Clinical, obstetrical and anaesthesia outcomes in pregnant women during the first COVID-19 surge in France: a prospective multicentre observational cohort study

Abstract Background: Hypothyroidism is the second most common endocrinological disease during pregnancy, with percentages that can range between 3.2 and 5.5%. A good maternal and foetal health outcome depends on thyroid hormone replacement therapy. The goal of such therapy is to maintain thyrotropin (TSH) in a range that is specific for pregnant women and varies between the trimesters of pregnancy. In our study, we wanted to analyse the adherence to hypothyroidism treatment among pregnant women and to evaluate the degree of control of the disease.Methods: We performed a retrospective observational cohort study in pregnant women between 2012 and 2018 in the Lleida health region. Therapeutic adherence was analysed by the proportion of days covered (PDC). The relationship with other variables was assessed using the regression coefficients and their 95% confidence interval (CI).Results: We examined a sample of 17281 women, representing more than 92% of the pregnant women in the Lleida health region in the period analysed. Among this sample, the mean prevalence of hypothyroidism was 6.52% (0.07% clinical and 6.45% subclinical). 3.3% of the 17281 pregnant women were treated. Among them, the mean adherence score was 79.6 ± 22.2. Of these, 54% presented high adherence. The latter had a higher mean age and better TSH control, in comparison to the ones showing low adherence. Conclusions: Half of the treated patients had good adherence to treatment and a better TSH control, in comparison to the others. Most of them achieved a good control at the third trimester of pregnancy.

Download Full-text

Maternal Outcomes in Women with Major Degree Placenta Previa: An Observational Cohort Study

Current Women s Health Reviews ◽

10.2174/1573404817999201230234519 ◽

2020 ◽

Vol 17 ◽

Author(s):

Safinaz Reda Mahmoud Abdelwhab ◽

Ali El-Shabrawy Ali ◽

Mostafa Abdo Ahmed ◽

Basem Mohamed Hamed

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Placenta Previa ◽

Observational Cohort Study ◽

Maternal Outcomes ◽

Significant Difference ◽

Before And After ◽

Screening Protocol ◽

Observational Cohort ◽

Study Participants

Objective:: We aimed to evaluate the maternal outcomes among pregnant women with major degree placenta previa. Methods:: We conducted an observational cohort study on 80 pregnant women diagnosed with major placenta previa (grades III and IV where the placenta partially or completely cover the internal cervical os) after 20 weeks of pregnancy, within the period from January 2019 to June 2019. The diagnosis of placenta previa was made by ultrasound and confirmed at the time of delivery. The study participants were divided into three groups based on the placental location (Anterior, Central, and Posterior). All analyses were conducted using IBM SPSS software package version 20.0. Results:: Eighty pregnant women, with a mean age of 32.3 (5.01) years and a mean gestational age of 36.2 (2.03) weeks, were included in our study. Of them, 56.30% had a previous abortion, and previous Cs delivery was reported in 75%. Most of the placenta previa cases were central (52.5%), with a completely covered internal cervical os (70%). Thirty-nine patients (48.8%) had placenta accreta. Blood transfusion, postpartum hemorrhage, and anemia were noted with a percentage of 75%, 32.5%, and 32.5%, respectively. Around 28.8% of the included patients had a hysterectomy. Before and after delivery, nine patients (21.4%) and 15 patients (35.7%) of the placenta previa centralis group had anemia, respectively. Moreover, there was no statistically significant difference between the three studies groups in terms of anemia before and after delivery (P= 0.41 and P= 0.78. respectively). Placenta previa centralis showed a higher incidence of CS hysterectomy (45.2%) while wound infection was higher in anterior placenta previa (18.2%). Conclusion:: As a predictor of possible obstetric adverse events, placenta previa should be considered. A combination of proper clinical assessment and timely delivery to reduce the associated complications should be considered as well as developing a prenatal screening protocol.

Download Full-text

Pregnancy physiology pattern prediction study (4P study): protocol of an observational cohort study collecting vital sign information to inform the development of an accurate centile-based obstetric early warning score

BMJ Open ◽

10.1136/bmjopen-2017-016034 ◽

2017 ◽

Vol 7 (9) ◽

pp. e016034 ◽

Cited By ~ 5

Author(s):

Fiona Kumar ◽

Jude Kemp ◽

Clare Edwards ◽

Rebecca M Pullon ◽

Lise Loerup ◽

...

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Early Warning ◽

Vital Signs ◽

Observational Cohort Study ◽

Mobile Internet ◽

Early Warning Score ◽

Evidence Based ◽

Reference Ranges ◽

Observational Cohort

IntroductionSuccessive confidential enquiries into maternal deaths in the UK have identified an urgent need to develop a national early warning score (EWS) specifically for pregnant or recently pregnant women to aid more timely recognition, referral and treatment of women who are developing life-threatening complications in pregnancy or the puerperium. Although many local EWS are in use in obstetrics, most have been developed heuristically. No current obstetric EWS has defined the thresholds at which an alert should be triggered using evidence-based normal ranges, nor do they reflect the changing physiology that occurs with gestation during pregnancy.Methods and analysisAn observational cohort study involving 1000 participants across three UK sites in Oxford, London and Newcastle. Pregnant women will be recruited at approximately 14 weeks’ gestation and have their vital signs (heart rate, blood pressure, respiratory rate, oxygen saturation and temperature) measured at 4 to 6-week intervals during pregnancy. Vital signs recorded during labour and delivery will be extracted from hospital records. After delivery, participants will measure and record their own vital signs daily for 2 weeks. During the antenatal and postnatal periods, vital signs will be recorded on an Android tablet computer through a custom software application and transferred via mobile internet connection to a secure database. The data collected will be used to define reference ranges of vital signs across normal pregnancy, labour and the immediate postnatal period. This will inform the design of an evidence-based obstetric EWS.Ethics and disseminationThe study has been approved by the NRES committee South East Coast–Brighton and Sussex (14/LO/1312) and is registered with the ISRCTN (10838017). All participants will provide written informed consent and can withdraw from the study at any point. All data collected will be managed anonymously. The findings will be disseminated in international peer-reviewed journals and through research conferences.

Download Full-text

Opiate Detoxification of Pregnant Women Using Clonidine: An Observational Cohort Study

Journal of Women's Health ◽

10.1089/jwh.1995.4.381 ◽

1995 ◽

Vol 4 (4) ◽

pp. 381-386 ◽

Cited By ~ 3

Author(s):

FRANK J. LePREAU ◽

BOBBI GARVEY ◽

NANCY PAULL ◽

MICHAEL D. STEIN

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Observational Cohort Study ◽

Observational Cohort

Download Full-text

Nausea, vomiting and poor appetite during pregnancy and adverse birth outcomes in rural Nepal: an observational cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03141-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Amanda Regodón Wallin ◽

James M Tielsch ◽

Subarna K Khatry ◽

Luke C Mullany ◽

Janet A Englund ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Pregnant Women ◽

Birth Outcomes ◽

First Trimester ◽

Observational Cohort Study ◽

Limited Resources ◽

Poor Appetite ◽

Observational Cohort ◽

Rural Nepal

Abstract Background Nausea and vomiting are experienced by a majority of pregnant women worldwide. Previous studies have yielded conflicting results regarding their impact on birth outcomes and few studies have examined this relationship in settings with limited resources. We aimed to determine the effect of nausea, vomiting and poor appetite during pregnancy on birth outcomes in rural Nepal. Methods Observational cohort study using data collected in two randomized, community-based trials to assess the effect of influenza immunization during pregnancy on reproductive and respiratory outcomes among pregnant women and their offspring. Pregnant women in Sarlahi District, Nepal were recruited from 2011 to 2013. Exposure was defined as nausea, vomiting or poor appetite at any point during pregnancy and by trimester; symptoms were recorded monthly throughout pregnancy. Adverse outcomes were low birth weight (LBW), preterm birth and small for gestational age (SGA). Adjusted relative risks (aRR) with 95% CIs are reported from Poisson regressions with robust variance. Results Among 3,623 pregnant women, the cumulative incidence of nausea, vomiting or poor appetite was 49.5% (n = 1793) throughout pregnancy and 60.6% (n = 731) in the first trimester. Significantly higher aRRs of LBW and SGA were observed among women experiencing symptoms during pregnancy as compared to symptom free women (LBW: aRR 1.20; 95% CI 1.05 1.28; SGA: aRR 1.16; 95% CI 1.05 1.28). Symptoms in the first trimester were not significantly associated with any of the outcomes. In the second trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.17; 95% CI 1.01 1.36; SGA: aRR 1.16; 95% CI 1.05 1.29) and a significantly lower aRR for preterm birth (aRR 0.75; 95% CI 0.59 0.96). In the third trimester, we observed significantly higher aRRs for LBW and SGA (LBW: aRR 1.20; 95% CI 1.01 1.43; SGA: aRR 1.14; 95% CI 1.01 1.29). Conclusions Symptoms of nausea, vomiting or poor appetite during pregnancy are associated with LBW, SGA and preterm birth in a setting with limited resources, especially beyond the first trimester. Trial registration Prospectively registered at ClinicalTrials.gov on Dec 17, 2009 (NCT01034254).

Download Full-text