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High risk pregnancies

Marion I Boldingh, Angelina H Maniaol, Cathrine Brunborg, Harald Weedon-Fekjær, Jan J G M Verschuuren, Chantal M E Tallaksen
OBJECTIVE: To study the risk of clinical onset of myasthenia gravis (MG) in pregnancy and during the first 6 months postpartum because an association between pregnancy or the postpartum period and the onset of autoimmune MG is widely assumed but not proven. METHODS: The design was a cross-sectional population-based cohort study of 2 MG cohorts (Norway and the Netherlands) with 1,038 healthy controls from Norway. Data were obtained on 246 women with MG (age at onset 15-45 years)...
October 21, 2016: Neurology
Stina Lou, Camilla P Nielsen, Lone Hvidman, Olav B Petersen, Mette B Risør
BACKGROUND: It is well documented that pregnant women experience increased worry and uncertainty following a high-risk prenatal screening result. While waiting for diagnostic results this worry continues to linger. It has been suggested that high-risk women put the pregnancy mentally 'on hold' during this period, however, not enough is known about how high-risk women and their partners cope while waiting for diagnostic results. The aim of this study was to identify the strategies employed to cope with worry and uncertainty...
October 21, 2016: BMC Pregnancy and Childbirth
Yaniv Zipori, Karen Reidy, T Gilchrist, Lex W Doyle, Mark P Umstad
BACKGROUND: Monochorionic diamniotic (MCDA) twin pregnancies are associated with adverse perinatal outcome. Intertwin discordances at the time of nuchal translucency (NT) screening may have a value in the prediction of fetal loss or twin-to-twin transfusion syndrome. We aimed to determine the ability of intertwin NT and crown rump length (CRL) discordances among MCDA twins to predict adverse outcomes. MATERIAL AND METHODS: All MCDA twins with a documented routine ultrasound at 11 to 13+6 weeks' gestation, and known pregnancy outcome between August 2003 and August 2012 were included...
October 21, 2016: Twin Research and Human Genetics: the Official Journal of the International Society for Twin Studies
Marcos Augusto Bastos Dias, Rosa Maria Soares Madeira Domingues, Arthur Orlando Corrêa Schilithz, Marcos Nakamura-Pereira, Maria do Carmo Leal
BACKGROUND: The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS: This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns...
October 17, 2016: Reproductive Health
Maria do Carmo Leal, Ana Paula Esteves-Pereira, Marcos Nakamura-Pereira, Jacqueline Alves Torres, Mariza Theme-Filha, Rosa Maria Soares Madeira Domingues, Marcos Augusto Bastos Dias, Maria Elizabeth Moreira, Silvana Granado Gama
BACKGROUND: The rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil. METHODS: Data are from the 2011-2012 "Birth in Brazil" study, which used a national population-based sample of 23,940 women...
October 17, 2016: Reproductive Health
Marcos Nakamura-Pereira, Maria do Carmo Leal, Ana Paula Esteves-Pereira, Rosa Maria Soares Madeira Domingues, Jacqueline Alves Torres, Marcos Augusto Bastos Dias, Maria Elisabeth Moreira
BACKGROUND: Cesarean section (CS) rates are increasing worldwide but there is some concern with this trend because of potential maternal and perinatal risks. The Robson classification is the standard method to monitor and compare CS rates. Our objective was to analyze CS rates in Brazil according to source of payment for childbirth (public or private) using the Robson classification. METHODS: Data are from the 2011-2012 "Birth in Brazil" study, which used a national hospital-based sample of 23,940 women...
October 17, 2016: Reproductive Health
L L Wang, R H Bai, Q Liu, Q Zhang, S N Dang, B B Mi, H Yan
Objective: To understand the incidence and epidemiological characteristics of adverse pregnancy outcome in Shaanxi province. Methods: General information of the study was derived from the prevalence and risk factors of birth defects in Shaanxi province in 2010-2013. Descriptive epidemiological method was used to analyze the data of adverse pregnancy outcome. Results: The overall incidence of adverse pregnancy outcome was 25.45% during 2010-2013 (26.84% in 2010, 26.11% in 2011, 24.96% in 2012 and 24.80% in 2013, respectively)...
October 10, 2016: Zhonghua Liu Xing Bing Xue za Zhi, Zhonghua Liuxingbingxue Zazhi
Aurélie Smets, Thomas Fauchier, Grégory Michel, Pierre Marty, Christelle Pomares
A maternal Toxoplasma gondii infection during pregnancy is a risk for congenital infection through maternal-fetal transplacental transmission. Estimation of the date of infection is of the utmost importance for management and treatment recommendations. In this setting, IgG avidity has been shown to be useful as high avidity rules out an infection dating less than 4 months. The estimated date of infection can also be obtained by the ratio of T. gondii IgG titers measured by the Vidas (bioMérieux) assay versus T...
2016: Parasite: Journal de la Société Française de Parasitologie
Mikko J Peltola, Tiina Mäkelä, E Juulia Paavonen, Elina Vierikko, Outi Saarenpää-Heikkilä, Tiina Paunio, Jari K Hietanen, Anneli Kylliäinen
Maternal prenatal anxiety is associated with infants' temperamental negative affectivity (NA), but it is unclear to what extent children vary in their susceptibility to prenatal influences. We tested a hypothesis that infants' respiratory sinus arrhythmia (RSA), an index of parasympathetic vagal tone and a potential marker of differential susceptibility to environmental influences, moderates the effects of maternal prenatal anxiety on the development of infant NA. Prenatal anxiety was assessed during the last trimester of pregnancy in a low-risk community sample...
October 20, 2016: Developmental Psychobiology
Nicole Yoder, Reshef Tal, J Ryan Martin
BACKGROUND: Ectopic pregnancy is the leading cause of maternal morbidity and mortality during the first trimester and the incidence increases dramatically with assisted-reproductive technology (ART), occurring in approximately 1.5-2.1 % of patients undergoing in-vitro fertilization (IVF). Abdominal ectopic pregnancy is a rare yet clinically significant form of ectopic pregnancy due to potentially high maternal morbidity. While risk factors for ectopic pregnancy after IVF have been studied, very little is known about risk factors specific for abdominal ectopic pregnancy...
October 19, 2016: Reproductive Biology and Endocrinology: RB&E
Eunice López-Muñoz, Jorge Antonio Ibarra-Avalos, Rosario Guadalupe Chan-Verdugo, Leovigildo Mateos-Sánchez, Olivia Sánchez-Rodríguez
In order to determine the prevalence of overt and subclinical hypothyroidism, and isolated hypothyroxinemia during pregnancy, thyroid hormone reference values established by UMAE HGO4, IMSS in Mexico City and those suggested by the American Thyroid Association (ATA) were used. All pregnant patients, whose thyroid function was measured and whose pregnancy was monitored and resolved in UMAE HGO4, IMSS from 1 January to 31 December 2013, were included. Significant differences (p = .00419) were observed in the frequency of subclinical hypothyroidism, being higher when using ATA criteria (18...
October 20, 2016: Journal of Obstetrics and Gynaecology: the Journal of the Institute of Obstetrics and Gynaecology
Marina Parca Cavelagna Teixeira, Tatiana Peloso Reis Queiroga, Maria Dos Anjos Mesquita
Objective: To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. Methods: This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio...
July 2016: Einstein
Flavia Westphal, Suzete Maria Fustinoni, Vânia Lopes Pinto, Patrícia de Souza Melo, Anelise Riedel Abrahão
Objective: To identify the profile of women seen in a Fetal Medicine unit, diagnosed with fetal abnormality incompatible with neonatal survival in their current pregnancy, and to check the association of gestational age upon diagnosis with the option of pregnancy termination. Methods: This is a retrospective cohort study carried out in the Fetal Medicine Outpatients Clinic of a university hospital, in the city of São Paulo (SP), Brazil, using medical records of pregnant women with fetus presenting abnormalities incompatible with neonatal survival...
July 2016: Einstein
Margaret Loyet, Amy McLean, Karen Graham, Cheryl Antoine, Kathy Fossick
BACKGROUND: Women carrying a fetus with a suspected or known fetal anomaly have complex needs such as emotional and informational support and help with the logistical aspects of arranging care and treatment from numerous specialists. IMPROVEMENT IN QUALITY OF CARE FOR WOMEN CARRYING A FETUS WITH A SUSPECTED OR KNOWN FETAL ANOMALY:: Our fetal care team was initiated in 2012 to meet the needs of this high-risk pregnant population. The fetal care team nurse coordinator supports the woman and her family through all aspects of care during the pregnancy and neonatal period including scheduling appointments with multiple specialists, being there with her as a support person, keeping her updated, making sure she has accurate information about the fetal diagnosis, and helping her to navigate the complex healthcare system...
November 2016: MCN. the American Journal of Maternal Child Nursing
G Chistyakova, I Gazieva, I Remizova, L Ustyantseva, V Lyapunov, S Bychkova
We conducted a study of markers of endothelial dysfunction and angiogenesis regulation, as well as the identification of the main lymphocyte populations, activated CD3 (+) CD95(+)-cells and cytokine-producing CD4 (+) IFN-γ(+)-, CD4 (+) IL-4(+ )-lymphocytes in the 1st trimester of gestation in women with ART-induced pregnancy and spontaneous pregnancy. We used the same indicators to assess the immune status of ELBW infants at birth and at the post-conceptual age of 38-40 weeks. It was determined that the risk factors of very early preterm delivery are: threatened miscarriage, chronic placental insufficiency, endothelial dysfunction, increased spontaneous production of intracellular cytokines...
October 2016: Gynecological Endocrinology
N V Bashmakova, N B Davydenko, G B Malgina, N V Putilova
AIM: The aim of this research was to have a thorough study of predictors of critical states during pregnancy after assisted reproductive technologies. MATERIALS AND METHODS: A retrospective study of 303 patients with "near-miss," out of which 37 are pregnancy cases after ART (the main group) and 265 are spontaneous pregnancy cases (the control group). RESULTS: Pregnancy after ART constituted 12.3% of all critical states. In the main group (10...
October 2016: Gynecological Endocrinology
N M Scott, J F Lauzon-Joset, A C Jones, K T Mincham, N M Troy, J Leffler, M Serralha, S L Prescott, S A Robertson, C Pasquali, A Bosco, P G Holt, D H Strickland
Infection-associated inflammatory stress during pregnancy is the most common cause of fetal growth restriction and/or miscarriage. Treatment strategies for protection of at-risk mothers are limited to a narrow range of vaccines, which do not cover the bulk of the common pathogens most frequently encountered. Using mouse models, we demonstrate that oral treatment during pregnancy with a microbial-derived immunomodulator (OM85), currently used clinically for attenuation of infection-associated airway inflammatory symptoms in infants-adults, markedly reduces risk for fetal loss/growth restriction resulting from maternal challenge with bacterial lipopolysaccharide or influenza...
October 19, 2016: Mucosal Immunology
Nicola M Grissom, Robert George, Teresa M Reyes
Nutritional conditions in early life can have a lasting impact on health and disease risk, though the underlying mechanisms are incompletely understood. In the healthy individual, physiological and behavioral responses to stress are coordinated in such a way as to mobilize resources necessary to respond to the stressor and to terminate the stress response at the appropriate time. Induction of proinflammatory gene expression within the brain is one such example that is initiated in response to both physiological and psychological stressors, and is the focus of the current study...
October 15, 2016: Brain, Behavior, and Immunity
Tasneem Khan, Shelley Macaulay, Shane A Norris, Lisa K Micklesfield, Estelle D Watson
BACKGROUND: Over the past decade the prevalence of gestational diabetes mellitus (GDM) has increased rapidly in both developed and developing countries and has become a growing health concern worldwide. A recent systematic review highlighted the paucity of data available on the prevalence and potential burden of GDM in Africa, which was emphasised by the fact that only 11 % of African countries were represented in the review. In South Africa, the prevalence of GDM remains unknown, although one would estimate it to be high due to urbanisation and the growing obesity epidemic...
October 18, 2016: BMC Women's Health
Matthew S Payne, Demelza J Ireland, Rory Watts, Elizabeth A Nathan, Lucy L Furfaro, Matthew W Kemp, Jeffrey A Keelan, John P Newnham
BACKGROUND: Detection of Ureaplasma, Mycoplasma and Candida spp. in the vagina during pregnancy has previously been associated with preterm birth (PTB). However, the prevalence of these microorganisms and the associated obstetric risks (likely to be population-specific) have not been determined in Australian women; furthermore, in the case of Ureaplasma spp., very few studies have attempted characterisation at the species level and none have examined genotype/serovar status to further refine risk assessment...
October 18, 2016: BMC Pregnancy and Childbirth
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