BMC Pregnancy and Childbirth最新文献

Background: This retrospective cohort study aimed to investigate the correlation between vaginal infections and adverse pregnancy outcomes in a Chinese obstetric population.

Methods: This study was conducted at the International Peace Maternity and Child Health Hospital in Shanghai from 2021 to 2023. The primary objective was to assess the incidence of various vaginal infections and their associations with preterm birth (PTB), low birth weight (LBW), and preterm premature rupture of membranes (PPROM). Data were collected from medical records, with vaginal infection diagnoses confirmed through standard laboratory procedures. This study included women who registered and delivered at our hospital between 2021 and 2023. Strict exclusion criteria were applied to control confounding factors, excluding women with a history of syphilis, human immunodeficiency virus infection, hepatitis virus infection, or non-live birth outcomes. Continuous variables were analyzed using the Mann-Whitney U test, whereas categorical variables were assessed using the Pearson chi-square test or Fisher exact test. Logistic regression analysis was employed for multivariate assessments to determine whether vaginal infections were independent risk factors for adverse pregnancy outcomes.

Results: Vaginal infections were significantly associated with adverse pregnancy outcomes. Women with vaginal infections had higher rates of PTB (15.65% vs. 9.16%, P < 0.001), LBW (10.82% vs. 5.93%, P < 0.001), and PPROM (7.41% vs. 5.31%, P < 0.001) compared with their uninfected counterparts. Mixed vaginitis demonstrated a stronger association with these adverse outcomes compared with single infections. The timing of infection during pregnancy emerged as a critical determinant of the risk of adverse outcomes.

Conclusions: The study underscores the critical need for comprehensive screening and management of vaginal infections during pregnancy to improve maternal and neonatal health. Targeted interventions, particularly in the later stages of pregnancy, are essential to mitigate the risks associated with vaginal infections. Future research should focus on developing more effective screening methods and therapeutic strategies to address the specific types of vaginal infections and their effects on pregnancy outcomes.

Background: Despite the known benefits of skin-to-skin contact (SSC), limited data exists on its implementation, especially its influencing factors. The current study was designed to use machine learning (ML) to identify the predictors of SSC.

Methods: This study implemented predictive SSC approaches based on the data obtained from the "Iranian Maternal and Neonatal Network (IMaN Net)" from January 2020 to January 2022. A predictive model was built using nine statistical learning models (linear regression, logistic regression, decision tree classification, random forest classification, deep learning feedforward, extreme gradient boost model, light gradient boost model, support vector machine, and permutation feature classification with k-nearest neighbors). Demographic, obstetric, and maternal and neonatal clinical factors were considered as potential predicting factors and were extracted from the patient's medical records. The area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F_1 Score were measured to evaluate the diagnostic performance.

Results: Of 8031 eligible mothers, 3759 (46.8%) experienced SSC. The algorithms created by deep learning (AUROC: 0.81, accuracy: 0.75, precision: 0.67, recall: 0.77, and F_1 Score: 0.73) and linear regression (AUROC: 0.80, accuracy: 0.75, precision: 0.66, recall: 0.75, and F_1 Score: 0.71) had the highest performance in predicting SSC. Doula support, neonatal weight, gestational age, attending childbirth classes, and maternal age were the critical predictors for SSC based on the top two algorithms with superior performance.

Conclusions: Although this study found that the ML model performed well in predicting SSC, more research is needed to make a better conclusion about its performance.

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection in pregnant women have an adverse impact on perinatal outcomes, including cesarean section, preterm birth, fetal distress. However, it's uncertain whether these adverse consequences are caused by previous SARS-COV-2 infection during pregnancy or acute infection at the time of delivery.

Methods: We conducted a single-center retrospective cohort study among pregnant women with singleton pregnancy who delivered between 1 December 2022 and 1 February 2023 (n = 2472). Pregnancies were divided into three groups: non-infected group, acute SARS-CoV-2 infection group, prior SARS-CoV-2 infection group based on PCR or antigen test. The clinical data for mothers and neonates came from medical records on internal healthcare system. Follow-up time spanned from admission to discharge. We investigated the impact of acute and prior SARS-CoV-2 infection on maternal and neonatal outcome. Multivariable logistic models were used to assess the risk of adverse perinatal outcome in pregnant women with acute and prior SARS-CoV-2 infection.

Results: Compared to the non-infected pregnant women, acute SARS-CoV-2 infected pregnant women had significant higher rates of intrahepatic cholestasis of pregnancy (ICP) (26 women [4.4%] vs. 8 women [1.0%]; aOR, 4.9 [95% CI, 2.2-11.0]; P < 0.001), preterm birth (<37 wk) (53women [9.0%] vs. 45 women [5.7%]; aOR, 1.7 [95% CI, 1.1-2.7]; P < 0.05), fetal distress(106 women [18.1%] vs. 82 women [10.4%]; aOR,1.9 [95% CI, 1.4-2.6]; P < 0.01), primary cesarean delivery (216 women [36.9%] vs. 239women [30.3%]; aOR, 1.4[95% CI, 1.1-1.8]; P < 0.01) and neonatal unit admission (69 neonates [12%] vs. 64 neonates [8.3%]; aOR, 1.6 [95% CI, 1.1-2.3]; P < 0.05), prior SARS-CoV-2 infection were associated with an increased risk of ICP (40 women [3.7%] vs. 8 women [1.0%]; aOR, 3.9 [95% CI, 1.8-8.5]; P <0.001).

Conclusions: Pregnant women at delivery with acute SARS-CoV-2 infection were associated with higher risk of ICP, preterm birth, fetal distress, primary cesarean delivery and neonatal unit admission. Prior SARS-CoV-2 infection during pregnancy was associated with higher risk ICP. These findings emphasize the need for optimization of strategies for prevention of SARS-CoV-2 infection in pregnant women, especially for acute infection at delivery.

Background: Current methods used to assess the progress of labor are often invasive and may cause discomfort to the mother. The purple line offers potential as a non-invasive marker for monitoring the labor process. However, its sensitivity and specificity in assessing critical components of labor, such as cervical dilatation and fetal descent, have not been adequately studied in different populations. This study was conducted to evaluate the effectiveness of the purple line, a method for assessing labor progress.

Methods: Data for this observational study were collected from 304 pregnant women who presented to a maternity hospital for birth on the Anatolian side of Istanbul between May and November 2021. The inclusion criteria for the study were that women were 38-42 weeks of gestation, spontaneous labor had started and were in active labor phase. Participants were selected by random sampling method among women who met the study criteria during labor. Data collection included demographic information, partograph records, and measurements of the purple line. Women's birth was assessed and documented on a partogram, with the purple line measured hourly via a disposable tape measure until birth. Descriptive analyses including means and standard deviations, medians and interquartile ranges, and cut-off point and sensitivity-specificity (ROC) values were performed for data analysis.

Results: A purple line was seen in 85.9% of pregnant women at any stage of labour, with a specificity of 86% and sensitivity of 65%. During the active phase of labor, the measurements of the purple line length in the sacral region increased proportionally with cervical dilatation. The sensitivity was 56%, and the specificity was 65% when the fetal head descent reached the - 2 level.

Conclusions: In conclusion, the purple line in the sacral region is a non-invasive method to assess the course of labor and can be used as an adjunct to vaginal examinations and may reduce the number of vaginal examinations in clinical settings.

Background: Recent studies have suggested a potential correlation between ecological dysregulation of the gut microbiota (GM) and the onset and development of postpartum depression (PPD). In addition, inflammatory factors (IFs) have been reported to play an important role in the development of PPD. However, the causal connections among GM, IFs, and PPD remain to be understood.

Objective: This study sought to determine if genetically predicted GM and IFs exert a causal effect on PPD and to study whether IFs mediate the causal effect of GM on PPD.

Methods: Two-step and two-sample Mendelian randomization (MR) analyses, primarily employing the inverse variance weighted (IVW) method, were conducted to evaluate the causal relationship between GM, IFs, and PPD, and to assess potential mediating effects. Heterogeneity and horizontal pleiotropy tests were performed to evaluate the robustness of the findings and the strength of the causal associations.

Results: Class Alphaproteobacteria, genus Family XIII AD3011 group exhibited a positive association with PPD risk; whereas, the family Clostridiales vadin BB60 group, family Veillonellaceae, genus Ruminococcaceae UCG011, and the inflammatory factors C-C motif chemokine ligand 5 (CCL5) and C-C motif chemokine ligand 3 (CCL3) demonstrated negative correlations with PPD risk. IFs did not exhibit a mediating role. No heterogeneity or horizontal pleiotropy was observed.

Conclusions: Our MR study offered genetic evidence that GM and IFs contribute to the pathogenesis of PPD, with no mediating effect of IFs. This enhances our understanding of PPD's pathological mechanisms and offers new perspectives for developing novel preventative and therapeutic strategies.

Background: Becoming a father is a challenging process that starts during pregnancy. During the late pregnancy period, depressive symptoms are the most common mental disorders among women. Engaged fatherhood is a strategy for gender equality that is good for the health outcomes of men, their spouses and their children. This study aims to explore the involvement of Thai expectant fathers during the last trimester of their partners' pregnancy when the mothers exhibit depressive symptoms.

Methods: A qualitative study with semi-structured interviews was conducted by use of an interview guide. All data were transcribed and subjected to content analysis.

Results: Twenty-seven expectant fathers at seven antenatal care clinics of public hospitals in a province of north-eastern Thailand participated. Six categories emerged: Having mixed emotional feelings, Adapting to spouse's emotional mood swings, Getting into challenges of fatherhood, Taking increased responsibility in the role of father, Receiving social support, and Wishing improvement of maternity care service. The expectant fathers experienced different psychological and physical situations and received support from family members and social networks, but they had not been encouraged to engage in parental education. Some were satisfied with healthcare service and some would like to be more involved.

Conclusions: On the basis of these findings, it is suggested that an intervention program should be developed that aims to engage expectant fathers in maternity health services. This could be done most effectively by starting with men who wish themselves to be involved in the healthcare of their spouses and continuing with men who do not have such wish. Professional support for nurses/midwives should be not only informative but also emotional and practical when needed.

Objective: To assess maternal energy intake and energy demand during childbirth, to understand the current status of energy management during childbirth, and to provide reference for midwives to manage childbirth.

Methods: Thirty-seven deliveries in a tertiary hospital were selected for observational study to compare the energy intake and energy demand of the mothers, and the mothers with energy intake greater than the energy demand were divided into the energy standard group and the mothers with energy intake less than the energy demand were divided into the energy non-standard group. Energy intake is measured by the mother's diet and fluid rehydration, finally, it will be converted into energy. Daily energy demand = energy coefficient * ideal body weight, the daily energy demand was converted into the actual energy demand by the duration of childbirth. Finally, the effects of energy during childbirth on the outcome of pregnancy were tracked and analyzed.

Results: There were 19 cases of patients in the energy-attainment group and 18 cases of patients in the energy-unattainment group, energy intake (4517.35 ± 1689.90) KJ and energy demand (3149.00 ± 1294.41) KJ in the energy-attainment group, and energy intake (3117.54 ± 1671.11) kJ and energy demand (4704.66 ± 1941.31) in the energy-unattainment group. kJ. The total duration of childbirth in the energy-attainment group was (512.21 ± 185.67) min, and the total duration of childbirth in the energy-unattainment group was (765.44 ± 315.83) min, and the comparison of the two groups suggests that the total duration of childbirth in the energy-attainment group was less than that in the energy-unattainment group, and the difference was statistically significant (T = -2.953, p < 0.05); three cases of postpartum hemorrhage occurred in the energy-unattainment group, and two cases of neonatal hypoglycemia, and the difference between the two groups was not statistically significant.

Conclusion: Mothers in childbirth generally have energy substandard situation, energy substandard affects the progress of childbirth, so midwives can encourage mothers to carry out the appropriate kinds of food in different stages of childbirth, to ensure that the energy intake is sufficient.

Background: Renal fornices rupture with urinoma formation in fetuses is an unusual condition that acts as a 'pop off' mechanism to buffer renal pelvis pressure. Ureteropelvic junction obstruction (UPJO) is the most common cause of prenatal hydronephrosis, but it rarely leads to the formation of urinoma. Fetal urinoma could be indicative of poor renal function after birth. We report a rare case of UPJO-related urinoma accompanied with urinary ascites, which ruptured during vaginal delivery.

Case presentation: A 30-year-old woman was admitted to our hospital at 25⁺³ weeks gestation for fetal bilateral hydronephrosis. This probable case of UPJO became further complicated at 29⁺⁵ weeks with the presence of a urinoma around the left kidney and ascites. Afterwards, the urinoma gradually enlarged and the ascites worsened, accompanied by testicular hydrocele, pleural effusion, and polyhydramnios. The last prenatal ultrasound at 36⁺¹ weeks disclosed that the size of the urinoma was approximately 9.0 × 6.3x8.7 cm. The amniotic membrane ruptured prematurely and a male infant was vaginally delivered at 37 weeks. The baby developed gradually worsening abdominal distension. Bedside US revealed the urinoma became irregular and smaller, accompanied by a significant increase in ascites. It was speculated that the urinoma might experience a secondary rupture. Ascites drainage was performed and the urinoma disappeared. But it reemerged 2 days later with a significant increase in serum creatinine. The parents opted to abandon treatment. Surprisingly, the infant developed good feeding and mental health after discharge. Serum creatinine returned to normal at 3 months. Due to compression of surrounding tissues by the huge urinoma, the infant accepted urinoma resection surgery at 6 months. By the age of one, the infant was developing normally without signs of renal impairment.

Conclusions: Prenatal identification of a large urinoma with urinary ascites requires necessary attention and appropriate management strategies. Prenatal urinoma drainage is indicated for large urinoma risking dystocia or rupture during delivery. Postnatal ascites requires active drainage to prevent creatinine and urea reabsorption and other complications. Small asymptomatic urinoma can be managed conservatively, but early surgery is recommended for large or recurrent urinoma exerting pressure on surrounding tissues.