BMC Pregnancy and Childbirth最新文献

Background: Classical ultrasound signs of placenta accreta spectrum (PAS) at birth, including anomalies of the lower uterine segment (LUS) and uteroplacental and intraplacental circulations, are now well established. The purpose of this study was to evaluate the use of "intracervical lakes" and "the rail sign," which are more recently described signs.

Methods: We conducted a retrospective analysis of ultrasound imaging data and primary surgical outcomes of consecutive singleton pregnancies in patients with a history of at least one prior CD presenting with an anterior low-lying or placenta previa at 32-36 weeks. Ultrasound findings were recorded using a standardized protocol. The diagnosis of PAS was confirmed when one or more placental lobules could not be digitally separated from the uterine wall at delivery or during the gross examination of hysterectomy or partial myometrial resection (PMR) specimens, and confirmed by histopathology. All analyses were performed using a logistic regression.

Results: Of the 227 patients in the cohort, 50 (22%) presented with intracervical lakes on transvaginal scan (TVS) and 97 (47.7%) with a rail sign on transabdominal sonography (TAS). A peripartum hysterectomy (PH) was performed in 116 cases (51%), and 97 patients were managed conservatively: 41 (18%) with PMR and LUS reconstruction, and 70 (31%) with a complex CD, with no intraoperative evidence of PAS. Placental lacunae were the strongest predictors of both PAS and PH, with a high lacunae score (3+) associated with odds ratios (ORs) of 320 (95% confidence interval (CI) 243,4231) for PAS and 9.00 (95% CI 3.01,26.9) for PH, respectively. Associations with PAS were also found for placental bulge (OR 8.24; 95% CI 2.54,26.8) and the rail sign (OR 3.01; 95% CI 1.04,8.67). Increased odds of PH were found for myometrial thinning of < 1 mm (OR 5.47; 95% CI 1.69,17.7) and the presence of intracervical lakes (OR 12.3; 95%CI 3.89,39.1).

Conclusions: The presence of a rail sign was associated with an increased odds of PAS at birth, whereas the presence of intracervical lakes was associated with an increased odds of peripartum hysterectomy in patients with a history of CD who presented with a placenta previa.

Trial registration: This study was prospectively registered. Ethical approval was obtained before the start of this study (Scientific and Research Ethical Committee approval at the University of Cairo, RSEC 021001). The study was conducted in accordance with the Declaration of Helsinki.

Background: Pregnancy-related low back pain (PLBP) is a highly prevalent musculoskeletal disorder, affecting 50-70% of pregnant women, yet effective predictive tools are lacking. While functional movement tests, motor control assessments, and pressure pain threshold (PPT) measurements show promise for evaluating musculoskeletal health, their combined predictive value for PLBP incidence remains unexplored.

Objective: This study will aim to evaluate the screening value of a comprehensive battery of motor control tests, functional movement tests, and PPT measurements for predicting the incidence of PLBP.

Methods: A prospective longitudinal cohort study will be conducted with 100 low-risk pregnant women at 10-12 weeks of gestation. At baseline, participants will undergo a 20-item motor control and functional test battery and PPT measurements at 27 lumbar points and three remote sites. The incidence of PLBP will be monitored monthly for up to 28 weeks via diaries, the Visual Analog Scale (VAS > 30mm), and the Roland-Morris Disability Questionnaire (RMDQ ≥ 3). Logistic regression and Receiver Operating Characteristic (ROC) curve analyses will be used to determine associations and predictive performance of the composite scores for PLBP incidence.

Results: Results are pending completion of the longitudinal follow-up.

Conclusion: This study is the first to comprehensively investigate the combined predictive power of motor control, functional movement, and pain sensitivity for PLBP. The findings are expected to identify key early risk factors and contribute to the development of a validated predictive score, ultimately informing targeted prevention strategies to reduce the burden of PLBP and improve maternal health outcomes.

Background: Early pregnancy loss (EPL) is a global public health concern with significant physical and psychological effects on individuals and society. The specific etiology of many EPL cases is not well understood, and first trimester maternal diet may play a role in EPL occurrence. This study aimed to examine the differences in first trimester maternal nutrient intake, nutritional habits and nutritional knowledge levels between healthy pregnant women and women who experienced EPL.

Methods: A single center retrospective case-control study was conducted at a public hospital in Istanbul, Turkey between May-October 2024. The case group comprised 65 women who experienced first-time pregnancy loss. The control group included 65 healthy pregnant women in the first trimester without a previous PL history, with both groups matched for age, body mass index (BMI) and parity. Data were collected from the participants regarding their general information, dietary habits, the Quantitative Food Frequency Questionnaire (QFFQ), and the Nutrition Knowledge Level Scale for Adults (NKLSA). Dietary nutrient intakes were evaluated on the basis of the Dietary Reference Intakes (DRI) values and compared between the two groups. To further investigate the link between specific dietary nutrient intakes and EPL risk, adjusted binary logistic regression models were employed.

Results: The mean age of the participants was 28.5 years, and their mean BMI was 24.20 kg/m². The dietary intake of carbohydrates, dietary fiber, monounsaturated fatty acids, omega-3 fatty acids, folate, vitamin C, potassium, iodine and total minerals were statistically higher in the control group (p < 0.05). Dietary vitamin D and cholesterol intake and the omega-6/omega-3 ratio were greater in the case group without statistical significance (p > 0.05). The control group presented significantly higher proportions of dietary supplement use, regular consumption between meals, and higher daily meal number (p < 0.05). Adjusted binary logistic regression analysis revealed negative correlations between total dietary fiber intake (continuous and Q3/Q4) and EPL risk in all models, even after adjusting for all potential confounders (p < 0.05). There was no statistically difference regarding nutrition knowledge level between two groups (p > 0.05).

Conclusions: This study contributes to the literature by showing the protective role of maternal nutritional status in the first trimester against EPL risk.