المؤلفون: Husby, Anne Engtrø, Simpson, Melanie Rae, Dalbye, Rebecka, Larsen, Marit, Vanky, Eszter, Løvvik, Tone Shetelig

المصدر: Acta Obstetricia et Gynecologica Scandinavica; Jun2024, Vol. 103 Issue 6, p1092-1100, 9p

مصطلحات موضوعية: POLYCYSTIC ovary syndrome, CHILDBIRTH, PREMATURE labor, PREGNANCY complications, PREGNANCY outcomes, LABOR complications (Obstetrics)

مصطلحات جغرافية: ICELAND, NORWAY, SWEDEN

مستخلص: Introduction: Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences. Material and methods: This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann–Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin‐treated (n = 180) and placebo‐treated (n = 185) women with PCOS, and for different subgroups of women with PCOS. Results: There was no difference in total CEQ score between women with PCOS and reference women—Wilcoxon–Mann–Whitney (WMW)‐odds 0.96 (95% confidence interval [CI] 0.78–1.17). We detected no difference in CEQ scores between the metformin‐ and placebo‐treated women with PCOS (WMW‐odds 1.13, 95% CI 0.89–1.43). Complications in pregnancy did not affect CEQ (WMW‐odds 1, 95% CI 0.76–1.31). Higher body mass index (WMW‐odds 0.75, 95% CI 0.58–0.96), longer duration of labor (WMW‐odds 0.69, 95% CI 0.49–0.96), and cesarean section (WMW‐odds 0.29, 95% CI 0.2–0.42) were associated with lower CEQ scores in women with PCOS. Conclusions: Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience. [ABSTRACT FROM AUTHOR]

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المؤلفون: Baas, Melanie A. M., Stramrood, Claire A. I., Dijksman, Lea M., Vanhommerig, Joost W., de Jongh, Ad, van Pampus, Mariëlle G.

المصدر: Acta Obstetricia et Gynecologica Scandinavica; Nov2023, Vol. 102 Issue 11, p1575-1585, 11p

مصطلحات موضوعية: EMDR (Eye-movement desensitization & reprocessing), FEAR of childbirth, PREGNANT women, INDUCED labor (Obstetrics), RANDOMIZED controlled trials, PREMATURE labor

مصطلحات جغرافية: NETHERLANDS

مستخلص: Introduction: Pregnant women with fear of childbirth display an elevated risk of a negative delivery experience, birth‐related post‐traumatic stress disorder, and adverse perinatal outcomes such as preterm birth, low birthweight, and postpartum depression. One of the therapies used to treat fear of childbirth is eye movement desensitization and reprocessing (EMDR) therapy. The purpose of the present study was to determine the obstetric safety and effectiveness of EMDR therapy applied to pregnant women with fear of childbirth. Material and methods: A randomized controlled trial (the OptiMUM‐study) was conducted in two teaching hospitals and five community midwifery practices in the Netherlands (www.trialregister.nl, NTR5122). Pregnant women (n = 141) with a gestational age between 8 and 20 weeks and suffering from fear of childbirth (i.e. sum score on the Wijma Delivery Expectations Questionnaire ≥85) were randomly allocated to either EMDR therapy (n = 70) or care‐as‐usual (CAU) (n = 71). Outcomes were maternal and neonatal outcomes and patient satisfaction with pregnancy and childbirth. Results: A high percentage of cesarean sections (37.2%) were performed, which did not differ between groups. However, women in the EMDR therapy group proved seven times less likely to request an induction of labor without medical indication than women in the CAU group. There were no other significant differences between the groups in maternal or neonatal outcomes, satisfaction, or childbirth experience. Conclusions: EMDR therapy during pregnancy does not adversely affect pregnancy or the fetus. Therefore, therapists should not be reluctant to treat pregnant women with fear of childbirth using EMDR therapy. [ABSTRACT FROM AUTHOR]

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المؤلفون: Bertholdt, Charline^1,2 charline.bertholdt@gmail.com, Menard, Sophie¹, Delorme, Pierre^1,3, Lamau, Marie‐Charlotte¹, Goffinet, François^1,3, Le Ray, Camille^1,3, Lamau, Marie-Charlotte⁴ (AUTHOR)

المصدر: Acta Obstetricia et Gynecologica Scandinavica. May2018, Vol. 97 Issue 5, p608-614. 7p.

مصطلحات موضوعية: *CESAREAN section, *PREMATURE labor, *PREGNANCY complications, *GESTATIONAL age, *CHILDBIRTH, *COMPARATIVE studies, *PREMATURE infants, *RESEARCH methodology, *MEDICAL cooperation, *RESEARCH, *SURGICAL complications, *LOGISTIC regression analysis, *EVALUATION research, *RETROSPECTIVE studies

مستخلص: Introduction: At the same time as survival is increasing among premature babies born before 26 weeks of gestation, the rates of cesarean deliveries before 26 weeks is also rising. Our purpose was to compare the frequency of intraoperative adverse events during cesarean deliveries in two gestational age groups: 24-25 weeks and 26-27 weeks.Material and Methods: This single-center retrospective cohort study included all women with cesarean deliveries performed before 28+0 weeks from 2007 through 2015. It compared the frequency of intraoperative adverse events between two groups: those at 24-25 weeks of gestation and at 26-27 weeks. Intraoperative adverse events were a classical incision, transplacental incision, difficulty in fetal extraction (explicitly mentioned in the surgical report), postpartum hemorrhage (≥500 mL of blood loss), and injury to internal organs. A composite outcome including at least one of these events enabled us to analyze the risk factors for intraoperative adverse events with univariate and multivariable analysis. Stratified analyses by the indication for the cesarean were performed.Results: We compared 74 cesarean deliveries at 24-25 weeks of gestation and 214 at 26-27 weeks. Intraoperative adverse events occurred at higher rates in the 24-25-week group (63.5 vs. 30.8%, p < 0.001). After adjustment for confounding factors, this group remained at significantly higher risk of intraoperative adverse events [adjusted odds ratio 5.04 (2.67-9.50)], even after stratification by indication for the cesarean.Conclusion: These results should help obstetricians and women making decisions about cesarean deliveries at these extremely low gestational ages. [ABSTRACT FROM AUTHOR]

المؤلفون: Scime, Natalie V., Chaput, Katie H., Faris, Peter D., Quan, Hude, Tough, Suzanne C., Metcalfe, Amy

المصدر: Acta Obstetricia et Gynecologica Scandinavica; Apr2020, Vol. 99 Issue 4, p459-468, 10p

مصطلحات موضوعية: MATERNAL age, PREGNANCY complications, PREMATURE labor, CHILDBIRTH, GESTATIONAL diabetes, AMNIOCENTESIS

مصطلحات جغرافية: ALBERTA

مستخلص: Introduction: Pregnancy-related medical complications are associated with a 2- to 5-fold increased risk of preterm birth (PTB), but the nature of this etiologic relation in context with maternal factors remains poorly understood. Previous studies have generally treated maternal age as a confounder but overlooked its potential as an effect modifier, whereby the magnitude of the effect of complications on PTB could differ significantly across age groups. We investigated whether advanced maternal age (≥35 years) modified the association between pregnancy complications and PTB, and compared population-attributable fractions of PTB from complications in women older vs younger than 35 years.Material and Methods: We analyzed population-based, cross-sectional data from the Alberta Discharge Abstract Database for women aged 18-50 years with singleton live births in hospital between 2014 and 2017 (n = 152 246). Complications were preeclampsia, gestational diabetes, and placental disorders identified using diagnostic codes. Outcomes were spontaneous (sPTB) or iatrogenic (iPTB) PTB before 37 weeks of gestation. We estimated risk ratios and risk differences using modified Poisson and log binomial regression, respectively, adjusting for confounders (pregnancy history, comorbidities). Population-attributable fractions estimates were calculated from risk ratios. Age modification was tested using interaction terms and Z-tests.Results: Prevalence of advanced maternal age was 19.2%. Pregnancy complications and s/iPTB were more common among women aged ≥35 years. Age modified the risk of PTB from preeclampsia only, with risk differences of 9.9% (95% CI 7.2%-12.6%) in older women vs 6.1% (95% CI 4.8%-7.4%) in younger women (P-interaction = 0.012) for sPTB, and 29.5% (95% CI 26.0%-33.1%) vs 20.8% (95% CI 18.9%-22.6%, P-interaction <0.001) for iPTB. Population-attributable fractions of s/iPTB types for all complications were consistently 2%-5% larger in women aged ≥35 years, and significantly larger for preeclampsia (sPTB: 5.1% vs 2.7%, P = 0.002; iPTB: 18.8% vs 14.0%, P < 0.001) and placental disorders (sPTB: 12.5% vs 8.7%, P < 0.001; iPTB: 13.2% vs 8.9%, P < 0.001).Conclusions: Of the pregnancy complications studied, advanced maternal age only modified the association between PTB and preeclampsia, such that older women with preeclampsia have a higher risk for s/iPTB than younger counterparts. Pregnancy complications contribute to a sizable proportion of PTBs in Alberta, especially among women aged ≥35 years. Findings may inform clinical risk assessment and population-level policy targeting PTB. [ABSTRACT FROM AUTHOR]

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المؤلفون: WATSON, LYNDSEY F.¹, RAYNER, JO-ANNE¹, KING, JAMES², JOLLEY, DAMIEN³, FORSTER, DELLA^1,2

المصدر: Acta Obstetricia et Gynecologica Scandinavica. Feb2012, Vol. 91 Issue 2, p204-210. 7p.

مصطلحات موضوعية: *PREMATURE labor, *CERVIX uteri surgery, *CHILDBIRTH, *PREGNANCY, *REPRODUCTIVE technology research

مصطلحات جغرافية: AUSTRALIA

مستخلص: Objective. To investigate the relation of prior intracervical procedures with very preterm birth. Design. A population-based case-control study. Setting. The study was conducted in Australia between 2002 and 2004. Sample. Three hundred and forty-five women having a medically indicated and 236 having a spontaneous singleton birth between 20 and 31 weeks of gestation and 796 women selected randomly from all those giving birth at ≥37 weeks of gestation. Methods. Interview data were analysed using logistic regression. Main outcome measure. Very preterm birth. Results. Very preterm birth was significantly associated with having any intracervical procedure [adjusted odds ratio (AOR) 2.07; 95% confidence interval (CI) 1.6-2.7], in particular curettage associated with abortion (AOR 1.80; 95% CI 1.2-2.6). Assisted reproductive technology procedures were significantly associated with medically indicated very preterm birth (AOR 3.07; 95% CI 1.8-5.3) and treatments for precancerous cervical changes were significantly associated with spontaneous very preterm birth, as follows: conization/cone biopsy (AOR 3.33; 95% CI 1.8-6.2) and cauterization/ablation (AOR 2.27; 95% CI 1.4-3.8). Suction aspiration for abortion, abnormal Pap smear without treatment and abortion without instrumentation were not associated with very preterm birth. Conclusions. Intracervical procedures are associated with very preterm birth. Notably, curettage rather than any other procedure associated with abortion appears to be implicated in the risk. The introduction of infection during cervical procedures may be the common link with risks found. Changing clinical practice in the management of abortion and human papillomavirus vaccination may lead to lowering the risks of very preterm birth. [ABSTRACT FROM AUTHOR]

المؤلفون: Baqui, Abdullah H., Lee, Anne C. C., Koffi, Alain K., Khanam, Rasheda, Mitra, Dipak K., Dasgupta, Sushil K., Uddin, Jamal, Ahmed, Parvez, Rafiqullah, Iftekhar, Rahman, Mahmoodur, Quaiyum, Abdul, Koumans, Emilia H., Christian, Parul, Saha, Samir K., Mullany, Luke C., Labrique, Alain, Lee, Anne Cc, Dasgupta, Sushil Kanta, MIST Study Team of the Projahnmo Study Group in Bangladesh

المصدر: Acta Obstetricia et Gynecologica Scandinavica; Mar2019, Vol. 98 Issue 3, p309-319, 11p

مصطلحات موضوعية: PREGNANT women, CHILDBIRTH, CLUSTER randomized controlled trials, BOTANY, PREMATURE labor

مصطلحات جغرافية: BANGLADESH

مستخلص: Introduction: The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes.Material and Methods: Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes.Results: The prevalence of AVF was 16.5%: 9.8% of women had bacterial vaginosis and 6.8% had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95% confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95% CI 2.12-8.12) compared to women without AVF.Conclusions: In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed. [ABSTRACT FROM AUTHOR]

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المؤلفون: BREUGELMANS, MARIA¹ mbreugel@uzbrussel.be, VANCUTSEM, ELLEN², NAESSENS, ANNE², LAUBACH, MONICA¹, FOULON, WALTER¹

المصدر: Acta Obstetricia et Gynecologica Scandinavica. Feb2010, Vol. 89 Issue 2, p256-260. 5p. 1 Chart.

مصطلحات موضوعية: *VAGINA, *PREMATURE labor, *PREGNANCY complications, *DELIVERY (Obstetrics), *CHILDBIRTH

مستخلص: Objective. To find out whether the presence of Ureaplasma species ( U. spp.) in combination with an alteration of the normal vaginal flora is an independent risk factor for preterm delivery. Design. Prospective observational study. Setting. Department of Obstetrics, University Hospital in Brussels. Population. A total of 1,988 singleton pregnancies were included. Methods. From each woman, a cervical culture for U. spp. was obtained and the vaginal flora evaluated at the first prenatal visit. The presence of known risk factors for preterm delivery was recorded. Preterm birth was defined as delivery < 37 weeks. Results. There were 97 (4.9%) preterm births. In patients delivered before 37 weeks, abnormal vaginal flora was detected in 22.7% and U. spp. in 53.6% of these. The conditions were found together in 17.5%. In patients delivered at term, an abnormal vaginal flora was detected in 14.4% and U. spp. in 41.4% of these women, while they co-existed in 8.2%. Using a logistic regression analysis taking into account known risk factors for preterm birth and the microbiological parameters, preterm delivery was correlated with the presence of U. spp. (odds ratio (OR) 1.64; 95% confidence interval (CI) 1.08–2.48; p = 0.02) and abnormal vaginal flora in combination with U. spp. (OR 2.35; 95% CI 1.35–4.10; p = 0.003). No significant correlation between the presence of abnormal vaginal flora and preterm delivery ( p = 0.09) was found. Conclusions. Preterm delivery was significantly correlated with the presence of U. spp. The risk for preterm delivery increased when U. spp. was associated with an abnormal vaginal flora. [ABSTRACT FROM AUTHOR]

المؤلفون: Haugen, Margaretha¹ margaretha.haugen@fhi.no, Meltzer, Helle Margrete¹, Brantsæter, Anne Lise¹, Mikkelsen, Tina², Østerdal, Marie Louise², Alexander, Jan¹, Olsen, Sjurdur F.², Bakketeig, Leiv³

المصدر: Acta Obstetricia et Gynecologica Scandinavica. Mar2008, Vol. 87 Issue 3, p319-324. 6p. 3 Charts.

مصطلحات موضوعية: *DIET, *PREMATURE labor, *MOTHER-child relationship, *CHILDBIRTH

مصطلحات جغرافية: NORWAY

مستخلص: Background. Mediterranean diet has been shown to reduce the incidence of preterm birth. We wanted to investigate whether a Mediterranean-type diet (MD) could be associated with a lower risk of preterm birth in the Norwegian Mother and Child Cohort Study (MoBa). Methods. The data collection was conducted as part of MoBa at the Norwegian Institute of Public Health. In MoBa, women answer a Food Frequency Questionnaire (FFQ) at week 18-22 of pregnancy. The MD criteria were intake of fish ≥2 times a week, fruit and vegetables ≥5 times a day, use of olive/canola oil, red meat intake ≤ times 2 a week, and ≤2 cups of coffee a day. Results. A total of 569 women (2.2%) met the MD criteria, 25,397 women (97.2%) met 1-4 criteria, and 159 women (0.01%) met none of the MD criteria. The number of preterm births in the MD group was 26 (4.6%), in those who met 1-4 criteria it was 1,148 (4.5%), and in those who met none of the criteria it was 10 (6.3%). The women who met the MD criteria did not have reduced risk of preterm birth compared with women meeting none of the MD criteria (OR: 0.73; 95% CI: 0.32, 1.68). Intake of fish twice or more a week was associated with a lower risk of preterm birth (OR: 0.84; 95% CI: 0.74, 0.95). Conclusions. The women who fulfilled the criteria of a MD did not have a reduced risk of preterm birth. [ABSTRACT FROM AUTHOR]

المؤلفون: Mikkelsen, Tina B.¹ tbm@forskningskonsulent.dk, Øterdal, Marie Louise¹, Knudsen, Vibeke K.¹, Haugen, Margaretha², Meltzer, Helle M.², Bakketeig, Leiv³, Olsen, Sjurdur F.¹

المصدر: Acta Obstetricia et Gynecologica Scandinavica. Mar2008, Vol. 87 Issue 3, p325-330. 6p. 3 Charts.

مصطلحات موضوعية: *PREMATURE labor, *CHILDBIRTH, *PREGNANT women, *DIET

مصطلحات جغرافية: DENMARK

مستخلص: Background. Thus far, few factors with a causal relation to preterm birth have been identified. Many studies have focused on the woman's diet, but most have been discouraging. The aim of the present study was to examine if maternal intake of a Mediterranean-type diet (MD) is associated with reduced risk of preterm birth. Methods. The Danish National Birth Cohort assessed diet in mid-pregnancy by food frequency questionnaires (FFQ). Women consuming MD were those who ate fish twice a week or more, used olive or rape seed oil, consumed 5+ fruits and vegetables a day, ate meat (other than poultry and fish) at most twice a week, and drank at most 2 cups of coffee a day. Results. Of 35,530 non-smoking women, 1,137 (3.2%) fulfilled all MD criteria, and 540 (1.5%) none. Odds ratios for preterm birth and early preterm birth were 0.61 (95% Confidence Interval (CI): 0.35-1.05) and 0.28 (0.11-0.76), respectively, in MD women compared to women fulfilling none of the MD criteria. Conclusion. Shifting towards a MD during pregnancy may reduce the risk of early delivery in Danish women. [ABSTRACT FROM AUTHOR]

المؤلفون: Melamed, Nir nirm@clalit.org.il, Yogev, Yariv, Hadar, Eran

المصدر: Acta Obstetricia et Gynecologica Scandinavica. Jan2008, Vol. 87 Issue 1, p63-67. 5p. 3 Charts, 1 Graph.

مصطلحات موضوعية: *PROSTAGLANDINS, *PREMATURE labor, *CHILDBIRTH, *CERVIX uteri, *MOTHERS

مستخلص: Objective. To evaluate the efficacy of prostaglandin E2 (PGE2) for cervical ripening at preterm and to identify factors predicting ripening failure. Design. A retrospective study of women admitted for preinduction cervical ripening with PGE2 vaginal tablets at preterm (n=444). PGE2 vaginal tablets were administered at 6-8 h intervals until cervical ripening was achieved (Bishop score ≥7) or ripening failed (Bishop score <7 after administration of 4 PGE2 tablets). Data were compared with a control group of women admitted for preinduction cervical ripening with PGE2 vaginal tablets at term (n=1,029). A multivariate logistic regression analysis was performed to detect factors predicting ripening failure. Results. Women at preterm required a significantly higher number of PGE2 tablets compared to women at term (2.0±1.1 versus 1.6±0.9, p<0.001). Overall rates of ripening failure and caesarean section due to failed induction were significantly higher in preterm than term gestations (11.4 versus 1.1% and 9.7 versus 0.4%, p <0.001), and were inversely related to gestational age. Nulliparity, lower gestational age at delivery, lack of cervical dilatation, and higher maternal age were significant predictors of ripening failure at preterm. Conclusion. The use of PGE2 for preinduction cervical ripening at preterm may be associated with an increased risk of ripening failure and caesarean section compared with term gestations. This information may be useful when consulting women regarding the available options when premature delivery is necessary. [ABSTRACT FROM AUTHOR]