Obstetrics and Gynecology International最新文献

{"title":"Risk of Uterine Rupture with Vaginal Birth after Cesarean in Twin Gestations.","authors":"Kimya Baradaran","doi":"10.1155/2021/6693142","DOIUrl":"10.1155/2021/6693142","url":null,"abstract":"<p><strong>Background: </strong>Women with a previous cesarean delivery may attempt a subsequent vaginal birth or repeat cesarean. Vaginal birth after cesarean carries a greater risk of uterine rupture, defined as the disruption of all uterine layers, resulting in maternal-fetal morbidity or mortality. It is unclear how the risk of uterine rupture compares in patients with twin gestations who undergo different delivery methods.</p><p><strong>Objective: </strong>The purpose of this systematic review is to determine if there is an increased risk of uterine rupture in patients with twin gestations attempting vaginal birth after cesarean (VBAC) versus planned repeat cesarean delivery (PRCD). <i>Study Design</i>. PubMed, Cochrane Library, and CINAHL were searched systematically. Eligible studies were prospective and retrospective studies that evaluated the incidence of uterine rupture in twin pregnancies that attempted VBAC or PRCD. Data were manually extracted from these studies, and the number of events in each group was used to calculate an odds ratio (OR) and 95% confidence interval (CI).</p><p><strong>Results: </strong>4 retrospective studies were included with a total of 7699 participants, 2305 of whom attempted VBAC and 5394 underwent PRCD. The absolute risk of uterine rupture in the VBAC and PRCD groups was 0.87% and 0.09%, respectively. The rate of uterine rupture was significantly higher in the VBAC group than in the PRCD group (OR: 9.43; CI: 3.54-25.17).</p><p><strong>Conclusion: </strong>Although VBAC is associated with higher rates of uterine rupture in twin pregnancies when compared with PRCD, the absolute risk of uterine rupture is low in both groups. Depending on individual risk factors, vaginal birth may be offered as a safe option to women with twin pregnancies and a history of cesarean delivery.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38818288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessments of Birth Outcome of Twin Delivery and Associated Factors among Newborns in Dessie Referral Hospital, Dessie, Ethiopia, 2019.","authors":"Nigusie Abebaw,&nbsp;Mohammed Abdu,&nbsp;Natnael Girma","doi":"10.1155/2021/2421843","DOIUrl":"https://doi.org/10.1155/2021/2421843","url":null,"abstract":"<p><strong>Background: </strong>There was a fast improvement of twin's birth outcomes in the past decade, but it was average in developing countries. Stillbirth, preterm birth, low birth weight, and birth asphyxia are the major contributors to poor twin birth outcomes. This study was crucial to address the gaps and clarify the outcome of twin delivery.</p><p><strong>Objectives: </strong>To assess the birth outcome of twin delivery and associated factors among newborns who were delivered in Dessie Referral Hospital, Ethiopia, 2019.</p><p><strong>Methods: </strong>Institutional-based retrospective cross-sectional study was employed among 385 maternal records from Nov 10/2013 to Dec 10/2019. Data were selected by using a random sampling technique. Frequencies, proportion, and summary statics were used to describe the study population. The data were entered into Epi Info and exported in the SPSS version 20 for analysis. All variables with <i>p</i> value < 0.20 in bivariable logistic regression analysis were considered for multivariable logistic regression analysis; adjusted odds ratio with 95% confidence interval was used to measure the association variable with <i>p</i> value < 0.05 which was statistically significant.</p><p><strong>Results: </strong>This finding showed that the prevalence of twin birth outcome accounts 23.4% (95 % CI, 19.2-27.5). Low birth weight 9.1%, stillbirth 4.2%, Apgar score < 7 9.1%, and neonatal death 1 % were accounted. Hypertension disorder (95% CI, 6.01(2.43-14.87)), rural residence (95% CI 2.46(1.39-4.37)), PROM (95% CI 6.39(2.52-16.16)), and no ANC follow-up (95% CI, 13.47(2.49-72.85)) were significantly associated with adverse twin birth. <i>Conclusions and Recommendations.</i> Magnitude of twins' adverse birth outcome was 23.4%. Hypertension disorder, rural residence, PROM, and no ANC follow-up were significant variables for twins' adverse birth outcome. Therefore, all healthcare providers should give sustainable educations and instructions about the importance of sticking with the recommended ANC follow-up.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25558290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Menstrual Pattern and Characteristics of One-Rod and Two-Rod Levonorgestrel Implant Users.","authors":"Eka Rusdianto Gunardi,&nbsp;Sulaeman Andrianto Susilo","doi":"10.1155/2021/2904542","DOIUrl":"https://doi.org/10.1155/2021/2904542","url":null,"abstract":"<p><strong>Introduction: </strong>The maternal mortality ratio (MMR) in Indonesia reaches 359 per 100,000 live births. The long-acting reversible contraceptive (LARC) method is an effective contraceptive choice for reducing MMR. The contraceptive implant is one of the LARCs that has low usage due to lack of education about the side effects. This study aims to compare the menstrual pattern and characteristics between one-rod and two-rod levonorgestrel implant users.</p><p><strong>Methods: </strong>A prospective cohort study was performed in patients at Cipto Mangunkusumo Hospital (RSCM) from March 2016 to May 2018. Subject recruitment was done by consecutive sampling. This study was conducted from March 2016 until May 2019. Statistical analysis was performed on the data using the chi-square test to determine the relationship between menstrual pattern and characteristics, and the use of one-rod or two-rod levonorgestrel implants.</p><p><strong>Results: </strong>A total of 140 subjects participated in the study, comprising 70 (50%) one-rod users and 70 (50%) two-rod users. In the first month, 32.9% one-rod users experienced amenorrhea, 22.9% experienced shortened menstrual period, 30% experienced normal menstrual period, and 14,2 % experienced lengthened menstrual period. In comparison, in the first month, 41.4% two-rod users experienced amenorrhea, 15.7% experienced shortened menstrual period, 32.9% experienced normal menstrual period, and 10% experienced lengthened menstrual period. There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users.</p><p><strong>Conclusion: </strong>There was no significant difference in menstrual patterns and characteristics between one-rod and two-rod levonorgestrel implant users. <i>Implications</i>. Menstrual patterns and characteristics from levonorgestrel implants user can help clinicians to reduce discontinuation rate from the acceptors. Further research should be conducted to know other side effects aside from menstrual bleeding patterns.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7972863/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25525009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of Postpartum Intrauterine Contraceptive Device Uptake among Women Delivering in Public Hospitals of South Gondar Zone, Northwest Ethiopia, 2019: An Unmatched Case-Control Study.","authors":"Mandefro Assefaw,&nbsp;Getnet Azanew,&nbsp;Ayenew Engida,&nbsp;Zenebe Tefera,&nbsp;Wondimnew Gashaw","doi":"10.1155/2021/1757401","DOIUrl":"https://doi.org/10.1155/2021/1757401","url":null,"abstract":"<p><strong>Introduction: </strong>Integrated use of postpartum intrauterine contraceptive devices with delivery service during the immediate postpartum period is ideal for both women and health-care providers. However, utilization of intrauterine contraceptive devices during the postpartum period was rare and in Ethiopia, with information regarding uptake of postpartum intrauterine contraceptive devices limited.</p><p><strong>Objective: </strong>Identify determinants of postpartum intrauterine contraceptive devices uptake among women delivering in public hospitals of South Gondar zone, Northwest Ethiopia, 2019.</p><p><strong>Methods: </strong>An unmatched case-control study was conducted in public hospitals of South Gondar, Ethiopia, from August 1, 2019, to November 10, 2019. A total of 140 cases and 280 controls have actively participated in the study. Five hospitals were selected by simple random sampling. Cases were selected consecutively, whereas two controls for each case were recruited by the lottery method. Pretested questionnaires were used to collect data and it was entered into Epidata version 4.4.2. Logistic regression analysis was used to identify variables associated with the use of outcome and adjusted odds ratio with a 95% confidence interval was used to determine the association between independent and outcome variables.</p><p><strong>Results: </strong>Completing secondary education (AOR = 4.5, 95%CI 2.3-8.85), having a total number of children of 3-4 (AOR = 3.6, 95%CI 1.25-10.2), having  ≥ 5 (AOR = 4.7, 95%CI 1.5-15.3), attending 3 antenatal care (AOR = 2.8, 95%CI 1.44-5.6), ever hearing about postpartum IUCD (AOR = 6.6, 95%CI 2.7-16.1), and having counseling from health-care provider about a postpartum intrauterine contraceptive device (AOR = 6.2, 95%CI 2.99-12.8) were significantly associated with uptake of the postpartum intrauterine contraceptive. <i>Conclusion and Recommendation.</i> Completing secondary education, having 3-4 and ≥5 children, attending three antenatal care, ever hearing about postpartum IUCD, and having counseling from health-care providers about the postpartum intrauterine contraceptive device among women were significantly associated with uptake of an intrauterine contraceptive device after birth. Therefore, it is better to advise women to strictly follow their antenatal care, access to information, and provide counseling.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25467857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Peripartum Hysterectomy in a Tertiary Care Unit and Its Effect on Patients' Long-Term Physical and Mental Wellbeing: Quest Is Not Over When You Save the Life.","authors":"P D M Pathiraja, Asanka Jayawardane","doi":"10.1155/2021/5720264","DOIUrl":"10.1155/2021/5720264","url":null,"abstract":"<p><strong>Objectives: </strong>Peripartum hysterectomy can be performed as an elective procedure or as a life-saving emergency procedure in obstetrics. It is associated with significant maternal morbidity and mortality. We report peripartum hysterectomies done during the study period in a tertiary referral centre, Colombo, Sri Lanka. <i>Methodology</i>. We collected data on all severe acute maternal morbidity and mortality events (SAMM) from June 01, 2014, to June 01, 2015, at De Soysa Hospital for Women (DSHW). We invited all women who underwent PPH to complete the 36-Item Short Form Health Survey questionnaire (SF-36) before hospital discharge and at six months after the hysterectomy date to assess their general and mental health before and after surgery. Focus group discussions (FGD) were used to further evaluate the patient experience and to identify service delivery improvements.</p><p><strong>Results: </strong>There were eleven peripartum hysterectomies done during the study period for 7160 deliveries. None were primigravida. Median age and gestation were 36 years and 37 weeks, respectively. The commonest indication for peripartum hysterectomy was a morbidly adherent placenta (seven). Nine of the deliveries were elective lower-segment caesarean section and two were vaginal deliveries. Four emergency peripartum hysterectomies were done for primary postpartum haemorrhage (PPH) and two for secondary PPH. All patients required intensive care and there were no maternal deaths. The analysis of SF-36 data revealed that all patients suffered a significant reduction in the quality of life at six months after the surgery. FGD highlighted that most patients needed further counselling and support to improve their physical, psychological, and social wellbeing. Some of the patients were willing to share their experience on voluntary basis to help those undergoing peripartum hysterectomies in the future.</p><p><strong>Conclusion: </strong>Peripartum hysterectomy is an important life-saving procedure associated with severe maternal morbidity and mortality. This study reveals that the physical, psychological, and social adverse effects would remain in the long term.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25444992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and Perinatal Outcome of Maternal Obesity at RSCM in 2014-2019.","authors":"Junita Indarti,&nbsp;Sulaeman Andrianto Susilo,&nbsp;Purnomo Hyawicaksono,&nbsp;Jimmy Sakti Nanda Berguna,&nbsp;Galuh Anindya Tyagitha,&nbsp;Muhammad Ikhsan","doi":"10.1155/2021/6039565","DOIUrl":"https://doi.org/10.1155/2021/6039565","url":null,"abstract":"<p><p>Obesity is a pandemic found in many countries. It is estimated that, in 2025, more than 21% of women in the world will suffer from obesity and its number keeps increasing yearly. Obesity in pregnancy is one of the important challenges in obstetric services given the prevalence and potential adverse effects on the mother and fetus. Obese women have a higher risk of developing gestational diabetes, gestational hypertension, preeclampsia, venous thromboembolism, postpartum hemorrhage, cesarean delivery, and maternal death. The aim of this research is to determine the prevalence of maternal and perinatal complication in various obesity grades. This research was an observational descriptive study using the cross-sectional design. The inclusion criterion is obese pregnant women whose delivery was done in Dr. Cipto Mangunkusumo National General Hospital (RSCM) from 2014 to 2019. The exclusion criterion in this study is the incomplete medical record. A total of 111 subjects were included in the study. Obesity grades in this study were based on World Health Organization (WHO) obesity, divided into 3 classifications which are obese I (30-34.9 kg/m²), obese II (35-39.9 kg/m²), and obese III (≥40 kg/m²). Maternal outcomes in this study were birth method, gestational diabetes, preeclampsia, and premature rupture of membrane (PROM). Perinatal outcomes in this study were preterm birth, birth weight, APGAR score, and postdelivery neonatal care. In this study, obese patients had a mean age of 31.23 years, mean gravida 2, parity 1, and abortion 0. Most of these patients used an intrauterine device (IUD) for family planning (74.8%). There were no differences in age, parity status, and family planning methods in each group of patients with different body mass index (<i>p</i> > 0.05). Maternal characteristics are the majority of deliveries performed cesarean delivery (86.5%), cases of diabetes mellitus are more common in obese I patients (50%), preeclampsia is more prevalent in obese grade II patients (34,4%), and premature rupture of membranes (PROM) is more common in patients with obese II (52,4%). However, there was no difference in the prevalence of maternal outcomes between groups. There was a median gestational age of 37 weeks in all obesity grades, the highest percentage of preterm births owned by obese II patients (32,6%), the mean birth weight of babies tends to increase along with the weighting of the body mass index group, and neonatal intensive care unit (NICU) treatment rooms were mostly occupied from mother with obese II groups (18%). There was no difference in the first-minute and fifth-minute APGAR scores between study groups (<i>p</i> > 0.05). There were no differences in perinatal outcomes between groups. There were no significant differences in maternal and perinatal outcomes prevalence between different obesity grades. However, the rate of maternal and perinatal complications in obese women is higher than the","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25408429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Integrated Emergency Surgical Officers at Mizan-Tepi University Teaching Hospital, Mizan-Aman, Ethiopia: A Retrospective Cohort Study.","authors":"Margo S Harrison,&nbsp;Ephrem Kirub,&nbsp;Tewodros Liyew,&nbsp;Biruk Teshome,&nbsp;Andrea Jimenez-Zambrano,&nbsp;Margaret Muldrow,&nbsp;Teklemariam Yarinbab","doi":"10.1155/2021/8875560","DOIUrl":"https://doi.org/10.1155/2021/8875560","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical physician extenders are used in Ethiopia and sub-Saharan Africa where there is a lack of surgical providers.</p><p><strong>Methods: </strong>We tested characteristics associated with and outcomes of births attended by an integrated emergency surgical officers (IESOs) as compared to midwives and physician providers.</p><p><strong>Results: </strong>Of 1,000 women in our convenience sample, data on birth attendant was missing on 5 women (0.5%). Of the remaining women, almost three-fourths (73.6%, <i>n</i> = 732) of women were attended by a midwife, almost a quarter were attended by an IESO (24.4%, <i>n</i> = 243), 10 women were attended by a physician with a General Practitioner level of training (1.0%), 5 women were delivered by an Ob/Gyn resident (0.5%), and 5 women were attended by an Ob/Gyn (0.5%). Women had a higher likelihood of being attended by an IESO than a midwife if they underwent forceps-assisted (RR 88.4, <i>p</i> < 0.05), vacuum-assisted (RR 45.2, <i>p</i> < 0.05), or cesarean birth (RR 161.8, <i>p</i> < 0.05) as compared to an unassisted vaginal birth. IESOs are performing more operative vaginal and cesarean births than other delivery providers. Outcomes of their deliveries are worse than those of midwives, but this is likely due to the acuity level of the patients and not the provider type.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38774952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exclusive Breastfeeding and Normative Belief among Rural Mothers in Ethiopia, 2019: A Cross-Sectional Survey Embedded with Qualitative Design.","authors":"Wolde Melese Ayele","doi":"10.1155/2021/5587790","DOIUrl":"https://doi.org/10.1155/2021/5587790","url":null,"abstract":"<p><strong>Background: </strong>Exclusive breastfeeding has an irrepressible benefit to a child. However, the practice is still low with salient factors in Ethiopia. Therefore, this study aimed to assess exclusive breastfeeding practice and normative beliefs among mothers who have children less than two years of age in Ethiopia, 2019.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted with a sample size of 423 in Ethiopia from March 12 to December 18, 2019. An interviewer-administered questionnaire was used to collect the data. Gender-matched six Focus Group Discussions were conducted. Semistructured guiding questions were used to carry out the discussion. The binary logistic regression model was used to determine the association between dependent and independent variables of the quantitative part.</p><p><strong>Results: </strong>The prevalence of exclusive breastfeeding practice was 77.5% (95% CI: 73.5, 81.5%). Married mothers (AOR = 2.57; 95% CI: 1.68, 5.65), mothers with antenatal care follow-up (AOR = 4.11; 95% CI: 2.66, 11.17), mothers who delivered at a health institution (AOR = 4.07; 95% CI: 2.99, 10.72), and mothers counseled during antenatal care (AOR = 1.96; 95% CI: 1.12, 4.73) had a positive association, whereas mothers who were unable to read and write (AOR = 0.11; 95% CI: 0.06, 0.99) and employed mothers (AOR = 0.22; 95% CI: 0.16, 0.56) were the variables that had a negative association with exclusive breastfeeding practice.</p><p><strong>Conclusions: </strong>Although the prevalence of exclusive breastfeeding was good when compared with other studies, rigorous interventions are needed to achieve the WHO recommendation of all infants should exclusively be breastfed. Marital status, educational status, occupation, antenatal care service, place of birth, and counseling of mothers during ANC were factors associated with the exclusive breastfeeding practice.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7987461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10390869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Selected Fetal Adverse Pregnancy Outcomes at Advanced Maternal Age: A Retrospective Cohort Study in Debre Markos Referral Hospital, Northwest Ethiopia.","authors":"Bikila Tefera Debelo,&nbsp;Melaku Hunie Asratie,&nbsp;Abayneh Aklilu Solomon","doi":"10.1155/2020/1875683","DOIUrl":"https://doi.org/10.1155/2020/1875683","url":null,"abstract":"<p><strong>Introduction: </strong>Pregnancy at an advanced maternal age is defined as pregnancy at 35 years or older. Today, women postpone pregnancy due to different socioeconomic and personal reasons. However, there was limited evidence on fetal adverse outcomes' association with pregnancy at an advanced maternal age in Ethiopia and particularly in the study area. This study was aimed at assessing the effect of pregnancy at an advanced age on selected neonatal adverse pregnancy outcomes in Debre Markos Referral Hospital, Ethiopia, 2019.</p><p><strong>Methods: </strong>Institution-based retrospective cohort study was conducted on 303 exposed (35 years and older) and 604 nonexposed (20-34 years old) immediate postpartum women who delivered at Debre Markos Referral Hospital after 28 weeks of gestation. All exposed women who fulfilled the inclusion criteria were sampled, and systematic random sampling was employed for those in the nonexposed group. The data were collected from 1st of July to 30th of December, 2019, by face-to-face interview and extraction from maternal chart using a structured questionnaire and data extraction checklist, respectively. Binary logistic regression (bivariate and multivariable) model was fitted, and wealth index was analyzed by principal component analysis. Adjusted relative risk with respect to 95% confidence interval was employed for the strength and directions of association between advanced maternal age and selected adverse pregnancy outcomes, respectively. <i>P</i>-value of <0.05 was used to declare statistical significance.</p><p><strong>Results: </strong>The incidence of adverse neonatal outcomes including stillbirth, preterm birth, and low birth weight in the advanced maternal age group was 13.2%, 19.8%, and 16.5%, respectively. The incidence of stillbirth, preterm birth, and low birth weight in the nonexposed group was 3.1%, 8.4%, and 12.4%, respectively. The advanced maternal age group had three times the risk of stillbirth compared with the nonexposed group (ARR = 3.14 95% CI (1.30-7.00)). The advanced maternal age group had 2.66 times the risk of delivering preterm fetus (ARR = 2.66 95% CI (1.81-3.77)) compared with the younger counterparts. Low birth weight was not significantly associated with pregnancy at an advanced maternal age.</p><p><strong>Conclusion: </strong>Fetal adverse outcomes including stillbirth and preterm birth were significantly associated with pregnancy at an advanced maternal age.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2020-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7775157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39139062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Placenta Creta: A Spectrum of Lesions Associated with Shallow Placental Implantation.","authors":"Jerzy Stanek","doi":"10.1155/2020/4230451","DOIUrl":"https://doi.org/10.1155/2020/4230451","url":null,"abstract":"<p><strong>Background: </strong>On placental histology, placenta creta (PC) ranges from clinical placenta percreta through placenta increta and accreta (clinical and occult) to myometrial fibers with intervening decidua. This retrospective study aimed to investigate the clinicopathologic correlations of these lesions.</p><p><strong>Methods: </strong>A total of 169 recent consecutive cases with PC (group 1) were compared with 1661 cases without PC examined during the same period (group 2). The frequencies of 25 independent clinical and 40 placental phenotypes were statistically compared between the groups using chi-square test or analysis of variance where appropriate.</p><p><strong>Results: </strong>Group 1 placentas, as compared with group 2 placentas, were statistically significantly (<i>p</i> < 0.05) associated with caesarean sections (11.2% vs. 7.5%), antepartum hemorrhage (17.7% vs 11.6.%), gestational hypertension (11.2% vs 4.3%), preeclampsia (11.8% vs 2.6%), complicated third stage of labor (18.9% vs 6.4%), villous infarction (14.2% vs 8.9%), chronic hypoxic patterns of placental injury, particularly the uterine pattern (14.8%, vs 9.6%), massive perivillous fibrin deposition (9.5% vs 5.3%), chorionic disc chorionic microcysts (21.9% vs 15.9%), clusters of maternal floor multinucleate trophoblasts (27.8% vs 21.2%), excessive trophoblasts of chorionic disc (24.3% vs 17.3%), segmental fetal vascular malperfusion (27.8% vs 19.9%), and fetal vascular ectasia (26.2% vs 15.2%).</p><p><strong>Conclusion: </strong>Because of the association of PC with gestational hypertensive diseases, acute and chronic placental hypoxic lesions, increased extravillous trophoblasts in the chorionic disc, chorionic microcysts, and maternal floor trophoblastic giant cells, PC should be regarded as a lesion of abnormal placental implantation and abnormal trophoblast invasion rather than decidual deficiency only.</p>","PeriodicalId":19439,"journal":{"name":"Obstetrics and Gynecology International","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2020-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2020/4230451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38694591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}