BMC Pregnancy and Childbirth最新文献

Background: Medication use during pregnancy is so prevalent worldwide. Self-medication may have drawbacks for maternal and fetal health. In Egypt, there are scarce studies assessing the knowledge, attitude, and practice (KAP) of pregnant women regarding the use of non-prescribed medications during pregnancy.

Methods: An analytic cross-sectional study was implemented using a structured interview to assess the KAP of pregnant women attending the antenatal care clinics at Mansoura University Hospital toward medication use during pregnancy.

Results: Out of 387 respondents. 30.5% of pregnant females used self-medication. Most participants demonstrated inadequate levels of knowledge, with 43% of participants classified as having poor knowledge, 39% fair knowledge, and 18% having good knowledge. Regarding Attitude, 94.6% of participants had a positive attitude, and 20% demonstrated good practice of medication use during pregnancy. Binary logistic regression analysis showed that participants' attitudes and practices are significantly associated with using non-prescribed medications. Participants with negative attitudes were 8.5 times more likely to use non-prescribed medications compared to those with positive attitudes. Also, participants with poor practice were 1.6 times more likely to use non-prescribed medications compared to those with moderate or good practice.

Conclusions: The study revealed inadequate levels of knowledge, and high level of poor practice among pregnant women that is associated with increased use of self- medication despite their positive attitude towards risks of medication use during pregnancy, therefore we recommend the implementation of an educational program to improve awareness among pregnant women about the importance of using medications only under medical supervision to enhance their practices.

Background: Vaginal Birth After Cesarean is a clinical measure that can reduce repeated cesarean deliveries, improve perinatal outcomes and shorten hospital stays. However, successful practice of Vaginal Birth After Cesarean remains restricted in the Middle East due to limited regional-specific guidelines. This study aimed to identify the predictors and maternal and neonatal outcomes of failed Vaginal Birth After Cesarean among a group of Middle Eastern women.

Methods: A retrospective case-control design was conducted between January 2023 and February 2024 across three hospitals in Oman. The case group involved failed Vaginal Birth After Cesarean requiring repeat cesarean, while the control group comprised successful Vaginal Birth After Cesarean. Descriptive and inferential statistics were used. Additionally, logistic regression analysis was conducted to identify significant predictors of failed vaginal birth after cesarean.

Results: Data of 364 participants were analyzed. The predictors of Vaginal Birth After Cesarean failure were high body mass index (32.66 ± 7.53; p < .001), low parity (median = 1; p < .001), low cervical dilation (2 cm vs. 4 cm; p < .001), obstetric complications (42.6% vs. 29.2%; p = .010), and meconium-stained amniotic fluid (16.3% vs. 6.9%; p = .006). Postpartum hemorrhage (21.6% vs. 4.6%; p < .001), scar tenderness (11.5% vs. 0.5%; p < .001), and low APGAR scores (p < .001) were more common in the case group.

Conclusions: The study findings advance the regional literature with critical information supporting the development of standardized Middle Eastern specific Vaginal Birth After Cesarean guidelines. Higher body mass index, lower parity, lower cervical dilation at admission, meconium-stained amniotic fluid, and obstetric complications are significant predictors of Vaginal Birth After Cesarean failure. A failed Vaginal Birth After Cesarean attempt may increase the risks of post-partum hemorrhage, scar tenderness, and lower APGAR scores. Future research may prioritize prospective multicenter studies across diverse regions of the Middle East to validate the Vaginal Birth After Cesarean predictive variables.

Background: Culture has an important influence on taboos during pregnancy with respect to food and other cultural practices in order to protect the pregnancy from any adversities. However, these dietary restrictions during pregnancy which consequently result in depletion of important micronutrients may be implicated in miscarriages. This study aimed to document the taboos, their cultural contexts and the association with miscarriage in light of maternal nutritional indicators (homocysteine, folate and vitamin B12).

Methods: A cross-sectional study was conducted among the 822 pregnant women attending Antenatal care clinic at Department of Obstetrics and Gynaecology, Lady Hardinge Medical College. Data on socio-demographic, reproductive profile and anthropometric variables were collected using standard techniques. Data pertaining to food and other cultural taboos were collected using semi-structured questionnaire. Blood samples (5mL) were collected from all participants for estimation of biochemical variables. Statistical analysis were done using SPSS version 22.

Results: The prevalence of food taboo and other cultural taboos was observed in 83.9% and 53.3% of the recruited pregnant women, respectively. Ten categories of food items and other cultural taboos were observed and documented with their respective reasons behind following the taboo. Participants who did not practise were food taboos and those who practised other cultural taboos showed significant increased risk for miscarriage. . Further, practicing food taboos was seen to pose significant increased risk for low vitamin B₁₂ and high homocysteine.

Conclusion: The present study highlights the role of food taboos and other cultural taboos in maternal health in India. Although the traditional knowledge of taboos play a protective role in miscarriage, they seem to be causing risk for micronutrient deficiencies in pregnant women. This warrants for careful dietary counselling during ANC visits, keeping in view the strong cultural contexts of practicing taboos.

Background: In Zambia's maternal and child health departments, midwives offer compulsory and free obstetric ultrasound scans during antenatal care (ANC). These scans monitor fetal growth and development and identify any possible pregnancy-related complications or abnormalities. However, the normalization of obstetric ultrasound scans (USS) by midwives in Zambia is still in progress. The study sought to assess the facilitators and barriers to the implementation of obstetric ultrasound scans by midwives during antenatal care within 11 healthcare facilities in Zambia: experiences of healthcare workers (HCWs).

Methods: This was an explorative qualitative study with 28 healthcare workers from 11 healthcare facilities in four districts of Zambia. In-depth interviews were conducted in English, guided by an interview guide. The interviews were recorded with audio recorders, transcribed in verbatim, coded with Nvivo version 12, and analysed using an inductive thematic analysis approach.

Results: Healthcare workers highlighted that pregnant women who accessed ultrasound scans during antenatal care within maternal and child health departments were more inclined to follow through with their ANC appointments. The availability of free ultrasound scans encouraged pregnant women to accept and utilize these services, leading to enhanced quality of ANC care provided by healthcare workers. Obstetric ultrasounds during ANC expedited decision-making processes about specialized pregnancy care by midwives. The main facility barriers were inadequate space in maternal and child health departments, heightened workloads for midwives leading to burnout, and lengthy waiting queues that discouraged pregnant women from utilizing ultrasound scan services.

Conclusion: The study underscores the significance of obstetric ultrasound scans in improving antenatal care within Zambia's healthcare facilities. Recommendations include prioritizing infrastructure upgrades to accommodate ultrasound services within MCH, implementing workload management strategies for midwives, and reducing waiting times for pregnant women to access the service. Furthermore, providing continuous training and support for midwives in ultrasound scanning technology will enhance the delivery of quality and normalisation of antenatal care in Zambia.

Background: To evaluate pregnancy and early neurodevelopmental outcomes in fetuses with prenatally diagnosed ventriculomegaly (VM) in a large single-center retrospective cohort (2011-2024), and to determine the independent predictive value of VM severity, isolation status, laterality, and intrauterine evolution for adverse neurodevelopmental outcomes among term survivors.

Methods: This retrospective cohort study included fetuses diagnosed with VM at West China Second University Hospital from 2011 to 2024. VM was defined as a lateral ventricular width ≥ 10 mm measured on standardized axial trans-thalamo-ventricular planes and categorized as mild (10-12 mm), moderate (12.1-15 mm), or severe (> 15 mm) per SMFM/ISUOG guidelines. Pregnancy and neonatal outcomes were extracted from medical records. Neurodevelopmental outcomes in term liveborn infants were assessed through structured telephone interviews and clinical documentation; for children born between 2019 and 2024, systematic follow-up at 2-3 years of age was implemented, with Gesell Developmental Schedule assessments performed when developmental concerns were identified. For those born between 2011 and 2018, outcomes were based on parental reports and available medical records. Logistic regression models were used to estimate adjusted associations.

Results: VM was identified in 983 of 154,436 deliveries (0.64%). Live birth rates were 94.8% for mild, 85.9% for moderate, and 24.6% for severe VM. Among 654 term survivors, 39 (5.96%) exhibited abnormal neurodevelopment. In univariable analyses, greater VM severity, bilateral VM, variation of ventricular width, and abnormal postnatal cranial ultrasound findings were significantly associated with adverse neurodevelopment. After adjustment, only ventricular severity remained independently predictive, with adjusted odds ratios of 2.77 (95% CI, 1.31-5.85) for moderate and 7.57 (95% CI, 1.34-42.61) for severe VM compared with mild VM. Non-isolated VM showed a nonsignificant trend toward increased risk (OR 1.64; 95% CI, 0.65-4.14).

Conclusions: Ventricular severity was the only prenatal factor that remained independently associated with adverse neurodevelopmental outcomes in this cohort, whereas associations with laterality, isolation status, and postnatal imaging findings attenuated after adjustment. Through a unified diagnostic pathway incorporating systematic neurosonography, selective fetal magnetic resonance imaging, and chromosomal microarray testing, this large Asian cohort adds real-world data supporting severity-based risk stratification and illustrating the potential value of multimodal prenatal evaluation for perinatal counseling and management. Given the retrospective design and non-standardized follow-up, however, these associations should be interpreted with caution.

Trial registration: Not applicable.

Introduction: This study investigated inflammation-related co-morbidities in women with gastroesophageal reflux (GER) and poor gestational outcomes.

Methods: A retrospective cohort of 17 women with GER and 207 without GER who were admitted to a pre-conceptional counseling program was analyzed. All patients were evaluated for the presence of risk factors associated with obstetric complications and poor gestational outcomes, including hereditary thrombophilia, methylenetetrahydrofolate reductase (MTHFR) polymorphisms, type 2 diabetes mellitus, chronic inflammatory diseases, and autoimmune disorders.

Results: GER was present in 7.59% (17/224) of women, and 35.3% (6/17) of GER-positive cases had gastritis and/or chronic peptic ulcer disease. Chronic inflammatory and autoimmune diseases were significantly more frequent in women with GER (p = 0.001 and p = 0.002, respectively). There was also a statistically significant difference in the distribution of MTHFR 677CC, -CT, and -TT genotypes in terms of the presence of GER (p = 0.036). A higher frequency of the MTHFR 677TT genotype was observed in women with GER.

Conclusions: Presence of GER may be indicative of inflammation-associated "placenta-related obstetric complications" and poor gestational outcomes in subsequent pregnancies.

Background: Despite Ghana's free maternal health services policy, antenatal care (ANC) utilization remains suboptimal. This study examines the predisposing, enabling, and need factors associated with ANC use among women in Ghana.

Methods: Using the 2022 Ghana Demographic and Health Survey (GDHS), this study examined 5,302 women aged 15-49 to identify key determinants of ANC use. Antenatal care utilization was defined as completing at least four visits. Guided by the Andersen's healthcare utilization model, predictors were categorized into predisposing (age, education, marital status, religion), enabling (household income, residence, health insurance), and need factors (self-rated health, pregnancy loss). Descriptive statistics and chi-square tests were used to assess differences in ANC utilization. A modified Poisson regression was applied to estimate adjusted prevalence ratio (aPR) for the association between predisposing, enabling, and need factors and ANC utilization.

Results: Overall, 88.1% of women utilized ANC. Women aged 25-34 were more likely to use ANC compared to those aged 15-24 ( aPR = 1.04; 95% CI: 1.00-1.07). Women with secondary ( aPR = 1.09; 95% CI: 1.05-1.14) and higher education ( aPR = 1.10; 95% CI: 1.04-1.15) were associated with greater ANC use. Married women ( aPR = 1.07; 95% CI: 1.03-1.10) and Muslim women ( aPR = 1.04; 95% CI: 1.01-1.07) were more likely to use ANC, whereas women practicing traditional/other religions were less likely to use ANC ( aPR = 0.83; 95% CI: 0.75-0.92). Women from rich households ( aPR = 1.08; 95% CI: 1.04-1.12) and those with health insurance ( aPR = 1.29; 95% CI: 1.14-1.46) were more likely to use ANC. Residence, self-rated health, and pregnancy loss were not significant predictors.

Conclusions: Key determinants of ANC utilization included age, education, marital status, religion, household income, and health insurance coverage. This suggests that reducing socioeconomic and cultural obstacles is essential for improving maternal health coverage. Future research is needed to understand the indirect barriers that continue to discourage women from seeking ANC in Ghana.