BMC Pregnancy and Childbirth最新文献

Background: Gestational diabetes mellitus (GDM) is linked to adverse fetal outcomes like macrosomia and neonatal hypoglycemia, with its global incidence increasing. While prior research indicates GDM may impair placental function and fetal oxygen delivery, direct evidence is limited. This study compares umbilical cord arterial blood gas measurements in pregnancies with and without GDM.

Methods: This retrospective study analyzed medical records from four hospitals in Tehran, Rasht, Ahvaz, and Isfahan in Iran, focusing on term singleton pregnancies (gestational age ≥ 37 weeks) that underwent elective cesarean sections between January and July 2024. Exclusions included maternal age < 18 or > 45 years, pre-existing diabetes, thyroid, hypertensive, malignant, metabolic, or autoimmune disorders, intrauterine growth restriction, hypertensive disorders of pregnancy, and substance use during pregnancy. GDM was diagnosed using a 75-gram oral glucose tolerance test at 24-28 weeks. Primary outcomes included umbilical cord arterial blood gas measures (potential of hydrogen [pH], partial pressure of carbon dioxide [PCO₂], partial pressure of oxygen [PO₂], bicarbonate [HCO₃], and base deficit). The neonatal outcomes were measured as secondary outcomes. Statistical analyses utilized Chi-square, Fisher's exact, and independent t-tests.

Results: Data from 430 pregnancies, including 87 with GDM, were analyzed. Pregnancies with GDM showed significantly lower pH (7.33 ± 0.08 vs. 7.36 ± 0.06, P-value = 0.006) and greater base deficit (-1.82 ± 3.79 vs. -0.50 ± 2.74 mEq/L, P-value = 0.003). However, no significant between-group differences were observed in PCO₂, PO₂, or HCO₃ (P-value > 0.05). Furthermore, we observed no significant differences in the mean birthweight, 1-minute, or 5-minute Apgar scores (P-values > 0.05), while neonates in the GDM group required more resuscitation (28.7% vs. 12.0%, P-value < 0.001) and neonatal intensive care unit admissions (34.5% vs. 16.9%, P-value < 0.001).

Conclusions: Pregnancies with GDM showed higher umbilical cord blood acidity, indicating impaired placental function and reduced fetal oxygenation. These findings underscore the need for enhanced monitoring, such as regular fetal surveillance and close glycemic control, along with timely interventions like early neonatal resuscitation protocols and preparedness for neonatal intensive care unit admissions, to mitigate impaired fetal oxygenation in GDM.

Trial registration: Not applicable.

Background: Mothers of preterm infants report traumatic, anxious and depressive symptoms in the postpartum period. Many studies have focused on biological, social, and life circumstance factors to explain the emergence of these symptoms. The process model proposes to focus on psychological processes, which are mechanisms underlying mental disorders. However, the psychological processes underlying the onset of traumatic, anxious, and depressive symptoms in postpartum mothers of preterm infants had not yet been investigated. The aim of this study was to identify the most common symptoms experienced in the first few days after delivery and determine whether processes of anhedonia, brooding rumination, and worry are related to posttraumatic stress (PTS), anxiety, and depression symptoms.

Methods: A sample of 106 mothers was screened for PTS, anxiety, and depression symptoms within the first 10 days after their preterm delivery. Anhedonia, brooding rumination, and worry were also assessed as psychological processes. Student's t-tests were performed to identify the most severe manifestation reported. To explore the relationship between psychological processes and symptoms, multiple linear regressions were performed on each symptom.

Results: Descriptive analysis shows that 75.5% of mothers reported a pathological symptom level for at least one of PTS, anxiety, or depression. Being alert and worrying are the predominant manifestations experienced in the first few days after preterm birth. Multiple linear regression showed that PTS symptoms were associated with worry and brooding rumination; anxiety symptoms were associated with worry, reminiscence pleasure and a deficit in consummatory pleasure; and depressive symptoms were associated with worry and a deficit in consummatory pleasure.

Conclusions: Our findings support the transdiagnostic nature of psychological processes and suggest that anhedonia, brooding rumination, and worry may be relevant targets for psychological interventions to concurrently treat PTS, anxiety, and depression symptoms. Behavioral activation could be an effective intervention to target these dysfunctional processes and thus improve maternal symptoms.

Background: Intrahepatic cholestasis of pregnancy (ICP) is a liver condition that may impact both mother and fetus, including preterm birth and hemorrhage. Vitamin K, a fat-soluble vitamin essential for coagulation, may be deficient in ICP due to impaired bile flow, raising hemorrhage risk. The study aimed to analyze Vitamin K1, K2 MK4, and K2 MK7 levels in pregnant women with ICP and determine associations between Vitamin K deficiency and postpartum hemorrhage.

Methods: This prospective cohort study included 44 pregnant women with ICP (L1) and 44 controls (L0). Serum Vitamin K levels, using high-performance liquid chromatography, and blood loss during delivery were assessed. Statistical analyses included t-tests and chi-square tests, with significance at p < 0.05. Study registration number ISRCTN21187408 https://www.isrctn.com/ISRCTN21187408 Registration date 03/06/2020.

Results: Women with ICP exhibited significantly lower mean levels of Vitamin K1 (0.15 ± 0.17 µg/L in L1 vs. 0.29 ± 0.30 µg/L in L0, p = 0.0085) and Vitamin K2 MK7 (0.17 ± 0.13 µg/L in L1 vs. 0.26 ± 0.14 µg/L in L0, p = 0.0024) compared to controls. Vitamin K1 deficiency was observed in 52.3% of the ICP group vs. 2.3% in controls. Mean blood loss during vaginal delivery was higher in the ICP group (351 ± 104 mL in L1 vs. 297 ± 87 mL in L0, p = 0.0373).

Conclusions: This study suggests that ICP contributes to significant Vitamin K1 deficiency in pregnant women, potentially increasing postpartum hemorrhage risk. Routine Vitamin K monitoring and possible supplementation with vitamin K in pregnant women with ICP may be beneficial to mitigate adverse maternal outcomes. Further research is warranted to confirm these findings.

Background: The endometrioma accompanying hydrosalpinx can affect the success rate of in vitro fertilization (IVF). We aimed to determine the incidence of hydrosalpinx in infertile patients with endometrioma and its effects on in vitro fertilization success.

Methods: In our retrospective study, we performed hysterosalpingography (HSG) on patients diagnosed with endometrioma through ultrasound evaluation. Then, we performed diagnostic laparoscopy on patients with suspected tubal pathology and/or hydrosalpinx after HSG assessment. Laparoscopic tubal occlusion was performed for patients with hydrosalpinx.

Results: HSG was performed on 760 patients diagnosed with ovarian endometriosis. After the assessment of HSG images, hydrosalpinx was detected in 184 of 760 patients (24.2%) and diagnostic laparoscopy was performed. Unilateral or bilateral hydrosalpinx were detected at 65 of 184 (35.3%) patients. Laparoscopy and proximal tubal occlusion were performed in these patients. Incidence of hydrosalpinx was found to be 8.5% in IVF patients with ovarian endometrioma.

Conclusion: Tubal patency screening may be considered for the patients with endometrioma before embryo transfer to prevent IVF failure due to hydrosalpinx.

Background: In this study, a total of 17 patients with Klippel-Trenaunay Syndrome (KTS) and pregnancy were evaluated. The patients were divided into two groups: those with organ involvement (10 patients) and those without organ involvement (7 patients). The clinical findings, complications, and treatment approaches between the two groups were compared, and the effects of KTS on the pregnancy process and potential risks were examined in detail. Significant clinical differences were observed between pregnant women with involvement of abdominal organs such as the liver, spleen, rectum, sigmoid, kidney, bladder, and uterus, as well as central organs like the brain, and those without such involvement. Organ involvement was defined as organ enlargement or venous anomalies detected by techniques such as ultrasound, magnetic resonance imaging (MRI), or computed tomography. Our literature review found that the risk of postpartum hemorrhage (PPH) was significantly higher in the group with organ involvement (p < 0.05). The presence of varicose malformations in organs such as the spleen, liver, and uterus was identified as an important factor increasing the risk of PPH. Therefore, close monitoring of coagulopathic disorders and taking precautions against thromboembolism in pregnant women with KTS is crucial. The case report discusses the complications and treatment processes experienced by a 26-year-old woman diagnosed with KTS and who developed preeclampsia during her two pregnancies. Complications such as preeclampsia and varices were observed in the first pregnancy, and intrauterine growth restriction (IUGR) and preeclampsia in the second pregnancy. Successful outcomes were achieved in both cases with a multidisciplinary approach and appropriate treatment methods. This study provides important information to understand the effects of KTS on pregnancy and the potential complications associated with this rare condition. Future studies will provide more information on the management of preeclampsia and other complications in pregnant women with KTS.

Background: Low back pain (LBP) is a significant musculoskeletal problem during pregnancy, which can negatively affect a woman's quality of life. The aim of this study was to determine the prevalence, the clinical characteristics and the factors associated with LBP during pregnancy among women attending the Antenatal Unit of the Bamenda Regional Hospital (BRH).

Methods: A cross-sectional study was carried out from February to April 2019 at the Antenatal unit of the BRH. We included all pregnant women who came for antenatal consultation during the study period and who gave their informed consent to participate in the study. A pretested, interviewer-administered questionnaire was used to collect data on the sociodemographic characteristics of the participants, the occurrence of LBP, its clinical characteristics and the factors associated with its occurrence. Data were analysed using SPSS version 25.0. Univariate logistic regression was used to identify risk factors and multivariate analysis was used to eliminate confounders. A p-value of < 0.05 was considered statistically significant.

Results: A total of 410 participants were included in the study. The prevalence of LBP in pregnancy was 53.9% (n = 221). The prevalences of lumbar pain and pelvic girdle pain were 34.9% (n = 143) and 26.1%, (n = 107), respectively. The factors that were associated with a higher likelihood of reporting LBP were a history of LBP in a previous pregnancy (aOR = 2.9, 95% CI, p = < 0.001), obesity (aOR 3.4 95% CI, p = < 0.001), and using a soft mattress (aOR = 2.4 95% CI, p = 0.006). Exercise during pregnancy was found to be a protective factor (aOR = 0.2 95% CI, p = < 0.001).

Conclusions: Low back pain during pregnancy is a common problem among pregnant women attending antenatal care at the Bamenda Regional Hospital. Health workers need to be proactive in identifying LBP in pregnancy and managing it promptly.

Background: Along with other low- and middle-income countries unintended pregnancies are a matter of grave concern for India as well as world. Preventing unintended pregnancy can significantly reduce fertility as well as population health.

Methods: Our study used data from three recent rounds of national family health survey (NFHS) which were conducted in 2005-06 (NFHS-3), 2015-16 (NFHS-4) and 2019-21 (NFHS-5). In union, currently married and pregnant women who have given birth to at least one child in last five years were taken into consideration for study. Dependent variable was unintended pregnancy (current pregnancy) which included mistimed as well as unwanted pregnancy. Univariate, bivariate analysis with point-to-point change was done to know aboutdependent variable. To know about important covariate of change in unintended pregnancy logistic regression has been used followed by multivariable decomposition analysis.

Results: Over all three - survey rounds considered in our study; prevalence of unintended pregnancy declined from 31.76% (NFHS-3) to 15.87% (NFHS-5). Highest percentage decline of 23.02% from NFHS-3 (39.01%) to NFHS-5 (15.99%) in unintended pregnancy was in the women of Muslim religion. Women of rural area have 19% lower chance of unintended pregnancy with adjusted odds ratio 0.81. Odds of having current unintended pregnancy were about 8 times in women whose last birth was unwanted. Women with incorrect knowledge of ovulatory cycle have 20% higher chance of having unintended pregnancy. After analysis it was found that out of total change in unintended pregnancies was proximately 23% due to compositional change and about 77% change was due to behavioural change.

Conclusions: Over the time prevalence of unintended pregnancies declining which can be helpful for better health to both child and women. Important factors leading to a decline in unintended pregnancy were young age groups, high education level, unwanted last birth, no and negative fertility gap, no intention to contraceptive use and incorrect knowledge of the ovulatory cycle. Most of decline in unintended pregnancies was due to behavioural change of women considered in our study.

Objective: This study aims to investigate the impact of socio-demographic factors on childbirth satisfaction in Hungary, with a particular focus on the role of informal payments. While previous research has extensively examined maternal satisfaction, the specific influence of socio-demographic characteristics on childbirth experiences remains insufficiently explored, particularly in Hungary, where informal payments and a dual healthcare system coexist. By addressing this gap, the study seeks to provide a deeper understanding of the factors that shape birth satisfaction.

Methods: This study examines satisfaction with childbirth using a representative sample of the Hungarian adult population surveyed between February and April 2024. Descriptive statistics (chi-square test) and factor analysis were applied to understand perceptions of quality obstetric care, including responses from childless women and men on general attitudes towards obstetric services (N = 1360). Logistic regression examined socio-demographic predictors of satisfaction with obstetric care among mothers and fathers who evaluated their partners' experiences (N = 772).

Results: Findings underscore the significance of financial factors in childbirth care. Individuals with lower education levels often consider informal payments and private doctors essential for quality care (χ² = 18.0, p < 0.05). Factor analysis revealed two key dimensions: financial and competency. Emphasis on financial aspects correlated with dissatisfaction (Financial components, Factor 1: OR = 0.74, 95%, p < 0.05) while prioritizing competency was linked to higher satisfaction (Competence, Factor 2: OR = 1.54, 95%, p < 0.01). The percentage of women dissatisfied with their childbirth experience was 13.8%, compared to 6.1% of men.

Conclusion: Efforts to reduce reliance on informal payments and enhance equitable access to high-quality obstetric care are critical for improving childbirth satisfaction in Hungary.

Background: Postpartum depression (PPD) is a global concern that adversely affects the well-being of mothers, their children, and their families. It is particularly prevalent in low- and middle-income countries, where limited research has been conducted. This study aimed to examine the perspectives of mothers regarding PPD and identify their health-seeking behaviors and barriers in a Palestinian context.

Methods: This study utilized a qualitative approach involving three focus group discussions (FGDs), with a total of 17 mothers in three different regions of the Bethlehem governorate, Palestine. A phenomenological orientation was used to explore the participants' experiences.  RESULTS: Regarding mothers' perceptions of PPD, not all mothers perceived PPD as a mental disorder; some considered it a result of envy. Risk factors for PPD include a lack of practical and emotional support from the extended family and husband, an unpleasant childbirth experience, or a lack of preparation for motherhood. Seeking help from family members was the first option for all participants; sometimes, it was the only method they considered. The extended family may have control over the decision-making process for help-seeking behavior. Mothers may not seek professional help to avoid acknowledgment of their condition or due to shyness, fear of negative reactions from others, lack of personal free time, family misperceptions of PPD, and the underestimation of psychological therapy. However, when mothers seek help, they prefer venting sessions that include receiving advice, and they refuse to take psychotropic medication.

Conclusion: In Palestine, PPD is often misunderstood and poses a significant barrier to seeking professional treatment. Addressing this challenge demands a holistic approach extending beyond mere medical interventions, given the complex social and cultural circumstances confronting Palestinian mothers. Vital steps include implementing regular PPD screenings, establishing a culturally suitable referral system, and actively combating the societal stigma surrounding mental health disorders.

Background: Adverse birth outcomes (ABOs) cause significant infant morbidity and mortality in resource-limited settings. Many of the maternal risk factors associated with ABOs can be prevented. We present the prevalence, trends, and risk factors of selected ABOs from a hospital-based birth defects surveillance program in Kampala, Uganda.

Methods: We analyzed data for all mothers with singleton deliveries collected from four urban hospitals between 2015 and 2022. Prevalence of preterm birth [PTB], low birth weight [LBW], small for gestational age [SGA], and stillbirth [SB] and maternal HIV seroprevalence were calculated among 222,427 births. SB was defined as infant born without life ≥ 28 weeks of gestation, LBW as term live birth weighing < 2500 g and PTB as live birth born < 37 weeks of gestation. Time trends of ABOs by maternal HIV status and age were computed using quasi-Poisson regression model and presented graphically. Risk factor associations were estimated using robust Poisson models adjusting for infant sex, hospital of delivery, and birth year.

Results: Prevalence of PTB, LBW, SGA, and SB were 14.8%, 4.3%, 17.8%, and 3.1%, respectively. Maternal HIV seroprevalence was 7.7%. Compared to mothers aged 25-34 years, young adolescents 10-18 years was associated with PTB (adjusted risk ratio [aRR]: 1.44, 95% confidence interval (CI): 1.38-1.50); LBW (1.65,1.51-1.81); and SGA (1.18; 1.12-1.24). HIV seropositivity was associated with PTB (1.18; 1.14-1.22), LBW (1.54; 1.43-1.65), and SGA (1.28; 1.23-1.33). Compared to starting ANC in the first trimester, no antenatal care (ANC) was associated with PTB (2.44; 2.33-2.56), LBW (1.80; 1.55-2.09), SGA (1.37; 1.27-1.49), and SB (3.73; 3.32-4.15) and late attendance with LBW (1.09; 1.02-1.16), SGA (1.26; 1.22-1.30), and SB (1.09; 1.02-1.17). Our findings also indicate a rising trend in PTB among adolescent and young women aged 10-24 years, and a declining trend in LBW and SGA over time (ptrend < 0.05 for all).

Conclusions: Young maternal age, maternal HIV, and late or no ANC attendance were associated with ABO. Childbearing in the ages 25-34, preventing HIV in women, and supporting early and frequent ANC attendance are important in improving birth outcomes.