Journal of Pregnancy最新文献

Background: Viral hepatitis has been associated with profound alterations in the coagulation system as well as liver biomarkers. Meanwhile, during pregnancy, the coagulation system also undergoes significant changes with an increase in the majority of the clotting factors and a decrease in natural anticoagulants. This study is aimed at evaluating the coagulation profile and liver biomarkers among hepatitis B-infected pregnant women in a Ghanaian population.

Methods: This case-control study was conducted at Afrancho Polyclinic in the Ashanti Region, Ghana from January 2022 to July 2023. This study recruited 90 hepatitis B pregnant women as cases and 90 hepatitis B-negative pregnant women as controls. A structured questionnaire was used to obtain sociodemographic, obstetric, and clinical data from each participant.

Results: Levels of albumin, fibrinogen (4.09 [3.57-5.94] vs. 6.89 [5.43-9.08], p < 0.0001), protein C (2.46 [1.09-3.42] vs. 4.12 [2.96-6.07], p < 0.0001), and protein S (2.61 [2.20-3.36] vs. 2.98 [2.53-3.54], p = 0.036) were significantly reduced in the hepatitis B-positive pregnant women than the negative controls. However, there were higher levels of AST, ALP, and bilirubins in hepatitis B-positive pregnant women than the controls. Also, protein C and protein S had a significantly positive association with PT and aPTT, whereby a rise in protein C and protein S resulted in an increasing PT and aPTT, respectively (all p values < 0.05). Conversely, albumin had a negative correlation with both PT and aPTT (p value < 0.05). In a ROC analysis, aPTT had the highest area under the curve (AUC) value (AUC = 0.881) and the optimal clotting time at which aPTT indicated chronic hepatitis B was ≥ 35.7 s with sensitivity of 79.4% and specificity of 91.6%.

Conclusion: Pregnant women with hepatitis B infection present with significant changes in their coagulation parameters, natural anticoagulants, and liver biomarkers. Furthermore, fibrinogen, protein C, and aPTT showed accurate diagnostic potential in detecting chronic viral hepatitis B infection and may be valuable surrogate indicators for managing chronic hepatitis-related complications.

Objectives: The objective of the study is To to determine the incidence of superimposed preeclampsia among pregnant women with chronic hypertension and associated factors of superimposed preeclampsia:preeclampsia.

Material and methods: A retrospective multicenter cohort study was conducted at Srinagarind Hospital, Khon Kaen University, and Khon Kaen hospitalHospital, Thailand, involving women who were admitted between November 1, 2017, to and October 31, 2022. The pregnant women who had been diagnosed with chronic hypertension were identified and their medical records were reviewed for incidence of superimposed preeclampsia. Various characteristics were examined to compare maternal complications, perinatal outcomes, and associated factors. Logisticfactors.Logistic regression analysis was performed to identify factors associated with superimposed preeclampsia.

Results: There was a total of 33,018 deliveries during the study period, out of which 406 (1.2%) women with chronic hypertension were identified. Superimposed preeclampsia occurred in 199 women, accounting for a rate of 49.0% (95% confidence interval; [CI] 44.1-53.9). One hundred and nineteen women (59.8%) were diagnosed with superimposed preeclampsia with severe features, and 80 (40.2%) without severe features. A mean arterial pressure (MAP) ≥100≥ 100 mmHg during pregnancy, the requirement of two or more antihypertensive agents, and a history of previous preeclampsia were significantly associated with an increased risk of superimposed preeclampsia (adjusted odds ratio; [OR] 9.97, 95% CI95%CI 5.95 - 16.71, adjusted OR 2.31, 95% CI95%CI 1.30 - 4.12, and adjusted OR 4.52, 95% CI95%CI 1.86 - 10.98, respectively).

Conclusion: Approximately half of the women with chronic hypertension developed superimposed preeclampsia. MAP ≥ 100 mmHg, the requirement of two or more antihypertensive agents, and a history of previous preeclampsia might be useful tools for predicting superimposed preeclampsia.

Background: An increasing trend of cesarean section (CS) rates has been observed worldwide, including Thailand. Various interventions to decrease unnecessary CS have been implemented as per recommendations. This study is aimed at evaluating a trend in CS rate during a 42-month period in a university-based tertiary care hospital in Thailand.

Methods: In a cross-sectional study, women who delivered at Siriraj Hospital between January 2021 and June 2024 were included. Those with private services were excluded. All women were categorized into 10 groups according to Robson classification. Overall and group-specific CS rates and their contribution to CS rate were evaluated. Trend of CS rate was evaluated by locally weighted scatterplot smoothing (LOESS) method.

Results: Of 13,645 deliveries, 2868 had private services, leaving 10,777 deliveries included in the analysis. Overall CS rate was 42.9% (95% CI: 42.1%-43.8%) and did not significantly change during the study period. Women in Groups 1 and 5 had the highest CS contribution of 25%-27%. Overall CS rate in Group 1 was 33.9% and the rates did not change significantly but showed a slight decrease to 31.4% in 2024. The LOESS regression showed that overall CS rate slightly increased during 2021, slightly decreased during 2022, and remained relatively stable during 2023 and 2024 at approximately 43%. CS rate in Group 1 slightly decreased during 2021, slightly increased during 2022, and a more obvious decrease during 2023-2024 was observed.

Conclusion: Over a 42-month period, a relatively stable high overall CS rate of 42.9% was observed, with the highest contribution from women in Groups 1 and 5 of the Robson classification. For women in Group 1, the CS rate showed a notable decrease during 2023-2024.

Background: Serum lactate dehydrogenase is a sensitive marker of hypoxia and cellular damage/death in preeclampsia due to vascular endothelial dysfunction. Evaluation of serum electrolytes can also indicate the severity of preeclampsia since it is a vascular endothelial disorder. However, in Ethiopia, there is a lack of data regarding the serum levels of lactate dehydrogenase and electrolytes among preeclamptic patients in comparison with apparently healthy normotensive pregnant women.

Method: A hospital-based comparative cross-sectional study was conducted with 128 participants (64 preeclamptic women and 64 apparently healthy normotensive pregnant women) from October 20, 2021 to January 3, 2022. Preeclamptic women were further classified into 32 without severe features and 32 with severe features. Blood samples (5 mL) were collected, and a Beckman Coulter 700 AU chemistry analyzer was used to measure serum LDH and electrolyte levels. The data were analyzed using SPSS version 25. One-way ANOVA was run to examine the mean variations, and the receiver operator characteristic curve was used to determine the potential diagnostic value for preeclampsia. A p value < 0.05 was considered statistically significant.

Result: Preeclamptic women showed a statistically significant elevation of LDH (p < 0.001) when compared with apparently healthy normotensive pregnant women. There was a substantial decrement in serum magnesium (p < 0.001), calcium (p < 0.001), and potassium (p = 0.029) in preeclamptic women than apparently healthy normotensive pregnant women. There was also a significant elevation of LDH (p < 0.001) but a reduction of calcium (p < 0.001) and potassium (p = 0.021) in preeclampsia with severe features than preeclampsia without severe features. Serum LDH detected preeclampsia with excellent accuracy (97.5%) at ≥ 350 U/L. Serum magnesium, calcium, and potassium demonstrated diagnostic accuracies of 69.5%, 82.3%, and 61%, respectively, for identifying preeclampsia, with optimal cutoff values of ≤ 1.505 mg/dl for magnesium, ≤ 8.65 mg/dl and 8.75 mg/dl for calcium, and 3.5 mmol/l and 3.75 mmol/l for potassium.

Conclusion: Serum LDH was significantly increased in the preeclamptic group compared with normotensive controls. There were significantly decreased levels of serum electrolytes (magnesium, calcium, and potassium) in preeclamptic women. Therefore, it is better to focus on the measurement of serum LDH and electrolytes for early detection and effective management of preeclampsia.

Background: Ectopic pregnancy remains a significant cause of maternal morbidity and mortality worldwide, particularly in low-resource settings. The aim of this study was to investigate the prevalence, clinical profile, and management outcomes of ectopic pregnancies at Ayder Comprehensive Specialized Hospital (ACSH) in Ethiopia between January 1, 2017 and December 31, 2021.

Methods: A cross-sectional study of 152 women diagnosed with ectopic pregnancy and admitted to ACSH between 2017 and 2021 was conducted. Data, including sociodemographic characteristics, obstetric history, clinical presentation, diagnostic methods, intraoperative findings, and management outcomes, were collected retrospectively from medical records. The prevalence of ectopic pregnancy was calculated based on the total number of deliveries during the study period. Descriptive statistics were used to summarize the data.

Results: Of 23,090 deliveries in the ACSH between 2017 and 2021, 152 cases of ectopic pregnancy were registered, corresponding to a prevalence of 6.58 per 1000 deliveries. The average age of the women was 28 years (SD ± 0.5), with the majority (55.5%) between 25 and 34 years old. Most patients (78.3%) lived in rural areas. Multigravida women accounted for 58.6% of cases. There was a history of abortion in 28.3% of women and a history of previous ectopic pregnancy in 6.6%. The most common clinical findings were tender abdomen (84%), adnexal motion tenderness (53%), and cervical motion tenderness (45%). Hemoglobin levels below 11 mg/dL were observed in 41% of cases. The majority of ectopic pregnancies were diagnosed using both clinical assessment and ultrasound (88.8%). Surgical management was the primary treatment modality (92.1%), with salpingectomy performed in 92.8% of cases. Blood transfusions were required in 29.6% of patients. The median length of hospitalization was 3 days (IQR = 2).

Conclusions: With a prevalence of 6.58 per 1000 deliveries, ectopic pregnancy remains a major health problem in ACSH. Most patients presented with acute symptoms requiring surgical intervention. Early detection and improved access to reproductive health services could reduce the morbidity of ectopic pregnancy in the region.

Pregnancy is one of the primary sources of stress, and unplanned pregnancy is a crisis in women's lives. In this study, we sought to determine the effect of crisis counseling on women's anxiety with an unplanned pregnancy. This semi-experimental study was conducted using the convenience sampling method. Sixty married pregnant women aged 15-49 years with unplanned pregnancies were randomly assigned to the two groups of intervention and control (n = 30 per group), of whom five were excluded from the intervention group, and three were excluded from the control group. The data collection tools included a medical-mental health checklist, the 28-item General Health Questionnaire-28 (GHQ-28), Winfield and Taigman's Social Support Scale, and Spielberg's State-Trait Anxiety Inventory (STAI). Three individual counseling sessions were held according to Roberts' seven-stage model. The participants' state and trait anxiety scores were assessed before and one month after the counseling sessions. There was no significant difference between the two groups regarding demographic characteristics, general health score, level of social support, and the mean score of general anxiety (p > 0.05). The mean scores of state anxiety before and after the intervention in the interventional group were 45.92 ± 6.8 and 42.8 ± 4.14, respectively, and the mean of trait anxiety scores were 46.84 ± 6.82 and 44.48 ± 5.46, respectively. In the control group, the mean of state anxiety scores before and after the intervention were 46.78 ± 6.09 and 46.63 ± 7.1, respectively, and the mean of trait anxiety scores were 46.41 ± 4.54 and 46.89 ± 5.09, respectively. Crisis counseling significantly impacted both state (p = 0.004) and trait (p = 0.047) anxiety. Crisis counseling reduces trait and state anxiety in women with an unplanned pregnancy. Therefore, establishing high-risk pregnancy clinics and employing midwifery consultants to assess and reduce anxiety levels in women with unplanned pregnancies will be beneficial.

Trial registration: Iranian Registry of Clinical Trials:IRCT2017100231117N5.

Background: Malaria and preeclampsia are major pregnancy-related complications that share overlapping complement and inflammation-mediated pathways. Although adipsin has been proposed as a diagnostic biomarker for preeclampsia, its diagnostic performance in the context of concurrent malaria infection remains poorly understood. This study investigated the impact of malaria infection on plasma adipsin levels and evaluated its diagnostic performance for preeclampsia.

Methods: This case-control study included 200 pregnant women between 20 and 42 weeks of gestation, stratified into four groups: normotensive without malaria, normotensive with malaria, preeclamptic with malaria, and preeclamptic without malaria (n = 50 per group). Plasma adipsin, C3a, C5a, TNF-α, IL-6, IL-8 and IFN-γ were measured using commercial ELISA kits. Malaria infection was confirmed with Giemsa-stained blood smears. Data were analysed using Statistical Package for the Social Sciences (SPSS) Version 27.0.

Results: Amongst the participants enrolled, malaria infection was present in 50% and preeclampsia in 50% of the sample. Plasma adipsin levels were significantly elevated in malaria-infected and preeclamptic participants (p < 0.001), with the highest concentrations observed in participants with coexisting preeclampsia and malaria infection. Plasma adipsin showed strong positive correlations with C5a (ρ = 0.695), IL-6 (ρ = 0.687), and TNF-α (ρ = 0.645), and moderate correlations with malaria parasite density (ρ = 0.553), IL-8 (ρ = 0.475) and C3a (ρ = 0.437) (p < 0.001 for all). Multivariable regression showed that preeclampsia and malaria independently elevated plasma adipsin levels, with a significant negative interaction between the two conditions (p < 0.001). ROC analysis showed reduced diagnostic specificity for preeclampsia in malaria-infected participants (62.1%, AUC = 0.719, p = 0.02) compared with malaria-negative participants (87.9%, AUC = 0.823, p < 0.001).

Conclusion: Plasmodium falciparum infection significantly alters plasma adipsin levels, reducing its diagnostic specificity for preeclampsia. Malaria-adjusted reference thresholds may be necessary when considering adipsin as a biomarker in endemic regions.

Background: Sexual violence during pregnancy is a critical global public health concern with severe consequences for maternal and neonatal outcomes, particularly in low- and middle-income countries like Ethiopia. Although previous studies in Ethiopia have primarily focused on general forms of violence, evidence specifically addressing sexual violence during pregnancy remains limited. Therefore, this study is aimed at assessing the prevalence of sexual violence and its associated factors among pregnant women in Arba Minch Town, Southern Ethiopia.

Method: A community-based cross-sectional study was conducted among 411 pregnant women from September 15 to October 30, 2024. Participants were selected using a systematic random sampling technique. Data were collected through an interviewer-administered questionnaire, entered into EpiData Version 4.6, and exported to SPSS Version 26 for analysis. Logistic regression was performed, and variables with p < 0.05 were considered statistically significant.

Result: The prevalence of sexual violence was 17% (95% CI: 13.4-20.4). Being a housewife (AOR = 4.0; 95% CI: [1.08, 8.91]), maternal age 15-24 years (AOR = 2.3; 95% CI: [1.08, 5.28]), having a partner with no formal education (AOR = 4.2; 95% CI: [1.84, 9.58]), and partner alcohol consumption (AOR = 2.9; 95% CI: [1.41, 6.37]) were significantly associated with sexual violence.

Conclusion: This study reveals that sexual violence among pregnant women is significant and associated with being a housewife, aged 15-24 years, having an uneducated partner, and a partner who drinks alcohol. Interventions should target at-risk groups, including young women and housewives, address partner substance use, and promote education and awareness programs to reduce the prevalence and adverse effects of sexual violence in pregnancy.

Human papillomavirus (HPV) infection is the most common sexually transmitted infection worldwide. It is highly prevalent among women of reproductive age. During pregnancy, hormonal changes and immunological modulation may promote viral persistence, thus likely increasing the risk of adverse maternal and neonatal outcomes. However, the clinical significance of HPV infection in pregnancy remains incompletely understood. This qualitative thematic analysis is aimed at evaluating the epidemiological and clinical impact of HPV during pregnancy, focusing on pathophysiological mechanisms, diagnostic challenges, obstetric and perinatal outcomes, and gaps in clinical management. A comprehensive literature search of PubMed and Scopus was conducted for peer-reviewed original studies published in the last 10 years in English. The review followed PRISMA 2020 guidelines. Of 1667 records initially identified, 34 studies met the inclusion criteria and were included in the qualitative synthesis. Study quality was assessed using the Newcastle-Ottawa Scale. Given the heterogeneity of study designs and outcomes, a thematic narrative synthesis was performed. Four major themes emerged: (1) pregnancy-related immunological, hormonal, and microbiome changes that facilitate HPV persistence; (2) diagnostic challenges arising from physiological cervical changes that affect cytology and colposcopy accuracy; (3) associations between maternal HPV infection and adverse outcomes such as preterm birth, premature rupture of membranes, miscarriage, low birth weight, and vertical transmission; and (4) disparities in screening and vaccination policies between high-income countries and low- and middle-income countries. While HPV is not directly teratogenic, evidence suggests it may indirectly compromise placental function and the integrity of the cervix. In conclusion, HPV infection during pregnancy is a clinically relevant concern with potential implications for both maternal and fetal health. Standardized screening strategies, improved vaccination coverage, and longitudinal studies are needed to guide evidence-based clinical practice and policy development.

Background: Viral hepatitis has been associated with profound alterations in the coagulation system as well as liver biomarkers. Meanwhile, during pregnancy, the coagulation system also undergoes significant changes with an increase in the majority of the clotting factors and a decrease in natural anticoagulants. This study is aimed at evaluating the coagulation profile and liver biomarkers among hepatitis B-infected pregnant women in a Ghanaian population.

Methods: This case-control study was conducted at Afrancho Polyclinic in the Ashanti Region, Ghana from January 2022 to July 2023. This study recruited 90 hepatitis B pregnant women as cases and 90 hepatitis B-negative pregnant women as controls. A structured questionnaire was used to obtain sociodemographic, obstetric, and clinical data from each participant.

Results: Levels of albumin, fibrinogen (4.09 [3.57-5.94] vs. 6.89 [5.43-9.08], p < 0.0001), protein C (2.46 [1.09-3.42] vs. 4.12 [2.96-6.07], p < 0.0001), and protein S (2.61 [2.20-3.36] vs. 2.98 [2.53-3.54], p = 0.036) were significantly reduced in the hepatitis B-positive pregnant women than the negative controls. However, there were higher levels of AST, ALP, and bilirubins in hepatitis B-positive pregnant women than the controls. Also, protein C and protein S had a significantly positive association with PT and aPTT, whereby a rise in protein C and protein S resulted in an increasing PT and aPTT, respectively (all p values < 0.05). Conversely, albumin had a negative correlation with both PT and aPTT (p value < 0.05). In a ROC analysis, aPTT had the highest area under the curve (AUC) value (AUC = 0.881) and the optimal clotting time at which aPTT indicated chronic hepatitis B was ≥ 35.7 s with sensitivity of 79.4% and specificity of 91.6%.

Conclusion: Pregnant women with hepatitis B infection present with significant changes in their coagulation parameters, natural anticoagulants, and liver biomarkers. Furthermore, fibrinogen, protein C, and aPTT showed accurate diagnostic potential in detecting chronic viral hepatitis B infection and may be valuable surrogate indicators for managing chronic hepatitis-related complications.