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Clinical Manifestations, Risk Factors, and Maternal-Perinatal Outcomes in Pregnancy
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Clinical Manifestations, Risk Factors, and Maternal-Perinatal Outcomes in Pregnancy

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Obstetrics & Gynecology".

Deadline for manuscript submissions: closed (25 April 2023) | Viewed by 9778

Special Issue Editor

Prof. Dr. Paolo Mannella

E-Mail Website
Guest Editor
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Interests: preeclampsia; hysterectomy; obstetric delivery; ynaecological surgery; obstetrical vacuum extraction; sterility; urogynecology; urogynecology & female urology; urinary incontinence; urodynamics

Special Issue Information

Dear Colleagues,

This Special Issue of JCM aims to focus on pregnancy, new clinical manifestations of associated pathologies, and how an appropriate assessment of risk factors and early diagnosis can significantly improve maternal and fetal outcomes.

The appearance of "new pathologies", until recently unknown to most people, such as SARS-CoV-2 infection, the tremendous spread of Chagas disease throughout the Americas, human infection with Zikas virus, monkeypox, and others, have also brought to the fore symptoms and clinical manifestations which were often neglected in the past. Common symptoms such as cough, fever, conjunctivitis, and joint pain constitute an essential alarm bell for the negative effects on mother and fetus.

These add to the other diseases already known but increasingly frequent thanks to the general aging of the population and the later onset of the first pregnancy (diabetes, hypertensive disorders, autoimmune syndromes, and others).

However, science is also taking important steps forward. There are many innovations in the study of maternal and fetal conditions: early fetal ultrasound, the use of artificial intelligence associated with obstetric ultrasound, the development of systems for the evaluation of the fetal nervous system, and the ultrasound study of maternal cardiac output, and others. Still, simulation in obstetrics has been introduced not only as a training tool but overall for the improvement of technical and organizational skills aimed at ameliorating maternal and fetal outcomes

All these new systems, protocols, and procedures will allow an increasingly refined diagnosis and, at the same time, determine a real cultural revolution in the field of modern obstetrics.

The final effects will hopefully be to minimize the medicalization of childbirth and excessive medical intervention thanks to awareness of which pregnancy presents risks or not based on a previous diagnosis.

We hope you can all contribute to this Special Issue.

Prof. Dr. Paolo Mannella
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ultrasound
  • prenatal diagnosis
  • simulation
  • high-risk pregnancies
  • diseases in pregnancies
  • artificial intelligence
  • fetal autonomic nervous system
  • childbirth
  • infection in pregnancy
  • fetal medicine
  • emergencies in obstetrics

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Published Papers (4 papers)

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Research

10 pages, 285 KiB  
Article
Safety and Effect of the Use of Hydrotherapy during Labour: A Retrospective Observational Study
by Elena Mellado-García, Lourdes Díaz-Rodríguez, Jonathan Cortés-Martín, Juan Carlos Sánchez-García, Beatriz Piqueras-Sola and Raquel Rodríguez-Blanque
J. Clin. Med. 2023, 12(17), 5617; https://doi.org/10.3390/jcm12175617 - 28 Aug 2023
Cited by 1 | Viewed by 2940
Abstract
Background: Hydrotherapy is a technique used for pain management during labour, but its safety for both the mother and foetus remains uncertain. Objective: The main aim of this study is to determine whether the use of hydrotherapy in the first stage of labour [...] Read more.
Background: Hydrotherapy is a technique used for pain management during labour, but its safety for both the mother and foetus remains uncertain. Objective: The main aim of this study is to determine whether the use of hydrotherapy in the first stage of labour is safe for both the mother and newborn. Methods: A retrospective observational study was conducted to collect data from the partogram, maternal and neonatal history. Results: A total of 377 women who gave birth at the Costa del Sol Hospital in Malaga between January 2010 and December 2020 were randomly selected. They were divided into a control group (253 women) and an intervention group (124 women) that used hydrotherapy in the first stage of labour. There were no significant differences between the groups in terms of age, history of previous miscarriages, type of delivery, or newborn weight. The results showed that most women who opted for hydrotherapy were nulliparous, and the use of hydrotherapy during labour was safe for both the mother and foetus. There were no significant differences in the variables of maternal arterial hypotension, postpartum haemorrhage, postpartum maternal fever, foetal complications, neonatal admission, 1 and 5 min Apgar scores, umbilical arterial or venous pH, or foetal cardiotocographic recording. However, there was a significant difference (p = 0.005) in the rate of breastfeeding among mothers who opted for hydrotherapy (96% vs. 85.7%). Conclusions: The use of hydrotherapy during the first stage of labour is safe and is associated with increased breastfeeding rates compared to conventional delivery. Full article
(This article belongs to the Special Issue Clinical Manifestations, Risk Factors, and Maternal-Perinatal Outcomes in Pregnancy)
13 pages, 572 KiB  
Article
The Efficacy of Misoprostol Vaginal Inserts for Induction of Labor in Women with Very Unfavorable Cervices
by Maciej W. Socha, Wojciech Flis, Mateusz Wartęga, Martyna Stankiewicz and Aleksandra Kunicka
J. Clin. Med. 2023, 12(12), 4106; https://doi.org/10.3390/jcm12124106 - 17 Jun 2023
Cited by 1 | Viewed by 2227
Abstract
Background: The purpose of the present study was to evaluate the effectiveness of a misoprostol vaginal insert as an induction-of-labor (IOL) agent in women with an unfavorable cervix (Bishop score < 2) in achieving vaginal delivery (VD) within 48 h, depending on the [...] Read more.
Background: The purpose of the present study was to evaluate the effectiveness of a misoprostol vaginal insert as an induction-of-labor (IOL) agent in women with an unfavorable cervix (Bishop score < 2) in achieving vaginal delivery (VD) within 48 h, depending on the gestational week, with particular emphasis on the cesarean section (CS) percentage, intrapartum analgesia application and possible side effects, such as tachysystole ratio. Methods: In this retrospective observational study involving 6000 screened pregnant patients, 190 women (3%) fulfilled the study inclusion criteria and underwent vaginal misoprostol IOL. The pregnant women were collected into three groups: patients who delivered at up to 37 weeks of gestation (<37 Group)—42 patients; patients who delivered between 37 and 41 weeks of gestation (37–41 Group)—76 patients; and patients who delivered after 41 weeks of gestation (41+ Group)—72 patients. The outcomes included time to delivery and mode of delivery, rate of tachysystole, need for intrapartum analgesia, and need for oxytocin augmentation. Results: Most of the patients delivered vaginally (54.8% in <37 Group vs. 57.9% in 37–41 Group vs. 61.1% in 41+ Group). A total of 89.5% (170/190) of patients delivered within 48 h (<37 Group—78.6% vs. 37–41 Group—89.5% vs. 41+ Group—95.8%). Statistical significance was demonstrated for the increased rate of vaginal deliveries and shortened time to delivery in the 41+ weeks group (p = 0.0026 and p = 0.0038). The indications for cesarean section were as follows: abnormal CTG pattern vs. lack of labor progression: 42.1% vs. 57.9% in <37 Group, 59.4% vs. 40.6% in 37–41 Group and 71.4% vs. 28.6% in 41+ Group. Statistical significance was demonstrated for the increased rate of abnormal CTG patterns as cesarean section indications in the 41+ Group (p = 0.0019). The need for oxytocin augmentation in each group was: 35.7% in <37 Group vs. 19.7% in 37–41 Group vs. 11.1% in 41+ Group. Statistical significance was shown for decreased need for oxytocin augmentation in +41 Group (p = 0.0016). The need for intrapartum anesthesia, depending on the group, was: 78.6% in <37 Group vs. 82.9% in 37–41 Group vs. 83.3% in 41+ Group. Statistical significance was demonstrated for increased need for intrapartum anesthesia application during labor in +41 Group (p = 0.0018). The prevalence of hyperstimulation was similar in all three groups (4.8% vs. 7.9% vs. 5.6% p > 0.05). Conclusions: The misoprostol vaginal regimen for IOL used in our study is effective in achieving vaginal delivery within 48 h. In post-term women, the use of this regimen is characterized by an increased rate of vaginal deliveries, a shorter time to delivery and a lower need for oxytocin. Full article
(This article belongs to the Special Issue Clinical Manifestations, Risk Factors, and Maternal-Perinatal Outcomes in Pregnancy)
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13 pages, 279 KiB  
Article
Maternal Baseline Risk Factors for Abnormal Vaginal Colonisation among High-Risk Pregnant Women and the Association with Adverse Pregnancy Outcomes: A Retrospective Cohort Study
by Junesoo Jeon, Yun-sun Choi, Yejin Kim, Siryeon Hong, Ji-Hee Sung, Suk-Joo Choi, Soo-young Oh and Cheong-Rae Roh
J. Clin. Med. 2023, 12(1), 40; https://doi.org/10.3390/jcm12010040 - 21 Dec 2022
Cited by 3 | Viewed by 1820
Abstract
Abnormal vaginal colonisation can lead to adverse pregnancy outcomes such as preterm birth through intra-amniotic inflammation. Despite the concern, little is known about its risk factors and impact in pregnant women at high-risk for spontaneous preterm birth. Thus, we conducted this single-centre retrospective [...] Read more.
Abnormal vaginal colonisation can lead to adverse pregnancy outcomes such as preterm birth through intra-amniotic inflammation. Despite the concern, little is known about its risk factors and impact in pregnant women at high-risk for spontaneous preterm birth. Thus, we conducted this single-centre retrospective cohort study including 1381 consecutive women who were admitted to the high-risk pregnancy unit. The results of vaginal culture at admission were categorised according to the colonising organism: bacteria (Gram-negative or -positive) and genital mycoplasmas. Maternal baseline socioeconomic, and clinical characteristics, as well as pregnancy, delivery, and neonatal outcomes were compared according to the category. Maternal risk factors for Gram-negative colonisation included advanced maternal age, increased pre-pregnancy BMI, a greater number of past spontaneous abortions, earlier gestational age at admission, and IVF. Gram-positive colonisation was likewise associated with earlier gestational age at admission. Genital mycoplasmal colonisation was associated with a greater number of past induced abortions, a lower level of education completed, and a lower rate of multifetal pregnancy and IVF. The neonates from mothers with Gram-negative colonisation had a greater risk of NICU admission, proven early onset neonatal sepsis, and mortality. However, not Gram-positive bacteria or genital mycoplasma was directly associated with adverse pregnancy outcomes. Full article
(This article belongs to the Special Issue Clinical Manifestations, Risk Factors, and Maternal-Perinatal Outcomes in Pregnancy)
13 pages, 273 KiB  
Article
Effects of Maternal Pre-Pregnancy BMI and Gestational Weight Gain on the Development of Preeclampsia and Its Phenotypes: A Prospective Cohort Study in China
by Senmao Zhang, Xing Qiu, Jiabi Qin, Xingli Song, Yiping Liu, Jianhui Wei, Mengting Sun, Jing Shu, Tingting Wang, Lizhang Chen and Yurong Jiang
J. Clin. Med. 2022, 11(19), 5521; https://doi.org/10.3390/jcm11195521 - 21 Sep 2022
Cited by 5 | Viewed by 2249
Abstract
Preeclampsia (PE) is a common and serious pregnancy-specific disorder, which is closely linked with adverse maternal and neonatal outcomes. This study aimed to evaluate whether maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) was associated with preeclampsia and its phenotypes. [...] Read more.
Preeclampsia (PE) is a common and serious pregnancy-specific disorder, which is closely linked with adverse maternal and neonatal outcomes. This study aimed to evaluate whether maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) was associated with preeclampsia and its phenotypes. In this prospective study, 32,531 women with singleton pregnancies were finally included. Compared with women with normal pre-pregnancy BMI, women with overweight and obesity were at increased risk of PE (RR = 1.62, 95%CI: 1.57–1.66; RR = 2.04, 95%CI: 1.97–2.11, respectively), while those who were underweight had a lower risk of PE (RR = 0.84, 95%CI: 0.81–0.88). When compared with women who gained adequate GWG, pregnant women with inadequate GWG and excessive GWG had an increased risk of PE (RR = 1.15, 95%CI: 1.12–1.19; RR = 1.56, 95%CI: 1.52–1.60, respectively). The observed increased risk was generally similar for mild-, severe-, early- and late-onset PE, and the reduced risk was similar for severe- and late-onset PE. No significant interactions between GWG and pre-pregnancy BMI on the risk of PE were identified (p-interaction > 0.05). In conclusion, pre-pregnancy overweight or obesity and excessive GWG have established risk factors for PE, and that the potential risk may vary according to PE phenotypes. Moreover, the synergistic effect that may exist between pre-pregnancy BMI and GWG. Full article
(This article belongs to the Special Issue Clinical Manifestations, Risk Factors, and Maternal-Perinatal Outcomes in Pregnancy)
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