Search Results (39)

Hemolytic disease of the fetus and newborn (HDFN) is a severe complication of pregnancy caused by maternal alloimmunization to fetal red blood cells, leading to significant perinatal morbidity and mortality. The prognosis is particularly poor in cases complicated by fetal hydrops. Prophylactic administration of anti-D immunoglobulin—during pregnancy, postpartum, and after events causing fetomaternal hemorrhage—has substantially reduced the incidence and severity of Rh-related HDFN. Nevertheless, the condition can still occur, either due to omitted prophylaxis or undetected fetomaternal hemorrhage. Definitive management often requires invasive interventions, including cordocentesis and intrauterine transfusions (IUTs), sometimes repeated multiple times, while the optimal timing of delivery remains uncertain, necessitating a careful balance between prematurity and ongoing fetal risk. We report the case of a 35-year-old multipara whose two most recent pregnancies were complicated by HDFN. The first affected pregnancy had a mild course, whereas the second was severe, necessitating multiple intrauterine transfusions (IUTs) throughout gestation. Despite an extremely low initial fetal hematocrit (4.5%), severe hydrops, and the requirement of six intrauterine transfusions (IUTs) during the pregnancy, the infant was delivered at 36 weeks’ gestation with a favorable postnatal outcome. This case report provides a comprehensive overview of intrauterine transfusion methodology, post-transfusion pregnancy monitoring, timing of successive IUTs, and optimal delivery planning in pregnancies complicated by HDFN. Full article

Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, considering factors like the COVID-19 pandemic, the opening of Ronald McDonald House, and sibling presence. Methods: We retrospectively analyzed data from the first eight weeks of life of 93 extremely preterm infants (<28 gestational weeks, <1500 g birth weight) treated at the Salzburg NICU from 2019 to 2023. Skin-to-skin times were recorded to the minute. Results: The mean value skin-to-skin time per visiting day was 241 min (±83), skin-to-skin was performed on 79.0% (±16.8) of the days of stay examined. During the pandemic, skin-to-skin care was performed on 64% of visit days, after the pandemic on 91% (p < 0.001). Before the Ronald McDonald House opened, the skin-to-skin time per visiting day was 215 min (±57.9), afterwards it was 273 min (±97) (p = 0.001). For Primipara the Kangaroo-Care time per day of visit was 257 min (±93), for Multipara 217 min (±52) (p = 0.043). Conclusions: Skin-to-skin is crucial for extremely premature infants and can be implemented for many hours a day. It is an integral part of parent-child interaction in a neonatal intensive care unit. External factors such as infrastructure, pandemic restrictions or siblings have a significant impact on skin-to-skin. Full article

Background and Objectives: Remifentanil is a potent synthetic μ-opioid receptor agonist known for its rapid onset and ultrashort duration of action, making it a popular choice for intravenous labor analgesia. The analgesic effectiveness of remifentanil patient-controlled analgesia (Remifentanil-PCA) may vary based on the stage of labor and parity, potentially influencing satisfaction with labor analgesia. This study aimed to evaluate the degree of pain reduction achieved with remifentanil-PCA, considering different cervical dilations in both nulliparous and multiparous women. Material and Methods: Women who were ≥37 weeks pregnant with singleton cephalic fetuses, either by spontaneous onset or induction of labor, were included in the study. Data were collected from the Labor Record form, which included demographic and obstetric information, as well as the onset of analgesia categorized by cervical dilation (1–3 cm, 4–6 cm, 7–9 cm, and full dilation). Additionally, data on analgesia onset and duration (the time interval between the start of analgesia and the delivery of the baby), initial numerical rating scale (NRS₀) for pain intensity, NRS after the first hour of analgesia (NRS₁), the lowest recorded NRS during labor (NRSmin), and pain reduction during the first hour of analgesia (NRS₀–VAS₁), satisfaction with labor analgesia (rated 0 for dissatisfied, 1 for moderately satisfied, 2 for very satisfied), and complication rates were obtained from the remifentanil-PCA form. Results: A total of 513 nulliparas and 523 multiparas who gave birth between 1 January 2019 and 31 December 2019 were reviewed. No significant differences were found between the two groups regarding age, body mass index, labor induction rates, occipito-posterior positioning, blood loss > 500 mL, or neonatal outcomes. Nulliparas exhibited a higher gestational age (p = 0.021), longer labor duration (p < 0.001), and increased rates of cesarean sections (p < 0.001) and vacuum extractions (p = 0.002). Remifentanil-PCA consistently provided mild to moderate pain intensity reduction. No differences were found in VAS₀, VAS_1, or pain intensity reduction (VAS₀–VAS₁) regardless of the stage of labor or parity. Significant differences in VAS min were observed among nulliparas at different stages of labor (p < 0.026). However, a higher proportion of multiparas reported moderate (24.7% vs. 9.5%, p < 0.001) and high satisfaction (90% vs. 75%, p < 0.001) with remifentanil-PCA compared to nulliparas. Importantly, no serious complications in mothers or neonates attributed to remifentanil-PCA were observed during the observational period. Conclusions: Remifentanil-PCA demonstrates consistent effectiveness regardless of the stage of labor or parity. This indicates that remifentanil-PCA can be administered at any point during labor. Coupled with its rapid availability and immediate analgesic effect, this feature enhances the flexibility of its use in clinical practice. Full article

Background: In the rooming-in system, mothers and their healthy newborns stay together for 24 h a day; however, many women in the early postpartum period often find it challenging to balance their recovery from childbirth with the demands of caring for their newborns. This study aims to investigate the need for postpartum women to entrust their newborns to medical staff for care, and the relationship of this need with perceived pain, fatigue, and anxiety. Methods: The study uses the Need to Entrust a Newborn under the Care of the Staff (NEN) scale and the Numerical Rating Scale (NRS) to assess participants’ levels of pain, fatigue and anxiety. These scales were chosen to provide a comprehensive assessment of participants’ needs and experiences. Results: The results of the study reveal that fatigue levels among study participants were significantly high, with an Me of 7.0 (IQR = 4.0), exceeding the reportable levels of both pain (Me = 6.0, IQR = 5.0) and anxiety (Me = 5.0, IQR = 6.0) The need for support during the day and at night was at a similar level and strongly correlated (rho = 0.723; p < 0.001). Pain levels showed a significant positive correlation with the need to entrust the newborn both during the day (rho = 0.296; p < 0.001) and at night (rho = 0.332; p < 0.001). During the daytime, the correlation of fatigue with the need for staff support was rho = 0.423 (p < 0.001), while overnight, this increased to rho = 0.485 (p < 0.001). Anxiety significantly correlated with the need for staff support, both during daytime (rho = 0.422; p < 0.001) and overnight (rho = 0.431; p < 0.001). Multiparas reported significantly lower results of anxiety (U(Z) = −13.224, p < 0.001). Conclusions: The need to entrust newborns to the care of maternity rooming-in staff is strong but is often unmet in many facilities. Further research should be conducted to explore solutions, and plan future actions to alleviate the burdens on postpartum women and facilitate their recovery. Full article

The surging prevalence of diabetes globally necessitates advancements in non-invasive diagnostics, particularly for the early detection of cardiovascular anomalies associated with the condition. This study explores the efficacy of Pulse Wave Analysis (PWA) for distinguishing diabetic from non-diabetic individuals through morphological examination of pressure pulse waveforms. The research unfolds in four phases: data accrual, preprocessing, Convolutional Neural Network (CNN) model construction, and performance evaluation. Data were procured using a multipara patient monitor, resulting in 2000 pulse waves equally divided between healthy individuals and those with diabetes. These were used to train, validate, and test three distinct CNN architectures: the conventional CNN, Visual Geometry Group (VGG16), and Residual Networks (ResNet18). The accuracy, precision, recall, and F1 score gauged each model’s proficiency. The CNN demonstrated a training accuracy of 82.09% and a testing accuracy of 80.6%. The VGG16, with its deeper structure, surpassed the baseline with training and testing accuracies of 90.2% and 86.57%, respectively. ResNet18 excelled, achieving a training accuracy of 92.50% and a testing accuracy of 92.00%, indicating its robustness in pattern recognition within pulse wave data. Deploying deep learning for diabetes screening marks progress, suggesting clinical use and future studies on bigger datasets for refinement. Full article

Tokophobia is regarded as the intensive fear of childbirth that some pregnant women have. However, little is known about the psychopathological details of tokophobia (fear of childbirth). Between 2020 and 2021, a total of 10 pregnant women (nine nulliparae and one multipara) with a strong fear of childbirth were referred by obstetricians. Semi-structured psychopathological interviews were conducted, and two cases were judged to have obsession, three an overvalued idea, and one secondary delusion. Three were characterised by both obsession and overvalued idea and one by both obsession and secondary delusion. In total, six cases had features of an overvalued idea. All of the participants except one had a lifetime history of a specific phobia. In addition, their history included social phobia in two cases, panic disorder in one case, obsessive–compulsive disorder (other than tokophobia) in two cases, depressive disorder in two cases, bipolar disorder in two cases, and PTSD in six cases. To conclude, this study showed that tokophobia was not a phobic disorder but a kind of overvalued idea that requires specific assessment and treatment. Full article

Gestational anemia (GA) is a global health concern with a remarkably high prevalence in Japan, which is associated with various maternal and neonatal outcomes. This study aimed to explore whether GA and non-anemic iron deficiency (NAID) during the third trimester is associated with maternal characteristics, nutrient intake, low birth weight (LBW), and preterm birth. Participants were categorized into GA, NAID, and normal groups, based on serum ferritin and hemoglobin levels. Nutrient intake was assessed using the Brief Diet History Questionnaire. Data from 317 pregnant women were analyzed, including 110 (34.7%), 151 (47.6%), and 56 (17.6%) women in the GA, NAID, and normal groups, respectively. Factors associated with GA included being multipara (p < 0.001) and not taking any type of iron supplements in the third trimester (p = 0.043). The normal group had a significantly higher proportion of preterm birth and LBW than the GA and NAID groups. The GA group had a significantly higher energy intake than the normal group (p = 0.044). Overall, energy and micronutrient intake were significantly below the estimated average requirement in the dietary reference intakes for Japanese. Health care professionals need to consider nutritional advice that can prevent GA by focusing on overall micronutrients, not just energy intake. Full article

Most preterm births occur in the late preterm period. While prematurity-related adverse outcomes are significantly diminished when birth occurs during this period, these infants are still at increased risk of complications. Parity affects the incidence of obstetric complications. The purpose of this study was to determine whether parity impacts the risk of spontaneous late preterm birth (SLPTB) and associated complications. A retrospective observational cohort study was conducted. Patients were divided into three study groups according to parity. The primary outcome was the rate of SLPTB in each group. Secondary outcomes were unplanned cesarean delivery (UCD), prolonged third stage of labor respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), intraventricular hemorrhage (IVH), neonatal hypoglycemia, duration of NICU admission, neonatal death, and composite adverse neonatal outcome (CANO). Primiparas were more likely to have SLPTB, UCD, and CANO compared to multiparas (2.6% vs. 1.9% OR 1.5 [1.3–1.7] p < 0.01) (4.1% vs. 1.3% OR 2.7 [1.2, 5.9] p < 0.01) (8.5% vs. 4.2 OR 2.1 [1.3–3.5] p = 0.002) and grandmultiparas (2.6% vs. 1.7% OR 1.4 [1.2–1.5] p < 0.001) 8.5% vs. 4.4% OR 2.0 [1.1, 3.8], p = 0.01) but no difference in UCD compared to grandmultiparas (4.1% vs. 3.3% OR 1.2 [0.6–2.7] p = 0.28). Primiparas are at increased risk of SLPTB and UCD, and this is accompanied by an increased risk of adverse neonatal outcomes. Full article

Background and Objectives: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. Materials and Methods: This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. Results: Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. Conclusions: Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery. Full article

Background: Fear of Childbirth (FOC) can significantly impact women’s physical and psychological health; therefore, healthcare providers must provide proactive care, which means they have to intervene before FOC becomes tokophobia. This study’s purpose is to evaluate the determinants of prenatal childbirth fear during the third trimester among low-risk expectant mothers. Methods: A cross-sectional comparative study was conducted at the Maternal and Children Hospital’s outpatient clinics in Najran City, Saudi Arabia, from April to July 2023. The study involved 377 nulliparous and multiparous women, using a systemic random sampling technique. The data were collected using an interview schedule composed of questions related to demographic and obstetrics characteristics, the FOC questionnaire, and a multidimensional scale of perceived social support. Significant FOC predictors were examined using a binary logistic regression model. Results: There was a statistically significant difference between nulliparous and multiparous participants concerning FOC; 80.0% of nulliparous participants had significant FOC compared to 67.8% of multiparous participants (p = 0.011). A binary logistic regression clarified that regular antenatal care and family and spousal support were significantly negatively correlated with significant FOC among multiparous and nulliparous women (p < 0.05). For multiparas, FOC was associated with pregnancy planning and previous labor-related complications. In addition, friends’ support was an important predictor of significantly lower FOC among nulliparous women (p < 0.05). Conclusions: Significant FOC was higher in nulliparous women when compared to multiparous women. Numerous obstetric variables and different types of social support play important roles in significant FOC. Special attention and support should be provided to high-risk women for proper FOC management during prenatal classes to improve their childbirth experiences. Full article

Inconsistent evidence exists regarding the association of grand multiparity with adverse neonatal outcomes. This study aims to compare specific adverse outcomes in grand multiparas (those with five or more births at twenty or more weeks of gestation, regardless of fetal outcome) compared to those with lower parity (those with less than five births at twenty or more weeks of gestation, regardless of fetal outcome). A retrospective cohort study was undertaken at the Maternity and Children Hospital in Ha’il region, Saudi Arabia. After calculating the required sample size, data were collected from consenting participants with a viable singleton delivery. Socio-demographic variables, select maternal characteristics, and adverse neonatal outcomes (admission to the neonatal intensive care unit, low birth weight, prematurity, and APGAR score less than 7 in the first 5 min) were compared between grand multiparas and women with lower parity. Two hundred ninety-four participants were recruited (ninety-eight grand multiparas and one hundred ninety-six of lower parity). There was a statistically significant difference between the two groups in relation to age, level of education, body mass index, and the occurrence of gestational diabetes. Out of the studied adverse neonatal outcomes after the adjustment for maternal age between the two groups, no statistically significant difference in the adverse neonatal outcomes was found between the two groups. Grand multiparity does not incur an additional risk of adverse neonatal outcomes compared to women of lower parity. Furthermore, increasing maternal age and comorbid conditions might have a more detrimental effect on neonatal outcomes than grand multiparity per se. Full article

The aim of this multicenter retrospective cohort study was to examine the impact of maternal age on perinatal outcomes in multiparas, stratified according to maternal age in one- and two-year increments. The analysis involved 302,484 multiparas who delivered between the years 2003 and 2021 in four university-affiliated obstetrics departments. Maternal age was considered both as a continuous variable and in two-year intervals, as compared with a comparison group of parturients aged 25–30 years. The study focused on cesarean delivery and neonatal intensive care unit (NICU) admission as primary outcomes. The findings revealed that cesarean delivery rates increased as maternal age advanced, with rates ranging from 6.7% among 25–30 year olds, rising continuously from 13.5% to 19.9% between the age strata of 31 and 42, to exceeding 20% among those aged ≥ 43 years (p < 0.01 for each stratum when compared to 25–30 year old group). Similarly, NICU admission rates rose from 2.7% in the comparison group to 6% in parturients aged 45–46 years (p < 0.01 for each stratum when compared to 25–30 year old group). The study highlights the association between incrementally advanced maternal age and increased rates of maternal and neonatal complications, necessitating global awareness of these implications for family planning decisions and maternal care. Full article

Preterm births and parity are two medical areas that seem to be entirely different from each other. The aim of this study was to analyze the relationships between parity and maternal and neonatal outcomes associated with preterm birth. This study involved a retrospective analysis of electronic medical records from St. Sophia Hospital in Warsaw (Poland). This study was conducted among women who gave birth to preterm infants between 1 January 2017 and 31 December 2021. A total of 2043 cases of preterm births were included in the final analysis. A higher odds ratio of preterm birth in primiparas was found in women living in a city/town (OR = 1.56) and having secondary (OR = 1.46) and higher education (OR = 1.82). Multiparas who gave birth to preterm infants were more frequently diagnosed with gestational diabetes (19.69%) than primiparas. Multiparas were more likely to give birth to preterm infants who received an Apgar score of ≤7 both at 1 and 5 min after birth (25.80% and 15.34%). The results of our study emphasize the differences between primiparas and multiparas who give birth to preterm infants. Knowledge of these differences is essential to improve the perinatal care provided to mothers and their infants. Full article

Objective: This study aimed to clarify the effectiveness of early skin-to-skin contact (SSC) after a cesarean section (CS) program. Methods: An “early SSC after CS” program was implemented at a tertiary care hospital in Tanzania. A non-equivalent group design was used. A questionnaire was used to collect data on exclusive breastfeeding, breastfeeding intention, Birth Satisfaction Scale—Revised Indicator (BSS-RI) score, perioperative pain with a visual analogue scale, and infant hospitalization for infectious diseases and diarrhea at 2–3 days postpartum. Follow-up surveys were conducted until 4 months postpartum regarding exclusive breastfeeding, breastfeeding intention, and hospitalization of the infants. Results: This study involved 172 parturient women who underwent CS, with 86 in the intervention group and 86 in the control group. The exclusive breastfeeding rates at 4 months postpartum were 57 (76.0%) in the intervention group and 58 (76.3%) in the control group, with no significant difference. The BSS-RI score was higher in the intervention group (7.91, range 4–12, SD 2.42) than in the control group (7.18, range 3–12, SD 2.02) (p = 0.007) for women who underwent emergency CS. The survival probability for infants hospitalized owing to infectious diseases, and diarrhea was significantly higher in the intervention group (98.5%) than in the control group (88.3%) (χ² = 5.231, p = 0.022) for multiparas. Conclusion: The early SSC after CS program showed a positive effect on the birth satisfaction of women undergoing emergency CS. It also reduced the incidence of infants hospitalized owing to infectious diseases and diarrhea for multiparas. Full article

The first-trimester prediction of spontaneous preterm birth (sPTB) has been elusive, and current screening is heavily dependent on obstetric history. However, nullipara lack a relevant history and are at higher risk for spontaneous (s)PTB ≤ 32 weeks compared to multipara. No available objective first-trimester screening test has proven a fair predictor of sPTB ≤ 32 weeks. We questioned whether a panel of maternal plasma cell-free (PCF) RNAs (PSME2, NAMPT, APOA1, APOA4, and Hsa-Let-7g) previously validated at 16–20 weeks for the prediction of sPTB ≤ 32 weeks might be useful in first-trimester nullipara. Sixty (60) nulliparous women (40 with sPTB ≤ 32 weeks) who were free of comorbidities were randomly selected from the King’s College Fetal Medicine Research Institute biobank. Total PCF RNA was extracted and the expression of panel RNAs was quantitated by qRT-PCR. The analysis employed, primarily, multiple regression with the main outcome being the prediction of subsequent sPTB ≤ 32 weeks. The test performance was judged by the area under the curve (AUC) using a single threshold cut point with observed detection rates (DRs) at three fixed false positive rates (FPR). The mean gestation was 12.9 ± 0.5 weeks (range 12.0–14.1 weeks). Two RNAs were differentially expressed in women destined for sPTB ≤ 32 weeks: APOA1 (p < 0.001) and PSME2 (p = 0.05). APOA1 testing at 11–14 weeks predicted sPTB ≤ 32 weeks with fair to good accuracy. The best predictive model generated an AUC of 0.79 (95% CI 0.66–0.91) with observed DRs of 41%, 61%, and 79% for FPRs of 10%, 20%, and 30%, including crown–rump length, maternal weight, race, tobacco use, and age. Full article