Journal of Pregnancy最新文献

Background: Brucellosis is one of the most prevalent zoonotic neglected tropical diseases across the globe. Brucella melitensis (B. melitensis), the most pathogenic species is responsible for several pregnancy adverse outcomes in both humans and animals. Here, we present the data on the magnitude of B. melitensis antibodies among pregnant women in Mwanza, Tanzania, the information that might be useful in understanding the epidemiology of the disease and devising appropriate control interventions in this region. Methodology. A hospital-based cross-sectional study involving pregnant women was conducted at two antenatal clinics in Mwanza between May and July 2019. The pretested structured questionnaire was used for data collection. Blood samples were collected aseptically from all consenting women followed by the detection of B. melitensis antibodies using slide agglutination test. Descriptive data analysis was done using STATA version 17.

Results: A total of 635 pregnant women were enrolled with the median age of 25 (interquartile range (IQR): 16-48) years and median gestation age of 21 (IQR: 3-39) weeks. Seropositivity of B. melitensis antibodies was 103 (16.2 (95% CI:13.3-19.1)). On the multivariate logistic regression analysis, as the gestation age increases, the odds of being seropositive decreases (aOR:0.972 (95% CI: 0.945-0.999), P = 0.045). Furthermore, being a housewife (aOR:3.902 (95% CI:1.589-9.577), P = 0.003), being employed (aOR:3.405 (95% CI:1.412-8.208), P = 0.006), and having history of miscarriage (aOR:1.940 (95% CI:1.043-3.606), P = 0.036) independently predicted B. melitensis seropositivity among pregnant women in Mwanza.

Conclusion: High seropositivity of B. melitensis was observed among employed and housewife pregnant women in Mwanza. This calls for the need of more studies in endemic areas that might lead to evidence-based control interventions.

Background: Discordant birth weight in twins is linked to poor outcomes and predicting this discrepancy may lead to enhanced screening and surveillance. Our purpose was to quantify the relationship between intertwin nuchal translucency (NT) and crown-rump length (CRL) discordance with birth weight discrepancies ≥ 20%.

Methods: We conducted a retrospective cohort study of 887 live twin births delivering at a Canadian tertiary care center over a 7-year period who opted for integrated prenatal screening. Categorical data are presented as numbers and percentages, and continuous data are expressed as means and standard deviations. Chi-square tests, Fisher's Exact tests, or T-test were performed as appropriate. We then used published data and receiver operating curves to determine the optimal thresholds for predicting birth weight discordance based on first trimester intertwin NT differences. These values were used in multivariate logistic regression models accounting for known confounders.

Results: Roughly 16% of twin pairs exhibited ≥ 20% difference in birth weight. Twin pairs with a CRL discordance greater than 10% have nearly a 4 times greater likelihood of having a birth weight discordance greater than 20% (OR 3.71, CI 2.24-6.14) while controlling for chorionicity, maternal age, gestational age at delivery, maternal body mass index (BMI), and parity. In these models, intertwin NT discordance ≥ 20% (OR 1.16, CI 0.77-1.77) and NT discordance ≥ 14% (OR 1.08, CI 0.73-1.60) were not statistically significant predictors of twin birth weight differences. However, when evaluating the effect of the larger intertwin NT value corresponding to the 95^th percentile, an NT difference ≥ 0.9 mm was predictive of birth weight discordance ≥ 20% (OR 2.53, CI 1.21-5.29).

Conclusion: Although intertwin CRL and NT discordance measured via ultrasound between 11-14 weeks gestation are related to birth weight discordance, there is uncertainty as to whether twin birth weight differences are related to adverse pregnancy outcomes in this population.

Background: Hypertensive disorder of pregnancy is the leading cause of maternal and perinatal morbidity and mortality worldwide and the second cause of maternal mortality in Ethiopia. The current study is aimed at assessing fetal-maternal outcomes and associated factors among mothers with hypertensive disorders of pregnancy complication at Suhul General Hospital, Northwest Tigray, Ethiopia, 2019. Methods:A hospital-based cross-sectional study was conducted from Oct. 1^st, 2019, to Nov. 30, 2019, at Suhul General Hospital women's chart assisted from July 1^st, 2014, to June 31^st, 2019. Charts were reviewed consecutively during five years, and data were collected using data abstraction format after ethical clearance was assured from the Institutional Review Board of Mekelle University College of Health Sciences. Data were entered into Epi-data 3.5.3 and exported to SPSS 22 for analysis. Bivariable and multivariable analyses were done to ascertain fetomaternal outcome predictors. Independent variables with p value < 0.2 for both perinatal and maternal on the bivariable analysis were entered in multivariable logistic regression analysis and the level of significance set at p value < 0.05.

Results: Out of 497 women, 328 (66%) of them were from rural districts, the mean age of the women was 25.94 ± 6.46, and 252 (50.7%) were para-one. The study revealed that 252 (50.3%) newborns of hypertensive mothers ended up with at least low Apgar score 204 (23.1%), low birth weight 183 (20.7%), preterm gestation 183 (20.7%), intensive care unit admissions 90 (10.2%), and 95% CI (46.1% -54.9%), and 267 (53.7%) study mothers also developed maternal complication at 95% (49.3-58.1). Being a teenager (AOR = 1.815: 95%CI = 1.057 - 3.117), antepartum-onset hypertensive disorders of pregnancy (AOR = 7.928: 95%CI = 2.967 - 21.183), intrapartum-onset hypertensive disorders of pregnancy (AOR = 4.693: 95%CI = 1.633 - 13.488), and low hemoglobin level (AOR = 1.704: 95%CI = 1.169 - 2.484) were maternal complication predictors; rural residence (AOR = 1.567: 95%CI = 1.100 - 2.429), antepartum-onset hypertensive disorders of pregnancy (AOR = 3.594: 95%, CI = 1.334 - 9.685), and intrapartum-onset hypertensive disorders of pregnancy (AOR = 3.856: 95%CI = 1.309 - 11.357) were predictors of perinatal complications.

Conclusions: Hypertensive disorder during pregnancy leads to poor fetomaternal outcomes. Teenage age and hemoglobin levels were predictors of maternal complication. A rural resident was the predictor of poor perinatal outcome. The onset of hypertensive disorders of pregnancy was both maternal and perinatal complication predictors. Quality antenatal care services and good maternal and childcare accompanied by skilled healthcare providers are essential for early detection and management of hypertensive disorder of pregnancy.

Background: Maternal and neonatal tetanus remains a public health problem in low-and-middle-income countries despite the increasing investment in tetanus toxoid containing vaccines (TTCV). Nigeria still records fatalities from tetanus, predominantly in women of reproductive age and in newborns. This is largely due to poor access to vaccinations and high rates of unsupervised labour and childbirth. We aim to investigate the antenatal uptake of TTCV and associated factors among first-time pregnant women in Nigeria.

Methods: Data obtained from the 2018 Nigeria Demographic Health Survey (NDHS) was used to generate a list of eligible patients who in the last five years had undergone their first childbirth experience. Data was analysed using univariable and multivariable analyses and reported using a 95% confidence interval.

Results: A total of 3640 participants were included in the analysis. 59.6% (95% CI, 57.6-61.8) of participants had received at least two doses of TTCV. Uptake of TTCV irrespective of current marital status was independently associated with number of and place of antenatal care. Other factors associated with receiving two doses of TTCV in all participants were ownership of mobile phones and region of residence. Among the currently married participants, wealth quintiles, region of residence, and having a polygamous family were additional associated factors.

Conclusion: There was low uptake of the minimal required dosage of TTCV among first-time pregnant women with the lowest uptake in Northern regions relative to Southern regions. We recommend mixed methods studies to further explore the motivation behind TTCV uptake in pregnant women which can help guide future policies and interventions to improve uptake of tetanus immunization in Nigeria.

Maternal near-miss (MNM) refers to a woman who nearly died but survived a complication that occurred during pregnancy, childbirth, or within 42 days of termination of pregnancy. Studies in Ethiopia showed an inconsistent proportion of MNM across time and in different setups. This study is aimed at assessing the magnitude, trends, and correlates of MNM at three selected hospitals in North Shewa Zone, Central Ethiopia. A hospital-based cross-sectional study was conducted among 905 mothers who gave birth from 2012 to 2017 in three hospitals using the WHO criteria for MNM. Medical records of the study subjects were selected using a systematic sampling technique. Data were retrieved using a pretested data extraction tool. Association between MNM and independent variables was assessed by using a binary logistic regression model. An odds ratio with a 95% confidence interval (CI) and p value of <0.05 were used to declare the level of significance. Of the 905 medical records reviewed, the prevalence of MNM was 14.3% (95%CI = 11.9 - 16.6) and similar over the last six years (2012-2017). The magnitude of life-threatening pregnancy complications was found to be 12.7%; severe preeclampsia (31%) and postpartum hemorrhage (26%) account for the highest proportion. Admission at a higher level of obstetric care like referral hospital (AOR = 4.85; 95% CI: 1.82-12.94) and general hospital (AOR = 3.76; 95% CI: 1.37-10.33), not using partograph for labor monitoring (AOR = 1.89; 95% CI: 1.17-3.04), history of abortion (AOR = 2.52; 95% CI: 1.18-5.37), and any other pregnancy complications (AOR = 6.91; 95% CI: 3.89-12.28) were factors significantly associated with higher MNM. Even though lower than the national figure, the proportion of MNM in the study area was very high, and there were no significant changes over the last six consecutive years. Giving special emphasis to women with prior history of pregnancy complications, hypertensive disorders of pregnancy, and obstetric hemorrhage with strict and quick management protocols and the use of partograph for labor monitoring are recommended to reduce the burden of severe maternal outcomes in the study area and Ethiopia.

Background: Stillbirth adversely affects pregnancy outcomes in low- and middle-income countries (LMICs). Viral infections have been implicated as one of the causes of stillbirths. Despite high rates of stillbirths and high viral prevalence in LMICs, there is limited information regarding their association. This study investigated the magnitude of herpes simplex 2 virus (HSV-2) and human cytomegalovirus (HCMV) among women with macerated stillbirth.

Methods: A cross-sectional hospital-based study was conducted involving 279 women with macerated stillbirth between July and August 2018 at different health facilities in Mwanza, Tanzania. Detection of HSV-2 was done by immunochromatographic test while that of HCMV was done using enzyme-linked immunosorbent assay (ELISA). Descriptive data analysis was done using STATA version 13.

Results: A total of 28 (10.04%, 95% CI: 6.8-13.9) tested positive for HSV-2 IgG antibodies with only 4 (1.43%, 95% CL: 0.3-2.8) testing positive for HSV-2 IgM antibodies. HCMV IgG antibodies were detected in 131 (77.98%, 95% CI: 71-84) of 168 women tested. By multivariate logistic regulation analysis, advanced age (OR: 0.93, 95% CI: 0.87-0.99, p = 0.025) was significantly associated with negative HSV-2 IgG antibodies. By log multinomial regression analysis, only urban residence (RRR.4.43: 95% CI 1.53-12.80, p = 0.006) independently predicted HCMV IgG seropositivity among women with stillbirth. Twenty-one (30.9%) of women with positive HCMV IgG antibodies had low avidity index (<40%) indicating recent infection.

Conclusion: Significant proportion of women with macerated stillbirth residing in urban and with low age have HCMV and HSV antibodies, respectively. This calls for the need to consider introducing screening of these infections in the Tanzanian antenatal package and further studies to explore the role of these viruses in causing stillbirth in Tanzania.

Introduction: Pelvic floor trauma in the form of partial or complete avulsions of the levator ani muscle (LAM) affects 6-42% of women after vaginal birth and can cause tremendous long-term morbidity. Many studies assessed morphological pelvic floor trauma after childbirth but lacked to evaluate women's associated short-term complaints. A proper assessment of trauma and subjective complaints after birth could help to assess possible associations between them and their relevance to women's daily life. Therefore, we aimed to assess women's complaints within the first months after birth in association to their LAM trauma.

Materials and methods: Between 3/2017 and 4/2019, we prospectively evaluated vaginal births of 212 primiparous women with singletons in vertex presentation ≥ 36 + 0 gestational weeks for levator ani muscle (LAM) trauma by translabial ultrasound, for pelvic organ prolapse by clinical examination, and for urogynecological complaints using questionnaires 1-4 days (P1), 6-10 weeks (P2), and 6-9 months (P3) after birth. The questionnaires were self-designed but oriented to and modified from validated questionnaires. Women's complaints were evaluated for P1-P3 according to their LAM trauma state.

Results: At P1, 67% of women showed an intact LAM, whereas 14.6% presented a hematoma, 6.6% a partial avulsion (PAV), and 11.8% a complete avulsion (CAV). At P2, 75.9% showed an intact LAM, 9.9% a PAV, and 14.2% a CAV. At P3, 72.9% of women with a LAM trauma in P1 and/or P2 were assessed with 21.6% being intact and 39.2% having a PAV and CAV, respectively. Obstetrical and baseline characteristics differed slightly between the groups. When comparing the time before and during pregnancy with the time after childbirth, birth itself affected women's complaints in all LAM state groups, but the presence of a LAM trauma, especially a CAV, had more negative effects.

Conclusions: Vaginal birth changes the anatomical structure of the maternal birth canal and genital tract, and it alters women's perceptions and body function. In our study, LAM trauma did not change these effects tremendously within the first months. Therefore, other maternal, fetal, and obstetrical factors need consideration for the explanation of maternal complaints, in addition to long-term effects of trauma and dysfunction of the LAM and other birth canal structures.

Exclusive breastfeeding (EBF) of infants for the first six months of life is a global public health goal that is linked to the reduction of morbidity and mortality in infants, especially in low middle-income countries. In low middle-income countries like Cameroon, it is realistic that compliance with EBF can significantly reduce the burden of under five mortality rate. The purpose of this study was to assess adherence and determinants influencing the duration of exclusive breastfeeding in Yaoundé, Cameroon. Data was collected through a mixed method and systematically through a retrospective survival analysis approach where a total number of 503 randomly selected individuals in Yaoundé, Cameroon, participated in the study. Data was collected between November 2019 and May 2020. A Cox proportional hazard modelling and Kaplan-Meier analysis were employed to identify prognostic factors affecting survival time defined as the duration, in months, from birth until the time of stopping EBF. The average time for nursing mothers to practice EBF was 3.61 ± 0.010 months. This study found that more than 90% of mothers were aware of the importance of compliance with EBF but only 38% practiced EBF and 62% of mothers could not adhere to EBF recommendations. Factors that influence compliance with EBF included a mother being married (HR: 0.70; 95% CI = [0.55-0.89], P =0.003) which was a protective factor while mother's tertiary education (HR: 1.43; 95% CI = [1.11-1.84], P =0.005) was a risk factor with non-compliance with EBF when compared to those with basic or no formal education. The Kaplan-Meier curve indicated that as time goes on, babies are less likely to be exclusively breastfed after a specific time period within two and three months. This implies that the chance for a baby to remain exclusively breastfed after five months is 74.3% (0.74). Continuous sensitization and enforcement measures are recommended to promote EBF.

Objective: The objective of this study was to estimate the time between removal of cerclage and delivery, stratified by indication for cerclage placement (elective or non-elective). Additionally, delivery within 72 hours after cerclage removal was compared between elective and non-elective cerclage placement, as well as between ultrasound-indicated and physical examination-indicated cerclage placement.

Design: A single-center retrospective cohort study. Participants/Materials, Setting, and Methods. Clinical information of 72 pregnant women who underwent transvaginal cerclage over a 4-year period was obtained. Comparisons were made between elective (history-indicated) and non-elective (ultrasound or physical examination-indicated) cerclage placement. Comparisons were also made between physical examination-indicated and ultrasound-indicated cerclage.

Results: Compared to those who had a non-elective cerclage, women undergoing elective cerclage were more likely to have history of cervical treatment (44% vs. 15%, p = 0.02), and spontaneous preterm delivery (92% vs. 61%, p = 0.003). There was no difference in the rate of delivery ≤72 hours following cerclage removal between women who had elective cerclage and those who had non-elective cerclage (46% vs. 58%, p = 0.47). Women who had an elective cerclage were more likely to have elective cerclage removal ≥36 weeks (71.8% vs. 39.4%, p = 0.01), compared to those who had undergone non-elective cerclage. The rate of delivery ≤72 hours following removal of cerclage was greater in women who had a physical examination-indicated cerclage compared to women who had ultrasound-indicated cerclage (80% vs. 39%, p = 0.04). Among women who had an elective cerclage, there was no difference in the rate of delivery at ≤72 hours between those who had elective cerclage removal at 36 weeks compared to those electively removed at 37 weeks (31% vs. 58%, p = 0.30). No complications such as fetal demise, iatrogenic amniotic membrane rupture, hemorrhage, or cervical laceration were reported within this cohort.

Conclusion: Cerclage indication should be considered prior to scheduling elective cerclage removal. Women who had an elective cerclage are most likely to get it electively removed at 36 weeks compared to their counterparts who had a non-elective cerclage. Furthermore, women who had a physical examination-indicated cerclage are most likely to deliver within 72 hours of cerclage removal.