Journal of Pregnancy最新文献

Background: Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19.

Methods: Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions.

Results: 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term.

Conclusion: COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.

Background: A preterm birth is the leading cause of death in both neonatal and children under five years of age every year throughout the world, particularly in Sub-Saharan Africa. The causes of a preterm birth are complex and multifactorial; many risk factors that contribute it are not fully understood. The aim of this study was to identify predictors of a preterm birth among mothers who gave birth in Silte Zone Public Hospitals, Southern Ethiopia (2019/20).

Methods and materials: A hospital-based unmatched case-control study design was carried out from July 15^th to October 30^th, 2019, by assigning mothers who gave preterm births as cases and those with term births as controls. A total of 365 respondents (91 cases and 274 controls) were selected by a consecutive simple random sampling until the required sample size was achieved. For each case, three consecutive controls were included. Data were collected using a structured interview questionnaire complement with record reviewing. The data were entered into Epi Info 7 and exported into SPSS 25 for analysis. Descriptive analysis was computed to obtain summary values for cases and controls separately. All candidate variables in bivariate analysis were entered into the multivariable logistic regression model by using the backward likelihood ratio selection methods. Finally, variables with p value ≤ 0.05 were considered as potential determinants of a preterm birth and reported in the form of adjusted odds ratio with 95% confidence interval.

Results: Among a total of 365 mothers who gave live birth, 91 (24.9%) were cases compared to 274 (75.1%) which were controls. The final multivariable logistic regression analysis results showed that having history of a previous preterm birth (AOR = 3.51; 95%CI = 1.40 - 8.81), having shorter interpregnancy interval (AOR = 4.46; 95%CI = 1.95 - 10.21), experiencing obstetric complication (AOR = 3.82; 95%CI = 1.62 - 9.00), and having infant born with low birth weight (AOR = 5.58; 95%CI = 2.39 - 13.03) were found to be independent predictors of a preterm birth.

Conclusions: According to this finding, mothers having previous history of a preterm birth, experiencing obstetric complication, having shorter interpregnancy interval, and having infant born with low birth weight were reported as the independent predictors of a preterm birth. Improving the quality of antepartum and intrapartum, counseling on birth space, creating awareness on family planning, and early screening of preterm determinants are mandatory.

The maternal immune response is essential for successful pregnancy, promoting immune tolerance to the fetus while maintaining innate and adaptive immunity. Uncontrolled, increased proinflammatory responses are a contributing factor to the pathogenesis of preeclampsia. The Th1/Th2 cytokine shift theory, characterised by bias production of Th2 anti-inflammatory cytokine midgestation, was frequently used to reflect the maternal immune response in pregnancy. This theory is simplistic as it is based on limited information and does not consider the role of other T cell subsets, Th17 and Tregs. A range of maternal peripheral cytokines have been measured in pregnancy cohorts, albeit the changes in individual cytokine concentrations across gestation is not well summarised. Using available data, this review was aimed at summarising changes in individual maternal serum cytokine concentrations throughout healthy pregnancy and evaluating their association with preeclampsia. We report that TNF-α increases as pregnancy progresses, IL-8 decreases in the second trimester, and IL-4 concentrations remain consistent throughout gestation. Lower second trimester IL-10 concentrations may be an early predictor for developing preeclampsia. Proinflammatory cytokines (TNF-α, IFN-γ, IL-2, IL-8, and IL-6) are significantly elevated in preeclampsia. More research is required to determine the usefulness of using cytokines, particularly IL-10, as early biomarkers of pregnancy health.

Background: Antenatal depression has immense public health importance, as it can adversely affect both the mother and child health. The problem contributes to the disease burden in both developed and developing countries. Despite this, it is less investigated and not getting the necessary attention in the study setting.

Objective: The aim of the study was to assess the prevalence of antenatal depression and associated factors among women attending antenatal care (ANC) service in Kochi Health Center, Jimma town, southwest Ethiopia, 2019.

Method: Institutional based cross-sectional survey was conducted on 314 pregnant women attending Kochi Health Center from February 15 to April 15, 2019. A systematic random sampling technique was used to include the study participants. Antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9) tool. Data was collected through face-to-face interviews using a pretested and structured questionnaire. Descriptive statistics was done to summarize the dependent and independent variables. Moreover, the chi-square test analysis was done to determine the association between the outcome and explanatory variables.

Results: A total of 314 pregnant women participated in the study, making a response rate of 96.7%. The study has revealed a total of 52 (16.6%) of the respondent had antenatal depression. A chi-square test of independence analysis showed a significant association between antenatal depression and marital status, family history of depression, pregnancy planning, history of abortion, social support, and intimate partner violence (P < 0.00001).

Conclusion: The study has shown that the prevalence of antenatal depression was high and associated with multiple psychosocial, clinical, and obstetric factors. Therefore, screening pregnant women for depression and the provision of necessary mental health services is recommended to mitigate the adverse health outcome of the problem.

Introduction: In Iran, the rate of cesarean section is three times more than the acceptable rate considered by the World Health Organization. This study aimed at reducing the selection of cesarean section by primigravida through an intervention based on social marketing in Boyer-Ahmad County, Iran, 2015.

Methods: In this field trial, 39 of primigravida women were identified and selected as a target group. Formative research (a quantitative survey and a qualitative study) was done to achieve the social marketing mix. The tailored intervention was developed based on the findings of formative research. The intervention was implemented for one month for pregnant women who had cesarean section intention. Their intention for the cesarean section was studied again one month after the implementation of the intervention. The effectiveness of the intervention was evaluated by the proportion test.

Results: The average age of the women was 25.82. All of the women 38.5 percent had a diploma degree and lower than and 61.5 percent had a university degree. Before the intervention, 39 women intended to do Cesarean. The intention of 30 pregnant women was changed significantly one month after the intervention.

Conclusion: The study showed the effectiveness of an intervention based on consumer-oriented social marketing theory and could be used to reduce Cesarean intention. More studies about related factors of vaginal delivery selection especially from behavioral intention up to behavior are suggested.

Introduction: Preeclampsia (PE) is a life-threatening condition for the mother, the fetus, and the newborn. Matrix metalloproteinases (MMP) participate in the two primary stages of PE: remodeling of blood vessels at the stage of placental formation and the development of hypertension due to damage to the basement membrane of blood vessels. The object of the present study was to reveal the role of MMP-2 and MMP-9 in the development of severe preeclampsia.

Materials and methods: We conducted a retrospective study that included 92 pregnant women at a gestational age of 26-38 weeks, of which the principal group consisted of 61 patients with severe PE. We divided the principal group into two subgroups: the first subgroup was designated the severe early-onset preeclampsia (EO-PE) group and consisted of 30 pregnant women. The second group was designated the severe late-onset preeclampsia (LO-PE) group, comprising 31 patients. We determined the plasma concentrations of MMPs 2 and 9 in the groups with an ELISA.

Results: In the group of PE patients with both EO-PE and LO-PE, the level of MMP-2 was significantly higher compared to the women undergoing normal pregnancy; and we observed no significant differences when we compared the levels of MMP-2 in the subgroups with EO-PE and LO-PE. Analysis of the concentrations of MMP-9 in EO-PE and LO-PE subgroups revealed attenuated levels of MMP-9 in both groups relative to the control group. We also noted a diminished level of MMP-9 in the EO-PE group compared to the LO-PE group.

Conclusions: The significantly increased levels of MMP-2 in women-both in the EO-PE and LO severe PE subgroups-explain the participation of this enzyme in endothelial dysfunction in the second stage of severe PE. A diminution in MMP-9 in the EO-PE group confirmed the participation of MMP-9 in the process of spiral artery transformation.

Background: Access to and utilization of facility delivery services is low in Ethiopia. The government of Ethiopia introduced a free delivery service policy in all public health facilities in 2013 to encourage mothers to deliver in health facilities. Examining the effect of this intervention on the utilization of delivery services is very important.

Objective: In this study, we assessed the effect of provisions of free maternity care services on facility-based delivery service utilization in central Ethiopia.

Methods: Data on 108 time points were collected on facility-based delivery service utilization (72 pre- and 36 postintervention) for a period of nine years from July 2007 to June 2016. Routine monthly data were extracted from the District Health Information System and verified using data from the delivery ward logbooks across the study facilities. An interrupted time-series analysis was conducted to assess the effect of the intervention.

Results: The implementation of the free delivery services policy has significantly increased facility deliveries. During the study period, there was a statistically significant increase in the number of facility-based deliveries after the 24^th and 36^th months of intervention (p < 0.05). Program effects on the use of public facilities for deliveries were persisted over a longer exposure period.

Conclusion: The findings suggested that the provision of free delivery services at public health facilities increased facility delivery use. The improved utilization of facility delivery services was more marked over a longer exposure period. Policy-makers may consider mobilizing the communities aware of the program at its instigation.

Purpose: As the rate of cesarean sections (CS) continues to rise in Flanders (northern part of Belgium), it is important to understand the reasons behind this evolution and to find ways to achieve appropriate CS rates. For this analysis, we categorized CS changes between 1992 and 2016, applying the Robson 10-Group Classification System (TGCS). We also applied the TGCS to analyze the information of the only clinics where between 2008 and 2016, the absolute CS rate had fallen by more than two percent.

Methods: This paper is based on a population-based cross-sectional study. Robson's TGCS was used to analyze CS rates for the years 1992, 2000, 2008, and 2016, using the Flemish population-based birth register.

Results: Between 1992 and 2016, the overall CS rate increased from 11.8% in 1992 to 20.9% in 2016. The major contributors to that increase were (a) single, cephalic nulliparous women, at term in spontaneous labor (Robson group 1); (b) single, cephalic nulliparous women, at term in induced labor or CS before labor (group 2); and (c) multiparous women with single cephalic at term pregnancy with history of CS (group 5). In the subgroup of the seven clinics where the collective CS rate had decreased from 23.2% in 2008 to 19.3% in 2016, the main contributors to this decrease were Robson groups 1 and 2.

Conclusions: The CS increase in Flanders between 1992 and 2016 is mainly the result of the absolute CS increase in the childbirth of nulliparous women with a single cephalic baby at term in spontaneous or induced labor and in women with a single cephalic presentation at term and a previous CS. Further research in these aforementioned groups is needed to identify the real reasons for the CS increase.

Introduction: Uterine rupture is a leading cause of maternal death in Ethiopia. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. This study was conducted to identify the risk factors of uterine rupture and its impacts in public hospitals of Tigrai.

Objective: This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia.

Method: A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture.

Result: Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture.

Conclusion: Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. This assertion was added to the abstract concluding session.

Background: Low birth weight is a significant index for survival, intrauterine growth, and mortality in infants. Thus, this study is aimed at determining the prevalence of low birth weight in Iranian infants through a systematic review and meta-analysis.

Methods: This study was performed by meta-analysis from January 2000 to December 2019. The studies relevant to the topic have been obtained through search in databases of Scopus, ScienceDirect, SID, Magiran, Barakat Knowledge Network System, Medline (PubMed), and Google Scholar. Heterogeneity of the studies has been assessed by the I ² index, and data analysis was done using Comprehensive Meta-Analysis software.

Results: By investigating 14 articles and 93924 infants, the total prevalence of low birth weight in infants in Iran was achieved at 8.5% (95% CI: 7.3-9.9%) according to the meta-analysis; the most prevalence of low birth weight was in infants in Hamedan at 19.1% (95% CI: 21.2-17.2%) in 2007, and the lowest prevalence of low birth weight was in infants in Tonekabon at 4.2% (95% CI: 3.4-5.2%) in 2005, and also, by increasing the sample size, the prevalence of low birth weight increases, by which the difference is statistically significant (P < 0.05).

Conclusion: Due to the high prevalence of low birth weight in infants in Iran, health policy-makers must take effective attempts in order to reduce it in infants.