Comparison of immediate postpartum contraception among women with a high versus low risk pregnancy in Mexico: a retrospective cohort study

ObjectiveWe tested whether women who reported high-risk pregnancies or deliveries were more likely to receive immediate postpartum contraception prior to discharge compared with normal-risk women in Mexico.MethodsThis is a retrospective study using the National Health and Nutrition Survey. We classified women as high-risk based on reported complications in pregnancy and delivery. We used multivariable logistic regression to test the association of high-risk status and receipt of postpartum contraception (any modern method and Tier one methods) prior to discharge.ResultsOur sample included 5030 deliveries (population N=3 923 657). Overall, 19.1% of the sample were high risk. Over 60% of women in the high-risk and normal-risk group received immediate postpartum contraception, but a greater proportion of high-risk women received a method (67% vs 61% normal risk; p<0.001). However, in multivariable models, there were no significant differences in receipt of any modern method or tier 1 method by risk group.ConclusionWomen with high-risk pregnancies were not more likely to receive postpartum contraception than the normal-risk group, once accounting for sociodemographic and clinical factors. Prenatal and postpartum contraception counselling should address the health effects of high-risk pregnancies and interpregnancy intervals to improve maternal health outcomes.

Download Full-text

Obstetric and neonatal outcome among women presenting with reduced fetal movements in third trimester

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175488 ◽

2017 ◽

Vol 7 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Vidyashree G. Poojari ◽

Sahan S. Kumar ◽

Akhila Vasudeva

Keyword(s):

High Risk ◽

Perinatal Outcome ◽

Neonatal Outcome ◽

Risk Group ◽

Low Risk ◽

High Risk Pregnancy ◽

High Risk Women ◽

Reduced Fetal Movements ◽

Risk Pregnancy ◽

Fetal Movements

Background: Reduced maternal perception of fetal movements allows early identification, timely evaluation and intervention for fetuses at risk of adverse outcome. The primary objective of this study was to assess the pregnancy characteristics and outcomes of pregnant women presenting to hospital with reduced fetal movements (RFM).Methods: Prospective observational study, recruiting all women with singleton pregnancy at or beyond 28 weeks of gestation presenting with a subjective perception of RFM from April 2015 to December 2016. Maternal characteristics, antenatal risk factors, management pathways and perinatal outcome studied.Results: 47% belonged to high risk pregnancy. Among high risk women, although only 39% showed poor BPP at the first presentation, 58% were delivered irrespective of their gestational age, out of which 32.75% had poor neonatal outcome. Among low risk who had >2 episodes of RFM, 50% had poor neonatal outcome. 7% among high risk pregnancies and 18% among low risk, presented with RFM within 48 hours following steroid prophylaxis.24% of high risk women showed liquor volume abnormalities as compared to low risk (6.3%).Conclusions: Significant proportion of those with RFM belonged to high risk pregnancy. Among high risk group, there were high rates of stillbirth and poor BPP at the time of admission when compared to low risk group. Due to early approach to the hospital and timely intervention, significant women with abnormal BPP had good perinatal outcome. All those fetuses who were delivered on first episode of RFM in low risk group did not show evidence of compromise at birth, probably indicating unnecessary delivery. More than 2 episodes of RFM even among low risk group seems significant as good number of fetuses were compromised at birth. Steroids prophylaxis for the fetal lung maturity causes transient changes in BPP, hence unnecessary delivery should be avoided especially those among low risk pregnancy.

Download Full-text

The high-risk pregnancy and delivery factors in the newborn pneumonia

Journal of Perinatal Medicine ◽

10.1515/jpme.1984.12.s1.69 ◽

1984 ◽

Vol 12 (s1) ◽

pp. 69-70

Author(s):

W. Grzywna ◽

K. Kozlowski ◽

Anna Wylot-Jończyk

Keyword(s):

High Risk ◽

High Risk Pregnancy ◽

Risk Pregnancy ◽

Pregnancy And Delivery

Download Full-text

P5730Do hypertensive women with coronary artery disease benefit from lowering systolic blood pressure under 130 mmHg? Long-term mortality in the INternational VErapamil SR-trandolapril STudy (INVEST)

European Heart Journal ◽

10.1093/eurheartj/ehz746.0670 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R I Sava ◽

Y Chen ◽

Y K Taha ◽

Y Gong ◽

S M Smith ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Coronary Artery Disease ◽

High Risk ◽

Risk Group ◽

Low Risk ◽

High Risk Women ◽

Artery Disease ◽

Long Term Mortality

Abstract Background Hypertension (HTN) and coronary artery disease (CAD) are a prevalent combination in women, however limited data are available to guide blood pressure (BP) management. We hypothesize older women with HTN and CAD may not derive the same prognostic benefit from systolic BP (SBP) lowering <130 mmHg. Purpose To investigate the long-term mortality implications of different achieved SBP levels in hypertensive women with CAD. Methods Long-term, all-cause mortality data were analyzed for 9216 women, stratified by risk attributable to clinical severity of CAD (women with prior myocardial infarction or revascularization considered at high, all others at low risk) and by age (50 - <65 or ≥65 yo). The prognostic impact of achieving mean in-trial SBP <130 (referent group) was compared with 130 to <140 and ≥140 mmHg using Cox proportional hazards, adjusting for demographic and clinical characteristics. Results During 108,838 person-years of follow-up, 2945 deaths occurred. High risk women (n=3011) had increased long-term mortality in comparison to low risk women (n=6205) (adjusted HR 1.38, CI 1.28–1.5, p<0.001). Within risk groups, crude mortality percentages decreased according to BP values (table). As expected, high risk women were more likely to be ≥65 yo (68.68% vs. 50.51%, p<0.0001) or have SBP ≥140 mmHg (43.08% vs. 31.18%, p<0.0001). In adjusted analyses, an SBP ≥140 mmHg was associated with worse outcomes than SBP <130 mmHg in the entire cohort (HR 1.3, CI 1.2–1.5, p<0.0001) and when stratifying by risk (low risk group, HR = 1.47, CI 1.28–1.7, p<0.0001; high risk group, HR = 1.71, CI 1.01–1.35, p=0.03). In analyses stratified by age and risk, women ≥65 years and at high risk had decreased mortality in the 130 - <140 SBP category vs. <130 mmHg (HR 0.812, 95% CI 0.689–0.957, p=0.0133; figure). Women and deaths by risk and SBP group Group SBP category Women (n) Mortality (n) Mortality (%) High risk <130 773 338 44 130–<140 941 414 44 ≥140 1297 694 54 Low risk <130 2187 390 18 130–<140 2083 451 22 ≥140 1935 658 34 SBP = systolic blood pressure; n = number; % = percent per each group. Mortality adjusted HRs Conclusion In women ≥65 yo with hypertension and prior myocardial infarction and/or coronary revascularization enrolled in INVEST, a SBP between 130 to <140 mmHg was associated with lower all-cause, long-term mortality versus SBP <130 mmHg. Acknowledgement/Funding The main INVEST (International Verapamil [SR]/Trandolapril Study) was funded by grants from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, A

Download Full-text

Anxiety and depression in women hospitalized due to high-risk pregnancy: An integrative quantitative and qualitative study

Current Psychology ◽

10.1007/s12144-021-01902-5 ◽

2021 ◽

Author(s):

Martina Smorti ◽

Francesca Ginobbi ◽

Tommaso Simoncini ◽

Federica Pancetti ◽

Alessia Carducci ◽

...

Keyword(s):

Depressive Symptoms ◽

High Risk ◽

Risk Group ◽

Depression Scale ◽

High Risk Group ◽

Low Risk ◽

High Risk Pregnancy ◽

Anxiety And Depression ◽

Risk Pregnancy ◽

Low Risk Pregnancy

AbstractLiterature has shown that hospitalized women with high-risk pregnancy tend to develop anxious and depressive symptoms. Research has used quantitative or qualitative methods. By integrating both quantitative and qualitative methods, this study aims to analyze: a) the level of depression, anxiety, and pregnancy-related anxiety in a group of women hospitalized with high-risk pregnancy (hospitalized high-risk) compared with a group of non-hospitalized women with low-risk pregnancy; b) the content of hospitalization-related emotions in a high-risk group. A cross-sectional study was conducted on 30 hospitalized high-risk pregnant women and 32 women with low-risk pregnancy. Participants completed the Edinburgh Postnatal Depression Scale, Hospital Anxiety and Depression Scale (Anxiety), and Pregnancy Related Anxiety Questionnaire. The hospitalized high-risk group also completed open-ended questions about emotions experienced during hospitalization. Univariate Analysis of Covariance showed that the hospitalized high-risk group reported higher general anxiety and depression than the low-risk pregnancy group. Low-risk group reported higher level of concerns about own appearance than high-risk group. Narratives showed that the anxious and depressive symptoms of hospitalized women are related to the loneliness of being away from family. Despite attempts to understand hospitalization, they express concerns about pregnancy. Psychological support for hospitalized pregnant women should be provided to facilitate the communication of emotions that leads women to elaborate the experience of hospitalization to better adapt and cope with the critical condition.

Download Full-text

Oncotype DX DCIS use and clinical utility: A SEER population-based study.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e12046 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e12046-e12046 ◽

Cited By ~ 1

Author(s):

Yao Yuan ◽

Alison Len Van Dyke ◽

Allison W. Kurian ◽

Serban Negoita ◽

Valentina I. Petkov

Keyword(s):

Breast Cancer ◽

High Risk ◽

Risk Group ◽

Low Risk ◽

Cancer Data ◽

Gene Assay ◽

Risk Patients ◽

To Receive ◽

In Situ Breast Cancer

e12046 Background: OncotypeDX DCIS is a 12-gene assay designed to predict the 10-year risk of local recurrence and to guide treatment decisions, specifically the benefit of radiation therapy in breast ductal carcinoma in situ (DCIS). The test became available in December 2011 and is not currently recommended by guidelines. The Surveillance, Epidemiology and End Results (SEER) program captures cancer data at the population-level and has been conducting annual linkages with Genomic Health Clinical Laboratory, the only lab performing the test, to identify patients receiving the test. Methods: SEER cases diagnosed with in situ breast cancer (DCIS or papillary in situ) between 2011-2015 were included in the analysis. SEER data on patient demographics, tumor characteristics, and treatments were combined with linkage variables for OncotypeDX DCIS tests reported by Genomic Health. Logistic regression was used to identify which patient related factors were associated with having received the test and to evaluate the relationship between test generated risk categories and treatments. Results: Of the 68,826 in situ breast cancer cases, 2,155 were linked to DCIS test data. Test utilization increased from < 1% to 5.3% for patients diagnosed in 2011 vs. 2015. Patients were less likely to receive the test if they had larger and higher-grade tumors, were divorced, had Medicaid insurance, and were in the lowest socioeconomic status tertile. The majority of patients (68%) were at low risk, 17% intermediate, and 15% in the high risk group. Patients at intermediate or high risk were more likely to receive radiation (OR = 2.4, 95% CI: 1.8-3.2 and OR = 3, 95% CI: 2.3,4.1, respectively) than the low risk group. High risk patients were more likely than low risk patients to receive chemotherapy (OR = 4.3, 95% CI: 1.2, 14.4) and to undergo mastectomy than lumpectomy (OR = 1.47, 95% CI: 1.12-1.93). Conclusions: Clinical adoption of the OncotypeDX DCIS test has been slow. The association between multiple demographic factors and receiving the test indicated disparities in the US population. Clinical factors also influenced whether patients received the test. OncotypeDX DCIS results appeared to guide clinical decisions.

Download Full-text

Comparison of Pregnancy Outcome in Non-Risk and High-Risk Antenatal Mothers

JMS SKIMS ◽

10.33883/jms.v17i1.228 ◽

2014 ◽

Vol 17 (1) ◽

pp. 16-19

Author(s):

Chandra Metgud

Keyword(s):

Risk Factors ◽

High Risk ◽

Pregnant Women ◽

Pregnancy Outcome ◽

Rural Areas ◽

Risk Group ◽

Common Factor ◽

High Risk Pregnancy ◽

Family Needs ◽

Risk Pregnancy

Objectives: 1. To know the incidence of high risk pregnancy. 2. To study the pregnancy outcome in Non-risk and High-risk antenatal mothers. Study Design: Longitudinal study. Setting: Shindolli Village of Belgaum District. Participants: All women in this village who were pregnant at the start of the study and who became pregnant during the study period. Sample Size: 125. Statistical Analysis: Percentages and Chi-square Test. Results: The incidence of High risk pregnancy was noted in 51(40.80%) pregnant women. The various risk factors noted were: primigravida 18 years, grand multipara, pre-eclampsia, bad obstetric history, severe anaemia etc. Among 125 pregnancy outcome, 69(93.24%) pregnant women in the non-risk group had good outcome compared to 34(66.67%) in the high risk group. The outcome of the pregnancy was significantly associated with presence of risk factors. Conclusion: The high-risk pregnancies are due to early marriages and child bearing at an early age. In rural areas early marriages are perpetuated by tradition, belief and family needs to reduce expenditures. A high percentage of anaemia in the pregnant women was due to the fact that, majority of them belonged to low social classes which affect their dietary intake and purchasing power adversely. Another common factor noted in rural area was grand multiparity, due to the need for male child. JMS 2014;17(1):16-19

Download Full-text