Sentimentos da mulher frente a gestação de alto risco / Sentimientos de la mujer frente al embarazo de alto riesgo / Women's feelings facing High-Risk pregnancy

Resumo Introdução: A gestação configura-se como um acontecimento único e memorável para a vida de uma mulher. A gravidez de alto risco é uma experiência estressante em razão dos riscos a que estão submetidos a mãe e o bebê e devido às mudanças que afetam negativamente o seu equilíbrio emocional. Objetivo: Identificar os sentimentos vivenciados pela gestante frente à gravidez de alto risco. Método: Descritivo e exploratório com abordagem qualitativa, com amostra por conveniência composta por mulheres com gestação de alto risco, selecionadas de acordo com a disponibilidade do serviço de internamento, até a saturação das entrevistas. A coleta dos dados foi realizada em um período de dois meses através de entrevistas guiadas por um roteiro. Os dados foram analisados por meio da técnica de análise de conteúdo segundo Minayo. Resultados: Fizeram parte 37 mulheres. Os resultados foram oeganizados nas categorias: Como se deu o diagnóstico de alto risco; Sentimentos ao descobrir que a gestação é/era de risco; Sentimentos em relação ao apoio familiar acerca da gestação de alto risco. Os sentimentos relatados pelas gestantes e puérperas que conviveram com a gravidez de alto risco, deixam evidentes os impactos que este evento traz não somente na saúde física sobretudo para a emocional, deixando as gestantes fragilizadas. Conclusão: Assim, o estudo nos permitiu perceber que os sentimentos vivenciados nesse processo podem interfir na vida dessas mulheres, e de forma negativa. Mas, que apesar dessa situação, estas expressam sentimentos ambíguos, pois mesmo com o risco gestacional, muitas mostram-se felizes pela dádiva de ser mãe.

Resumen Introducción: El embarazo se considera un evento único y memorable en la vida de una mujer. El embarazo de alto riesgo es una experiencia estresante debido a los riesgos a los que están expuestas tanto la madre como su bebé y a los cambios que afectan negativamente su equilibrio emocional. Objetivo: Identificar los sentimientos experimentados por las mujeres embarazadas frente a un embarazo de alto riesgo. Metodología: Descriptivo y exploratorio con enfoque cualitativo, con una muestra a conveniencia compuesta por mujeres con embarazos de alto riesgo, seleccionadas según la disponibilidad del servicio de hospitalización, hasta la saturación de las entrevistas. La recopilación de datos se llevó a cabo durante un período de dos meses a través de entrevistas guiadas. Los datos fueron analizados utilizando la técnica de análisis de contenido según Minayo. Resultados: Participaron 37 mujeres y los resultados se organizaron en las siguientes categorías: cómo se realizó el diagnóstico de alto riesgo; sentimientos al descubrir que el embarazo era de riesgo; sentimientos con respecto al apoyo familiar en relación con el embarazo de alto riesgo. Los sentimientos relatados por las mujeres embarazadas y posparto que vivieron un embarazo de alto riesgo evidencian los impactos que tiene este evento no solo en la salud física sino, especialmente, en el bienestar emocional, pues deja a las mujeres embarazadas en un estado de vulnerabilidad. Conclusión: El estudio nos permitió darnos cuenta de que los sentimientos experimentados en este proceso pueden interferir en la vida de estas mujeres de manera negativa. Sin embargo, a pesar de esta situación, muchas de ellas expresan sentimientos ambiguos, porque, incluso con el riesgo gestacional, están agradecidas por el regalo de la maternidad.

Abstract Introduction: Pregnancy is considered a unique and memorable event in a woman's life. High-risk pregnancy is a stressful experience due to the risks to which the mother and the baby are exposed, and due to the changes that negatively affect their emotional balance. Objective: To identify the feelings experienced by pregnant women facing high-risk pregnancy. Method: Descriptive and exploratory, employing a qualitative approach, the study featured a convenience sample of women with high-risk pregnancies, selected based on inpatient service availability, until interview saturation was achieved. Data collection was conducted over a two-month period through scripted interviews. Data analysis was performed utilizing Minayo's content analysis technique. Results: Thirty-seven women participated in the study. The results were categorized as follows: How the high-risk diagnosis was determined; Feelings upon discovering the pregnancy was high-risk; Feelings regarding family support regarding the high-risk pregnancy. The feelings reported by pregnant and postpartum women who experienced high-risk pregnancies clearly reveal the impacts this event has, not only on physical health, but especially on emotional well-being, leaving the pregnant women in a vulnerable state. Conclusion: The study allowed us to realize that the feelings experienced in this process can negatively interfere in the lives of these women. However, despite this situation, many of them express mixed feelings, because even with the gestational risk, they are grateful for the gift of motherhood.

Basic human needs in pregnant women at high risk obstetrician analyzed under the Wanda Horta Theory / Necesidades humanas básicas en gestantes con alto riesgo obstétrico analizado bajo la Teoría de Wanda Horta / Necessidades humanas básicas em gestantes de alto risco obstétrico analisadas sob a Teoria de Wanda Horta

Objetivo: identificar las necesidades humanas básicas de lasembarazadas de alto riesgo hospitalizadas con base en la Teoríade Wanda Horta.Método: investigación asistencial realizada con dieciséis gestantesde alto riesgo hospitalizadas en una maternidad de referenciaen Ceará entre septiembre y noviembre de 2019. Se recolectóinformación a través de diario de campo y ficha de caracterizaciónde las gestantes y registros de necesidades humanas básicas.Los resultados se analizaron mediante estadística descriptivasimple y un enfoque integral a la luz del marco de Wanda Horta.Resultados: las gestantes presentaron necesidades psicobiológicas,psicosociales y psicoespirituales, siendo prevalentes: ausencia deactividades de ocio, inseguridad emocional, escaso conocimiento,sueño y descanso perjudicados, y actividades físicas restringidaspor indicación de descanso.Consideraciones finales: se cree que el razonamiento crítico y eljuicio clínico de los enfermeros se centraron en la individualidadde las gestantes, identificando necesidades en los tres nivelespropuestos por la teoría, apuntando caminos para cualificarel cuidado de enfermería a las gestantes de alto riesgo.(AU)

Objective: to identify the basic human needs of hospitalizedhigh-risk pregnant women based on Wanda Horta's Theory. Method: care research carried out with sixteen high-risk pregnantwomen hospitalized in a reference maternity hospital in Cearábetween September and November 2019. Information was collectedthrough a field diary and a form to characterize the pregnantwomen and records of basic human needs. The results wereanalyzed by simple descriptive statistics and a comprehensiveapproach in the light of the framework of Wanda Horta.Results: the pregnant women presented psychobiological,psychosocial and psychospiritual needs, being prevalent: absenceof leisure activities, emotional insecurity, poor knowledge,impaired sleep and rest, and restricted physical activities byindication of rest.Final considerations: it is believed that the nurses' criticalreasoning and clinical judgment were focused on the individualityof pregnant women, identifying needs at the three levels proposedby the theory, pointing out ways to qualify nursing care forhigh-risk pregnant women.(AU)

Objetivo: identificar as necessidades humanas básicas de gestantesde alto risco hospitalizadas com base na Teoria de Wanda Horta.Método: pesquisa-cuidado realizada com dezesseis gestantes de altorisco hospitalizadas em maternidade de referência no Ceará entresetembro e novembro de 2019. As informações foram coletadasatravés de diário de campo e formulário para caracterizaçãodas gestantes e registros das necessidades humanas básicas. Osresultados foram analisados por estatística descritiva simples eabordagem compreensiva à luz do referencial de Wanda Horta.Resultados: as gestantes apresentaram necessidades psicobiológicas,psicossociais e psicoespirituais, sendo prevalentes: ausênciade atividades de lazer, insegurança emocional, conhecimentodeficiente, sono e repouso prejudicado e atividades físicasrestritas por indicação de repouso.Considerações finais: acredita-se que o raciocínio crítico eo julgamento clínico dos enfermeiros estiveram focados naindividualidade das gestantes, identificando necessidades nostrês níveis propostos pela teoria, apontando caminhos paraqualificar a assistência de enfermagem às gestantes de alto risco.(AU)

Homelessness in pregnancy.

OBJECTIVES: To evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital. METHODS: A retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements. RESULTS: Women in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001). They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01-2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001). CONCLUSION: Women in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements.

Detection and Control of Pregnancy Hypertension Using Self-Monitoring of Blood Pressure With Automated Telemonitoring: Cost Analyses of the BUMP Randomized Trials.

BACKGROUND: Pregnancy hypertension continues to cause maternal and perinatal morbidity. Two linked UK randomized trials showed adding self-monitoring of blood pressure (SMBP) with automated telemonitoring to usual antenatal care did not result in earlier detection or better control of pregnancy hypertension. This article reports the trials' integrated cost analyses. METHODS: Two cost analyses. SMBP with usual care was compared with usual care alone in pregnant individuals at risk of hypertension (BUMP 1 trial [Blood Pressure Monitoring in High Risk Pregnancy to Improve the Detection and Monitoring of Hypertension], n=2441) and with hypertension (BUMP 2 trial, n=850). Clinical notes review identified participant-level antenatal, intrapartum, and postnatal care and these were costed. Comparisons between trial arms used means and 95% CIs. Within BUMP 2, chronic and gestational hypertension cohorts were analyzed separately. Telemonitoring system costs were reported separately. RESULTS: In BUMP 1, mean (SE) total costs with SMBP and with usual care were £7200 (£323) and £7063 (£245), respectively, mean difference (95% CI), £151 (-£633 to £936). For the BUMP 2 chronic hypertension cohort, corresponding figures were £13 384 (£1230), £12 614 (£1081), mean difference £323 (-£2904 to £3549) and for the gestational hypertension cohort were £11 456 (£901), £11 145 (£959), mean difference £41 (-£2486 to £2567). The per-person cost of telemonitoring was £6 in BUMP 1 and £29 in BUMP 2. CONCLUSIONS: SMBP was not associated with changes in the cost of health care contacts for individuals at risk of, or with, pregnancy hypertension. This is reassuring as SMBP in pregnancy is widely prevalent, particularly because of the COVID-19 pandemic. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03334149.

Low-molecular-weight heparin for the prevention of preeclampsia in high-risk pregnancies without thrombophilia: a systematic review and meta-analysis.

OBJECTIVES: To systematically evaluate the efficacy of low molecular weight heparin (LMWH) to prevent preeclampsia in high risk pregnant women without thrombophilia. SEARCH STRATEGY: PubMed, Embase and the Cochrane library were searched for articles published before 1st August 2022 using the combination keywords "preeclampsia", "Low Molecular Weight Heparin", "LMWH", "Heparin, Low Molecular Weight", "Dalteparin", "Nadroparin", and "Tinzaparin". SELECTION CRITERIA: Randomized controlled trials evaluating the use of LMWH in pregnant women at high risk of preeclampsia without thrombophilia. DATA COLLECTION AND ANALYSIS: Ten studies were included in the meta-analysis (1758 patients in total). Outcomes were expressed as relative risk (RR) with 95% confidence intervals (CI). RESULTS: LMWH reduced the incidence of PE (RR = 0.67; 95% CI = 0.50-0.90; P = 0.009) in high risk pregnant women without thrombophilia. Subgroup analysis found that the prophylactic effect of LMWH was only significant in studies using low-dose aspirin (LDA) as the primary intervention. The combination of LMWH and LDA was also effective for the prevention of preterm birth and fetal growth restriction, but had no effect on the incidence of placenta abruption. CONCLUSION: For women at high risk of developing preeclampsia without thrombophilia, the combination of LMWH and low-dose aspirin is effective for the prevention of preeclampsia, preterm birth and fetal growth restriction and is superior to LDA alone.

Spontaneous haemoperitoneum in the second trimester of pregnancy.

This is a case of a spontaneous haemoperitoneum occurring in the second trimester of pregnancy which was managed with interventional radiology to avoid laparotomy and its potential consequences. We aim to raise awareness of this condition in pregnancy because the perinatal mortality rate is as high as 36%. Spontaneous haemoperitoneum in pregnancy (SHiP) has frequently been associated with vascular rupture from pre-existing endometriosis. Most cases of SHiP have been managed with laparotomy. However, transcatheter embolisation can impart lifesaving alternatives to more invasive interventions when caring for pregnant patients. More judicious use of imaging procedures may also help improve diagnostic and therapeutic pathways with SHiP. We recommend that high-risk pregnancies are managed in level IV regional perinatal healthcare centres, when possible, where subspecialists and alternative measures of management exist.

Development of a single-visit protocol for the management of pregnancy of unknown location following in vitro fertilization: a retrospective study.

STUDY QUESTION: Can women with pregnancy of unknown location (PUL) following in vitro fertilization (IVF) be risk-stratified regarding the subsequent need for medical intervention, based on their demographic characteristics and the results of serum biochemistry at the initial visit? SUMMARY ANSWER: The ratio of serum hCG to number of days from conception (hCG/C) or the initial serum hCG level at ≥5 weeks' gestation could be used to estimate the risk of women presenting with PUL following IVF and needing medical intervention during their follow-up. WHAT IS KNOWN ALREADY: In women with uncertain conception dates presenting with PUL, a single serum hCG measurement cannot be used to predict the final pregnancy outcomes, thus, serial levels are mandatory to establish a correct diagnosis. Serum progesterone levels can help to risk-stratify women at their initial visit but are not accurate in those taking progesterone supplementation, such as women pregnant following IVF. STUDY DESIGN, SIZE, DURATION: This was a retrospective study carried out at two specialist early pregnancy assessment units between May 2008 and January 2021. A total of 224 women met the criteria for inclusion, but 14 women did not complete the follow-up and were excluded from the study. PARTICIPANTS/MATERIALS, SETTING, METHODS: We selected women who had an IVF pregnancy and presented with PUL at ≥5 weeks' gestation. MAIN RESULTS AND THE ROLE OF CHANCE: A total of 30/210 (14.0%, 95% CI 9.9-19.8) women initially diagnosed with PUL required surgical intervention. The hCG/C was significantly higher in the group of women requiring an intervention compared to those who did not (P = 0.003), with an odds ratio of 3.65 (95% CI 1.49-8.89, P = 0.004). A hCG/C <4.0 was associated with a 1.9% risk of intervention, which accounted for 25.7% of the study population. A similar result was obtained by substituting hCG/C <4.0 with an initial hCG level <100 IU/l, which was associated with 2.0% risk of intervention, and accounted for 23.8% of the study population (P > 0.05). LIMITATIONS, REASONS FOR CAUTION: A limitation of our study is that it is retrospective in nature, and as such, we were reliant on existing data. WIDER IMPLICATIONS OF THE FINDINGS: A previous study in women with PUL after spontaneous conception found that a 2% intervention rate was considered low enough to eliminate the need for close follow-up and serial blood tests. Using the same 2% cut-off, a quarter of women with PUL after IVF could also avoid attending for further visits and investigations. STUDY FUNDING/COMPETING INTEREST(S): No external funding was required for this study. No conflicts of interest are required to be declared. TRIAL REGISTRATION NUMBER: N/A.

Expectations related to home-based telemonitoring of high-risk pregnancies: A qualitative study addressing healthcare providers' and users' views in Norway.

INTRODUCTION: A pregnancy can be evaluated as high-risk for the woman and/or the fetus based on medical history and on previous or ongoing pregnancy characteristics. Monitoring high-risk pregnancies is crucial for early detection of alarming features, enabling timely intervention to ensure optimal maternal and fetal health outcomes. Home-based telemonitoring (HBTM) is a marginally exploited opportunity in antenatal care. The aim of this study was to illuminate healthcare providers' and users' expectations and views about HBTM of maternal and fetal health in high-risk pregnancies before implementation. MATERIAL AND METHODS: To address diverse perspectives regarding HBTM of high-risk pregnancies, four different groups of experienced healthcare providers or users were interviewed (n = 21). Focus group interviews were conducted separately with midwives, obstetricians, and women who had previously experienced stillbirth. Six individual interviews were conducted with hospitalized women with ongoing high-risk pregnancies, representing potential candidates for HBTM. None of the participants had any previous experience with HBTM of pregnancies. The study is embedded in a social constructivist research paradigm. Interviews were analyzed using a thematic approach. RESULTS: The participants acknowledged the benefits and potentials of more active roles for both care recipients and providers in HBTM. Concerns were clearly addressed and articulated in the following themes: eligibility and ability of women, availability of midwives and obstetricians, empowerment and patient safety, and shared responsibility. All groups problematized issues crucial to maintaining a sense of safety for care recipients, and healthcare providers also addressed issues related to maintaining a sense of safety also for the care providers. Conditions for HBTM were understood in terms of optimal personalized training, individual assessment of eligibility, and empowerment of an active patient role. These conditions were linked to the importance of competent and experienced midwives and obstetricians operating the monitoring, as well as the availability and continuity of care provision. Maintenance of safety in HBTM in high-risk pregnancies was crucial, particularly so in situations involving emerging acute health issues. CONCLUSIONS: HBTM requires new, proactive roles among midwives, obstetricians, and monitored women, introducing a fine-tuned balance between personalized and standardized care to provide safe, optimal monitoring of high-risk pregnancies.

Risk and protective factors for pregnancy-related urinary incontinence until 1 year postpartum: A cohort study using patient-reported outcome measures in Italy.

OBJECTIVE: To investigate the epidemiology of pregnancy-related urinary incontinence (UI) and the related risk factors, focusing also on women's characteristics related to maternity pathway utilization. METHODS: In this prospective cohort study, we used patient-reported data obtained from the systematic survey on the maternity pathway that all pregnant women in Tuscany, Italy, can join. We selected 8410 women who completed-between March 2019 and November 2022-all five follow-up questionnaires from the first trimester until 12 months postpartum, each including a UI-specific patient-reported outcome measure. We performed panel regression models to explore the related risk factors. RESULTS: Prevalence of UI was 4.4% at the first trimester, 23.7% at the third trimester, and 15.6%, 12.6%, and 12.4% at 3, 6, and 12 months postpartum. UI occurrence and severity were higher in older, overweight/obese, and unemployed women. High-risk pregnancy and discomfort during pregnancy were risk factors. Receiving a cesarean section reduced the risk, while spontaneous tears, episiotomy, and high birth weight increased it. Women who experienced delays in pregnancy examinations because of long waiting times and women who had planned pregnancy had a higher risk, while performing during-pregnancy pelvic-floor-muscle training was protective. CONCLUSION: Besides confirming the classic risk and protective factors for UI, we also found novel determinants related to the proper maternity pathway utilization.

Efeitos da suplementação do cálcio sobre marcadores da pré-eclâmpsia: ensaio clínico randomizado / Efectos de los suplementos de calcio en marcadores de preeclampsia: ensayo clínico aleatorizado / Effects of calcium supplementation on markers of preeclampsia: randomized clinical trial

Resumo Objetivo Analisar os efeitos da suplementação de cálcio nos marcadores da pré-eclâmpsia ao longo do tempo, comparando o uso de cálcio em alta e baixa dosagem em mulheres grávidas com hipertensão. Métodos Trata-se de ensaio clínico randomizado com três grupos paralelos, placebo controlado, realizado no ambulatório de referência para o pré-natal de alto risco na Região Sul do Brasil, com análise de intenção de tratar e seguimento após quatro e oito semanas. A intervenção consistiu na ingestão de cálcio 500mg/dia, cálcio 1500mg/dia e placebo. Os dados foram analisados segundo um modelo generalizado de estimação de equações mistas adotando α 0,05. Resultados O efeito do cálcio em baixa e alta dosagem na evolução ao longo do tempo foi mantido entre os grupos, mesmo após o ajuste para os fatores de confusão. Houve diferença significativa nos parâmetros analisados na interação tempo e grupo (p <0,000) e diminuição nas médias de 12,3mmHg na PAS, 9,2 mmHg na PAD, 3,2 mg/dl creatinina e 7,2 mg/dl proteinúria para o grupo cálcio 500mg/dia. Os resultados foram semelhantes para o grupo com suplementação máxima. Conclusão O cálcio melhorou o prognóstico vascular em mulheres grávidas com hipertensão ao reduzir os níveis pressóricos e os marcadores da pré-eclâmpsia.

Resumen Objetivo Analizar los efectos de los suplementos de calcio en los marcadores de preeclampsia a lo largo del tiempo, comparando el uso de calcio en dosis altas y bajas en mujeres embarazadas con hipertensión. Métodos Se trata de un ensayo clínico aleatorizado con tres grupos paralelos, placebo controlado realizado en consultorios externos de referencia en el control prenatal de alto riesgo en la Región Sur de Brasil, con análisis de intención de tratar y seguimiento luego de cuatro y ocho semanas. La intervención consistió en la ingesta de calcio 500 mg/día, calcio 1500 mg/día y placebo. Los datos se analizaron de acuerdo con un modelo generalizado de estimación de ecuaciones mixtas adoptando α 0,05. Resultados El efecto del calcio en dosis bajas y altas en la evolución a lo largo del tiempo se mantuvo entre los grupos, inclusive después de los ajustes por los factores de confusión. Hubo diferencia significativa en los parámetros analizados en la interacción tiempo y grupo (p <0,000) y reducción de los promedios de 12,3 mmHg en la PAS, 9,2 mmHg en la PAD, 3,2 mg/dl creatinina y 7,2 mg/dl proteinuria en el grupo calcio 500 mg/día. Los resultados fueron parecidos en el grupo con suplemento en dosis máxima. Conclusión El calcio mejoró el pronóstico vascular en mujeres embarazadas con hipertensión al reducir los niveles de presión y los marcadores de preeclampsia. Registro Brasileiro de Ensaios Clínicos: RBR-9ngb95

Abstract Objective To analyze the effects of calcium supplementation on markers of preeclampsia over time by comparing the use of high- and low-dose calcium in hypertensive pregnant women. Methods This is a randomized clinical trial, placebo controlled, with three parallel groups carried out at the reference outpatient clinic for high-risk prenatal care in the South Region of Brazil, with intention-to-treat analysis and follow-up after four and eight weeks. The intervention consisted of ingesting calcium 500mg/day, calcium 1500mg/day and placebo. Data were analyzed according to a generalized mixed equation estimation model adopting α 0.05. Results The effect of low- and high-dose calcium on evolution over time was maintained between groups, even after adjustment for confounding factors. There was a significant difference in the parameters analyzed in the time and group interaction (p <0.000) and a decrease in the means of 12.3 mmHg in SBP, 9.2 mmHg in DBP, 3.2 mg/dl creatinine and 7.2 mg/dl proteinuria for the 500mg calcium/day group. The results were similar for the maximal supplementation group. Conclusion Calcium improved vascular prognosis in hypertensive pregnant women by reducing blood pressure levels and markers of preeclampsia. Brazilian Registry of Clinical Trials: RBR-9ngb95

Longitudinally assessed maternal sleep position, measures of breathing during sleep, and fetal growth in high-risk pregnancies.

STUDY OBJECTIVES: Subjective recall of supine sleep during pregnancy has been linked to increased risk of stillbirth, but longitudinal, objective data are lacking. We aimed to examine how sleep position and breathing parameters change throughout pregnancy, and investigated associations between maternal supine sleep, assessed objectively in early and late gestation, and fetal growth velocity in high-risk women. METHODS: Women with singleton pregnancies and body mass index (BMI) ≥27 kg/m2 underwent level-III sleep apnea testing. Sleep position was assessed by accelerometry. We derived percentiles of estimated fetal weight and birthweight using FetalGPSR software, then calculated growth velocity as change in percentile/week between the second-trimester anatomy scan and birth. RESULTS: In total, 446 women were included, with N = 126 in the longitudinal sleep pattern analysis and N = 83 in the fetal growth analysis. Sleep-onset position and predominant sleep position were significantly correlated in both early (p = 0.001) and late (p < 0.01) pregnancy. However, supine going-to-bed position predicted predominant supine sleep in only 47% of women. Between early and late pregnancy there was a reduction in predominant supine sleepers (51.6% to 30.2%). Percent of sleep spent supine and oxygen desaturation index, in the third trimester, were significantly associated after BMI adjustment (B = 0.018, p = 0.04). Models did not suggest significant effects of early or late pregnancy supine sleep on growth velocity (p > 0.05). CONCLUSIONS: Going-to-bed position predicts predominant supine sleep in less than half of women with overweight and obesity. Time spent supine throughout pregnancy correlates with measures of sleep-disordered breathing. Maternal sleep position patterns did not affect fetal growth velocity in this high-risk population, but the study was not powered to detect differences.

A survey of screening and support systems for socially high-risk pregnancies at obstetric facilities in Japan.

AIM: To clarify the state of screening and support systems for socially high-risk pregnant women at obstetric facilities across Japan and identify the characteristics of facilities related to the implementation of screening. METHODS: This cross-sectional study used a self-administered questionnaire. Participants were managers of hospitals, clinics, and midwifery birth centers handling deliveries in 47 prefectures across Japan. The questionnaire comprised items regarding the characteristics of participants and their facilities, service provision related to socially high-risk women available at the facility, the number of specified pregnant women (tokutei ninpu) per year, methods of screening, and support systems within the obstetric facilities. Descriptive statistics and multivariate logistic regression analysis were performed using IBM-SPSS version 24 for the association between facility characteristics and screening practices for socially high-risk pregnant women. RESULTS: Valid responses were received from 716 of 2512 obstetric facilities. Rates of specified expectant mothers per annual number of deliveries were identified as follows: perinatal medical centers (2.7%), general hospitals (1.6%), obstetrics and gynecology hospitals (1.0%), and clinics (0.8%). A total of 426 facilities (60.6%) reported screening all expectant mothers to identify socially high-risk pregnant women. Multiple logistic regression analysis revealed that facility characteristics and service/care provision related to screening practices included availability of in-hospital midwife-led care and in-hospital midwifery clinics (adjusted odds ratio 1.61; 95% CI [1.30, 1.47]), one-on-one care by midwife (1.73; 95% CI [1.15, 2.59]), multidisciplinary meetings within the facility (1.70; 95% CI [1.14, 2.56]), follow-up support systems after discharge (1.90; 95% CI [1.17, 3.09]), and participation in the regional council for children in need of protection (2.33; 95% CI [1.13, 4.81]). CONCLUSIONS: Approximately 60% of surveyed obstetric facilities screen for socially high-risk women. Increasing service provision at facilities may be necessary to implement screening.

Elevated first-trimester PAPP-A is a marker in high-risk pregnancies with an increased risk of placenta accreta in predicting adverse outcomes.

OBJECTIVE: Our work aims to determine whether there is an association between first-trimester serum pregnancy-associated plasma protein A (PAPP-A) multiples of the median (MoM) value and placenta previa with or without placenta accreta spectrum disorders (PAS) in women. PATIENTS AND METHODS: A retrospective analysis was performed on 267 patients who had first-trimester screening test results for aneuploidy, including nonadherent placenta previa (n=106), placenta previa with PAS (n=60), and control group (healthy pregnant women with previous cesarean section and normal placental location, n=101). To assess the significant difference between these groups, PAPP-A MoMs were compared. RESULTS: The median PAPP-A MoM of 1.96 in placenta previa with PAS was significant (>0.88) in nonadherent placenta previa and 0.89 in the control group (p<0.001). Serum PAPP-A was found to be significantly associated with the severity of bleeding, such that patients with severe bleeding of 1,500 mL or more (n=54) had a higher mean PAPP-A MoM (1.93±0.69; p<0.001). Furthermore, the mean PAPP-A MoM was found to be 1.96±0.74 in the hysterectomy group and 0.89±0.47 in the conservative management group, and the difference was found to be significantly higher (p<0.001). CONCLUSIONS: Elevated PAPP-A values in the first trimester of pregnancy may be a useful marker for identifying women at higher risk of PAS and adverse outcomes.

Investigate the relationship between the microbiota awareness in first trimester and high risk pregnancy in Turkish women: cross-sectional study.

BACKGROUND: It is suggested that pregnancy risks may be related to microbial dysbiosis, and it is known that knowledge on this subject is reflected in behaviors. The purpose of this study was to investigate whether microbiota awareness in the first trimester of pregnancy is associated with pregnancy-related risks. METHODS: Within the scope of the study, the microbiota awareness scale was administered to 426 individuals in the first trimester of pregnancy, and information on any diagnosis related to high-risk pregnancy, gestational age, birth weight, and birth height of the newborn was obtained from their file records. RESULTS: The mean total microbiota awareness score of individuals was 61.38 ± 11.00 (26.00-91.00). The microbiota awareness score (56.85 ± 11.65) was found to be lower in individuals diagnosed with high-risk pregnancy (p < 0.05) than in healthy subjects (63.64 ± 9.94). Moreover, in individuals with high-risk pregnancies, a positive correlation was found between the microbiota awareness score and newborn birth weight and height (p < 0.05). CONCLUSION: The poor microbiota awareness level in pregnant women is associated with high-risk pregnancy and neonatal growth status.

Role Of Shear Wave Elastography In Assessment Of Placental Elasticity In Normal And High-Risk Pregnancies In Third Trimester.

Objective: To assess the elasticity of placenta using shear wave elastography in normal and high-risk pregnancies in the third trimester. METHODS: The prospective, observational study was conducted at the Dow Institute of Radiology, Dow University of Health Sciences, Karachi, from September 15, 2022, to January 15, 2023, and comprised singleton pregnant women during 28-40 weeks of gestation who were referred from the obstetric department. The subjects were divided into normal pregnancy group A and high-risk pregnancy group B. Risk factors include gestational hypertension, gestational diabetes, intrauterine growth restriction, placenta previa, morbidly adherent placenta, old primigravida, teen age and morbid obesity were noted. All the patients underwent grey scale, Doppler ultrasonography and shear wave elastography. Data was analysed using SPSS 26. RESULTS: Of the 104 subjects, 78(75%) were in group A and 26(25%) were in group B. The overall mean age was 34.2±3.59 years. In group B, mean placental shear wave velocity was 2.34±1.17m/sec and elasticity was 24.41±25.51kPa compared to 1.42±0.55 m/sec and 13.6±10.23kPa in group A (p<0.05). Significant positive correlation was found between shear wave velocity and elasticity values in both groups (p<0.001). Conclusion: Shear wave elastography was found to be a useful technique in detecting placental stiffness, and can be used as an adjunct to the currently available ultrasonographic methods in high-risk pregnancies.

Psychological distress in pregnancy and postpartum: a cross-sectional study of Babol pregnancy mental health registry.

BACKGROUND: Psychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum. METHODS: A cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions. RESULTS: The prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (ß = 1.776, P < 0.001), as well as its three subscales: somatization (ß = 1.355, P = 0.019), anxiety symptoms (ß = 2.249, P < 0.001), and depressive symptoms (ß = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (ß = 1.344, P = 0.038) and the somatization subscale (ß = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (ß = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (ß = 1.998, P = 0.012) and depressive symptoms (ß = 1.949, P = 0.020). CONCLUSION: The high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits.

Prenatal assessment of high-risk pregnancies in primary and specialized outpatient care: a mixed study.

OBJECTIVES: to assess high-risk prenatal care and identify strategies for improving care. METHODS: a mixed study of a prospective cohort, with 319 mothers in a public maternity hospital, from October 2016 to August 2017, using a semi-structured instrument and interview. Analysis was performed using the chi-square test (p≤0.05). The qualitative approach was carried out through interviews with guiding questions to 13 managers, at their workplace, between January and March 2020, analyzed under social phenomenology. RESULTS: higher rates of inadequacy were identified for all criteria. However, when care was shared, there was a higher rate for performing tests (p=0.023), consultations (p=0.002), risk stratification (p=0.013) and emergency information (≤0.000). Weaknesses in the record evidenced impairment in communication and continuity of care. FINAL CONSIDERATIONS: shared care is a strategy for improving care, however there is a need to strengthen effective referral and counter-referral to care continuity.

Social representations of pregnant women about high-risk pregnancy: repercussions for prenatal care.

OBJECTIVE: To analyze the Social Representations of pregnant women about high-risk pregnancy and its repercussions for prenatal care. METHOD: Qualitative study, based on the procedural aspect of the Theory of Social Representations, carried out with 62 high-risk prenatal pregnant women at a High Complexity Maternity, in Belém, PA, Brazil. Data from semi-structured interviews were processed by the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires. RESULTS: Four categories emerged, in which three dimensions of the Theory composing the genesis of Social Representations are considered: the affective dimension, the biological dimension and the sociocultural dimension. CONCLUSION: Affects, negative feelings, and adaptations were revealed, with high-risk pregnancy being represented as an unusual and uncomfortable event, influenced by common sense and science, communication means, and dialogues with health professionals, with family support being considered of paramount importance. and prenatal care a propitious moment for establishing bonds with the health professional, seen as essential for their adherence to the care offered.

Overcoming challenges in managing a high-risk pregnancy with placenta previa and newly diagnosed Bombay phenotype.

BACKGROUND: Bombay phenotype is rare and characterized by a lack of H antigen on the surface of red blood cells (RBCs) with naturally occurring anti-H antibodies. The presence of anti-H necessitates the exclusive use of Bombay phenotype RBCs for transfusion. We present a case of a pregnant woman with Bombay phenotype who required urgent cesarean section delivery due to high-risk placenta previa. CASE DESCRIPTION: A 36-year-old G1P0 woman of Indian origin presented at 36 weeks and 4 days gestation for management of a high-risk pregnancy with complete placenta previa. Bombay phenotype was unexpectedly identified on routine testing. Given the rarity of the blood, advanced gestation, and risk of post-partum hemorrhage associated with complete placenta previa and spontaneous labor, prompt strategic planning commenced for a successful delivery. Two frozen allogeneic Bombay phenotype RBCs were available as part of a concise transfusion plan. Intraoperative cell salvage was successfully employed and allogeneic transfusion was not required. CONCLUSION: Management of patients with rare blood types can be extremely challenging and guidance for those presenting later in pregnancy is scarce. Our patient's gestational age precluded the use of well-known effective strategies, including hemoglobin optimization, autologous and directed donation, and procurement of large quantities of rare blood. Rather, our approach utilized multidisciplinary expertise and strategic planning to yield a successful outcome.

(Non-)disclosure of lifetime sexual violence in maternity care: Disclosure rate, associated characteristics and reasons for non-disclosure.

BACKGROUND: In maternity care, disclosure of a past sexual violence (SV) experience can be helpful to clients to discuss specific intimate care needs. Little evidence is available about the disclosure rates of SV within maternity care and reasons for non-disclosure. AIM: The aim of this study was to examine (1) the disclosure rate of SV in maternity care, (2) characteristics associated with disclosure of SV and (3) reasons for non-disclosure. METHODS: We conducted a descriptive mixed method study in the Netherlands. Data was collected through a cross-sectional online questionnaire with both multiple choice and open-ended items. We performed binary logistic regression analysis for quantitative data and a reflexive thematic analysis for qualitative data. RESULTS: In our sample of 1,120 respondents who reported SV, 51.9% had disclosed this to a maternity care provider. Respondents were less likely to disclose when they received obstetrician-led care for high-risk pregnancy (vs midwife-led care for low-risk pregnancy) and when they had a Surinamese or Antillean ethnic background (vs ethnic Dutch background). Reasons for non-disclosure of SV were captured in three themes: 'My SV narrative has its place outside of my pregnancy', 'I will keep my SV narrative safe inside myself', and 'my caregiver needs to create the right environment for my SV narrative to be told'. CONCLUSIONS: The high level of SV disclosure is likely due to the Dutch universal screening policy. However, some respondents did not disclose because of unsafe care conditions such as the presence of a third person and concerns about confidentiality. We also found that many respondents made a positive autonomous choice for non-disclosure of SV. Disclosure should therefore not be a goal in itself, but caregivers should facilitate an inviting environment where clients feel safe to disclose an SV experience if they feel it is relevant for them.