Introduction: Following the implementation of the universal two-child policy in China, many multiparous women who had a history of induced abortion gave birth again. However, there is a lack of studies exploring the associations between induced abortion for nonmedical reasons and maternal and neonatal perinatal complications.
Methods: In this retrospective cohort study, the participants were multiparous women who gave birth to singleton babies at or after 28 weeks of gestation between 1 December 2015, and 1 December 2020. The exposure factor was a maternal history of induced abortion for nonmedical reasons. Logistic regression models were used to adjust for potential confounding factors, and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for maternal and neonatal perinatal outcomes. The dose-effect relationships between the number of induced abortions for nonmedical reasons and adverse outcomes were tested by the Cochran-Armitage trend test (p for trend). Stratified analyses were conducted to test the robustness of the results in subgroups with different maternal ages or interpregnancy intervals.
Results: There were 3985 multiparous women with a history of induced abortion for nonmedical reasons and 1823 multiparous women without such a history. Compared to women without such a history, women with a history of induced abortion for nonmedical reasons had increased risks of cesarean section (adjusted OR, 1.44; 95% CI: 1.23 - 1.69), placenta-related complications (adjusted OR, 2.14; 95% CI: 1.68 - 2.72), uterine-related complications (adjusted OR, 1.24; 95% CI: 0.97 - 1.59), HDP (adjusted OR, 1.49; 95% CI: 1.16 - 1.93), and preterm birth (adjusted OR, 1.24; 95% CI: 1.05 - 1.48) in subsequent pregnancy. In addition, there were dose-effect relationships between the number of induced abortions and the number of cesarean sections (Ptrend <.001), placenta-related complications (P trend <.001), uterine-related complications (Ptrend =.016), HDP (Ptrend =.0003), and preterm birth (P trend =.0006). Similar trends were observed in most subgroups with different maternal ages or interpregnancy intervals.
Conclusions: A history of induced abortion for nonmedical reasons was associated with increased risks of maternal and neonatal perinatal complications. Furthermore, dose-effect relationships were observed for these associations.
Objective: To determine the effect of postpartum care models on the occurrence of postpartum depression.
Methods: A prospective case-control study was conducted using EPDS among 419 women who underwent 42-day postpartum checkups between August 2023 and August 2024. The subjects were divided into two groups based on whether they had PPD. The influence of postpartum care models (the modes of receiving care from discharge to 42 days after delivery) on the occurrence of PPD was analyzed, and the independent influence factors on the occurrence of PPD were clarified.
Results: Among the enrolled parturients, 84 had PPD, 11 of whom breastfed, 31 artificially fed, and 42 mixed fed their infants. There were 59 cases of prenatal depression and 25 cases of non-prenatal depression. 31 subjects were satisfied with the gender of the baby, and 53 were not satisfied. PPD occurred in 9 subjects who asked for maternity care at home, 12 who received care in the maternity center, and 63 who were under the care of family members at home. Analysis of the relationship between the occurrence of PPD and various parameters showed that BMI (X2 = 6.111 p = 0.047), feeding methods (X2 = 32.332 p = 0.000), prenatal depression (X2 = 62.988 p = 0.000), satisfied with the gender of the baby (X2 = 39.212 p = 0.000), and puerperal care model (X2 = 11.750 p = 0.003) were significantly correlated with the occurrence of PPD. Furthermore, multivariate logistic regression revealed that mixed feeding (OR 2.922(1.898-4.497) p = 0.000), prenatal depression (OR 0.147(0.079-0.273) p = 0.000), dissatisfaction with the gender of the baby (OR 0.156(0.082-0.297) p = 0.000), and received home care from relatives (OR 2.119(1.371-3.275) p = 0.001) were independent risk factors for the occurrence of PPD. BMI (OR 0.655(0.420-1.021) p = 0.062) was not an independent risk factor.
Conclusion: Parturient received home care with nanny or go to maternity center may reduce the occurrence of PPD. In addition, we recommend strengthened counseling for parturients with prenatal depression, those who use mixed feeding of their infants, and those who were dissatisfied with the gender of the baby in an effort to reduce the occurrence of PPD.
Background: Neonatal transportation, when done adequately, has been associated with reduced morbidity and mortality among referred neonates. In many developing countries, safe and specialized system for neonatal transportation has not been adequately considered and this has a contribution to a burden of neonatal morbidity and mortality specifically in sub-Saharan Africa. This study describes attributes of neonatal transportation services from primary to secondary health care facility in rural Tanzania and predictors of short-term outcome.
Methods: This was part of the larger study conducted in Iringa Regional Referral hospital conducted from April - June 2023 looking at neonatal mortality and associated factors. Participants were consecutively recruited into study including those who were referred from primary health care facilities across the region and whose parents or care giver provided a written consent. Data were collected by a structured questionnaire and inspection of the transportation vehicle used on arrival. Frequency tables were used to summarize the data with logistic regression performed to assess predictors of poor condition on arrival.
Results: Most of the participants were male neonates (61.3%) weighing more than 2500 g at birth with the gestation age of 37 weeks or more (58.7%). Upon arrival, over half of the participants (53.3%) had referral notes readily available. Majority of the neonates were transported by a public ambulance (72%) but only 1.9% of these had respiratory and cardiovascular system supporting equipment. Two-third of the escorting health personnel had no training on neonatal resuscitation and essential newborn care. Neonates who traveled for over 30 min were more likely to arrive in critical condition, AOR = 6, 95%CI (1.44-18.18) compared to those who used less time.
Conclusion: Enhancing neonatal transportation services in rural Tanzania is crucial for specialized care and safety, ultimately impacting morbidity and mortality rates.
Objective: The aim of the present pilot study was to determine associations between maternal Apolipoprotein E (ApoE) genotype, lipid levels during pregnancy, fetal growth, and placental pathology.
Methods: In this case-control study, serum samples from pregnant women without hypertension who delivered small-for-gestational age (SGA) infants (n = 50) were matched on gestational age at sample collection with non-SGA infants (n = 100). ApoE allele distributions and lipid levels were compared between cases and controls and among placental pathological findings.
Results: No differences in ApoE genotypes were noted between groups. High density lipoprotein (HDL) cholesterol levels were higher in ε2 carriers versus ε3/ε3 and ε4 carriers (78.1 vs. 67.7 vs. 64.0 mg/dL, p < 0.01 and p < 0.001, respectively), and in SGA pregnancies (73.2 vs 65.1 mg/dL, p = 0.003).
Conclusion: Findings suggest increased HDL in pregnancy may be associated with the ε2 allele and decreased fetal growth. These findings provide a useful starting point for further research and should be explored in larger population-based studies.
The incidence for congenital heart block is estimated as high as 1 in 15,000 live births. Up to 90% of cases of congenital heart block, in which there is no anatomical abnormalities, are attributed to maternal systemic lupus erythematous or Sjögren's disease. 50% of these mothers are asymptomatic at time of diagnosis. The post-natal cardiac manifestations have been felt to be irreversible. In this article we present, to our knowledge, the first case of spontaneous conversion of immune mediate 3rd degree heart block to sinus rhythm postnatally.
Objective: This retrospective analysis evaluates the safety and efficacy of the vaginal use of the chitosan covered gauze ("Celox™ PPH") in managing lower genital tract trauma with high blood loss, where conventional repair failed.
Methods: Data from patients receiving chitosan covered gauze intravaginally or locally at the vulva due to substantial blood loss because of birth injury were examined retrospectively, using data from a university hospital 2017-2024. Parameters included blood loss, anesthesia, transfusions, length of hospitalization, infection signs, need for intensive care, and tamponade success, defined as bleeding cessation within 5 min and no requirement of further operative intervention.
Results: Use of chitosan covered gauze effectively controlled bleeding in 26 severe birth injury cases except one. Seven women presented with bleeding due to vaginal tears, 2 with cervical tears, 14 with combined vaginal and perineal or cervical tears, 2 with clitoral lacerations and one with a paravaginal hematoma. In the single unsuccessful case the tamponade was applied late after initial suturing because of under-estimated blood loss, and a second subsequent surgery became necessary. In two women of the cohort the gauze was initially used as a bridging concept because of reduced surgical visibility. Median blood loss in the study cohort was 1000 ml resulting in a median hemoglobin-reduction of 3.65 g/dl. Four patients required blood transfusion and intensive care after the bleeding event. Tamponade application duration varied, ranging from 20 min to 24 h, with a median duration of 8.5 h. The median hospital stay was 3 days. Infection parameters were not elevated after gauze application, with no reported cases of postpartum fever nor signs of infection. Removal was uneventful in all patients, expulsion did not occur. Three successful pregnancies after the event have been reported so far.
Conclusion: Vaginal insertion of chitosan covered gauze proved to be safe and effective for the management of severe lacerations after vaginal birth in our retrospective cohort. Shorter application time may be sufficient for birth injuries.
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