers, liaison workers, and case managers. Data analysis revealed that costs per enrollee by strategy were: outreach workers: $429; liaison workers: $98; and case managers: $187. Cost per strategy must be considered cautiously, however, because outreach and enrollment strategies at this agency are not mutually exclusive. Data analysis also revealed that the number of low and very low birth weight babies born to women enrolled in the study agency was half that of the general population, even though less than half the participants were enrolled in prenatal care during the first trimester of pregnancy. Findings from this study support the use of outreach and enrollment strategies to reduce barriers to access to health care and reduce health disparities of low-income, vulnerable populations. [ABSTRACT FROM AUTHOR]

Objective. The present study was aimed to test the association between asymptomatic bacteriuria during pregnancy, among patients in whom antibiotic treatment was recommended, and perinatal outcome. Our study was also designed to characterize common bacteria and risk factors associated with asymptomatic bacteriuria during pregnancy. Methods. A retrospective population-based study comparing all singleton pregnancies of women with and asymptomatic bacteriuria was conducted. Patients with urinary tract infection were excluded from the analysis. Multiple logistic regression model was used to control for confounders. Results. Out of 199,093 deliveries, 2.5% (n = 4890) were in patients with asymptomatic bacteriuria. E. coli was the most common pathogen associated with asymptomatic bacteriuria, representing 78.6% of the cultures with specified growth. Patients with asymptomatic bacteriuria were more likely to deliver preterm (PTD, 13.3%vs. 7.6%, odd ratio (OR) = 1.9, 95% confidence interval CI 1.7-2.0; P < 0.001) and deliver low birth-weight neonates (<2500 g, 13.3%vs. 7.9%, OR = 1.8; 95% CI 1.6-2.0; P < 0.001). Asymptomatic bacteriuria was independently associated with PTD (adjusted OR = 1.6; 95% CI 1.5-1.7; P < 0.001), fertility treatments, hypertensive disorders, recurrent abortions, diabetes mellitus, intrauterine growth restriction, polyhydramnion and oligohydramnion, premature rupture of membranes and labour induction, in a multivariable analysis with backwards elimination. Perinatal mortality rates (1.5%vs. 1.4%; P = 0.707) as well as low 5 min Apgar scores (0.8%vs. 0.6%; P = 0.065) were comparable between the groups. Conclusion. Asymptomatic bacteriuria is an independent risk factor for preterm delivery. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to identify risk factors associated with maternal night blindness in rural South India. Methods: At delivery, women enrolled in a population-based trial of newborn vitamin A supplementation were asked whether they were night blind at any time during the pregnancy. Multivariate logistic regression was used to identify socioeconomic, demographic, and pregnancy-related factors associated with maternal night blindness. Results: Women reported night blindness in 687 (5.2%) of 13,171 pregnancies. In a multivariate model, having a concrete roof (Odds Ratio (OR): 0.60, 95% Confidence Interval (CI): 0.47, 0.78), religion other than Hindu (OR: 0.46, 95% CI: 0.27, 0.76), maternal literacy (OR: 0.58, 95% CI: 0.49, 0.69), and maternal age from 25 to 29 years (OR: 0.68, 95% CI: 0.50, 0.93) were associated with a lower risk of night blindness in pregnancy. The odds of night blindness were higher for those leasing rather than owning land (OR: 1.78, 95%CI: 1.08, 2.93), parity 6 or more compared to 0 (OR: 2.11, 95% CI: 1.09, 4.08), and with twin pregnancies (OR: 3.23, 95% CI: 1.93, 5.41). Factors not associated with night blindness in the multivariate model were other markers of socioeconomic status such as electricity in the house, radio and television ownership, type of cooking fuel and household transportation, and number of children under 5 years of age in the household. Conclusions: Maternal night blindness was prevalent in this population. Being pregnant with twins and of higher parity put women at higher risk. Maternal literacy and higher socioeconomic status lowered the risk. [ABSTRACT FROM AUTHOR]

Teenage pregnancy is a global problem and is considered a high-risk group, in spite of conflicting evidence. Our objective was to compare obstetric outcomes of pregnancy in teenagers and older women. This was a retrospective study of case records of pregnancies from August 2000 to July 2001. Girls aged ≤19 years were compared with pregnancy outcomes in older women (19-35 years) in the same hospital. The study took place in the Government General Hospital, Sangli, India, a teaching hospital in rural India, with an annual delivery rate of over 3,500. A total of 386 teenage pregnancies were compared with pregnancies in 3,326 older women. Socioeconomic data, age, number of pregnancies, antenatal care and complications, mode of delivery, and neonatal outcomes were considered. The incidence of teenage pregnancy in the study was 10%. A significant proportion of teenage pregnant mothers were in their first pregnancies. The teenage mothers were nearly three times more at risk of developing anaemia (OR = 2.83, 95% CI = 2.2-3.7, p < 0.0001) and delivering pre-term (OR = 2.97, 95% CI = 2.4-3.7, p < 0.0001). Teenage mothers were twice as likely to develop hypertensive problems in pregnancy (OR = 2.2, 95% CI = 1.5-3.2, p < 0.0001) and were more likely to deliver vaginally with no significant increase in the risk of assisted vaginal delivery or caesarean section. Young mothers were nearly twice at risk of delivering low birth weight babies (OR = 1.8, 95% CI = 1.5-2.2, p < 0.0001) and 50% less likely to have normal birth weight babies (OR = 0.5, 95% CI = 1.2-2.9, p < 0.0001). The outcome of this study showed that teenage pregnancies are still a common occurrence in rural India in spite of various legislations and government programmes and teenage pregnancy is a risk factor for poor obstetric outcome in rural India. Cultural practices, poor socioeconomic conditions, low literacy rate and lack of awareness of the risks are some of the main contributory factors. Early booking, good care during pregnancy and delivery and proper utilisation of contraceptive services can prevent the incidence and complications in this high-risk group. [ABSTRACT FROM AUTHOR]

Despite low fertility rates in Western countries, maternity remains one of the major goals of women from various socioeconomic backgrounds. While most women will have low-risk pregnancies, common serious disorders of pregnancy, such as preeclampsia, premature rupture of the membranes, placenta previa, or fetal growth restriction, may compromise maternal and infant outcomes. The experiences of urban and rural women in Australia who have had difficulties in maintaining their pregnancies are analyzed in this article. We study the impact of individual and social factors that facilitate or impede women's adjustment to the risks associated with these disorders. The analysis of in-depth interviews with 27 women hospitalized antenatally indicates that most women were unfamiliar with the diagnoses and acted as passive “decision takers,” complying with medical advice to remain in the hospital. Admission to a tertiary hospital ward that provided care to women with pregnancy disorders promoted the formation of a new identity, that of a woman whose pregnancy did not follow the expected path. Further, hospitalization offered women the opportunity to interact with others in similar difficult situations and, hence, feel less isolated. [ABSTRACT FROM AUTHOR]

Previous studies have indicated that sperm quality may be related to unexplained recurrent pregnancy loss. This study evaluated the degree of sperm DNA fragmentation using the TUNEL assay on sperm from 24 couples with unexplained recurrent pregnancy loss (RPL) compared to sperm from 2 control groups: donors of known fertility and unscreened men from the general population. The percentage of sperm staining positive for DNA fragmentation was increased (p < .001) in the RPL group (38 ± 4.2) compared to the donor (11.9 ± 1.0) or general population (22 ± 2.0) control groups. In the RPL group, no correlation was observed between semen quality parameters and the TUNEL data. These data indicate that some RPL patients have a significant increase of sperm DNA fragmentation, which may be causative of pregnancy loss in some patients. [ABSTRACT FROM AUTHOR]

The authors examined the independent and interactive effects of acculturation status and family cohesiveness on a series of psychosocial and medical risk factors of pregnancy among 500 women of Mexican origin. In general, both higher and lower levels of acculturation produced positive or negative psychosocial and healthcare consequences, and the operative relationships depended heavily on the particular outcome chosen. Higher levels of family cohesiveness tended to foster the most constructive health and psychosocial outcomes. However, in some circumstances higher levels of family cohesiveness resulted in less coping and a lower quality of prenatal care for less acculturated women. An important implication of this study is that psychosocial and health information can be obtained through assessments that identify different subgroups of Mexican American women and depend on women's level of acculturation and family cohesiveness. Culturally competent health practitioners or clinicians can conduct these assessments in a prenatal healthcare setting. [ABSTRACT FROM AUTHOR]

This paper sets out a methodology for risk assessment of pregnancies in terms of adverse outcomes such as low birth-weight and neonatal mortality in a situation of multiple but possibly interdependent major dimensions of risk. In the present analysis, the outcome is very low birth-weight and the observed risk indicators are assumed to be linked to three main dimensions: socio-demographic, bio-medical status, and fertility history. Summary scores for each mother under each risk dimension are derived from observed indicators and used as the basis for a multidimensional classification to high or low risk. A fully Bayesian method of implementation is applied to estimation and prediction. A case study is presented of very low birth-weight singleton livebirths over 1991-93 in a health region covering North West London and parts of the adjacent South East of England, with validating predictions to maternities in 1994. [ABSTRACT FROM AUTHOR]

Objective: To compare perioperative and pregnancy outcome between women undergoing laparoscopic appendectomy and those undergoing open appendectomy during pregnancy for presumed acute appendicitis. Methods: A retrospective cohort study of all women undergoing appendectomy during pregnancy in a tertiary referral medical center from 2000 to 2009. Outcome was compared between those undergoing laparoscopic appendectomy and those undergoing open appendectomy. Results: Overall, 83 510 deliveries occurred during the study period, 85 (0.10%) were eligible for the study group. Of these, 26 (31%) had a laparoscopic appendectomy and 59 (69%) had an open appendectomy. No significant difference was found in the general, delivery and neonatal outcome characteristics between the two groups. There was a significant difference in the mean gestational age at surgery between laparoscopic appendectomy and the open appendectomy groups (14.6 versus 19.3 weeks respectively, p = 0.009). Post-operative complications (fever >38.0 °C or the presence of uterine contractions) rate was higher in the open appendectomy compared to the laparoscopic appendectomy group (25.5% versus 3.8%, respectively, p = 0.009). Conclusion: Laparoscopic appendectomy appears to be a safe procedure for presumed acute appendicitis during pregnancy with less post-operative complications as compared to open appendectomy. [ABSTRACT FROM AUTHOR]

Objective: It is suggested that grandmultiparity is a troublesome condition in obstetric settings because of increased perinatal complications. Our objective was to compare the incidence of antenatal and intrapartum complications and perinatal outcomes among women who had delivered ≥5 times (grandmultiparous) with those of women who had delivered 1-4 times (parous). Method: A retrospective study was conducted in a university hospital. The study population consisted of age-matched 249 grandmultiparous women and 338 parous women, who had delivered between January 2008 and January 2011. Maternal case records were retrieved and analyzed from the labor ward records. Statistical analysis was done using SPSS version 14.0; χ2 test was used to analyze categorical variables. Results: The frequencies of hypertensive disorders and gestational diabetes mellitus did not differ between gropus ( p > 0.05). Obstructed labor, cord prolapse, placenta previa and abruptio placenta were higher in grandmultiparous women. A significantly higher rate of cesarean deliveries was observed in the study population. There was no difference in terms of mode of delivery, prevalence of low and high birthweight (<2.5 and >4 kg) babies, stillbirth, multiple pregnancy and fetal distress. Conclusions: We did not observe an increased incidence of perinatal complications in grandmultiparous women. [ABSTRACT FROM AUTHOR]

An editorial is presented on the importance of mental health in women before and after pregnancy as it also affects physical fitness. It talks about preconception care for pregnant women until the time for child birth or delivery. It tells about the importance of mental health in women during the perinatal period which after pregnancy.

The article discusses the management of diabetes mellitus in pregnancy. It explores the risks associated with diabetes during pregnancy and the different types of this disorder such as gestational diabetes (GDM) and pregestational diabetes. Moreover, it emphasizes the need for maintaining excellent glycaemic control for at least three months before conception to reduce the incidence of congenital anomalies, and emphasizes the importance of dietary advice.

Objective. To assess the association of late preterm births (LPB [[340/7-366/7]]) and maternal risk factors with Neonatal Intensive Care Unit (NICU) admissions. Methods. A retrospective cross-sectional analysis was conducted using data of all who delivered between 2000 and 2008. Statistical analysis was done using Chi-square and multivariable logistic regression. Results. During the study period, 259,576 babies were delivered, and 11.6%% were admitted to the NICU. Using logistic regression (NICU admission vs. no NICU admission), there was a 9-fold increased risk associated with preterm labor including preterm premature rupture membranes (PTL/PPROM) while LPB and essentially all other maternal risk factors were not significant. Conclusions. In our study, NICU admissions are more associated with PTL/PPROM rather than LPB and maternal risk factors. [ABSTRACT FROM AUTHOR]

Cushing's syndrome occurs rarely in pregnancy because of ovulatory disturbances including anovulation which is caused by hypercortisolism, but it can cause maternal complications such as hypertension, gestational diabetes, spontaneous abortion, premature birth, pre-eclampsia and stillbirth. Herein we present the case of a 22-year-old patient in the 11th week of pregnancy who was admitted to our hospital with Cushing's syndrome complicated by early pre-eclampsia. Severe pre-eclampsia has high maternal and perinatal morbidities, and therefore the possibility of this complication requires that Cushing's syndrome, although rare in pregnancy, be given a high clinical suspicion. Medical therapy and/or surgical therapy should be considered promptly to influence outcome favorably. [ABSTRACT FROM AUTHOR]

We aimed to assess the risk factors for hepatitis B infection among pregnant women in Enugu, southeast Nigeria. This was a prospective case-control study of risk factors for hepatitis B surface antigen positivity among pregnant women seen in two tertiary health institutions in Enugu, southeast Nigeria. It was carried out over an 8-month period, January – August 2005. Of the 1,499 pregnant women attending the antenatal clinic, 4.6% (n = 69) were seropositive for hepatitis B surface antigen. A total of 35 (50.7%) HBsAg positive women and 71 negative controls were interviewed. The risk factors for HBsAg were present in 71% (n = 25) of the positive cases, while only 27% (n = 19) of the negative cases had risk factors. The significant risk factors for HBsAg positivity were higher mean parity, higher number of sexual partners since sexual debut, polygamy and previous positive history of sexually transmitted diseases (STD) (p < 0.05). The two groups did not differ with respect to presence of tattoo or scarification marks, positive history of jaundice or contact with a jaundiced patient, previous blood transfusion or contact with blood products, intravenous drug abuse or sharing personal instruments (p > 0.05). Screening pregnant women for hepatitis B infection on the basis of presence of risk factors may not effective. Universal antenatal screening for HBsAg, health education aimed at reducing risk factors and immunisation of all newborn and those at risk of hepatitis B is advocated. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old pregnant woman with pyogenic liver abscess who was diagnosed with leukocytosis, ill-defined focal lesion, and subacute cholecystitis. It notes that the patient was treated with ultrasound-guided percutaneous aspiration and broad spectrum intravenous antibiotic and was then discharged without any medical issues.

In the article, the authors discuss the regulations on the issue of who is responsible in securing informed consent and parental permission for conducting clinical trial in extremely premature infants in the U.S. as of April 2015. According to two local institutional review boards (IRB), attending physicians could secure parental permission. Protocol, however, disqualifies attending physician of record from securing approval. Also cited are the rule of the Food and Drug Administration (FDA).

The article discusses the impacts of grandmultiparity on adverse pregnancy outcomes on the pregnancy planning in Japan. It examines the pregnancy outcomes of 41 Japanese women and observe an increased in incidence of perinatal complications in grandmultiparous women. Two tables are presented which shows the research result on the pregnancy outcomes of Japanese women and of the age-matched Japanese women.