BMC Pregnancy and Childbirth最新文献

Background: Extremely low birth weight (ELBW) infants, which weighing less than 1000 g, are at high risk of adverse neonatal outcomes, including intraventricular hemorrhage (IVH), respiratory distress syndrome, and long-term neurodevelopmental impairments. En caul cesarean section (ECCS) is often performed for delivery of ELBW infants to minimize potential damages to the skin, bones, and brain. Although a few studies reported that ECCS is a safe procedure for infants, there is limited research investigating the association between this procedure and neonatal IVH. This study aims to assess whether ECCS contributes to adverse effects during delivery, and association with the occurrence of neonatal IVH.

Methods: We retrospectively examined 252 ELBW infants delivered at our hospital from April 2015 to December 2023. Patients were divided into four groups according to delivery mode: successful ECCS, unsuccessful ECCS, non-trial ECCS, and vaginal delivery. The primary outcome was the incidence of IVH grade ≥ 3 during the neonatal period. The secondary outcomes were hemoglobin level of the infant, umbilical artery blood pH level, and maternal blood loss at delivery.

Results: No significant differences were observed in the median umbilical artery blood pH levels, Hb levels of infants at delivery, the amounts of maternal blood loss at delivery, incidence of IVH grade ≥ 3, intestinal perforation, or neonatal mortality between the group of patients who were attempted en caul cesarean delivery and the group of patients who were not. The incidence of IVH grade ≥ 3 was significantly lower in the group of successful ECCS compared with the other groups (4.8% vs. 15.8%, respectively; p < 0.05). The significant factors for IVH grade ≥ 3 identified on multivariate analysis were gestation week at delivery ≤ 24 weeks (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.33-6.62), steroid administration (OR 0.10, 95% CI 0.01-0.77) and successful ECCS (OR 0.29, 95% CI 0.09-0.87).

Conclusion: ECCS for ELBW infants may reduce the risk of neonatal IVH grade ≥ 3, and does not contribute to anemia and hypoxia of infants at delivery.

Background: Obstetric violence is an emerging health problem in maternal health services utilization. In the study context, there was limited evidence on obstetrics violence. Hence, the aim of this study to assess obstetric violence and its associated factors among HIV-positive women received birth care at public health facilities, Addis Ababa, Ethiopia.

Result: A total of 318 HIV-positive women had been participated in this study yielding 100% response rate. In this study 79% of HIV-positive women reported they had been subjected to at least one form of obstetric violence during birth care. The top three reported forms of obstetric violence: 249 (78.3%) failure to get informed consent, 227 (71.4%) unconsented medical procedure, 140 (44%) neglecting to suffer life-threatening complication. In the multivariable logistic regression analysis were identified that Female birth attendants (AOR = 2.85; 95% CI 1.57, 5.15), less than three times ANC-visitors (AOR = 2.99; 95% CI 1.39, 6.45), age > 35 years old (AOR = 2.47; 95% CI 1.25, 4.90) and primary school attendants (AOR = 2.13; 95% CI 1.08, 4.17) were significantly associated with obstetrics violence. This study identified that high prevalence of obstetric violence among HIV positive women. Hence, mitigation is needed to be undertaken by taking the reported forms of obstetrics violence, socio-demographic and obstetrics variables by ensuring a systematic and strategic intervention for quality birth care utilization through an inclusive involvement like families, communities, government and stakeholders.

Objective: To explore the related factors of spontaneous premature birth (SPB) in pregnant women with gestational diabetes mellitus (GDM), and to construct its nomogram risk prediction model.

Methods: A retrospective collection of clinical data was conducted on 410 GDM patients admitted to our hospital from October 2020 to October 2023 as the training set. In addition, clinical data of 144 GDM patients admitted to our hospital from November 2023 to September 2024 retrospectively were collected as the validation cohort set for external validation. Both groups were separated into SPB group and non-SPB group based on whether SPB occurred.

Results: Logistic analysis of training set showed that age, pre-pregnancy BMI, history of spontaneous abortion, history of infection during pregnancy, family history of diabetes, hypertension, and premature rupture of membranes were the risk factors for SPB in GDM pregnant women (P < 0.05). The AUC of the ROC curve for the discrimination of the training set was 0.850, the optimism-corrected C-index was 0.753,and the H-L test showed χ² = 6.987 (P = 0.699). DCA curve showed that when the threshold probability was between 0.13 and 0.99, the model had high clinical application value. The external validation results showed that the AUC of the ROC curve was 0.891, the optimism-corrected C-index was 0.771, and the H-L test showed χ² = 7.016 (P = 0.699), and the threshold probability of the DCA curve results was between 0.11 and 0.87, indicating that the model had high clinical application value.

Conclusion: Age, pre-pregnancy BMI, history of spontaneous abortion, history of infection during pregnancy, family history of diabetes, hypertension, and premature rupture of membranes are the risk factors for SPB in GDM pregnant women. The nomogram prediction model constructed based on these factors has good calibration and discrimination.

Background: "Unintended pregnancy" is a ubiquitous indicator of poor public health, but is highly problematic and limited. A conceptual evolution in pregnancy intention measurement and categorization has led to numerous, often hard-to-compare studies using a multitude of non-binary, multi-dimensional pregnancy measures. Herein we conducted a systematic review of research studying non-binary measures of pregnancy perceptions, attitudes, and reactions, as predictors of public health outcomes.

Methods: Forty-three articles met inclusion criteria. We summarized existing pregnancy measures, cataloged the dimensions of pregnancy they measure, and tracked significant outcomes associated with these measures.

Results: We documented numerous pregnancy-related measures including those on ambivalence, acceptability, timing, intention, emotional response, use of contraception, preparation for pregnancy, opinions/reactions of partners and others, perceived fecundity, readiness, denial, and self-efficacy to prevent pregnancy. The strongest associations with maternal and child health outcomes were observed for depression. Relationships with pregnancy complications and outcomes, postpartum care, breastfeeding, attachment, and child health are very unclear. Temporal confounding precludes many conclusions about psychosocial outcomes.

Conclusions: Acknowledging multiple dimensions of and pathways to pregnancy is critical for researchers in public health, clinical care, and the social sciences. Research questions should be clear in their hypothesized relationships and pathways, and specific in their dimensions of interest. New paradigms are needed that move beyond pregnancy planning and intention.