BMC Pregnancy and Childbirth最新文献

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.

Background: Uterine prolapse during pregnancy is an extremely rare and challenging obstetric complication, particularly in the third trimester. Trauma-induced prolapse is even less common and can have significant maternal and fetal consequences. Reporting such rare presentations is crucial for guiding clinical management.

Case presentation: We present the case of a 25-year-old gravida 3, para 1 woman at 36 weeks of gestation who was admitted to the emergency department after trauma to the vaginal region. She reported spontaneous rupture of membranes at home prior to admission. On examination, a grade 4 uterine prolapse with a hyperemic and edematous cervix was observed protruding through the vaginal introitus. Laboratory and imaging findings were within normal limits, and there were no signs of retroplacental bleeding or fetal distress. Due to the advanced stage of prolapse and ongoing regular contractions, an emergency cesarean section was performed. The maternal and neonatal outcomes were favorable, and the prolapse resolved completely postpartum.

Conclusions: This case highlights the importance of recognizing and promptly managing trauma-induced uterine prolapse in late pregnancy. It underlines the need for multidisciplinary care and individualized decision-making to ensure optimal maternal and fetal outcomes in such rare clinical scenarios.

Objective: Significant disparities remain in prenatal care utilization across countries, the specific socioeconomic and systemic factors contributing to these gaps have not been consistently synthesized. This review evaluates the gap by comparing barriers to timely and adequate prenatal care between high and low resource settings by focusing on the factors affecting prenatal service utilization through socioeconomic status and geography cultural barriers and system-related factors.

Methodology: The systematic review explored databases such as PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect. The recent studies from 2014 up to 2024 underwent evaluation based on Boolean operators combined with indexed keywords. Eligible studies included quantitative study designs examining barriers to prenatal care among women of reproductive age. Screening was conducted by two reviewers independently by following PRISMA guidelines. A total of 20 studies were included as per the eligibility criteria. Due to heterogeneity in study design, a structured narrative review synthesis was conducted.

Results: The main barriers identified were Socioeconomic limitations because of low income and insufficient insurance coverage and the challenges of distance to healthcare facilities and inadequate transportation combined with cultural barriers such as traditional gender roles and stigmatization and traditional beliefs. The barriers identified in high-income settings were that immigrant and refugee women faced challenges due to their status uncertainties, difficulties with language and unfamiliarity with healthcare systems. Depression along with abuse and multiple caregiving duties emerged as a major psychological factor that prevented women from accessing healthcare. System-related factors like Long waiting times and inadequate medical personnel along with insufficient respect from healthcare providers were the major identified factors.

Conclusion: The utilization of prenatal care is influenced by a multifaceted interplay of the individual, cultural, socioeconomic, and systems factors. It is important to strengthen these community-based measures, including financial and structural assistance, to enhance equitable, timely, and sufficient prenatal care across diverse settings.

Background: Stillbirth research priorities for Australia were identified in 2015. A renewed priority setting exercise identified current research priorities to address the national burden of stillbirth.

Methods: Bereaved parents, healthcare professionals, researchers, policymakers, and community-based support organisations participated in this priority setting partnership. Using a modified James Lind Alliance approach, proposed research questions were collated, refined and reviewed against existing evidence, with participants ranking their top ten research questions. Twenty-six key stakeholders at an in-person forum then determined the top research priorities.

Results: Consultations were attended by 243 participants, representing over 30 community and professional organisations, 219 participated (48% with lived experience of stillbirth) in the prioritisation survey. In the final prioritisation forum 25 research questions were prioritised, and six overarching priority areas identified: (1) Determine the causes of, and pathways that lead to stillbirth; (2) Identify and implement strategies to prevent stillbirth; (3) Build the capacity of health services and systems; (4) Understand and improve care for families after perinatal loss; (5) Ensure culturally safe and responsive care for Aboriginal and Torres Strait Islander families; and (6) Ensure culturally safe and responsive care for families of migrant and refugee background.

Conclusion: This process identified a relevant stillbirth research agenda to improve outcomes for women and families in Australia.

Background: Obstetric anal sphincter injury refers to the unintended tearing of the anal sphincter and/or rectal mucosa during vaginal delivery, a complication associated with significant morbidity. Well-known risk factors for obstetric anal sphincter injury include primiparity, high maternal age, instrumental delivery, oxytocin augmentation, and large fetal size. Recently, we identified amniotomy as a potential novel independent risk factor, regardless of parity. This study aims to further explore whether amniotomy increases the risk of obstetric anal sphincter injury including known determinants in singleton vaginal births after 34 weeks of gestation at Innlandet Hospital Trust, using a cohort study design.

Methods: Retrospective cohort study using data from the Innlandet Perinatal Database, including all women who had singleton vaginal births after 34 weeks of gestation at Innlandet Hospital Trust from 2012 to 2022. We used multivariate logistic regression models to develop a risk-factor model for obstetric anal sphincter injury employing backward elimination with stratification for parity. We included established risk factors in the models, as well as the novel potential risk factor amniotomy.

Results: The annual incidence of obstetric anal sphincter injury at the hospitals was stable around 2% in the study period and a total of 26,349 births were included. First, amniotomy was not found to be a risk factor for obstetric anal sphincter injury in this contemporary cohort. Second, instrumental delivery was identified as an independent modifiable risk factor for obstetric anal sphincter injury: vacuum extraction presenting relative risks (95% CI) of 2.72 (2.06-3.61) and 3.29 (2.09-5.17) in vaginally primiparous and parous women and forceps 5.97 (3.96-9.00) in vaginally primiparous women. Episiotomy and epidural analgesia were associated with reduced risks of obstetric anal sphincter injury, but only in vaginally primiparous women (relative risks: 0.53 (0.40-0.70) and 0.69 (0.55-0.86)).

Conclusions: Based on systematically collected data from our regional birth registry, this cohort study confirmed the association between established risk factors for obstetric anal sphincter injury, such as instrumental vaginal delivery. However, we could not identify amniotomy as a risk factor for obstetric anal sphincter injury, possibly due to changes in clinical practice and potential data limitations.