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Introduction: Bartter’s syndrome comprises a heterogeneous group of inherited salt-losing tubulopathies. There are two forms of clinical presentation: classical and neonatal, the most severe type. Types I and II account for most of the neonatal cases. Types III and V are usually less severe. Characteristically Bartter’s syndrome type IV is a saltlosing nephropathy with mild to severe neonatal symptoms, with a specific feature - sensorineural deafness. Bartter’s syndrome type IV is the least common of all recessive types of the disease. Description: the first reported case of a Portuguese child with neurosensorial deafness, polyuria, polydipsia and failure to thrive, born prematurely due to severe polyhydramnios, with the G47R mutation in the BSND gene that causes Bartter’s syndrome type IV. Discussion: there are few published cases of BS type IV due to this mutation and those reported mostly have moderate clinical manifestations which begin later in life. The poor phenotype-genotype relationship combined with the rarity of this syndrome usually precludes an antenatal diagnosis. In the presence of a severe polyhydramnios case, with no fetal malformation detected, normal karyotype and after maternal disease exclusion, autosomal recessive diseases, including tubulopathies, should always be suspected.

Stress is one of the effective factors in the occurrence of negative effects during pregnancy that can cause adverse outcomes such as preterm delivery and reduced intrauterine growth of the fetus in pregnant women. Therefore, one of the serious concerns during the COVID-19 pandemic is the physical health and mental health of pregnant women. This study aimed to evaluate the physical health status with the spiritual and mental health of pregnant women during the COVID-19 pandemic. The study is a descriptive study in 2019–2020 and the samples were randomly selected from all pregnant women who referred to hospitals and private maternity centers before and during the COVID-19 pandemic and performed all pregnancy and fetal health tests. It was performed on 560 pregnant female samples. The mental status of pregnant women was assessed using the DASS Spiritual Health and Stress Questionnaire. Data analysis was performed using SPSS statistical software (version 24). The results of this study showed that preterm birth, height, weight, and head circumference of babies and lungs and respiratory status of children with mental health and stress levels of pregnant women during the corona are significant compared with the previous of corona (p

Objective To determine the maternal risk factors associated with preterm delivery in Iran. Methods A population-based case-control study was conducted including 48 women having preterm delivery (case group) and 100 women having term delivery (control group) between March 2007 and March 2012 in the maternity hospitals of the Selseleh County, Lorestan province, Iran. Information regarding maternal risk factors was collected by structured interview and reviewing the medical records. The maternal risk factors associated with preterm delivery were identified using univariate and multivariable logistic regression analysis after adjusting the sparse data bias. The area under the receiver operating characteristic (ROC) curves was estimated to evaluate the discrimination power of the statistical models. Results Multivariable analysis demonstrated that multiparty (odds ratio [OR], 14.23; 95% confidence interval [CI], 1.60–127.05), history of gestational diabetes (OR, 0.10; 95% CI, 0.01–0.99), thyroid dysfunction (OR, 97.32; 95% CI, 5.78–1,637.80), urinary tract infection (OR, 16.60; 95% CI, 3.20–85.92), and taking care during pregnancy (OR, 0.12; 95% CI, 0.03–0.50) had significant impact on preterm delivery after adjusting the potential confounders. The area under the ROC curve for the aforementioned maternal risk factors was 0.86 (95% CI, 0.80–0.92). Conclusion Our study provides evidence for the associations between multiparty, history of gestational diabetes, thyroid dysfunction, urinary tract infection, as well as taking care during pregnancy, and preterm delivery.

Background and Objectives: Therapeutic interventions targeting molecular factors involved in the transition from uterine quiescence to overt labour are not substantially reducing the rate of spontaneous preterm labour. The identification of novel rational therapeutic targets are essential to prevent the most common cause of neonatal mortality. Based on our previous work showing that Tbx2 (T-Box transcription factor 2) is a putative upstream regulator preceding progesterone withdrawal in mouse myometrium, we now investigate the role of TBX2 in human myometrium. Materials and Methods: RNA microarray analysis of (A) preterm human myometrium samples and (B) myometrial cells overexpressing TBX2 in vitro, combined with subsequent analysis of the two publicly available datasets of (C) Chan et al. and (D) Sharp et al. The effect of TBX2 overexpression on cytokines/chemokines secreted to the myometrium cell culture medium were determined by Luminex assay. Results: Analysis shows that overexpression of TBX2 in myometrial cells results in downregulation of TNFα- and interferon signalling. This downregulation is consistent with the decreased expression of cytokines and chemokines of which a subset has been previously associated with the inflammatory pathways relevant for human labour. In contrast, CXCL5 (C-X-C motif chemokine ligand 5), CCL21 and IL-6 (Interleukin 6), previously reported in relation to parturition, do not seem to be under TBX2 control. The combined bioinformatical analysis of the four mRNA datasets identifies a subset of upstream regulators common to both preterm and term labour under control of TBX2. Surprisingly, TBX2 mRNA levels are increased in preterm contractile myometrium. Conclusions: We identified a subset of upstream regulators common to both preterm and term labour that are activated in labour and repressed by TBX2. The increased TBX2 mRNA expression in myometrium collected during a preterm caesarean section while in spontaneous preterm labour compared to tissue harvested during iatrogenic preterm delivery does not fit the bioinformatical model. We can only explain this by speculating that the in vivo activity of TBX2 in human myometrium depends not only on the TBX2 expression levels but also on levels of the accessory proteins necessary for TBX2 activity.

Resumen. Introducción: El parto pretérmino es uno de los principales problemas de la salud infantil. Es la principal causa de mortalidad infantil en los países en vía de desarrollo. Los últimos 20 años ha venido en aumento en el mundo por diferentes causas. Conocer su tendencia y características poblacionales es un elemento útil para su atención. Objetivo: Describir las características poblacionales asociados al parto pretérmino en Colombia desde los datos del Registro del Nacido Vivo en la década 2008 - 2017. Métodos: Estudio descriptivo ecológico a partir de fuentes segundarias: microdatos de Estadísticas Vitales del DANE; información almacenada en el programa Excel de Microsoft Office®. Análisis de las variables tiempo/lugar/persona en el programa estadístico SPSS™ mediante estadística descriptiva, análisis de asociación utilizando el estadístico Ji-cuadrado y el coeficiente de correlación Phi para la asociación estadística entre variables. Resultados. Fueron analizados 6.705.385 registros de nacidos vivos, 1.277.839 correspondientes a parto hasta las 37 semanas de gestación. Prevalencia del 19% de todos los años. Departamentos con mayor tasa de prematuros: Atlántico, Bogotá, Antioquía y Santander. No se encontró una asociación fuerte con los datos del registro del nacido vivo. Conclusiones: Existe déficit de información acerca del parto pretérmino en aspectos de datos completos y accesibles a los investigadores. La información no es homogénea ni sigue parámetros específicos. El registro de nacido vivo, sin embargo, es un excelente instrumento de recolección de datos poblacionales y base de aproximación al evento. Abstract Background: Preterm birth is one of the main problems in infant health and it is the leading cause of infant mortality in developing countries. During the last 20 years this particularity has been increasing in the world for different reasons. Knowing its trend and population characteristics is a useful element for its attention. Objectives: To describe the population characteristics associated with preterm birth in Colombia from the data of the Live Birth Registry in the decade 2008 - 2017. Methods: Descriptive ecological study using secondary sources such us Vital Statistics microdata from DANE; information stored in the Microsoft Office® Excel program. Also, the analysis of the time/place/person variables in the SPSS ™ statistical program through descriptive statistics, and association analysis using the Chi-square statistic and the Phi correlation coefficient for the statistical association between variables was implemented. Results: 6,705,385 records from live-born registry were analyzed. 1,277,839 corresponded to preterm birth up to 37 weeks of gestation with 19% of prevalence all years. The departments with the highest rate of premature infants were Atlántico, Bogotá, Antioquia, and Santander. No strong association was found with live birth registry data. Conclusions: There is lack of complete and accessible information to researchers related to preterm birth. The data is not homogeneous and does not follow specific parameters. However, the live-born registry is an excellent instrument for collecting population data and a useful basis for approaching this event.

Background Risk perception is based on collective indicators, but it is influenced by the individual’s self-perception of his health-disease process. This study aims to investigate the risk perception of pregnant women who were identified as high-risk for premature birth and to seek strategies for better management of such cases. Methods This is a cross-sectional study where women who had completed their participation in P5 trial were contacted and invited to answer a structured questionnaire with open questions. Data were collected by telephone and analyzed using thematic analysis. The analysis categories were defined, and all the answers were reviewed, categorized, grouped, and a descriptive summary was prepared. Results Two hundred eight Brazilian women have participated. Three categories were identified: (1) Risk perception mediated by health professionals; (2) Self-perception of risk through personal experiences and relationships; (3) Perception of treatment success. After receiving an explanation from a health professional about short cervix and premature birth, women understood the risk of premature delivery, recognizing the importance of early diagnosis to prevent premature birth. Unsuccessful previous experiences in prior pregnancies influenced women’s risk perception. Patients believed in the success of the treatment performed, placing their hopes on the treatment even without research guarantees about benefits. Conclusions Pregnant women’s risk perception regarding prematurity is based partly on personal and family experiences but mainly on information given by health professionals. The risk perception about preterm birth may contribute to healthy pregnancy, guiding necessary interventions and preventing adverse outcomes. Prevention studies on prematurity should thus focus on neonatal outcomes.

Thyroid dysfunction in pregnancy is strongly associated with adverse maternal and foetal outcomes. The effects of treatment are less clear. There is ongoing discussion on whom to treat, when to treat and whether treatment is beneficial. Although universal screening for thyroid disease during pregnancy increases diagnosis and treatment of thyroid dysfunction, there is currently insufficient evidence demonstrating a positive effect of screening on maternal and foetal outcomes. We therefore, at present, recommend against universal screening for thyroid disease before and during pregnancy.

The article presents the analysis of the health status of children born prematurely during the first year of their life. There is the comparison of morbidity rates for five years of the operation of the catamnesis center of Kazan. Profoundly premature children demonstrated the highest level of morbidity with more frequent pathologies of the central nervous system, respiratory organs, eyes and anemia of premature children. In 2017 there was a decrease in the frequency and severity of respiratory diseases (bronchopulmonary dysplasia with chronic respiratory insufficiency 1.6 times), the nervous system (severe ischemic and hypoxic-hemorrhagic lesions of CNS 2.7 times), eyes and its adnexa (a complicated retinopathy of premature children 1.7 times) in extremely premature infants.

Acquired hemophilia A (AHA) is a rare antibody-mediated condition in which autoantibodies form against a coagulation factor, most commonly factor VIII (FVIII), causing severe coagulopathy. Here the present report presents a case of AHA in a 35-year-old postpartum woman with continuous polyserous bloody effusions who was admitted to the First Affiliated Hospital of Zhejiang Chinese Medical University (Hangzhou, China) in October 2017 without a history of trauma, anticoagulation treatment or coagulopathy. At presentation, the patient's hemoglobin level was low (70 g/l; normal range: 115-150 g/l) g/l, blood pressure was 89/58 mmHg (normal range, 90-140/60-90 mmHg), and activated partial thromboplastin time was 68.4 sec (normal range: 25.0-36.0 sec), with a normal international normalized ratio (0.94; normal range, 0.8-1.2). The reaction time in thrombography was prolonged (35.8 min; normal range: 5-10 min), coagulation FVIII had markedly decreased activity (12.6%; normal range, 60-150%), and FVIII inhibitor had a high titer [7.4 Bethesda units (BU)/ml; normal range, 0-0.6 BU/ml]. Notably, the patient's autoantibody level was markedly higher than normal (1:320; normal range

Made available in DSpace on 2020-12-12T01:17:56Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01. Added 1 bitstream(s) on 2021-07-15T15:07:11Z : No. of bitstreams: 1 S1516-31802019000600486.pdf: 133413 bytes, checksum: 906c92a04d534e8f7ab435dd545e2f52 (MD5) BACKGROUND: Exposure to air pollutants has several effects on human health, including during pregnancy. OBJECTIVE: To identify whether exposure to benzene and toluene among pregnant women contributes to preterm delivery. DESIGN AND SETTING: Longitudinal study using data on newborns from mothers living in São José dos Campos (SP) in 2016, who had been exposed to benzene and toluene. METHODS: A logistic regression model with three hierarchical levels was constructed using maternal variables relating to newborns, and using benzene and toluene concentrations in quartiles. Occurrences of cesarean births, twins or malformations were excluded. Maternal exposure windows of 5, 10, 15, 30, 60 and 90 days prior to delivery were considered. RESULTS: Out of the 9,562 live births, 3,671 newborns were included and 343 newborns were born at less than 37 weeks of gestation (9.3%). The average birth weight was 3,167.2 g. Exposure to benzene and toluene was significantly associated (P = 0.04) with preterm delivery in the five-day window. There was no association in any of the other exposure windows. CONCLUSIONS: It was possible to identify that maternal exposure to benzene and toluene has an acute effect on preterm delivery. Department of Energy Universidade Estadual de São Paulo (UNESP) Department of Energy Universidade Estadual de São Paulo (UNESP)

Preterm deliveries have multiple aetiologies and management is dependent on cause. Recent studies have shown that caesarean sections performed late in labour have been associated with recurrent, early premature births and late miscarriages (Figure 1). Both the prediction and management of these under‐recognised high‐risk cases needs to be elucidated.

Background In clinical trials, pregnant women are potentially vulnerable, and the fetus is exposed to the intervention. This study aimed to identify the reasons that led pregnant women at a high risk of premature delivery to participate in a randomized clinical trial. Methods The women participating in the main trial were contacted by telephone postpartum and invited to answer an open questionnaire in a cross-sectional study. Data were collected by telephone and analyzed using thematic analysis. After the analysis categories were defined, all the answers were reviewed, categorized and grouped. A descriptive summary of the content of each category was then made. Results Overall, 208 women from different geographical regions of the country agreed to participate. Four categories were identified: 1) The risk of losing the baby; 2) A previous experience of premature delivery; 3) The role of the doctor and other health professionals, and 4) The availability of quality medical care and free medication. The main reason given for agreeing to participate was to reduce the risks associated with the baby being born prematurely, particularly when the woman herself or someone close to her had already experienced premature delivery. Other reasons were having received clear guidance and explanations from the doctor regarding prematurity and about the study and being given the opportunity to receive free treatment with greater access to the public healthcare system. Conclusions The decision to participate in a clinical trial is not easy, particularly when the individual is vulnerable and in a critical situation as in the case of a pregnant woman at a high risk of delivering prematurely. Fears and uncertainties regarding the pregnancy outcome, as well as the woman’s previous experiences and her awareness of the actual risks she faces will affect her decision regarding whether or not to participate. Recruitment challenges could be overcome by ensuring that the research team provides adequate information and support, thus creating a bond with participants that would foster a sense of safety and trust in the study proposals. Electronic supplementary material The online version of this article (10.1186/s12884-019-2240-8) contains supplementary material, which is available to authorized users.

Funding: Ter Meulen Grant of the Royal Netherlands Academy of Arts and Sciences and the European Union’s Seventh Framework Programme for research, technological developmentand demonstration under grant agreement no 602030 (A.L.F.v.d.K.). Background: Observational studies have suggested that perinatal outcomes are worse in offspring of cancer survivors. We conducted a systematic review and meta-analysis to examine the risks of perinatal complications in female cancer survivors diagnosed before the age of 40 years. Methods: All published articles on pregnancy, perinatal or congenital risks in female cancer survivors were screened for eligibility. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Results: Twenty-two studies met the inclusion criteria. Meta-analysis indicates that offspring of cancer survivors are at increased risk of prematurity (relative risk [RR]: 1.56; 95% confidence interval [CI] 1.37–1.77) and low birth weight (RR 1.47; 95% CI 1.24–1.73) but not of being small for gestational age (RR 0.99; 95% CI 0.81–1.22). Cancer survivors have higher rates of elective (RR: 1.38; 95% CI 1.13–1.70) and emergency caesarean section (RR: 1.22; 95% CI 1.15–1.30) as well as assisted vaginal delivery (RR: 1.10; 95% CI 1.02–1.18) and are at increased risk of postpartum haemorrhage (RR: 1.18; 95% CI 1.02–1.36). The risk of congenital abnormalities also appears increased (RR 1.10; 95% CI 1.02–1.20), but this is likely to be an artefact of analysis. Although meta-analysis of the effects of radiotherapy was not possible for all outcomes, there was an increased risk of prematurity (RR 2.27; 95% CI 1.34–3.82) and consistent findings of low birth weight (RR 1.38–2.31). Risk of being small for gestational age was increased only after high uterine radiotherapy dosage. Conclusion: The increased perinatal risks warrant a proactive approach from healthcare providers in both counselling and management of perinatal care for cancer survivors. Postprint

(1) Background: Premature infants require mothers&rsquo, milk fortification to meet nutrition needs, but breast milk composition may be variable, leading to the risk of inadequate nutrition. We aimed at determining the factors influencing mothers&rsquo, milk macronutrients. (2) Methods: Milk samples were analyzed for the first five weeks after premature delivery by infrared spectroscopy. Mothers&rsquo, nutritional intake data were obtained during standardized interviews with dieticians, and then analyzed with reference software. (3) Results: The composition of 367 milk samples from 81 mothers was (median (range) g/100 mL): carbohydrates 6.8 (4.4&ndash, 7.3), lipids 3.4 (1.3&ndash, 6.4), proteins 1.3 (0.1&ndash, 3.1). There was a relationship between milk composition and mothers&rsquo, carbohydrates intake only (r = 0.164, p &lt, 0.01). Postnatal age was correlated with milk proteins (r = &minus, 0.505, 0.001) and carbohydrates (r = +0.202, p &lt, 0.001). Multiple linear regression analyses showed (coefficient) a relationship between milk proteins r = 0.547 and postnatal age (&minus, 0.028), carbohydrate intake (+0.449), and the absence of maturation (&minus, 0.066), associations were also found among milk lipids r = 0.295, carbohydrate intake (+1.279), and smoking (&minus, 0.557). Finally, there was a relationship among the concentration of milk carbohydrates r = 0.266, postnatal age (+0.012), and smoking (&minus, 0.167). (4) Conclusions: The variability of mothers&rsquo, milk composition is differentially associated for each macronutrient with maternal carbohydrate intake, antenatal steroids, smoking, and postnatal age. Improvement in milk composition could be achieved by the modification of these related factors.

Background Preterm birth is a major public health problem in developed countries. In this context, we have conducted research into outpatient monitoring of uterine electrical activity in women at risk of preterm delivery. The objective of this preliminary study was to perform automated detection of uterine contractions (without human intervention or tocographic signal, TOCO) by processing the EHG recorded on the abdomen of pregnant women. The feasibility and accuracy of uterine contraction detection based on EHG processing were tested and compared to expert decision using external tocodynamometry (TOCO) . Methods The study protocol was approved by local Ethics Committees under numbers ID-RCB 2016-A00663-48 for France and VSN 02-0006-V2 for Iceland. Two populations of women were included (threatened preterm birth and labour) in order to test our system of recognition of the various types of uterine contractions. EHG signal acquisition was performed according to a standardized protocol to ensure optimal reproducibility of EHG recordings. A system of 18 Ag/AgCl surface electrodes was used by placing 16 recording electrodes between the woman’s pubis and umbilicus according to a 4 × 4 matrix. TOCO was recorded simultaneously with EHG recording. EHG signals were analysed in real-time by calculation of the nonlinear correlation coefficient H2. A curve representing the number of correlated pairs of signals according to the value of H2 calculated between bipolar signals was then plotted. High values of H2 indicated the presence of an event that may correspond to a contraction. Two tests were performed after detection of an event (fusion and elimination of certain events) in order to increase the contraction detection rate. Results The EHG database contained 51 recordings from pregnant women, with a total of 501 contractions previously labelled by analysis of the corresponding tocographic recording. The percentage recognitions obtained by application of the method based on coefficient H2 was 100% with 782% of false alarms. Addition of fusion and elimination tests to the previously obtained detections allowed the false alarm rate to be divided by 8.5, while maintaining an excellent detection rate (96%). Conclusion These preliminary results appear to be encouraging for monitoring of uterine contractions by algorithm-based automated detection to process the electrohysterographic signal (EHG). This compact recording system, based on the use of surface electrodes attached to the skin, appears to be particularly suitable for outpatient monitoring of uterine contractions, possibly at home, allowing telemonitoring of pregnancies. One of the advantages of EHG processing is that useful information concerning contraction efficiency can be extracted from this signal, which is not possible with the TOCO signal.

From a clinical point of view, easily obtainable and useful markers of a particular pathological status are required for appropriate diagnosis and treatment. Analysis of the proteomic profile of saliva may allow for the selection of potential marker of preterm delivery in humans. Saliva samples were collected from 12 patients diagnosed with threatened preterm delivery and 10 controls with uncomplicated pregnancies at the same gestational age. Samples were analysed using 2D electrophoresis. Based on statistical analysis, spots of interest were selected and collected from gels. Subsequently, spots were decoloured and proteins were identified by mass spectrometry using the matrix assisted laser desorption ionization-time of flight technique. The results of identification were compared with the Swiss-Prot database. A total of 1,393 spots were detected in the present study with 59 significantly different between control and preterm samples. Increased intensity of staining of 32 spots was observed in the premature delivery group compared with control patients and 27 spots were stained more intensely in the control group compared with the premature delivery group. A total of nine spots, which were significantly different between examined samples were identified and three of them exhibited increased intensity of staining in premature delivery group compared with controls, including dedicator of cytokinesis protein 1, metallothionein-2, guanylyl cyclase-activating protein 1. The six remaining spots included, epithelial-stromal interaction protein 1, serum albumin, tyrosine-tRNA ligase, cytoplasmic, protein chibby homolog 3, leukemia inhibitory factor receptor and adenosylhomocysteinase 3, and exhibited increased intensity of staining in healthy controls compared with premature delivery group. Further studies with an increased number of patients and identification of the complete protein profile are required to confirm the results of the present study and applicability of saliva as a source of disease biomarkers.

Pregnancy is a unique period during a woman's life and is characterized by complex physiological changes, which may adversely affect oral health. The present systematic review was conducted to assess knowledge and awareness regarding oral health among pregnant women in India. Relevant cross-sectional observational studies were included in the systematic review to assess the level of knowledge and awareness regarding oral health among pregnant women in India. Seven studies out of 255 were finally included in the present review after conducting both electronic and manual search of scientific databases. Potential biases were reported and appropriate data were extracted by the concerned investigators. Almost 67% of the subjects had good knowledge and awareness regarding oral health in one of the study findings. Knowledge regarding effect of decayed teeth on the appearance of the people was significantly related to the parity status of the subjects (P = 0.024) in other study reports. Very few subjects (17.1% and 37.5%) felt the need for visiting a dentist during pregnancy in two studies. The results of the present review showed that pregnant women had poor knowledge and awareness regarding oral health. Therefore, there is an urgent need for education and motivation of expectant mothers regarding oral health through various health promotion interventions.

Background: Corticosteroids are widely used in obstetrics due to their striking effect on perinatal morbidity and mortality of premature neonates. Despite this, relatively few studies have explored short term fetal effects of corticosteroids as measured by ultrasound. Objectives: 1) To present a literature review of short term fetal cardiovascular effects of corticosteroids 2) To describe the protocol of a current observational study (SUPER‐A*STEROID) of cardiovascular effects of dexamethasone and betamethasone in the first week after their administration. This trial is nested within the A*STEROID blinded multicentre randomised controlled trial of the two steroid preparations. Findings: Existing data suggest corticosteroids have little effect on the major measured fetal blood vessels when the baseline ultrasound is normal. In the compromised fetus, where the umbilical artery end‐diastolic flow is abnormal prior to maternal corticosteroids, flow is temporarily restored in approximately 50% of cases. Whether such changes are beneficial is uncertain. Very little data exist that directly compare the short‐term effects of betamethasone and dexamethasone. The SUPER‐ A*STEROID study described will help provide this information.

The use of combination antiretroviral therapy for the prevention of mother to child transmission of HIV infection has achieved vertical HIV transmission rates of

International audience; To assess the impact of endometriosis on obstetric outcomes and to determine whether the severity, location and surgical treatment of the disease before the pregnancy had an impact on the prevalence of these disorders, a monocentric, case-control study was performed. In total, 113 pregnancies obtained by assisted reproductive treatment among patients with endometriosis were matched with control selected among assisted reproductive treatment pregnancies due to male infertility. The main result measures were pregnancy outcome at the obstetrical and neo-natal levels. The incidence of first trimester bleeding, pre-eclampsia, premature delivery threat, pelvic pain and Caesarean section was significantly higher (P < 0.05) in women with endometriosis. Except for gestational diabetes and intrauterine growth restriction (IUGR), the severity, location of lesions and surgical treatment of endometriosis did not have an impact on either pregnancy outcome or risk of obstetric complications. The IUGR is mainly due to deep locations and the revised American Fertility Society (rAFS) stages III-IV. Newborns with a mother suffering from endometriosis are at greater risk of being premature, smaller for their gestational age and more frequently hospitalized than the control group. Deep location of endometriosis is associated with more prematurity, hospitalization and smaller birthweight than ovarian locations.

Prematurity (5 days per week) in the causal pathway of premature delivery (6). Long working hours and heavy lifting are alleged to be associated with preterm delivery (7). Whilst some studies conclude there is a causal link between heavy lifting and preterm birth, another study concluded that, regardless of the exposure periods and the frequency of lifting, there is no significant association between heavy lifting and preterm birth (8). In a recent National Birth Cohort in Denmark, researchers published in the Scandinavian Journal of Work, Environment and Health concluded that occupational lifting of medium-to-heavy loads can lead to pelvic pain during pregnancy (9) whilst pelvic pain is a common signal of labor initiation. Interventions, such as health education, maternity leave, or reassignment to a less-physical task, are already in place in most Western countries to prevent exposure to heavy lifting at work among pregnant women. However, it is unclear which intervention produces better pregnancy outcomes. A systematic review (10) on the effects of bed rest as a preventive measure of preterm birth compared to no intervention among high-risk singleton pregnant women found no evidence to support this preventive measure. No other reviews on the comparative effectiveness of preventive measures for heavy lifting in preventing preterm birth were found. We therefore performed a systematic review of the published literature to locate evaluation studies of interventions to prevent heavy lifting during pregnancy. We searched for randomized or quasi-randomized controlled trials (RCT/quasi RCT) comprising pregnant employees exposed to lifting tasks, which evaluated an intervention aimed at decreasing lifting exposure and the effects on the incidence of prematurity. Based on these inclusion criteria we developed a search strategy and searched the databases Medline (via PubMed), Scopus, and CINAHL up to 28 June 2012 (see appendix for full search strategy). Two authors independently scrutinized the references for eligible trials but none fulfilled our inclusion criteria. A further search of reference lists of potentially relevant studies also failed to identify any RCT. Thus, the hypothesis that an intervention that decreases heavy lifting exposure among pregnant woman may have a positive impact on pregnancy outcomes could be not proven either right or wrong. We went strictly for RCT because of the quality in terms of study design (11) as rigorous procedures are carried out to establish the cause and effect relationship between an outcome and intervention (12). Nevertheless, our search did yield five observational studies that did not fit the inclusion criteria (RCT, pregnant employees as subjects, exposure to heavy-lifting tasks, and an intervention aiming at decreasing lifting exposure). Three of the studies investigated a causal association between preterm birth and heavy lifting whilst two were intervention studies. The three exposure studies (6, 13, 14) indicated a negative impact of occupational exposure to strenuous physical activities on gestational age. One literature review suggested that exercise could be beneficial and an observational evaluation study concluded that current legislation in Germany sufficiently protects pregnant women against preterm birth (15, 16). However, their lack of validity and greater margins of errors associated with the studies’ designs make it difficult to rely on these observational studies. Existing systematic reviews of exposure are inconclusive on the subject matter. A meta-analysis indicated a statistically significant association between preterm birth and physically demanding work (5). Similarly, a systematic review (17) suggested a possible association between lifting and prematurity. In contradiction to these results, a third systematic review (18) refuted an association between lifting, especially during the first trimester, and premature delivery. This review was recently updated and came to similar conclusions (19). In spite of this, another Scand J Work Environ Health systematic review of the risk of miscarriage due to exposure to lifting during pregnancy cautions against lifting high loads during pregnancy (20). A phenomenon that characterized the identified primary studies was misclassification of exposure. The flaws in the estimation of especially the exposure severely hamper the drawing of strong conclusions in these studies and reviews. In almost all the studies, women self-reported their lifting exposure retrospectively or prospectively. It is unsure if the subjective measurement of exposure leads to non-differential misclassification. It has been argued that differential misclassification usually leads to an underestimation of the relation between exposure and outcome if there is any, but this is surrounded by uncertainty especially when exposure is on a continuous scale (21). It could be that misclassification is differential in case–control studies. Among cases, lifting exposure could be better remembered and reported as a result of recall bias. Therefore, there is a need for a high quality evaluation study in which a group of pregnant women with heavy lifting exposure are subjected to an intervention that decreases the exposure while a second group of unexposed women serves as a control. Such a study would provide reliable evidence for both an effect of the intervention and a causal relation (22). There are several possible explanations for the absence of high quality studies to support practice. To start, financial support is a major factor in every research. A substantial amount of money is required to conduct a high quality study. In low- and middle-income countries, where strenuous physical activity and premature birth are common occurrences (3, 6), access to finance to conduct research is always a challenge as evidenced by the “10/90 gap”, which indicates only 10% of global resources are earmarked for health research addressing 90% of global disease burden (23). Secondly, ethical considerations can also be a limiting factor. Human lives are involved and there may be ethical issues as to who should and should not be advised to avoid heavy lifting given the current uncertainty about the evidence necessitating precautionary measures (5). Thirdly, an RCT requires recruitment of participants from the first trimester to determine the consequences of varied exposure to strenuous work during the three different trimesters, however, the chances of attrition can be high due to the length of the study. Finally, in high income countries where health research is more common, there already exists legislation on maternity leave that protects pregnant women and therefore researchers may not have enough motivation to carry out such studies. Education to decrease physical activity during pregnancy has been shown to be effective for improving patients’ outcome and the prevention of unwanted occurrences such as prematurity (24). However, there is currently no evidence to support or refute its implementation for women who are exposed to lifting during pregnancy. Due to the aforementioned inconclusive nature and the methodological flaws in available studies, an RCT is needed to fill the gap. Such an ideal future RCT would hypothesize a reduction in the incidence of preterm birth among pregnant women who receive an intervention to avoid heavy lifting. The intervention could consist of health education pointing out the possibilities to avoid heavy lifting during pregnancy. The study should be a prospective two-arm RCT that is parallel and pragmatic to ascertain the effectiveness of the intervention. Looking at the global trends of premature birth, the appropriate trial must be centered within Asia or Africa because these continents have the highest proportions of preterm birth of 54% and 31%, respectively, in the world (3). Recruitment of participants could be done with the assistance of staff of antenatal clinics. Eligibility criteria for participants could be: women whose pregnancy has not gone beyond 12 weeks, singleton pregnancy, and women who are exposed to heavy lifting (≥10 kg) either at home or at work ≥10 times per day. Eligible participants would be assigned to either the experimental or control group at different antenatal clinics using an appropriate randomization method. Proper randomization will generate two groups that are equal in known and unknown extraneous variables with the exception of the intervention. To prevent contamination of the control group with the treatment of the intervention group when they are both attending the same clinic, randomization of antenatal clinics with their patients to either the intervention or the control group in a cluster randomized design would be desirable. Again, it will be difficult to realize randomization at the individual level in developing countries as a result of high cost and the complex nature of data collection (25). A sufficiently varied intensity of the health education intervention should be given to the treatment group during antenatal sessions with the content focusing on the meaning of heavy lifting, the possible implications of heavy lifting during pregnancy, encouragement of avoidance of lifting, and means to avoid lifting. The intervention could be elaborated further to ensure that this advice can also be implemented into practice. On the other hand, the control group should receive routine health education during their antenatal sessions. It would be important to monitor the level of exposure to heavy lifting in both groups to be able to show that the intervention had indeed been effective in the intervention group. For the outcome, the future study should measure the length of pregnancy according to the four subgroups of gestational age described by Goldenberg et al (26): births that occur at

The frequency of triplet pregnancies is increasing due to medically assisted reproduction. This retrospective study, carried out in 2 university hospitals in Yaounde (Cameroon) over a 6-year period, was done to evaluate the complications that occurred during triple pregnancies as well as the mode of delivery of triplets. A total of 43 cases were analyzed. The most common complications that occurred during pregnancy were preterm delivery and pre-eclampsia. Twenty seven women (62.8%) delivered vaginally and 16 (37.2%) were delivered by caesarean section with the most common indications being mal presentation and cord prolapse of the 1st triplet. In patients who have proper antepartum monitoring, it is possible to pre-select cases for trial of vaginal delivery because vaginal delivery is possible and carries no significant risk for the foetuses.Keywords triplet gestations; pre-eclampsia; premature delivery; vaginal delivery; caesarean section

Background Use of highly active antiretroviral therapy (HAART), a triple-drug combination, in HIV-infected pregnant women markedly reduces mother to child transmission of HIV and decreases maternal morbidity. However, there remains uncertainty about the effects of in utero exposure to HAART on foetal development. Methods Our objectives were to investigate whether in utero exposure to HAART is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts ≤250 cells/mm3 attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Low birth weight (

Background: Intrahepatic Cholestasis of Pregnancy (ICP) carries with it a higher frequency of premature delivery (20 to 60%), a marker ofperinatal morbility/mortality. Therefore, it is important to identify markers of premature delivery. Aim: To retrospectively evaluate, in a large case study, the presence of markers predictive of premature delivery. Materials and Methods: Clinical records of all patients diagnosed with ICP in Policlinic S.Orsola-Malpighi (Bologna, Italy) from January 2001 until December 2007 have been collected. For all patients the following informations were available: subjective pruritus evaluation, standard biochemical parameters, serum bile acids (BA) determination, abdomen ultrasonography and APGAR index. From diagnosis until a week after delivery, biochemistry and fetal health have been controlled weekly. Student’s t Test, Mann-Whitney, Pearson’s correlation test and a stepwiselogistic regression analysis were performed as appropriate. Results: 169 clinical records have been gathered. Patients with premature delivery, compared to those who delivered closer to term, presented a significantly earlier appearance of pruritus (r = 0.4858) and higher levels of chenodeoxycholic acid (r = −0.2835). No significant differences were observed for APGAR index and rate of fetal complications according to treatment and time of delivery. Two fetal deaths occurred (fetal infection by Parvovirus B19 and haemolysis for ABO incompatibility) before week 34 with serum BA below 20 mM/l. According to the multivariate analysis, the only variable associated with preterm delivery is the early onset of cholestasis, that exposes to a risk twice than normal (OR = 2.044; 95% CI 1.40−2.98; p = 0.0002). Conclusions: The strongest predictor of premature delivery in our population is the time of onset of pruritus with an OR of 2.044.

Background Hypermobile Ehlers-Danlos syndrome (hEDS), is probably the most common disease among heritable connective tissue disorders. It affects women more than men and causes symptoms in multiple organs. It is associated with chronic pain, skin fragility and abnormal bleeding. These characteristics may hamper reproductive life. We conducted a study to evaluate the gynecologic and obstetric outcomes in women with hEDS. We also explored a possible hormonal modulation of the hEDS symptoms. The gynecologic and obstetric history of 386 consecutive women diagnosed with hEDS was collected by a standardized questionnaire and a medical consultation performed by a senior gynecologist in an expert centre for hEDS between May 2012 and December 2014. Results We observed a high frequency of gynecologic complaints, specifically: menorrhagia (76 %), dysmenorrhea (72 %) and dyspareunia (43 %). Endometriosis was not highly prevalent in this population. The obstetric outcomes were similar to those of the general French population for deliveries by cesarean section (14.6 %) and premature births (6.2 %) but the incidence of multiple spontaneous abortion (13 %) and spontaneous abortion (28 %) were significantly higher. A subset of women were sensitive to hormonal fluctuations with more severe symptoms occurring during puberty, prior to menstruation, during the postpartum period as well as on oral contraception. Conclusions Increased awareness of the gynecological symptomatology in women with hEDS can help discriminate between endometriosis and thus prevent useless, and potentially dangerous, surgery. This study also suggests that hormonal modulation may be an appropriate treatment for a subset of women with hEDS.