BMC Pregnancy and Childbirth最新文献

Background: Gestational diabetes mellitus is hyperglycemia in special populations (pregnant women), however gestational diabetes mellitus (GDM) not only affects maternal health, but also has profound effects on offspring health. The prevalence of gestational diabetes in my country is gradually increasing.

Objective: To study the application effect of self-transcendence nursing model in GDM patients.

Methods: One hundred fourteen GDM patients undergoing prenatal examination in Hai'an People's Hospital from January 2019 to November 2021 were selected and divided into two groups of 57 cases respectively according to the principle of random single blind. The patients in the control group should receive pregnancy health care under the routine nursing mode, while those in the observation group should receive pregnancy health care under the self-transcendence nursing mode. Then, we would compare the insulin utilization rate, admission before delivery, gestational weeks, delivery outcome and neonatal conditions between the two groups, examine the changes of blood glucose related indexes in the two groups and evaluate the differences between the two groups' Diabetes Distress Scale (DDS) scores and Chinese Versions of Diabetes Management Self-efficacy Scale (C-DMSES) scores.

Results: The number of hospital admissions (1.12 ± 0.31) and the hospital stay (7.54 ± 1.45) days in the observation group were less than those in the control group (1.56 ± 0.42) and (10.23 ± 2.32) days. There was no difference between the two groups after statistical analysis of gestational weeks and insulin utilization rate (P > 0.05). After the intervention, the total DDS score and emotional burden, doctor/life law/interpersonal relationship related distress score of GDM in the two groups were lower than those before the intervention, while the scores of healthy diet, regular exercise, regular monitoring of blood glucose and medication compliance in C-DMSES were higher than those before the intervention. In addition, the improvements of overall DDS scores and C-DMSES scores of GDM in the observation group were significantly better than those in the control group, so there was statistical significance (P < 0.05). In terms of the pregnancy outcomes and neonatal conditions, the rates of premature delivery and neonatal delivery in the observation group were higher than those in the control group, and there was no difference (P > 0.05) in other aspects of pregnancy outcomes and neonatal conditions.

Conclusion: Self-transcendence nursing mode intervention can improve blood sugar, reduce psychological distress, and improve self-efficacy in GDM patients, thereby reducing the rate of pregnancy-induced hypertension and premature birth.

Background: Understanding fetal growth is essential for predicting perinatal outcomes and long-term health implications. This study explores the correlation between ultrasound parameters and gestational age in the Minangkabau ethnic group, focusing on the biometric variables biparietal diameter (BPD), head circumference (HC), abdominal circumference (AC), femur length (FL), and humerus length (HL) during the second trimester.

Methods: Conducted from December 2020 to December 2021, the research employed a cross-sectional design at the Fetomaternal clinic of Hospital M. Djamil Padang and affiliated hospitals. Pregnant women (n = 600) meeting inclusion criteria were sampled consecutively. Univariate, bivariate (Pearson correlation test), and multivariate (linear regression) analyses were performed using SPSS software.

Results: Demographically, most participants were 21-30 years old, primigravida, with senior high school education, and employed. Fetal biometric measurements displayed increasing variability with gestational age. AC exhibited the strongest correlation (r = 0.95, p < 0.005) with gestational age during the second trimester. The study validated the accuracy of AC in estimating gestational age based on LMP (r = 0.95, p = 0.0001).

Conclusion: This study contributes to the understanding of fetal growth dynamics, emphasizing the reliability of ultrasound parameters in estimating gestational age during the second trimester, particularly in the Minangkabau ethnic group. The strong correlation, especially with AC, enhances the precision of due date predictions and refines prenatal care strategies. However, limitations include the study's focus on a single ethnic group, potentially restricting generalizability. Future research should explore fetal growth dynamics across diverse populations, incorporate longitudinal designs to assess growth trajectories, and evaluate additional maternal and environmental factors. Enhanced standardization of AC measurement techniques is also necessary to reduce variability and improve clinical utility.

Background: Gestational hypertension and preeclampsia are potentially linked to similar pathophysiological processes. Maternal preeclampsia increases the occurrence of early-onset neonatal thrombocytopenia. We hypothesized that maternal gestational hypertension may impact the incident early-onset neonatal thrombocytopenia.

Methods: We included 538 neonates, comprising 318 and 220 neonates born to healthy mothers and those with pregnancy-induced hypertension. The minimum platelet count within 72 h of birth was recorded for these neonates. The incidence of early-onset thrombocytopenia in neonates in relation to maternal gestational hypertension, preeclampsia, and health status was evaluated. Logistic regression analysis was conducted to assess the relationship between maternal gestational hypertension and the risk of early-onset neonatal thrombocytopenia.

Results: The incidence of early-onset thrombocytopenia was significantly higher in neonates born to mothers with preeclampsia than in those born to mothers with gestational hypertension or healthy mothers. Significant differences were observed among the three groups (30.0% vs. 13.3% vs. 7.9%, p < 0.001). Maternal gestational hypertension (OR = 2.79, 95%CI 1.19-6.54) increased the risk of early-onset neonatal thrombocytopenia when compared to healthy mothers.

Conclusions: Maternal gestational hypertension increases the occurrence of early-onset neonatal thrombocytopenia. Therefore, we recommend conducting platelet count screening at the early stages of neonates of mothers with gestational hypertension.

Background: Mindfulness centered therapy has been shown to improve perinatal mental health outcomes. There is emerging evidence that mindfulness training (MT) can also be harnessed to improve somatic outcomes. Yet, little is known about which perinatal populations might benefit the most from mindfulness training interventions. We aimed to evaluate the association between trait mindfulness and adverse pregnancy outcomes.

Methods: This is a planned secondary analysis of a prospective cohort study of nulliparous participants recruited between May 2019 and February 2022 from a single, high volume tertiary care center. Participants completed the validated Mindfulness and Attentive Awareness Scale prior to 20 weeks gestation. Trained research staff abstracted pregnancy and delivery data. The primary outcome was unplanned cesarean delivery (CD). Secondary outcomes included gestational diabetes, hypertensive disorders of pregnancy and a neonatal morbidity composite. We examined outcomes by mindfulness quartile (Q), adjusting for covariates determined a priori.

Results: Of the 281 participants with full outcome data, 47.9% experienced one or more of the adverse perinatal outcomes and the median trait mindfulness score was 4.6 (IQR 3.9-5.3). After adjusting for potential confounders, there were significantly lower rates of CD rates in those in Q2 and Q3 compared to Q4 (adjusted odds ratio [aOR] Q2 0.42, 95% confidence interval [CI] 0.20 - 0.87, Q3 aOR 0.23, 95% CI 0.10-0.51). There were no differences in rates of gestational diabetes, hypertension or composite neonatal outcomes by trait mindfulness quartile.

Conclusions: In this prospective cohort of nulliparous people, those with trait mindfulness in the 2nd and 3rd quartiles had lower rates of CD. Given prior literature suggesting active MT decreases adverse outcomes, there may be a component of the active practice of mindfulness, rather than trait mindfulness levels, associated with improved outcomes.

Background: Concerning maternity service, the mother's quality assessment is central because emotional, cultural, and respectful support is vital during labour and the delivery process. Studies concerning the perceived quality of maternity services from the perspective of mothers have rarely been carried out in Iranian hospital settings. Therefore, this study aimed to measure the gap between the expectations of patients with maternity services and their perceptions of the service and identify associated factors at a maternity hospital in northwest Iran using service quality (SERVQUAL) and health quality (HEALTHQUAL) questionnaires.

Methods: This cross-sectional study consists of 350 randomly selected participants visiting a maternity hospital in Tabriz, Iran between November 2022 and February 2023. Admitted patients responded to two questionnaires adopted from the SERVQUAL and HEALTHQUAL instruments. The questionnaire was provided on hospital admission for expectation and before hospital discharge for perception. The quality gaps between the expectations and perceptions of participants were analyzed. Data were analyzed using SPSS (Version 24) through descriptive analyses, paired t-tests, and multivariate linear regression.

Results: Based on the SERVQUAL questionnaire, the overall score for expectation and perception were 3.69 and 4.15, respectively and the overall gap in service quality was - 0.45. Similarly, according to the HEALTHQUAL questionnaire, the overall score for expectation and perception were 3.66 and 4.53, respectively, and the overall gap in service quality was - 0.87. In addition, the results indicated that the highest gap was observed for the Effectiveness and Assurance dimensions with gap scores of - 1.20 and - 0.69, respectively. Older patients, having an academic education, women who were residents in urban and those who visited for the first time were found to have significantly higher expectations compared with their perceived quality of care (P < 0.005).

Conclusions: The results of the current study confirmed that there is a negative gap between maternity service women's expectations and their perceptions. These results suggest there is capacity for improvement in the quality of health service delivery from the patient's perspective. Therefore, hospital managers need to develop several strategies to improve the interpersonal skills of staff and communication, strengthen trust between patients and health providers, and meet the psychological and emotional needs of patients.

Background: Epidural labor analgesia (ELA) is widely and safely used for labor pain relief. However, it remains unclear whether ELA affects maternal and neonatal outcomes in women suffering from preeclampsia.

Methods: This study reviewed the medical records of women with preeclampsia at ≥ 28 weeks of gestation between January 2015 and December 2020. The medical records of women were divided into ELA and no analgesia (NA) groups. The primary endpoint was the cesarean section (CS) rate. Secondary endpoints included hypotension, operative vaginal delivery, fetal distress, neonatal intensive care unit admission, and complications. Using multivariate logistic regression analysis and propensity score matching (PSM), the association between ELA and maternal and neonatal outcomes was examined.

Results: A total of medical records of 686 women were enrolled, with 242 (35.3%) receiving ELA. Of these, 126 (18.4%) had a higher incidence of CS in the ELA group than in the NA group (22.7% vs. 16.0%, P = 0.020). Multivariable analysis indicated greater risks of CS [adjusted Odds Ratio (aOR) = 1.71; 95% CI, 1.07-2.74; P = 0.025] and operative vaginal delivery (aOR = 2.810; 95% CI, 1.379-5.725; P = 0.004) in the ELA group than that of NA group. In the PSM, ELA did not increase the risk of CS (aOR = 1.56; 95% CI, 0.97-2.52; P = 0.067) and OVD (aOR = 2.048; 95% CI, 0.936-4.484; P = 0.073). The secondary endpoints showed no significant differences between the two groups.

Conclusion: The study indicates an association between ELA and maternal and neonatal outcomes, supporting the safety of ELA in this population.

Background: Vaginal childbirth is one of the main risk factors for pelvic floor dysfunction. Magnetic resonance imaging (MRI) can facilitate quantitative evaluation of the morphology and function of the pelvic floor in static and dynamic environments. The objective of this study was to investigate the changes in pelvic floor morphology and function in primigravida women before pregnancy (BP) and after vaginal delivery.

Methods: Primigravida women underwent pelvic floor MRI scans BP, at 3 months postpartum (3mPP), and at 6 months postpartum (6mPP). Various pelvic floor MRI data were measured, including the obturator internus muscle (OIM) area, anterior pelvic area, puborectalis muscle thickness (PRT), levator plate angle (LPA), iliococcygeal angle, bladder-pubococcygeal line (B-PCL), uterus-pubococcygeal line (U-PCL), puborectal hiatus line, muscular pelvic floor relaxation line, levator hiatus area, urethral mobility, bladder neck descent, and cervix descent.

Results: In the resting state, the OIM area and PRT decreased whereas the anterior pelvic area increased from BP to 3mPP. During the straining maneuver, all parameters except U-PCL and urethral mobility showed statistically significant differences (P < 0.05). The OIM area and PRT increased whereas the anterior pelvic area decreased from 3mPP to 6mPP. During the straining maneuver, B-PCL, bladder neck descent, levator hiatus area, and LPA showed statistically significant differences (P < 0.05). In the resting state, the OIM area and PRT decreased whereas the anterior pelvic area increased from BP to 6mPP. During the straining maneuver, B-PCL, muscular pelvic floor relaxation line, and bladder neck descent showed statistically significant differences (P < 0.05).

Conclusion: Vaginal delivery can cause pelvic floor injury that may gradually recover over time. However, the injury does not fully recover to the pre-pregnancy level within 6mPP.

Background: Behçet's disease (BD) during pregnancy is a relatively rare condition, and there are currently no established guidelines for its management. The effects of BD on both mothers and children remain unclear. In this paper, we present the diagnostic and treatment processes for a patient with BD during pregnancy.

Case presentation: A 20-year-old woman, gravida 2, para 1, presented to our inpatient department with recurrent oral and genital ulcers at 28 weeks and 3 days of gestation. Given the complexity of the patient's condition, we initiated the first multidisciplinary consultation to establish appropriate treatment regimens. However, the initial treatment was ineffective, and the patient experienced a fever for four days. Consequently, we conducted a second multidisciplinary consultation. The final treatment regimen included azithromycin, hydroxychloroquine, prednisone, and low-molecular-weight heparin calcium. The clinical symptoms resolved, and the female neonate was delivered successfully. No relapse was observed during the four-month follow-up.

Conclusions: The critical issues in treatment involve ensuring medication safety for pregnant women and preventing adverse pregnancy outcomes. Notably, one potential cause of adverse pregnancy outcomes in individuals with BD is vasculopathy, which necessitates prompt treatment with anticoagulant therapy. Obstetricians should closely monitor disease progression and remain vigilant for complications in order to minimize adverse outcomes during pregnancy.

Background: Human milk electrolytes are known biomarkers of stages of lactation in the first weeks after birth. However, methods for measuring milk electrolytes are available only in laboratory or expert settings. A small handheld milk sensing device (Mylee) capable of determining on-site individual secretory activation progress from sensing the conductivity of a tiny milk specimen was developed. Here we evaluate the validity of a novel milk-sensing device (Mylee) for measuring the progress of milk maturation and secretory activation status.

Methods: Retrospective data analysis of laboratory records generated using the Mylee device. Device conductivity measurements were assessed for accuracy, reliability and stability in rigorous laboratory tests with standard materials. A set of human milk specimens (n = 167) was used to analyze the agreement between the milk maturation score and laboratory measurements of the secretory activation biomarker milk sodium [Na+].

Results: The Mylee device was demonstrated to have excellent reproducibility (CV_95%<5%) and accuracy (error < 5%) for conductivity measurements of a small specimen (350 µl), with good device stability and almost perfect inter-device unit reliability (ICC > 0.90). With regression analysis, we revealed excellent agreement between Mylee milk maturation (MM%) output or its raw conductivity signal and laboratory measurements of conductivity and sodium [Na+] in a dataset of milk specimens (n = 167; R² > 0.9). The Mylee MM% score showed good predictive ability for secretary activation status, as determined by sodium threshold (18 mmol/L) in human milk specimens.

Conclusions: In this study, we demonstrated the reliability and validity of the Mylee device and its ability to detect on-site milk secretory activation in a manner comparable to that of electrolyte-based methods. The novel MyLee device offers the potential to generate real-time information about the lactation stage, measured by mothers at the commodity of their home.