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OBJECTIVE: To investigate the level and determinants of nonreceipt of contraception among women admitted to facilities with abortion-related complications in East and Southern Africa. METHODS: Cross-sectional data from Kenya, Malawi, Mozambique, and Uganda collected as part of the World Health Organization (WHO) Multi-Country Survey on Abortion-related morbidity. Medical record review and the audio computer-assisted self-interviewing system were used to collect information on women's demographic and clinical characteristics and their experience of care. The percentage of women who did not receive a contraceptive was estimated and the methods of choice for different types of contraceptives were identified. Potential determinants of nonreceipt of contraception were grouped into three categories: sociodemographic, clinical, and service-related characteristics. Generalized estimating equations were used to identify the determinants of nonreceipt of a contraceptive following a hierarchical approach. RESULTS: A total of 1190 women with abortion-related complications were included in the analysis, of which 33.9% (n = 403) did not receive a contraceptive. We found evidence that urban location of facility, no previous pregnancy, and not receiving contraceptive counselling were risk factors for nonreceipt of a contraceptive. Women from nonurban areas were less likely not to receive a contraceptive than those in urban areas (AOR 0.52; 95% CI, 0.30-0.91). Compared with women who had a previous pregnancy, women who had no previous pregnancy were 60% more likely to not receive a contraceptive (95% CI, 1.14-2.24). Women who did not receive contraceptive counselling were over four times more likely to not receive a contraceptive (AOR 4.01; 95% CI, 2.88-5.59). CONCLUSION: Many women leave postabortion care having not received contraceptive counselling and without a contraceptive method. There is a clear need to ensure all women receive high-quality contraceptive information and counselling at the facility to increase contraceptive acceptance and informed decision-making.

To investigate whether women with a short cervical length (CL), but delivered at term in the first pregnancy might have increased risks of having short cervix and spontaneous preterm birth (sPTB) in the subsequent pregnancies.This is a retrospective cohort study including singleton gestations who were delivered between Jan 2011 and Dec 2018, who had had one childbirth experience and who had transvaginal sonographic CL assessment performed at mid-trimester (18 ~ 30 weeks) in both pregnancy. The women were divided into four group according to the history of preterm birth and a short cervix ( 25 mm before 30 weeks of gestation): (1) the Preterm-short cervix group, (2) the Preterm-no shortening group, (3) the Term-short cervix group, and (4) the Term-no shortening group. We compared the risk of having short cervix and sPTB during the second pregnancy of women. Secondary outcomes were threatened preterm labor, need for tocolytics, and cerclage placement.A total of 804 women met our inclusion criteria. The rate of having short cervix ( 25 mm before 28 weeks of gestation) during the second pregnancy in women in the Term-short cervix group (43.2%) was significantly higher than those in women in the Term-no shortening group (6.6%), and in the Preterm-no shortening group (8.8%) (all p 0.001 with Bonferroni correction), but not higher than those in women with the Preterm-short cervix group (30.8%, p 0.05 with Bonferroni correction). When compared with women in the Preterm-no shortening group, women in the Term-short cervix group were also at an increased risk of need for need of tocolytics (60.2% vs. 26.5%) and cerclage placement (15.9% vs. 6.1%, all p 0.001). Women in the Term-short cervix group had an increased risk of sPTB ( 37 weeks) during the second pregnancy, as compared to those in the Term-no shortening group (adjusted odds ratio 5.098, 95% CI 2.107-11.874).Women with a history of short cervix in their first pregnancy, but who delivered at term, were at increased risk of having a short cervix and sPTB in their second pregnancy, as compared to women with a history of term delivery without cervical shortening. Thus, short cervix of the previous pregnancy might be a predictive factors for preterm birth in the subsequent pregnancy.

The risk of adverse birth outcomes is higher in birthing people with a prior adverse birth outcome including stillbirth, preterm birth, and neonatal mortality. Studies from national registries and hospital data from countries like the United States (U.S.), Sweden, Netherlands, Australia, India, China, and Tanzania have shown that having one of these outcomes increases the risk of having a similar subsequent adverse outcome. While global systematic reviews support these findings, there are country-specific disparities that need further exploration. In the U.S., for example, the rate of stillbirth recurrence is three times higher among Black birthing people than among White people. Other race-based comparisons show that Black people with stillbirth in their first pregnancy had four times the risk of a subsequent neonatal death compared to Black people with no prior stillbirth; for White people with previous stillbirth, this risk was twice as high compared to White women with a live term first birth (Sharma et al.). Therefore, this review of studies from the U.S. will quantify the risk of recurrence of adverse birth outcomes and identify risk factors that might produce disparities in these outcomes. To account for an adequate pool of studies to review, we will focus on six adverse outcomes and recurrent cross-outcomes.

There is evidence of an elevated risk of hypertension in populations that are primarily of African origin. Hypertension is predominantly asymptomatic, necessitating increased awareness. May Measurement Month was a descriptive, population-based, cross-sectional study of blood pressure (BP) screening and awareness campaign conducted in 2019 in a sample of 2550 participants (≥18 years) in Jamaica. In total, 1791 (70.2%) of the participants were female, 756 (29.6%) were male, with an average age of 49.3 years, and a body mass index (kg/m2) of 28.5 (6.2). Of all participants, 2289 (89.8%) were black and 154 (6.0%) were of mixed races. Twenty-two (0.9%) had never had their BP measured, whereas 354 (13.9%) had their measurements more than a year ago, and 2129 (83.5%) had measured within the year. Of all 2550 participants, 1055 (41.4%) had hypertension, 69.9% of our subjects with hypertension were aware, whereas only 62.5% were on antihypertensive medication and 27.8% had controlled BP (systolic

Infertility is defined as when a couple failed to conceive within one or more years of regular unprotected coitus. Primary infertility denotes those patients who have never conceived. Secondary infertility denotes previous pregnancy but failure to conceive subsequently. 80% of the couples achieve conception if they so desire, within one year of having regular intercourse with adequate frequency. Another 10% will achieve the objective by the end of second year. As such, 10% remain infertile by the end of second year. Now days, PCOS is one of the most common cause of infertility in women. In PCOS the hormonal imbalance interferes with the development and release of ovum from the ovaries. PCOS manifested by amenorrhoea, hirsutism and obesity associated with enlarged polycystic ovaries. PCOS is characterised by excessive androgen production by ovaries and adrenals which interferes with growth of the ovarian follicles. Therefore PCOS is a state of androgen excess and chronic anovulation. A 27 years old female visited OPD of PTSR NIA with complaints of wants issue since two years. After thorough examination, she was diagnosed as PCOS in Ultrasonography. At first, medicine for withdrawal bleeding was given. Then Shatapushpa churna and Phalasarpi was given for two months and then after she was conceived.

It is estimated that about one-third of women ever experienced violence in their lifetime. India has experienced steady urban growth accompanying increase of urban populations living in slums. Several studies have reported prevalence of various forms of violence in urban slums. To our knowledge, no systematic review has been conducted exclusively reporting violence against women in India's urban slums. The review aims to synthesise the studies of violence against women conducted in the last two decades (2000-2020). We searched PubMed, Scopus and other relevant search engines to identify articles published between years 2000 and 2020, which focused on Indian women slum dwellers' experiences of violence. We included 14 studies, which satisfied the inclusion criteria in this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was used to assess the studies. The prevalence of any form of violence against women, as reported in the studies, ranged from 15% to 59.3%. The major risk factors identified were husband's alcohol abuse, women justifying the violence inflicted on then, low educational levels of both women and men, dowry issues, age difference between the spouses and termination of a previous pregnancy. It is evident from the review that urban slum women experience persistent violence.

Objective To describe eight cases of women who became pregnant after a previous pregnancy that resulted in a fetus with congenital Zika syndrome (CZS). Methods A prospective case series follow up study of all children of mothers that were pregnant with a fetus with CZS epidemics and delivered in a subsequent pregnancy. Head circumference at birth and abnormalities detected at neuroimaging were the primary outcomes. One- and five-minutes Apgar scores, gestational age at delivery, birth weight and birth length, laboratory diagnosis of ZIKV, the newborn condition at discharge and the neurological evaluation were secondary outcomes. Results Eight mothers were included. Mean HC at birth was 31.3 ± 2.93 cm for the first child (with CZS) and 34.4 ± 1.48 cm for the second child (without CZS), p=0.02. Microcephaly was detected in 50% and neurological abnormalities in all the newborns after the first pregnancy; while there were no cases of microcephaly or neurological abnormalities in the infants resulting from the second pregnancy. Conclusions Despite the outcome of the cases evaluated suggest that most probably ZIKV does not persist as a chronic or latent, a large sample cohort is required to establish the safety of a subsequent pregnancy following ZIKV infection.

Several factors are associated with sexual satisfaction during the postpartum period. However, there is a lack of studies among low-income women with depression during the previous pregnancy. The a...

PURPOSE: To investigate the associations of previous pregnancy failures, including implantation failures (IFs), biochemical pregnancy losses (BPLs), and early (EMs) and late miscarriages (LMs), with blastocyst aneuploidy and pregnancy outcomes after PGT-A. METHODS: This study included 792 couples who underwent PGT-A after multiple pregnancy failures. Subgroup analyses were used to compare the blastocyst aneuploidy rate (BAR), implantation rate (IR), early miscarriage rate (EMR), and live birth rate (LBR). Multiple linear and logistic regression models were used to evaluate the associations. The control group comprised couples with ≤ 2 IFs, ≤ 1 BPL, ≤ 1 EM, and no LM. RESULTS: Notably, a history of ≥ 4 IFs was significantly associated with an increase in aneuploid blastocysts (42.86% vs. 33.05%, P = 0.044, B = 10.23 for 4 IFs; 48.80% vs. 33.05%, P = 0.002, B = 14.43 for ≥ 5 IFs). Women with ≥ 4 prior EMs also harbored more aneuploid blastocysts (41.00% vs. 33.05%, P = 0.048; B = 9.23). Compared with the control group, women with ≥ 4 prior EMs had a significantly higher EMR (6.58% vs. 31.11%, P

The measurement of cervical dilation of a pregnant woman is used to monitor the progression of labor until 10 cm when pushing begins. There is anecdotal evidence that labor tracks across repeated pregnancies; moreover, no statistical methodology has been developed to address this important issue, which can help obstetricians make more informed clinical decisions about an individual woman’s progression. Motivated by the NICHD Consecutive Pregnancies Study (CPS), we propose new methodology for analyzing labor curves across consecutive pregnancies. Our focus is both on studying the correlation between repeated labor curves on the same woman and on using the cervical dilation data from prior pregnancies to predict subsequent labor curves. We propose a hierarchical random effects model with a random change point that characterizes repeated labor curves within and between women to address these issues. We employ Bayesian methodology for parameter estimation and prediction. Model diagnostics to examine the appropriateness of the hierarchical random effects structure for characterizing the dependence structure across consecutive pregnancies are also proposed. The methodology was used in analyzing the CPS data and in developing a predictor for labor progression that can be used in clinical practice.

Recent studies have shown that pregnancies complicated by hyperglycemia in pregnancy (HIP) and insulin resistance had the highest risk of poor outcomes as compared to normoglycemic pregnancies. This study aimed to determine, only among women with HIP, the characteristics and pregnancy outcomes by increasing insulin resistance. We included from a prospective cohort study 1,423 women with HIP whose insulin resistance was evaluated using the homeostasis model assessment for insulin resistance (HOMA-IR) when HIP care begun. We compared characteristics and pregnancy outcomes by tertiles of HOMA-IR (intertertile range: 1.9 and 3.3). Increasing tertiles of HOMA-IR were positively associated with plasma glucose levels during screening for HIP; preconception BMI; family history of diabetes; previous pregnancy with HIP, macrosomia and hypertensive disorders; and non-European ethnicity (p Disclosure E. Cosson: None. H. Bihan: None. C. Nachtergaele: None. E. Vicaut: None. M. Sal: None. N. Berkane: None. S. Pinto: None. S. Tatulashvili: None. P. Valensi: None. L. Carbillon: None.

Introducción: El adenocarcinoma de endometrio es el más común de los carcinomas endometriales, siendo la edad media de diagnóstico los 61 años; sin embargo, hasta 2-14% puede ser diagnosticado antes de la menopausia. Los factores de riesgo son la nuliparidad, exposición a estrógenos, obesidad, síndrome de Stein Leventhal, entre otros. Material y métodos: Estudio descriptivo retrospectivo de 6 casos de pacientes menores de 30 años, estudiadas en el departamento de Patología del Hospital General San Juan de Dios de la ciudad de Guatemala, entre 2009 y 2019 con diagnóstico de adenocarcinoma endometrioide. Se revisaron las laminillas para confirmar el diagnóstico y el grado de diferenciación, y se obtuvo la información clínica disponible de las pacientes. Resultados: Dos de las pacientes habían tenido gestas previas y las demás eran nulíparas. Todas tuvieron ciclos irregulares desde la menarquia, 2 tenían diagnóstico de síndrome de Stein-Leventhal y 1 tenía sospecha. Tres pacientes tenían obesidad al momento del diagnóstico. No fue posible obtener la historia clínica de una paciente. Discusión: La frecuencia del adenocarcinoma de endometrio en pacientes menores de 30 años es muy baja. La literatura tiene pocos informes; en la revisión más se hace referencia a pacientes menores a 40 años. Nuestra revisión hace el aporte de 6 pacientes menores de 30 años, una de las cuales era menor de 20 años; siendo la frecuencia del total de adenocarcinomas en el período informado de 2.17%.

Objetivo: identificar o consumo de bebida alcoólica entre as adolescentes gestantes. Método: estudo de abordagem quantitativa, descritiva e de corte transversal. Os participantes foram 27 adolescentes gestantes adscritas nas Estratégia de Saúde da Família. Resultados: constatou-se que 54% referiram fazer uso de bebida alcoólica nos últimos 12 meses e 7,4% apresentavam chance de ter diagnóstico de dependência alcoólica. Das 5 participantes que relataram ser a segunda gestação, 80% afirmaram ter utilizado álcool na gravidez anterior. Identificou-se que em relação de risco sobre o padrão de consumo de álcool 81,4% se enquadram na zona I, 14,8% na zona II e 7,4% na zona IV. Conclusão: reafirma-se a necessidade de ações de prevenção do uso de álcool na gestação e a relevância do papel do enfermeiro no acompanhamento integral durante o pré-natal.

Children in Nigeria are frequently born with HIV, despite available services to prevent mother-to-child transmission (MTCT). Not offering, or non-acceptance of, HIV testing during antenatal care (ANC) delays anti-retroviral commencement for infected women, thereby increasing the risk of MTCT. This study assessed the determinants of HIV testing during antenatal care in Nigeria using nationally representative data from the 2013 Nigerian Demographic Health Survey. This study included 13,352 women aged 15–49 years who reported having at least one antenatal visit. The outcome variables were HIV testing during ANC and during labour, while socio-demographic and maternal factors, including number of ANC visits, offer of HIV testing during ANC and labour, place of delivery and knowledge and counselling on MTCT, were among the independent variables. Multivariate regression analysis was used to predict HIV testing during ANC and labour. About half (53%) of the women were tested for HIV during antenatal care with 85% of those tested receiving their test results. Only 6% had HIV tests during labour. There was a 33% excess probability of urban women testing during ANC compared with rural women. Never having a previous pregnancy terminated was associated with lower odds of testing during ANC. No counselling on MTCT and no counselling to get tested were associated with a lower probability of testing during ANC. Counselling on the prevention of MTCT is crucial for women’s willingness to be tested, and acceptance of testing. More effort is needed to ensure that providers in Nigeria offer these services to all women, educate women on the dangers of opting out and ensure the earliest commencement of ARV enrolment for those infected.

Background: Gestational trophoblastic neoplasia (GTN) can derive either from molar or non-molar pregnancy. Our primary objective is to compare clinical presentation and outcome of treatment of non-molar and post-molar GTN. Our secondary outcome is to evaluate and compare the prognostic factors of non-molar GTN compare to post-molar GTN in subgroup classification of GTN patients by stage and by low-risk and high-risk groups.Methods: Retrospective chart review of GTN patients treated from 2007 to 2016 was done. General characteristics, clinical data, treatment options and treatment outcomes were collected. The cases with missing significant data were excluded. Statistics analysis of the data was performed with SPSS version 22.0. Mean, mode, median and percent were used to present the data. Student t-test, Mann Whitney-U test and Kaplan Meier were used to analyze the data. The results were presented in Tables or graphs where appropriate. Results: Total of 71 GTN patients were recruited into the study. Fifty-one patients were post-molar GTN and 20 were non-molar GTN patients. The mean age of the patients was not different (p=0.25). Median duration from previous pregnancy and time to achieve remission were longer in non-molar GTN (292 days vs. 42 days and 163 vs. 64 days, respectively). Mortality rate of the non-molar GTN is higher that of the post-molar GTN (15% vs. 1.9%). Comparison of stage to stage showed no differences between the post-molar and the non-molar GTN. According to previous pregnancy type, post-abortion had higher resistant to treatment rate than post-term delivery.Conclusion: Non-molar GTN is different form post-molar GTN in several aspects, such as the duration from previous pregnancy, stage and score at diagnosis, treatment resistance and mortality rate. Comparison between the non-molar and post-molar GTN stage by stage and risk scores could not identify the difference between the two groups.

Purpose: Nitrosatable drugs can react with nitrite in the stomach and form N-nitroso compounds. Exposure to nitrosatable drugs has been associated with congenital malformations and preterm birth, but use during pregnancy as a cause of fetal death is not well-known. We examined if prenatally nitrosatable drug use is associated with risk of stillbirth. Methods: A nationwide cohort was conducted using 554 844 women with singleton and first recorded pregnancies regardless of previous pregnancy history from the Danish Medical Birth Register from 1996 to 2015. Exposure was recorded by use of the Danish National Prescription Register and defined as women who had redeemed a prescribed nitrosatable drug in the first 22 weeks of pregnancy. The reference group was women with no redeemed prescribed nitrosatable drug in this time period. We categorized nitrosatable drugs as secondary amines, tertiary amines, and amides. Cox hazard regression was used to estimate crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for stillbirth. Results: Among the 84 720 exposed women, 348 had a stillbirth compared with 1690 stillbirths among the 470 124 unexposed women. Women who used any prescribed nitrosatable drug were more likely to have a stillbirth compared with unexposed women (aHRs 1.24; 95% CI, 1.03-1.49). Conclusion: Nitrosatable drug use during the first 22 weeks of pregnancy might increase risk of stillbirth. The findings should be interpreted cautiously because of important unmeasured factors that might influence the observed association, including maternal vitamin C intake, dietary, and other sources of nitrate/nitrite intake.

The study aimed to evaluate pregnancy per artificial insemination (P/AI) of cows subjected to synchronization and resynchronization in ovulation protocols using intravaginal progesterone-releasing insert (P4) before pregnancy diagnosis (PD) and the relationship of PR with the diameter of preovulatory follicles (OPOF) before TAI. Cows (n = 378) were distributed into two groups: a resynchronization group with new devices (GRN; n = 185) and resynchronization group with used devices (GRU; n = 193). On Day 0, both groups received a new P4 and estradiol benzoate (EB). On D8, P4 removal + D-cloprostenol + eCG + estradiol cypionate (EC) was done. On d10, TAI was conducted. On d32, cows were resynchronized and divided into two groups, GRN (n = 185) and GRU (n = 193). The GRN group received a new P4 + EB, and the GRU group received a used P4 + EB. On d40, the P4 was removed + PD. The non-pregnant cows received D-cloprostenol + eCG + EC. US was done again on d42 to determine OPOF before the second TAI. The P/AI of the GRN and GRU groups after synchronization were 56.2% and 57.0% (p = 0.87), respectively, and those after resynchronization were 58.0% and 37.3% (p < 0.008), respectively. The P/AI of the GRN and GRU groups observed after TAI (synchronization + resynchronization) were 81.6% and 73.1%, respectively (p = 0.047). No difference (p = 0.067) in OPOF between the pregnant and non-pregnant cows in the GRN was found, whereas the GRU group showed a significant difference (p = 0.003). Resynchronization protocols optimized the P/AI in both groups. New intravaginal devices resulted in greater P/AI and P/AI accumulation in resynchronization as compared with the GRU; the OPOF was related with P/AI.

Background Preconception care (PCC) defines health interventions prior to conception aimed at improving pregnancy and infant outcomes. Aim To explore the understanding and provision of PCC by general practitioners (GPs) within the Sydney Local Health District. Materials and methods A questionnaire developed with GPs assessed structure and content of PCC provided, attitudes toward PCC and perceived barriers and facilitators. Results One hundred and ten GPs completed the survey: 84% reported that GPs should be the main providers of PCC; however, only 53% were aware of PCC guidelines. Seventy-five percent of responders initiated PCC discussion with women of reproductive age, 56% provided PCC to women at higher risk of adverse outcomes and 16% waited for the discussion to be initiated by the patient. Smoking, vaccination, alcohol and supplements/medication use were the most discussed PCC components, while serology, full blood count and blood pressure were the most performed assessments. Most respondents stated that PCC is essential for women with pre-existing diabetes, previous pregnancy complications or chronic illness. However, only 45% stated PCC was essential for women >35 years and 39% for women who were overweight. Importantly, weight and mental health were among the least discussed PCC components. Conclusion General practitioners are key providers of PCC; however, only half are aware of PCC guidelines and most do not recognise overweight to be a significant preconception issue. The most common barriers to PCC delivery were time constraints, lack of knowledge and lack of resources for patients. Improved resources and education are required to support adequate PCC provision.

Purpose The purpose of this study is to determine the correlation between having a baby of the desired gender and related factors. Design and methods The participants were 612 women who gave birth to their babies in the postpartum unit of a hospital in Malatya, Turkey. Findings Factors linked to having a baby of the desired gender were: having had a gender preference in a previous pregnancy (2.13 times on average; P = 0.001), their partners having a gender preference (2.87 times on average; P = 0.001 and 0.005). Practice implications It was found that having a baby of the desired gender was an important factor that affected some fertility characteristics. Implications for nursing practice It is important to recognize that gender preference exists and investigate it as a variable.

*Ateş, Can ( Aksaray, Yazar ), SciVal Topics Funding details Abstract Background: Chronic urticaria (CU) predominantly affects women, and sex hormones can modulate disease activity in female CU patients. As of now, the impact of pregnancy on CU is largely unknown. Aim: To analyze the course and features of CU during and after pregnancy. Patients and methods: PREG-CU is an international, multicenter study of the Urticaria Centers of Reference and Excellence (UCARE) network. Data were collected via a 47-item questionnaire completed by CU patients, who became pregnant within the last 3 years. Results: A total of 288 pregnancies of 288 CU patients from 13 countries were analyzed (mean age at pregnancy: 32.1 ± 6.1 years, duration of CU: 84.9 ± 74.5 months; CSU 66.9%, CSU + CIndU 20.3%, CIndU 12.8%).During pregnancy, 51.1% of patients rated their CU as improved, 28.9% as worse, and 20.0% as unchanged.CU exacerbations most commonly occurred exclusively during the third trimester (in 34 of 124 patients; 27.6%) or the first (28 of 124; 22.8%). The risk factors for worsening of CU during pregnancy were having mild disease and no angioedema before pregnancy, not taking treatment before pregnancy, CIndU, CU worsening during a previous pregnancy, treatment during pregnancy, and stress as a driver of exacerbations. After giving birth, urticaria disease activity remained unchanged in 43.8% of CU patients, whereas 37.4% and 18.1% experienced worsening and improvement, respectively. Conclusions: These results demonstrate the complex impact of pregnancy on the course of CU and help to better counsel patients who want to become pregnant and to manage CU during pregnancy.

Resumen Antecedentes: la variabilidad en el peso del recién nacido, ya sea como bajo peso o macrosomía, puede ocasionar morbimortalidad infantil y materna, además de ser un predictor del estado de salud a lo largo de la vida. Objetivo: determinar factores sociodemográficos, antecedentes patológicos, exposición a sustancias psicoactivas, actividad física y características alimentarias de la madre relacionados con el peso de recién nacidos en una IPS de Medellín, Colombia, en 2018. Materiales y métodos: estudio de cohorte con información de madres seguidas hasta el nacimiento de los bebés. Resultados: la edad promedio de las madres fue de 24±6 años, el peso promedio del recién nacido fue de 3150 g. Embarazo previo, consumo de lácteos y derivados, consumo de proteínas y de suplementos dietarios fueron factores presentes en madres de recién nacidos con mayor peso. Haber fumado alguna vez en la vida, antecedente de preeclampsia, parto previo, aborto en el último embarazo y consumo de alimentos ultraprocesados se presentaron en madres de recién nacidos con menor peso. Conclusiones: se recomienda a las gestantes limitar el consumo de alimentos ultraprocesados, supervisar el consumo de lácteos y derivados, proteínas y suplementos dietarios en madres con embarazos previos, antecedente de preeclampsia, abortos o hábitos como haber fumado. Abstract Background: The variability in newborn birthweight, whether low birth weight or macrosomia, can contribute to maternal and infant morbidity and mortality as well as be a predictor of lifelong health. Objective: Determine socio-demographic factors, pathologic history, exposure to psychoactive substances, physical activity levels, and maternal diet as related to birth weight in newborns an in IPS in Medellin, Colombia 2018. Materials and Methods: Cohort study using maternal information obtained from following a sample of mothers of newborns until their infant’s birth. Results: Average age of the mothers was 24±6 years and average newborn birthweight was 3150g. Previous pregnancies, consumption of dairy products, intake of protein, and use of dietary supplements were factors present in mothers of newborns with higher birthweight. Having ever smoked, history of preeclampsia, previous delivery, abortion in previous pregnancy, and intake of ultra-high processed foods (UHPF) were factors found among mothers whose infants had lower birthweight. Conclusions: It is recommended that pregnant women limit intake of highly processed foods, supervise their intake of dairy products, protein and dietary supplements in women who have had previous pregnancies, history of preeclampsia, abortions, or who have ever smoked.

In general, infertility affects one in the seven couples across the globe. Therefore, an innovative and beneficial procedure is used to fertilize an egg outside the human body with the help of in vitro fertilization (IVF) procedure. IVF is considered as the most common procedure, as it accounts for 99% of the infertility procedures. From being the most widely used procedure, its success rate for women under 35 is 39.6%, and above 40 is 11.5% depending on the factors like age, previous pregnancy, previous miscarriages, BMI and lifestyle. However, human embryos are complex by nature, and some aspects of their development are still remaining as a mystery for biologists. Embryologists will subjectively evaluate an embryo and its efficiency by making their observations manually during the embryo division process. Since these embryos are dividing rapidly, the manual evaluations are more prone to error. This paper gives a brief explanation and insights into the topic of evaluation and the success rate prediction by using artificial intelligence techniques.

Amaç: Bu araştırtma gebelerin OGTT testi yaptırma durumlarına medyanın etkisini belirlemek amacı ile yapılmıştır.Yöntem: Kasım 2018-Haziran 2019 tarihleri arasında bir üniversite hastanesinin gebe polikliniğinde gerçekleştirilen bu tanımlayıcı araştırmanın örneklemini 384 gebe oluşturmuştur. Veriler, anket formu ile yüz yüze görüşme yöntemi ile toplanmıştır. Verilerin analizinde sayı, yüzde, ortalama, standart sapma, ki-kare ve fisher exact testi kullanılmıştır.Bulgular: Gebelik haftası 24. haftadan küçük olan gebelerin çoğunluğunun OGTT yaptırmayı düşünmediği ve 24 haftadan büyük olan gebelerin ise neredeyse yarınsın OGTT yaptırmadığı saptanmıştır (p, Aim: To determine the effect of media on the OGTT during pregnancy.Method: The sample of this descriptive study conducted in the pregnancy outpatient clinic of a university hospital in November 2018-June 2019 included 384 pregnant women. The data were collected using face to face interview method and a questionnaire and analyzed using the number, percentage, mean, standard deviation, chi-square, and Fisher exact tests.Results: The majority with less than 24 weeks of pregnancy did not intend to have OGTT, and nearly half of those more than 24 weeks of pregnancy did not have it (p

Introduction Altered placental expression of high temperature requirement factor A1 (HtrA1) is implicated in abnormal trophoblastic invasion and endothelial dysfunction in pre-eclampsia (PE). Serum levels of HtrA1 have been proposed as a novel biomarker to improve the prediction of PE. This study assesses serum HtrA1 levels in prospectively collected samples of women who developed PE compared to normotensive pregnancies. Methods This was a case-control study of serum HtrA1 levels in second and third trimester samples in women who later developed preterm or term PE compared to controls. Overall, 300 serum samples were drawn from a prospective observational study of adverse pregnancy outcomes in three different gestational age windows (19–24, 30-34 and 35–37 weeks) at the Fetal Medicine Research Institute, King's College Hospital, London. Serum HtrA1 levels were determined by enzyme-linked immunosorbent assay (ELISA) by a blinded laboratory professional. Median HtrA1 MoM values, adjusted for gestational age and maternal characteristics, were compared between cases and controls at each gestational age group. Results Women who later developed PE, compared to controls, had significantly higher maternal weight and more frequently had chronic hypertension or a history of PE in a previous pregnancy. In normotensive pregnancies, serum HtrA1 increased with increasing gestational age, whereas, in PE pregnancies HtrA1 levels remained stable, but were not significantly different from control pregnancies at any gestational age. Discussion Serum HtrA1 levels are not significantly different in women who develop PE compared to controls.

Introduction low back pain (LBP) during pregnancy is an important health concern among women globally. The prevalence and risk factors for LBP in pregnancy vary from and within sub-regions and have implications in preventive and treatment strategies. In West African sub-region, there is scanty data on LBP during pregnancy. This study aimed to determine the prevalence and predisposing factors for LBP during pregnancy in this environment. Methods this was a cross-sectional study carried out among pregnant women admitted into the Labour Ward of Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria over a period of 8 months. They were interviewed within 2 to 7 days postpartum with a questionnaire. Sociodemographic and obstetrics characteristics as well as LBP intensity, features and associated factors were evaluated. Significant factors for LBP that emerged from the univariable analysis were entered into multivariable regression analysis to evaluate the risk of each factor when adjusted to other factors. Results of the 478 women interviewed, 138 (28.9%) of them (95% CI 25.1-33.1) reported LBP in the index pregnancy. The onset of pain was predominantly in the third trimester and the mean pain intensity was 4.3 ± 1.36. In the univariable analysis, six factors were significantly associated with LBP. Logistic regression analysis identified LBP in previous pregnancy (aOR: 24.76, (95% CI 6.88-89.11); p< 0.001), macrosomia (aOR: 4.15(95% CI 2.05-8.42); p< 0.001) and absence of domestic help (aOR: 0.50(95% CI 0.31-0.82); p=0.006) as independent risk factors for LBP during pregnancy among the women. Conclusion in this study, LBP during pregnancy is within worldwide range and predominantly mild to moderate in intensity. The independent risk factors identified call for high priorities accorded to women with these factors in measures aimed at addressing LBP during pregnancy.

To study whether low serum ferritin (s-ferritin) levels are associated with recurrent pregnancy loss (RPL), and whether low s-ferritin predicts the risk of another pregnancy loss or the ability to conceive.Cohort study.Fertility clinic at a university hospital.Eighty-four women referred to the RPL Unit and 153 women of reproductive age with no known fertility problem. s-Ferritin levels were measured in serum samples taken before pregnancy attempt.None.s-Ferritin levels were correlated to pregnancy history, ability to conceive, and time to conception during the first 2 years after sampling. Furthermore, s-ferritin levels were correlated to outcome of the first pregnancy after referral for RPL.Women with RPL had lower s-ferritin than the comparison group, 39.9 μg/L versus 62.2 μg/L, and had a higher prevalence of low iron stores (s-ferritin30 μg/L), 35.7% versus 13.7%. We found an inverse relationship between s-ferritin level and number of pregnancy losses before referral. We did not find s-ferritin level to be associated with ability to conceive or time to pregnancy in either group. Nor did s-ferritin level predict the risk of losing the first pregnancy after referral for RPL.The inverse relationship between s-ferritin levels and previous pregnancy losses suggests that low s-ferritin is associated with a more severe reproductive disturbance in women with RPL. Whether low s-ferritin is causally related to RPL and if such women could benefit from iron supplementation to achieve a live birth warrants further investigation.

Pregnancy poses a threat to women with aortopathy. Conclusive data on the obstetric and aortic outcome in this risk collective, especially when it comes to aortic complications in the long term, are still missing. This study offers a comparative analysis of pregnancy-associated outcome in 113 consecutive women with Marfan syndrome or bicuspid aortic valve disease, including 46 ever-pregnant and 37 never-pregnant women with Marfan syndrome, and 23 ever-pregnant and 7 never-pregnant females with bicuspid aortic valve disease. The overall obstetric outcome was comparable between ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease (p = 0.112). Pregnancy-associated aortic dissection occurred in two women with Marfan syndrome (3%) during a total of 62 completed pregnancies, whereas no single case of aortic event occurred in women with bicuspid aortic valve disease during a total of 36 completed pregnancies (p = 0.530). In the long-term follow-up, aortic dissection occurred in 21% of ever-pregnant women with Marfan syndrome, but in none of the women with bicuspid aortic valve disease (p = 0.022). Proximal aortic surgery was performed with similar frequency in ever-pregnant women with Marfan syndrome and with bicuspid aortic valve disease in the long term (p = 0.252). However, ever-pregnant women with Marfan syndrome were younger when surgery was performed (44 ± 9 vs. 59 ± 7 years, p = 0.041). In Marfan syndrome, long-term growth of the aorta was comparable between ever-pregnant and never-pregnant women. Pregnancy thus exhibited an increased immediate aortic risk only in women with Marfan syndrome, but not in women with bicuspid aortic valve disease. Previous pregnancy did not relate to an increased long-term risk of adverse aortic events in women with Marfan syndrome or with bicuspid aortic valve disease.

A retrospective study to assess the prevalence and risk factors of gestational diabetes mellitus amongantenatal mothers in a selected Tertiary Care Hospital at Kelambakkam, Kanchipuram District, Tamil Nadu,India The objectives were to Assess the prevalence of Gestational Diabetes Mellitus within last two years(2016 to 2018) in a selected Tertiary Care Hospital at Kelambakkam, at Kanchipuram district, Tamil Naduand to associate the risk factors of GDM with the selected demographic variables. The convenient samplingwas used to select 35 medical records of antenatal mothers with gestational diabetes mellitus .The dataregarding risk factors like History of GDM in previous pregnancy, Fasting blood glucose, Random bloodglucose, Diagnosed at which trimester, Previous history of LSCS, previous history of abortion, duration inhospital,complications other than gestational diabetes mellitus were collected from the medical records. Theresult showed that 120 antenatal mothers were diagnosed with gestational diabetes mellitus within last 2years. There is a significant association of demographic variables like parity with the risk factors of historyof gestational diabetes mellitus in previous pregnancy (?2 = 7.882, P ? 0.05)

Objectives Very short interpregnancy intervals are associated with negative health outcomes for mothers and children, and pregnancies with very short interpregnancy intervals are more likely to be unintended than pregnancies that are more widely spaced. The objective of this study was to improve understanding of women's motivations regarding pregnancy spacing. Methods In 2017, we conducted 8 focus group discussions with 49 English- and Spanish-speaking postpartum women in central North Carolina. The groups explored participants' preferences for birth spacing and factors that influenced their decisions. We recorded, transcribed, and coded the discussions and analyzed these data for core themes. Results Participants' ideas about when and whether to have more children were fluid—some had specific ideas during pregnancy or after delivery that changed over time; others had no definite plans. The primary reason for close birth spacing was to promote their children's having a closer relationship. Reasons for wider spacing included recovery from the previous pregnancy, challenges related to having 2 babies concurrently, and desire to wait for more favorable life circumstances. Participants did not mention health risks to children of short interpregnancy intervals and said that no health care providers discussed these risks with them. They had mixed perspectives about whether this information would influence their own child-spacing preferences but agreed that it should be shared with women to promote informed decision-making. Conclusion This study adds to limited research regarding the factors that women consider when determining pregnancy spacing. Better understanding of women's motivations can help inform counseling to help women achieve their desired pregnancy spacing.

Aims We sought to describe the clinical presentation, management, and 6-month outcomes in women with peripartum cardiomyopathy (PPCM) globally. Methods and results In 2011, >100 national and affiliated member cardiac societies of the European Society of Cardiology (ESC) were contacted to contribute to a global registry on PPCM, under the auspices of the ESC EURObservational Research Programme. These societies were tasked with identifying centres who could participate in this registry. In low-income countries, e.g. Mozambique or Burkina Faso, where there are no national societies due to a shortage of cardiologists, we identified potential participants through abstracts and publications and encouraged participation into the study. Seven hundred and thirty-nine women were enrolled in 49 countries in Europe (33%), Africa (29%), Asia-Pacific (15%), and the Middle East (22%). Mean age was 31 ± 6 years, mean left ventricular ejection fraction (LVEF) was 31 ± 10%, and 10% had a previous pregnancy complicated by PPCM. Symptom-onset occurred most often within 1 month of delivery (44%). At diagnosis, 67% of patients had severe (NYHA III/IV) symptoms and 67% had a LVEF ≤35%. Fifteen percent received bromocriptine with significant regional variation (Europe 15%, Africa 26%, Asia-Pacific 8%, the Middle East 4%, P 50%) occurred only in 46%, most commonly in Asia-Pacific (62%), and least commonly in the Middle East (25%). Neonatal death occurred in 5% with marked regional variation (Europe 2%, the Middle East 9%). Conclusion Peripartum cardiomyopathy is a global disease, but clinical presentation and outcomes vary by region. Just under half of women experience myocardial recovery. Peripartum cardiomyopathy is a disease with substantial maternal and neonatal morbidity and mortality.

Gestational diabetes (GDM) is a serious condition predisposing both the mother and child to health complications. Key means for treatment are lifestyle related, primarily adherence to a healthy diet and increase in physical activity. The aim of the study was to evaluate dietary quality and physical activity in early pregnancy of women reporting history of GDM compared to healthy women participating in a population-based study. Pregnant women were enrolled to the study by announcements in social media. The interested women (n = 1034) filled in an electronic questionnaire on their background data, validated Index of Diet Quality (IDQ) and index of leisure-time physical activity (MET-index) in early pregnancy. The protocol was approved by the Ethics Committee of the University of Turku, Finland. The study population characteristics were representative of the Finnish pregnant women as compared with values reported in national perinatal statistics, except for overrepresentation of primiparas (54% compared to 41%) and underrepresentation of smokers during pregnancy (2.2% compared to 13%). Of the multiparas, 18.3% reported having been diagnosed with GDM in a previous pregnancy, which is in accordance to that in the general population (19%). Having a history of GDM was not reflected in the dietary quality in the present pregnancy. The IDQ score of the women with history of GDM (adj. mean 9.5) did not differ from those with no history (adj. mean 9.3, NS). When evaluating the categorized values, 45.8% of the women with the history of GDM and 45.4% of those without had a good dietary quality (IDQ score 10 or above). Similarly, the MET-index of the women with history of GDM (4.8 hrs/wk) did not differ from that of the women with no history (4.8 hrs/wk). Also, the categorized MET-index did not differ between the groups. The physical activity level of the women with history of GDM was light in the majority (52%) of the women, moderate in 41% and vigorous in 7%. Despite the known risks that GDM induces to health of the pregnant women and their babies, the dietary quality and physical activity of the women with a history of GDM did not differ from that of the women who were not previously affected. The results indicate that new means are needed alongside with the traditional counselling practices to motivate healthy lifestyle changes in pregnant women, particularly those at risk for recurrent GDM.

Purpose To understand the preconception experiences of women with epilepsy who have been taking the teratogenic drug valproate. Methods Seven women were recruited, three from a preconception clinic and four from an antenatal clinic in a region of the UK. All had taken valproate preconceptionally. Three preconception clinic encounters were observed and audio-recorded. Interviews with all women were analysed using Interpretative Phenomenological Analysis (IPA). Results Women experienced a "trajectory of balance". Women moved from "maintaining balance" by using valproate to control seizures, to a "shattering of harmony" at the prospect of changing medication and as a result of the physical and mental effects of changing medication, to "restoring balance" which could involve "a new self" due to dramatic changes. Women balanced their health needs with those of their baby, and took responsibility for medication decision-making. They found it difficult to see "who is looking after me" in the healthcare system, either to access preconception care, or to support them through the stress of changing medication. Their journey ended with coming to terms with a variety of experiences: choosing not to have a baby due to unsuccessful change from valproate, recognising that a child from a previous pregnancy had been harmed by valproate or that the current pregnancy might be at risk, or successful medication change in preparation for pregnancy. Conclusion A clear and adequately funded preconception care pathway is needed from epilepsy diagnosis, including support for stress. Understanding what influences maternalisation may help understand uptake of preconception care.

Background Misconceptions about medications’ safety can lead pregnant women with asthma to stop their medications, resulting in asthma-related neonatal morbidity and mortality. Our aim was to assess the level of pregnancy-related asthma knowledge and education about asthma medications’ safety, among women of childbearing age with a history of bronchial asthma. Methods A cross-sectional survey of convenience sample of outpatient clinic attendees of Pulmonary, Family Medicine and Obstetrics & Gynecology among women of childbearing age with history of asthma at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Participants (n = 171) completed a questionnaire to determine levels of education and knowledge, as well as attitudes and practice relating to asthma treatment. Results Among participants, 77.1% were pregnant at the time of the survey, 77.8% had used asthma medications during current or previous pregnancy, 70.8% of all respondents who ever been pregnant believed in the safety of asthma medications during pregnancy, 49.1% had received education about asthma, and 46.8% had been educated about the safety of asthma medications during pregnancy. Responses indicated that 46.8% had stopped (or expressed the desire to stop) asthma medications during pregnancy, and 48% believed asthma medications would harm them and their babies more than asthma itself, but 92.4% expressed that they would be willing to use asthma medications during pregnancy if their safety was confirmed by a physician. Education level and employment status were both associated with an increased likelihood of having received asthma education (p values

Gestational choriocarcinoma is an uncommon trophoblastic malignancy, occurring in females after pregnancy, which is rarely encountered by urologists. It can be rapidly progressive, however metastases to other organs can occur after a prolonged latency period. We describe a rare case of solitary metastatic gestational choriocarcinoma presenting with spontaneous bleeding from a renal mass, over a decade after the associated pregnancy with a presumed sub-clinical primary tumour. This case demonstrates the importance of recognising gestational choriocarcinoma as a potential differential diagnosis of spontaneous bleeding renal mass in females of child-bearing age as a urologist given the often-aggressive nature of the disease.

A long time to get pregnant is the lag time of the return of pregnancy after the discontinuation of contraceptive use or after the end of the previous pregnancy. One of the factors that affect the time of return of pregnancy is the use of contraception. According to WHO the time to return pregnant normally is less than 6 months. The purpose of this study was to determine the difference in the duration of re-pregnancy in the mother of 1 month injection acceptor KB with 3 month injection in the work area of Puskesmas Daya Murni Tumijajar District, Regency Year 2017. This type of research is quantitative research. The population in this study were all women hormonal contraceptive mother (1 month injection and 3 month injection) who had been pregnant or have given birth and are currently pregnant with 126 acceptors. The number of samples in this study was 96 respondents. The result of statistic test in obtaining p-value 0.000 which mean at significance value ≤ 0,05 can be concluded there is a difference of mean time duration of pregnancy return between 1 month injection and 3 month injection. Researchers suggest to further researchers to be able to conduct research and studies of other factors that affect the length of time re-pregnant.

Objectives To assess rates of informed choice among women offered non‐invasive prenatal testing (NIPT) for aneuploidy as part of routine clinical care. Methods A cross‐sectional survey was conducted across 6 antenatal clinics in England. Women with a high risk (≥1/150) Down syndrome screening result were offered NIPT, invasive testing, or no further testing. Pretest counselling was delivered as part of routine care by the local maternity team. Women were given a questionnaire containing a measure of informed choice immediately after pretest counselling. Results In total, 220 of 247 women completed the questionnaire. Seventy‐six percent were judged to have made an informed choice, a significant decline from our previous study (89.0% vs 75.6%; χ2(2) = 20.2, P, What's already known about this topic? Non‐invasive prenatal testing for aneuploidy is a highly accurate screening test, but concerns exist around potential routinisation.Previous evidence indicated high levels of informed choice are possible, but this was a tightly controlled research setting. What does this study add? Non‐invasive prenatal testing can be offered within routine prenatal care in a way that facilitates high levels of informed choice.However, the decline in rates of informed choice compared with those in the research setting highlight the challenges of offering non‐invasive prenatal testing in routine prenatal care.

This study aimed to analyze the outcome and impact of pregnancy in women with myasthenia gravis (MG). Obstetric and clinical data were retrospectively analyzed before, during and after pregnancy. Predictors of outcome were studied. We included 35 pregnancies from 21 MG patients. In the course of MG symptoms in 30 pregnancies with live births, 50% deteriorated (mainly during the second trimester, p = 0.028), 30% improved, and 20% remained unchanged. The deterioration group had more frequent abnormal repetitive nerve stimulation (RNS) (p = 0.028) and lower myasthenia gravis composite (MGC) scores (p = 0.045) before pregnancy. The improvement group was associated with higher MGC scores (p = 0.012) before pregnancy. The no-change group was associated with longer duration of MG (p = 0.026) and normal RNS (p = 0.008) before pregnancy. The course of MG in the second pregnancy was different from that in the previous pregnancy in 65.3% of cases. Obstetric complications were reported in 20 pregnancies; the most common was preterm premature rupture of membranes (PPROM) (25.8%), and the most severe were abortion (11.4%) and fetal death (2.9%). Most of the patients delivered via caesarean section (66.7%). Spinal anesthesia was performed in 73.3%. Transient neonatal myasthenia gravis occurred in 12.9% of live-born infants, and no predictors were found. In conclusion, severity and duration of MG, RNS and treatment influence MG and pregnancy. Pregnant MG patients have greater rates of PPROM and caesarean delivery. Our data suggest that duration of MG, MGC and RNS before pregnancy may be useful in helping to predict the course of MG during pregnancy.

Objective The purpose of the study was to develop an easily applicable predictive model to predict deep infiltrating endometriosis in patients with ovarian endometrioma. Study design We performed a retrospective analysis of 178 consecutive women with ovarian endometrioma who underwent surgery, with histological confirmation and complete removal of endometriosis in the Hospital Clinic of Barcelona. Several markers were prospectively obtained and compared between the group of patients presenting deep infiltrating endometriosis associated with ovarian endometrioma and women with only ovarian endometrioma. Multiple logistic regression analysis was performed to create a model to predict the presence of deep infiltrating endometriosis and internal validation was later performed. Results Of the 178 patients studied, 80 (45%) were classified in the ovarian endometrioma group and 98 (55%) in the group of patients presenting deep infiltrating endometriosis associated with ovarian endometrioma. The independent variables to predict deep infiltrating endometriosis were: at least one previous pregnancy, a past history of surgery for endometriosis and the mean endometriosis-associated pelvic pain score. The area under the ROC curve was 0.91 (95% confidence interval: 0.86–0.94), with an optimal cut-off of the predicted probability of 0.54. The sensitivity of the model was 80% and the specificity 84%. Conclusions This model predicts the development of deep infiltrating endometriosis in patients with ovarian endometriomas allowing prioritization of women for referral to specialized centers.

Background Herbal medicines in pregnancy are increasingly used worldwide with prevalence of up to 67%. Although this popularity is mainly because of the common belief that these medicines are safe, recent reports suggest that several herbal medicines are potentially harmful to mother and fetus if used in pregnancy. Methods This cross-sectional study was conducted in July and August of year 2017, at maternity wards of two public hospitals in Dhaka, Bangladesh. Postpartum women were interviewed via the structured questionnaire to collect information regarding socio-demographic and health characteristics, patterns of herbal medicines used in the previous pregnancy, and outcome of pregnancy. Results Two hundred forty-three postpartum women participated in the study, with 70% of them using at least one modality of herbal medicines in previous pregnancy. Ginger, black seed, lemon tea, prune, and mustard oil were most commonly used herbal medicines. Herbal medicines were mostly used for pregnancy-related symptoms such as nausea, vomiting, and cold. Fifteen (8.8%) herbal medicine users reported side effects. Conclusions This study highlights popularity of herbal medicines during pregnancy in Bangladesh. Previous herbal medicine users and unemployed women turned significantly more to herbal medicines during pregnancy. Reports of side effects and use of some potentially harmful modalities warrant awareness regarding proper use of herbal medicines in pregnancy and its pharmacovigilance. Electronic supplementary material The online version of this article (10.1186/s12906-018-2399-y) contains supplementary material, which is available to authorized users.

Distúrbios Hipertensivos Gestacionais (DHG) são as principais causas de morte materna, sendo necessário desenvolver meios de padronização e qualificação do atendimento hospitalar dessas gestantes e puérperas. Objetivo: Descrever o perfil de gestantes com DHG e o desenvolvimento de instrumentos para qualificação do cuidado hospitalar. Métodos: o estudo foi desenvolvido em uma instituição privada do sul do Brasil. O perfil das gestantes foi avaliado no período de janeiro a dezembro de 2017. Foram avaliadas as seguintes variáveis: PA, IG, tempo de internação, gestação anterior, prematuridade, reinternação, internação em CTI. Para qualificar o atendimento hospitalar foram desenvolvidos um protocolo institucional e uma carteirinha com orientações de alta para a puérpera. O desenvolvimento dos instrumentos baseou-se em grupos focais com profissionais especialistas e seguiu as seguintes etapas: definição de equipe de trabalho, revisão da literatura, identificação das necessidades de padronização e qualificação no atendimento; protótipo; ajustes; aprovação e implementação. Resultados: 3.458 gestantes internadas em 2017, 684 (19,78%) apresentaram pressão arterial elevada durante a internação e 120 (3,47%) desenvolveram DHG. Entre as alterações hipertensivas (n=684), a média de idade foi 31,6 anos; idade gestacional no parto em média 37,7 semanas, maioria primigesta (n=377; 55,2%). O protocolo contemplou os seguintes itens: Padronização da Aferição da pressão arterial (PA); Conduta se PA elevada; Diagnóstico; Classificação; Fatores predisponentes; Critério para internação; Manejo; Interrupção da gestação; Alta hospitalar e medicamento na lactação. A carteirinha apresenta orientações sobre cuidados no puerpério. Conclusão: Complicações da HAS gestacional estendem-se ao puerpério. Os produtos qualificam a assistência.

Background and purpose: The decreased tendency toward childbearing is considered as one of the most social issues. High-risk pregnancy problems and the fear of recurrence can reduce the desire for re-pregnancy. The purpose of this study was to determine the relationship between high-risk pregnancies in childbearing tendency. Materials and Methods: This descriptive study was cross-sectional. The statistical population included married women aged 15–49 years with at least one previous pregnancy. 928 women with histories of low-risk and high-risk pregnancy were selected by applying a continuous sampling method. The demographic information form and childbearing desire questionnaire were used. The data were analyzed by SPSS-16 and applying descriptive statistics tests, mean and standard deviation, inferential statistics, regression, independent t-test. Findings: The mean of childbearing tendency in mothers with a history of high-risk pregnancy and low-risk pregnancy were 3.25 ± 5.43 and 8.65 ± 3.96, respectively. Before modifying the intervention variables, the mean scores of childbearing desire were significantly different in mothers with a history of low-risk pregnancy and high-risk pregnancy; it was higher in mothers with a history of low-risk pregnancy (P < 0.001). After modifying the variables of the ideal number of children, the mothers' attitude toward childbearing desire, and the number of natural childbirths, stillbirths, and miscarriages. The difference was not significant (P = 0.263). Conclusion: Childbearing tendency was not different in women with a history of low-risk pregnancy and those with a history of high-risk pregnancy.

This case report describes a right-sided borderline ovarian tumour diagnosed unexpectedly following suspected torsion in the third trimester of pregnancy. The patient had had a right mucinous cystadenoma and left serous cystadenoma in her previous pregnancy and underwent bilateral ovarian cystectomy at the time of her first elective caesarean section. The management of borderline ovarian tumours is generally difficult in younger women of reproductive age and is made more complex by pregnancy. The authors share the challenges of managing this condition in pregnancy together with a review of the literature.

Key content Postpartum ovarian vein thrombosis (POVT) is a rare but potentially fatal condition. Symptoms up to 4 weeks postpartum often include vague abdominal pain and pyrexia. A high index of suspicion is required to make the diagnosis. As there is no consensus regarding management, a multidisciplinary approach is advised. Learning objectives Recognise the symptoms and signs of POVT and formulate a differential diagnosis. Recognise the importance of imaging in confirming the diagnosis and involvement of the multidisciplinary team to plan management. Understand that conservative management with low-molecular-weight heparin is the first-line treatment, and understand the situations that may require vena caval filter insertion or surgical intervention. Ethical issues How can we counsel women about risks of conservative and surgical management of this condition when there is no consensus for this management? Should women who have had an ovarian vein thrombosis in a previous pregnancy be counselled toward avoiding future pregnancy?

Background Alcohol and substance use is a major health challenge in Turkey, as it is worldwide. Recently, there has been a rapid increase in the number of females using substances and although usage tends to reduce during pregnancy, it is of critical importance to determine its exact level as substance use negatively impacts on the health of both the mother and infant. Aim The aim of the present study was to investigate the frequency of smoking, alcohol, and substance use, and quitting rates during pregnancy. Method This study was conducted on pregnant females in Sakarya, Turkey. A total of 1,082 consecutively presenting females who agreed to participate in the study were evaluated. The study team prepared a sociodemographic data form and adapted the "Introduction" section, derived from the Addiction Profile Index, to cover substance use during pregnancy. Results The substances most frequently used by pregnant females in their previous pregnancies and current pregnancies were cigarettes/tobacco products (11% and 11.8%, respectively), alcohol (0.6% and 0.4%, respectively), and rarely, synthetic cannabinoids (0.3% and 0.2%, respectively). Daily tobacco smokers continued to smoke during pregnancy, with a rate of 42.5%. Based on research into predictors of smoking (cigarettes) in pregnancy, a correlation was found between lifetime smoking and smoking during a previous pregnancy. A similar link was found with respect to alcohol. Conclusion Cigarettes are the most frequently used substance in pregnancy, and to a lesser extent, alcohol and synthetic cannabinoids, also considered to be risky substances. A high incidence of smoking regularly during pregnancy was found in daily smokers. It is recommended that physicians should sensitively ask pregnant females presenting at clinics about all forms of substance use, including alcohol and synthetic cannabinoids, and to include such questions in their routine enquiries.