AJOG global reports最新文献

{"title":"Using machine learning to predict the risk of developing hypertensive disorders of pregnancy using a contemporary nulliparous cohort","authors":"Jonathan S. Schor PhD ,&nbsp;Adesh Kadambi BEng ,&nbsp;Isabel Fulcher PhD ,&nbsp;Kartik K. Venkatesh MD, PhD ,&nbsp;Mark A. Clapp MD, MPH ,&nbsp;Senan Ebrahim MD, PhD ,&nbsp;Ali Ebrahim PhD ,&nbsp;Timothy Wen MD, MPH","doi":"10.1016/j.xagr.2024.100386","DOIUrl":"10.1016/j.xagr.2024.100386","url":null,"abstract":"<div><h3>Background</h3><div>Hypertensive disorders of pregnancy (HDP) are significant drivers of maternal and neonatal morbidity and mortality. Current management strategies include early identification and initiation of risk mitigating interventions facilitated by a rules-based checklist. Advanced analytic techniques, such as machine learning, can potentially offer improved and refined predictive capabilities.</div></div><div><h3>Objective</h3><div>To develop and internally validate a machine learning prediction model for hypertensive disorders of pregnancy (HDP) when initiating prenatal care.</div></div><div><h3>Study Design</h3><div>We developed a prediction model using data from the prospective multisite cohort Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) among low-risk individuals without a prior history of aspirin utilization for preeclampsia prevention. The primary outcome was the development of HDP. Random forest modeling was utilized to develop predictive models. Recursive feature elimination (RFE) was employed to create a reduced model for each outcome. Area under the curve (AUC), 95% confidence intervals (CI), and calibration curves were utilized to assess discrimination and accuracy. Sensitivity analyses were conducted to compare the sensitivity and specificity of the reduced model compared to existing risk factor-based algorithms.</div></div><div><h3>Results</h3><div>Of 9,124 assessed low risk nulliparous individuals, 21% (n=1,927) developed HDP. The prediction model for HDP had satisfactory discrimination with an AUC of 0.73 (95% CI: 0.70, 0.75). After RFE, a parsimonious reduced model with 30 features was created with an AUC of 0.71 (95% CI: 0.68, 0.74). Variables included in the model after RFE included body mass index at the first study visit, pre-pregnancy weight, first trimester complete blood count results, and maximum systolic blood pressure at the first visit. Calibration curves for all models revealed relatively stable agreement between predicted and observed probabilities. Sensitivity analysis noted superior sensitivity (AUC 0.80 vs 0.65) and specificity (0.65 vs 0.53) of the model compared to traditional risk factor-based algorithms.</div></div><div><h3>Conclusion</h3><div>In cohort of low-risk nulliparous pregnant individuals, a prediction model may accurately predict HDP diagnosis at the time of initiating prenatal care and aid employment of close interval monitoring and prophylactic measures earlier in pregnancy.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100386"},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000807/pdfft?md5=1d72d5b9a6a289e9fc9dc49b95536460&pid=1-s2.0-S2666577824000807-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314470","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":"Preferences for induction of labor methods in India: a qualitative study of views and experiences of women, clinicians, and researchers","authors":"Lydia A. Hawker MBChB ,&nbsp;Shuchita Mundle MD ,&nbsp;Jaya P. Tripathy MD ,&nbsp;Pradeep Deshmukh MD ,&nbsp;Beverly Winikoff MD ,&nbsp;Andrew D. Weeks MD ,&nbsp;Carol Kingdon PhD ,&nbsp;Kate Lightly PhD","doi":"10.1016/j.xagr.2024.100389","DOIUrl":"10.1016/j.xagr.2024.100389","url":null,"abstract":"<div><h3>Background</h3><p>Induction of labor (IOL) is an increasingly common intervention, but experiences and preferences of induction methods are under-researched particularly in low -and middle-income countries. Understanding these perspectives is important to improve the childbirth experience.</p></div><div><h3>Objective</h3><p>To explore the experiences and preferences of IOL methods for women, clinicians, and researchers in the “Misoprostol or Oxytocin for Labour Induction” (MOLI) study.</p></div><div><h3>Study Design</h3><p>This qualitative study was based in two government hospitals in the city of Nagpur, India—one tertiary referral hospital and one women's hospital. Fifty-three semi-structured interviews with women before and after induction (between days 1 and 5 postnatal), with women recruited to the “Misoprostol or Oxytocin for Labour Induction (MOLI)” randomized controlled trial (NCT03749902). Eight focus group discussions with doctors, nurses, and trial research assistants before and during trial delivery were conducted. Thematic analysis was conducted using the Framework approach.</p></div><div><h3>Results</h3><p>Four themes emerged: (1) <em>IOL methods,</em> (2) <em>impact of the study,</em> (3) <em>IOL and childbirth as one small part of the wider experiences in life</em>, and (4) <em>key moments in the childbirth experience.</em> For women, the safety of their baby was more important than any IOL method. Clinicians had apprehensions over misoprostol use which could affect protocol implementation; they reported that changing perception is difficult as usual practice feels “comfortable.” Women wanted to share their experiences and reported key moments during childbirth including vaginal examinations, “trying for normal,” bearing the pain, waiting, and relationships with staff.</p></div><div><h3>Conclusion</h3><p>Women did not have a strong preference for the IOL method and viewed childbirth positively when maternal and neonatal outcomes were good. Labor pain, vaginal examinations, a normal birth, and interactions with staff impacted women's experiences.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100389"},"PeriodicalIF":0.0,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000832/pdfft?md5=e76f967d42d729e7b9d67da589f19285&pid=1-s2.0-S2666577824000832-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164565","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":"A new classification method for gestational diabetes mellitus: a study on the relationship between abnormal blood glucose values at different time points in oral glucose tolerance test and adverse maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus","authors":"Yongqing Zhang MD ,&nbsp;Luping Chen MD ,&nbsp;Yinluan Ouyang MD ,&nbsp;Xiaoyan Wang MD ,&nbsp;Tiantian Fu MD ,&nbsp;Guohui Yan MD ,&nbsp;Zhaoxia Liang MD, PhD ,&nbsp;Danqing Chen MD, PhD","doi":"10.1016/j.xagr.2024.100390","DOIUrl":"10.1016/j.xagr.2024.100390","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;p&gt;Gestational diabetes mellitus (GDM) can lead to various adverse pregnancy outcomes for both mothers and infants, including gestational hypertension, premature rupture of membranes, preterm birth, macrosomia, large for gestational age (LGA) infants, and neonatal hypoglycemia. Previous studies have mainly focused on the overall risk of GDM for adverse maternal and neonatal outcomes, but there has been limited research specifically investigating the relationship between different patterns of abnormal oral glucose tolerance test (OGTT) results and adverse maternal and neonatal outcomes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;p&gt;The study aimed to analyze the maternal and neonatal outcomes among GDM women with different OGTT patterns and to explore a new classification method capable of stratifying GDM into high-risk (GDM-HR) and low-risk subtypes based on OGTT results.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design&lt;/h3&gt;&lt;p&gt;We conducted a retrospective cohort study at the Women's Hospital, School of Medicine, Zhejiang University, spanning from November 1, 2015, to April 30, 2018. During the study period, a total of 3268 cases of GDM were enrolled. Based on the results of the OGTT, these GDM cases were classified into 7 subtypes, and the composition ratio of each subtype and their maternal and neonatal outcomes were analyzed. Innovatively, we proposed to categorize GDM-HR (characterized by elevated fasting blood glucose [FBG] levels, including T0, T0+1, T0+2, and T0+1+2) and low-risk GDM (GDM-LR, without elevated FBG, including T1, T2, and T1+2) and compared the maternal and neonatal outcomes between the two subtypes.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;p&gt;(1) In this cohort of 3268 GDM cases, the composition ratios of the 7 GDM subtypes were as follows: T0 (7.9%, &lt;em&gt;n&lt;/em&gt;=260), T1 (24.2%, &lt;em&gt;n&lt;/em&gt;=791), T2 (27.4%, &lt;em&gt;n&lt;/em&gt;=897), T0+1 (5.4%, &lt;em&gt;n&lt;/em&gt;=175), T0+2 (1.7%, &lt;em&gt;n&lt;/em&gt;=56), T1+2 (26.2%, &lt;em&gt;n&lt;/em&gt;=855), and T0+1+2 (7.2%, &lt;em&gt;n&lt;/em&gt;=234). (2) GDM subtypes with elevated FBG levels (GDM-HR) exhibit more severe adverse prognostic outcomes compared to those without elevated FBG levels (GDM-LR). (3) Multiple logistic regression analysis revealed that compared to the GDM-LR group, the GDM-HR group showed increased fetal birth weight (by approximately 150 grams), and had higher rates of cesarean section (adjusted odds ratio [aOR]: 1.45, 95% confidence interval [CI]: 1.19–1.76), hypertensive disorders of pregnancy (aOR: 1.78, 95% CI: 1.35–2.35), preterm birth (aOR: 1.59, 95% CI: 1.17–2.16), macrosomia (aOR: 2.66, 95% CI: 2.07–3.43), LGA infants (aOR: 2.46, 95% CI: 2.05–2.97), and neonatal hypoglycemia (aOR: 2.00, 95% CI: 1.37–2.91). Partial correlation analysis shows a positive correlation between fetal birth weight and FBG levels, with &lt;em&gt;r&lt;/em&gt;=0.222, &lt;em&gt;P&lt;/em&gt;&lt;.001. Multiple linear regression indicates that for every 1 mmol/L increase in FBG, the fetal weight is estimated to increase by approximately 188 grams.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusio","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100390"},"PeriodicalIF":0.0,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000844/pdfft?md5=1025a5f3dc6b0bf91c2ed312380a72b7&pid=1-s2.0-S2666577824000844-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164564","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":"Trends in sensor-based health metrics during and after pregnancy: descriptive data from the apple women's health study","authors":"Anshuman Mishra PhD ,&nbsp;Jihyun Park PhD ,&nbsp;Ian Shapiro PhD ,&nbsp;Tyler Fisher-Colbrie MBA ,&nbsp;Donna D. Baird PhD ,&nbsp;Sanaa Suharwardy MD ,&nbsp;Shunan Zhang PhD ,&nbsp;Anne Marie Z. Jukic PhD ,&nbsp;Christine L. Curry MD, PhD","doi":"10.1016/j.xagr.2024.100388","DOIUrl":"10.1016/j.xagr.2024.100388","url":null,"abstract":"<div><h3>Background</h3><p>While it is known that vital signs and behaviors change during pregnancy, there is limited data on timing and scale of changes for sensor-derived health metrics across pregnancy and postpartum. Wearable technology provides an opportunity to understand physiologic and behavioral changes across pregnancy with greater detail, more frequent measurements, and improved accuracy. The aim of this study is to describe changes in physiologic and behavioral sensor-based health metrics during pregnancy and postpartum in the Apple Women's Health Study (AWHS) and their relationship to demographic factors.</p></div><div><h3>Methods</h3><p>The Apple Women's Health Study is a digital, longitudinal, observational study that includes U.S. residents with an iPhone and Apple Watch. We evaluated changes from pre-pregnancy through delivery and postpartum for sensor-derived health metrics. Minimum required data samples per day, week and overall were data element specific, and included 12 weeks prior to pregnancy start, and 12 weeks postpartum for pregnancies lasting between 24 and 43 weeks.</p></div><div><h3>Findings</h3><p>A total of 757 pregnancies from 733 participants were included. Resting heart rate (RHR) increased across pregnancy, peaking in the third trimester (pre-pregnancy median RHR 65.0 beats per minute [BPM], interquartile range [IQR] 60.0–70.2 B.M. third trimester median RHR 75.5 B.M. IQR 69.0–82.0 B.M., with a decrease prior to delivery and nadir postpartum (postpartum median RHR 62.0 B.M. IQR 57.0–66.0 B.M.. Heart rate variability (HRV) decreased from pre-pregnancy (39.9 milliseconds, IQR 32.6–48.3 milliseconds), reaching a nadir in the third trimester (29.9 milliseconds, IQR 25.2–36.4 milliseconds), before rebounding in the last weeks of pregnancy. Measures of activity, such as exercise minutes, stand minutes, step count and Cardio Fitness were all decreased in each trimester compared to pre-pregnancy, with their nadirs postpartum. Total sleep duration increased slightly in early pregnancy (pre-pregnancy 7.2 hours, IQR 6.7–7.7 hours; 1st trimester 7.4 hours, IQR 6.8–7.9 hours), with the lowest sleep duration postpartum (6.2 hours, IQR 5.4–6.8 hours).</p></div><div><h3>Interpretation</h3><p>Resting heart rate increased during pregnancy, with a decrease prior to delivery, while heart rate variability decreased across pregnancy, with an upward trend before delivery. Behavioral metrics, such as exercise and sleep, showed decreasing trends during and after pregnancy. These data provide a foundation for understanding normal pregnancy physiology and can facilitate hypothesis generation related to physiology, behavior, pregnancy outcomes and disease.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100388"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000820/pdfft?md5=bb9f818bb446be97362923f386b51539&pid=1-s2.0-S2666577824000820-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142152046","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":"Efficacy of Dilapan S compared to foley balloon in preinduction cervical ripening—a noninferiority trial","authors":"Krishna Priya Leela MS, MRCOG ,&nbsp;Maheswari Somasundaram MS ,&nbsp;Zinia T. Nujum PhD ,&nbsp;Latha Maheshwari Subbarayan DNB","doi":"10.1016/j.xagr.2024.100387","DOIUrl":"10.1016/j.xagr.2024.100387","url":null,"abstract":"<div><h3>Background</h3><div>The need for induction of labor is increasing in present obstetric practice. The available non-pharmacological methods for cervical ripening at term are Foley balloon and Dilapan-S. With the gaining popularity of Dilapan-S worldwide, there are very few clinical trials conducted in India to evaluate its effectiveness.</div></div><div><h3>Objective</h3><div>To compare the efficacy of Dilapan-S and Foley balloons for pre-induction cervical ripening.</div></div><div><h3>Study design</h3><div>This single-center randomized non-inferiority trial included primi- and multi-gravida women between 37 and 41 weeks of gestation and unfavourable cervix with a Bishop's score between 0 and 2. Using a random number table, patients were assigned to study Group 1 Dilapan-S and to control Group 2 Foley balloon. Dilapan-S or Foley balloon was inserted intracervically and assessed for dilation after 12 hours. Patients with unfavourable dilatation were further provided prostaglandins (PgE 1 and 2) for further augmentation of induction. Primary outcome measures included improvement in Bishop's score, and mode of delivery, followed by time to delivery from intervention, use of other augmentation methods, and maternal and neonatal outcomes.</div></div><div><h3>Results</h3><div>After screening, 296 patients with Bishop score less than 2, (148 in each group) were enrolled in the study. The number of patients who had vaginal delivery was comparable between both groups (<em>p</em>=.72), and so were the maternal outcomes. Two cases of cord prolapse occurred with Foley balloon. Group 2 showed significant improvement in Bishop's score (<em>p</em>&lt;.001), and Group 1 had a significantly higher use of augmentation with PgE1 (<em>p</em>-.01) and PgE2 (<em>p</em>&lt;.001). The number of contractions was significantly lower in Group 1 (<em>p</em>&lt;.001), and contraction intensity was higher in Group 2. There was no significant difference in cesarean delivery for failed induction of labor between the groups (<em>p</em>=.72). Based on the primary outcome measure, Dilapan-S was found to be non-inferior to the Foley balloon.</div></div><div><h3>Conclusion</h3><div>Dilapan-S is non-inferior to Foley balloon in achieving pre-induction cervical ripening in term pregnancies, and therefore Dilapan-S can be suggested as an alternative in clinical practice with minimal risks.</div></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100387"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000819/pdfft?md5=11bcf4a70769963288838286133b452d&pid=1-s2.0-S2666577824000819-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142314452","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":"Pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors at Dessie town health institutions, Ethiopia","authors":"Abdusellam Yimer MSc ,&nbsp;Seada Endris MSc ,&nbsp;Alemtsehay Wossen MSc ,&nbsp;Mengistu Abate MSc","doi":"10.1016/j.xagr.2024.100391","DOIUrl":"10.1016/j.xagr.2024.100391","url":null,"abstract":"<div><h3>BACKGROUND</h3><p>Physical exercise consists of planned, repetitive, and intentional movements that reduce the risk of pregnancy-related complications. Worldwide, there is a high rate of physical inactivity during pregnancy, including in Ethiopia, which has detrimental effects on both pregnant women and their developing fetus.</p></div><div><h3>OBJECTIVE</h3><p>This study aimed to assess pregnant women's knowledge, attitude, and practice toward physical exercise during pregnancy and its associated factors among antenatal care attendants at health institutions in Dessie, South Wollo Zone, Amhara Region, Ethiopia, in 2023.</p></div><div><h3>STUDY DESIGN</h3><p>An institutional-based cross-sectional study was conducted among 614 pregnant women receiving antenatal care between January 18, 2023, and February 25, 2023. The study participants were selected using systematic random sampling technique. Data were collected using a pretested, face-to-face interviewer-administered, and semistructured questionnaire. The data were cleaned, coded, and entered into EpiData (version 4.6; <span><span>www.epidata.dk</span><svg><path></path></svg></span>) and analyzed using SPSS (version 25; SPSS Inc, Chicago, IL). Bivariate and multivariate binary logistic regression analyses were performed to identify factors associated with knowledge, attitude, and practice toward physical exercise during pregnancy. Variables with a <em>P</em> value of &lt;.2 in the bivariate analysis were transferred to the multivariate analysis. Finally, the adjusted odds ratio and 95% confidence interval with a <em>P</em> value of &lt;.05 in the multivariate analysis were considered statistically significant.</p></div><div><h3>RESULTS</h3><p>The study found that 56.3% of participants had good knowledge, 51.5% of participants had a favorable attitude, and 32.2% of participants practiced physical exercise during pregnancy. Age, educational level, and heard about physical exercise during pregnancy were positively associated with pregnant women's knowledge and attitude. In addition, age, antenatal care follow-up, no history of abortion, ever done physical exercise before becoming pregnant, and good knowledge were positively associated with pregnant women's practice of physical exercise during pregnancy.</p></div><div><h3>CONCLUSION</h3><p>Our findings indicate that approximately half of the participants had good knowledge and a favorable attitude. However, almost one-third of the participants practiced physical exercise during their pregnancy. It is recommended that antenatal care providers advise pregnant women to strengthen their antenatal care follow-up and offer health education and counseling about the benefits of physical exercise during pregnancy.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 4","pages":"Article 100391"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000856/pdfft?md5=83cee1bac04de839c387db788ec95869&pid=1-s2.0-S2666577824000856-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142152007","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":"Pre-referral management of preeclampsia with severity features in a low-income country—characteristics and challenges in a Sub-Saharan setting: a mixed method study","authors":"Abraham Fessehaye Sium MD ,&nbsp;Abrham Getachew MPH ,&nbsp;Wondimu Gudu MD, MPH","doi":"10.1016/j.xagr.2024.100379","DOIUrl":"10.1016/j.xagr.2024.100379","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;BACKGROUND&lt;/h3&gt;&lt;p&gt;Preeclampsia continues to be a major cause of maternal and perinatal mortality and morbidity globally. Although pre-referral treatment constitutes a bigger part of the management package for preeclampsia with severity features in low-income settings, little is known regarding the characteristics and challenges of preeclampsia pre-referral and referral management in the Sub-Saharan setting.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;OBJECTIVE&lt;/h3&gt;&lt;p&gt;To determine the characteristics and challenges of pre-referral and referral management of preeclampsia with severity features.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;STUDY DESIGN&lt;/h3&gt;&lt;p&gt;We conducted a mixed method study on the pre-referral management of pregnant women complicated by preeclampsia with severity features in Ethiopia. We prospectively collected data on clinical characteristics, management outcomes, and pre-referral characteristics of pregnant women who are complicated by preeclampsia with severity features. Data were collected using a structured questionnaire. For the qualitative part of our study, we conducted 20–30 minutes of semistructured, qualitative, face-to-face, in-depth interviews with 14 health professionals. Quantitative data were analyzed using SPSS (version 23), and simple descriptive statistics were employed. We used thematic analysis on Open Code 4.03 software to analyze the qualitative data.&lt;/p&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;RESULTS&lt;/h3&gt;&lt;p&gt;A total of 261 pregnant women who had preeclampsia with severity features were included in the study, and 14 care providers were interviewed about existing challenges with pre-referral management for patients with preeclampsia with severity features. The mean systolic and diastolic blood pressures were 154.3 mm Hg and 100.3 mm Hg, respectively. The total perinatal mortality was 6.5% (17/261). Three of 261 mothers (1.1%) were complicated by intracranial hemorrhage, and other 1.1% (3/261) of other women developed pulmonary edema. Out of 261 patients, only 41 patients (15.7%) received magnesium sulfate before referral. Similarly, antihypertensive medication was given only to 35 of 261 patients (13.4%) pre-referral. Eight of 261 mothers convulsed (3.1%) during referral. Two of 261 mothers (0.8%) developed pulmonary edema when they arrived at recipient health institutions after referral. Similarly, another 2 of 261 (0.8%) women developed disseminated intravascular coagulation by the time of arrival from the referring health institution. On the basis of qualitative data analysis, 3 overarching themes were recognized: (1) challenges related to patient and family resistance, (2) Challenges related to healthcare providers’ knowledge, skill, and confidence, and (3) health system-related challenges. Low use of magnesium sulfate and antihypertensive drugs, patient misperceptions regarding reasons for referral, providers’ lack of knowledge on the pre-referral management, inadequate communication between referring and recipient health institutions, and nonexistence of uniform preeclamp","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S266657782400073X/pdfft?md5=ee0353a07d74582068d7f3d50cb21241&pid=1-s2.0-S266657782400073X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715783","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":"Revolutionizing chronic endometritis diagnosis: real-time polymerase chain reaction unveils microbial pathogens in Indian women with abnormal bleeding and reproductive challenges","authors":"Murugan Nandagopal M.Phil, Ph.D., PDF. ,&nbsp;Rajesh Rajan N M.Sc. ,&nbsp;Chirayu Padhiar MBBS., DCP. ,&nbsp;Mayur Abhaya MS. ,&nbsp;Uma Bansal MS (OG). ,&nbsp;Prakash Ghambir MD (Ped)","doi":"10.1016/j.xagr.2024.100377","DOIUrl":"10.1016/j.xagr.2024.100377","url":null,"abstract":"<div><h3>Background</h3><p>This study aimed to assess the utility of real-time-polymerase chain reaction (PCR) for diagnosing chronic endometritis (CE) by targeting 11 prevalent pathogens and to compare the outcomes with conventional culture-based diagnosis.</p></div><div><h3>Study Design</h3><p>A retrospective analysis was conducted on 500 patients with clinical conditions such as abnormal bleeding, in vitro fertilization failure, recurrent implantation failure, recurrent miscarriage, and recurrent pregnancy loss. The prevalence of 11 key pathogens associated with CE was evaluated in endometrial biopsy samples.</p></div><div><h3>Results</h3><p>In our study, PCR identified 318 cases (63.6%) positive for at least one of the 11 investigated pathogens, while culture-based methods detected 115 cases (23%). Predominant pathogens detected by PCR included <em>Enterococcus faecalis</em> (<em>E. faecalis</em>) (19%), <em>Escherichia coli</em> (<em>E. coli</em>) (6.8%), <em>Staphylococcus aureus</em> (<em>S. aureus</em>) (9%), <em>Mycoplasma hominis</em> (5%), <em>Mycoplasma genitalium</em> (6.2%), <em>Streptococcus agalactiae</em> (<em>S. agalactiae</em>) (4.2%), <em>Ureaplasma urealyticum</em> (4%), nontuberculous <em>Mycobacterium</em> (5.2%), <em>Mycobacterium tuberculosis</em> (1.2%), <em>Neisseria gonorrhoeae</em> (0.6%), and <em>Chlamydia trachomatis</em> (2.4%). Standard culture methods identified <em>E. faecalis</em> (10.8%), <em>S. aureus</em> (6.2%), <em>E. coli</em> (3.8%), and <em>S. agalactiae</em> (2.2%).</p></div><div><h3>Conclusion</h3><p>The DICE panel proves itself as a swift, precise, and cost-effective diagnostic tool for detecting both culturable and nonculturable endometrial pathogens in CE. Demonstrating superiority, the Molecular method outshines microbial culture, ensuring accurate and sensitive detection of CE-associated pathogens, harmonizing seamlessly with histology and hysteroscopy findings.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100377"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000716/pdfft?md5=2570037d6c2f5734f5463577dcf2222f&pid=1-s2.0-S2666577824000716-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141697972","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":"Analysis of episiotomy incidence and risk factors in vaginal deliveries: a single-center","authors":"Suskhan Djusad MD, PhD,&nbsp;Intan Indah Permatasari MD,&nbsp;Annisa Futihandayani MD,&nbsp;Puti Shahnaz MD,&nbsp;Daniel Hadiwinata MD,&nbsp;Hana Fathia Herianti MD","doi":"10.1016/j.xagr.2024.100371","DOIUrl":"10.1016/j.xagr.2024.100371","url":null,"abstract":"<div><h3>Introduction</h3><p>Episiotomy is a surgical procedure involving the enlargement of the posterior vagina to facilitate the delivery of the baby. This study aims to further investigate the associated risk factors for episiotomy and the specific indications for its use in spontaneous labor.</p></div><div><h3>Methodology</h3><p>This institutional-based cross-sectional study was conducted among 349 vaginal births with a ratio of 1:4 from January 2020 to December 2020. We recruited study participants using consecutive sampling techniques. The sample size was calculated with a hypothesis test for two population proportions (one-sided test formula). Adjusted odds ratio with the corresponding 95% confidence interval was used to declare the significance of variables.</p></div><div><h3>Results</h3><p>In our multivariate analysis, it was found that pregnant women who underwent instrumental delivery (<em>P</em>-value=.00; OR=25.63; 95% CI: 5.76–114.0) and those with fetal birth weight &gt;3,000 grams (<em>P</em>-value=.00; OR=11.31; 95% CI: 3.96–32.32) had the highest risk of undergoing an episiotomy. Subsequently, the duration of the second stage of labor &gt;30 minutes (<em>P</em>-value=.049; OR=16.34; 95% CI: 1.01–264.48) was associated with a slightly increased risk of episiotomy. Fetal head circumference &gt;34 cm was not found to be risk of an increased risk of episiotomy in this study. However, pregnant women aged &gt;30 years (<em>P</em>-value=.049; OR=0.306; 95% CI: 0.94–0.99) showed a reduced risk of episiotomy.</p></div><div><h3>Conclusion</h3><p>The prevalence of episiotomy practice in this study exceeds the recommended threshold set by the World Health Organization (WHO). Instrumental delivery, high birth weight, and prolonged second-stage labor emerged as significant factors influencing episiotomy practice. Hence, further interventions are warranted to mitigate the prevalence of episiotomy practice.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100371"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000650/pdfft?md5=572b25fe9f2f8de04d5874b5ecd2ba0a&pid=1-s2.0-S2666577824000650-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842845","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":"Global inequities in adverse pregnancy outcomes: what can we do?","authors":"James M. Roberts MD ,&nbsp;Seye Abimbola MBChB, PhD ,&nbsp;Tracy L. Bale PhD ,&nbsp;Aluisio Barros MD, PhD ,&nbsp;Zulfiqar A. Bhutta MBBS, PhD ,&nbsp;Joyce L. Browne MD, PhD ,&nbsp;Ann C. Celi MD, MPH ,&nbsp;Polite Dube PhD ,&nbsp;Cornelia R. Graves MD ,&nbsp;Marieke J. Hollestelle PhD ,&nbsp;Scarlett Hopkins BSN, MA ,&nbsp;Ali Khashan PhD ,&nbsp;Koiwah Koi-Larbi LLM ,&nbsp;Eve M. Lackritz MD ,&nbsp;Leslie Myatt PhD ,&nbsp;Christopher W.G. Redman MBBChir ,&nbsp;Özge Tunçalp MD, PhD ,&nbsp;Sten H. Vermund MD ,&nbsp;Michael G. Gravett MD","doi":"10.1016/j.xagr.2024.100385","DOIUrl":"10.1016/j.xagr.2024.100385","url":null,"abstract":"<div><p>The Health Equity Leadership &amp; Exchange Network states that “health equity exists when all people, regardless of race, sex, sexual orientation, disability, socioeconomic status, geographic location, or other societal constructs, have fair and just access, opportunity, and resources to achieve their highest potential for health.” It is clear from the wide discrepancies in maternal and infant mortalities, by race, ethnicity, location, and social and economic status, that health equity has not been achieved in pregnancy care. Although the most obvious evidence of inequities is in low-resource settings, inequities also exist in high-resource settings. In this presentation, based on the Global Pregnancy Collaboration Workshop, which addressed this issue, the bases for the differences in outcomes were explored. Several different settings in which inequities exist in high- and low-resource settings were reviewed. Apparent causes include social drivers of health, such as low income, inadequate housing, suboptimal access to clean water, structural racism, and growing maternal healthcare deserts globally. In addition, a question is asked whether maternal health inequities will extend to and be partially due to current research practices. Our overview of inequities provides approaches to resolve these inequities, which are relevant to low- and high-resource settings. Based on the evidence, recommendations have been provided to increase health equity in pregnancy care. Unfortunately, some of these inequities are more amenable to resolution than others. Therefore, continued attention to these inequities and innovative thinking and research to seek solutions to these inequities are encouraged.</p></div>","PeriodicalId":72141,"journal":{"name":"AJOG global reports","volume":"4 3","pages":"Article 100385"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666577824000790/pdfft?md5=789fcac4101e40c738c1fbb095b7807f&pid=1-s2.0-S2666577824000790-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848506","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}