scholarly journals High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244072
Author(s):  
Sushma Rajbanshi ◽  
Mohd Noor Norhayati ◽  
Nik Hussain Nik Hazlina
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Risk Stratification ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Maternal Morbidity ◽  
Low Risk ◽  
Severe Maternal Morbidity

Background The early identification of pregnant women at risk of developing complications at birth is fundamental to antenatal care and an important strategy in preventing maternal death. This study aimed to determine the prevalence of high-risk pregnancies and explore the association between risk stratification and severe maternal morbidity. Methods This hospital-based prospective cohort study included 346 pregnant women between 28–32 gestational weeks who were followed up after childbirth at Koshi Hospital in Nepal. The Malaysian antenatal risk stratification approach, which applies four color codes, was used: red and yellow denote high-risk women, while green and white indicate low-risk women based on maternal past and present medical and obstetric risk factors. The World Health Organization criteria were used to identify women with severe maternal morbidity. Multivariate confirmatory logistic regression analysis was performed to adjust for possible confounders (age and mode of birth) and explore the association between risk stratification and severe maternal morbidity. Results The prevalence of high-risk pregnancies was 14.4%. Based on the color-coded risk stratification, 7.5% of the women were categorized red, 6.9% yellow, 72.0% green, and 13.6% white. The women with high-risk pregnancies were 4.2 times more likely to develop severe maternal morbidity conditions during childbirth. Conclusions Although smaller in percentage, the chances of severe maternal morbidity among high-risk pregnancies were higher than those of low-risk pregnancies. This risk scoring approach shows the potential to predict severe maternal morbidity if routine screening is implemented at antenatal care services. Notwithstanding, unpredictable severe maternal morbidity events also occur among low-risk pregnant women, thus all pregnant women require vigilance and quality obstetrics care but high-risk pregnant women require specialized care and referral.

scholarly journals Incidence and Predictors of Pre-Eclampsia Among Pregnant Women Attending Antenatal Care at Debre Markos Referral Hospital, North West Ethiopia: Prospective Cohort Study

2020 ◽  
Vol Volume 12 ◽  
pp. 1013-1021
Author(s):  
Molla Yigzaw Birhanu ◽  
Habtamu Temesgen ◽  
Gebreselassie Demeke ◽  
Moges Agazhe Assemie ◽  
Alehegn Aderaw Alamneh ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Referral Hospital ◽  
North West ◽  
North West Ethiopia ◽  
Debre Markos

scholarly journals Differences in optimality index between planned place of birth in a birth centre and alternative planned places of birth, a nationwide prospective cohort study in The Netherlands: results of the Dutch Birth Centre Study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016958 ◽  
Author(s):  
Marieke A A Hermus ◽  
Marit Hitzert ◽  
Inge C Boesveld ◽  
M Elske van den Akker-van Marle ◽  
Paula van Dommelen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Home Birth ◽  
Low Risk ◽  
Place Of Birth ◽  
Home Births ◽  
Birth Centre ◽  
Hospital Births

ObjectivesTo compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife.DesignProspective cohort study.SettingLow-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study.Participants3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births.Main outcome measurementsThe Optimality IndexNL-2015, a tool to measure ‘maximum outcome with minimal intervention’, was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth.ResultsThere were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women.ConclusionThe Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.

scholarly journals Serum tenascin-C predicts resistance to steroid combination therapy in high-risk Kawasaki disease: A multicenter prospective cohort study

2020 ◽  
Author(s):  
YUKAKO YOSHIKANE ◽  
YOSHIAKI OKUMA ◽  
TATSUKI MIYAMOTO ◽  
JUNICHI HASHIMOTO ◽  
RYUJI FUKAZAWA ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Kawasaki Disease ◽  
Combination Therapy ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Initial Treatment ◽  
Low Risk ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background Tenascin-C (TN-C) is an extracellular matrix glycoprotein related to tissue inflammation. Our previous retrospective study conducted in 2016 revealed that the serum TN-C level was higher in patients with Kawasaki disease (KD) who were resistant to intravenous immunoglobulin (IVIG) and developed coronary artery lesions (CALs). The present study is a prospective cohort study to assess if the serum level of TN-C could be used as a novel biomarker to predict the risk of resistance to initial treatment for high-risk patients. Methods A total of 380 KD patients were registered and provided serum samples for TN-C measurement before commencing their initial treatment. Patients who did not meet the inclusion criteria were excluded from analysis; of the 181 remaining subjects, there were 144 low-risk patients (Kobayashi score: ≤4 points) and 37 high-risk patients (Kobayashi score: ≥5 points). The initial treatments for low-risk patients and high-risk patients were conventional therapy (IVIG with aspirin) and prednisolone combination therapy, respectively. The patient clinical and laboratory data, including the serum TN-C level, were compared between responders and non-responders to initial treatment. Results In the low-risk patients, there was no significant difference in the median levels of serum TN-C between responders and non-responders to initial therapy. However, in the high-risk patients, the median serum TN-C level in non-responders was significantly higher than that in responders (175.8 ng/ml vs 117.6 ng/ml). Conclusions Serum TN-C could be a biomarker for predicting the risk of high-risk patients being non-responsive to steroid combination therapy. Trial registration: This study was a prospective cohort study. It had been performed in accordance with the Declaration of Helsinki and had been approved by the ethics committee in each institute.

scholarly journals Cardiac dysfunction and remodeling regulated by anti-angiogenic environment in patients with preeclampsia: the ANGIOCOR prospective cohort study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Johana Ullmo ◽  
Monica Cruz-Lemini ◽  
Olga Sánchez-García ◽  
Lidia Bos-Real ◽  
Patricia Fernandez De La Llama ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Cardiac Function ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Cardiac Dysfunction ◽  
Prospective Cohort ◽  
First Trimester ◽  
Cardiac Biomarkers ◽  
Cvd Risk

Abstract Background Cardiovascular diseases (CVD) are cause of increased morbidity and mortality in spite of advances for diagnosis and treatment. Changes during pregnancy affect importantly the maternal CV system. Pregnant women that develop preeclampsia (PE) have higher risk (up to 4 times) of clinical CVD in the short- and long-term. Predominance of an anti-angiogenic environment during pregnancy is known as main cause of PE, but its relationship with CV complications is still under research. We hypothesize that angiogenic factors are associated to maternal cardiac dysfunction/remodeling and that these may be detected by new cardiac biomarkers and maternal echocardiography. Methods Prospective cohort study of pregnant women with high-risk of PE in first trimester screening, established diagnosis of PE during gestation, and healthy pregnant women (total intended sample size n = 440). Placental biochemical and biophysical cardiovascular markers will be assessed in the first and third trimesters of pregnancy, along with maternal echocardiographic parameters. Fetal cardiac function at third trimester of pregnancy will be also evaluated and correlated with maternal variables. Maternal cardiac function assessment will be determined 12 months after delivery, and correlation with CV and PE risk variables obtained during pregnancy will be evaluated. Discussion The study will contribute to characterize the relationship between anti-angiogenic environment and maternal CV dysfunction/remodeling, during and after pregnancy, as well as its impact on future CVD risk in patients with PE. The ultimate goal is to improve CV health of women with high-risk or previous PE, and thus, reduce the burden of the disease. Trial registration NCT04162236

scholarly journals Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e049271
Author(s):  
Tewodros Seyoum ◽  
Mekuriaw Alemayehu ◽  
Kyllike Christensson ◽  
Helena Lindgren
Keyword(s):  
Cohort Study ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Northwest Ethiopia ◽  
Exposed Group ◽  
Neonatal Outcomes ◽  
Negative Binomial Regression Model ◽  
Neonatal Complications

ObjectivesTo examine the relationship between complete of providers’ adherence to antenatal care (ANC) guideline during first visit and maternal and neonatal complications during intrapartum and postpartum periods.DesignProspective cohort study.SettingGondar town public health facilities in Northwest, Ethiopia.ParticipantsA total of 832 pregnant women with gestational age <28 weeks who came for first ANC visit were enrolled and followed up to the first 6 hours of the postpartum periods.ExposureProviders’ adherence to ANC guideline during first visit was the exposure variable. An 18-point checklist was used to record the level of providers’ adherence. Clients who received care from providers who adhered completely to the guideline constituted the ‘exposed group’, and those who did not receive such care constituted the ‘unexposed group’.Main outcomesMaternal and neonatal complications occurred during the intrapartum and postpartum periods.Data analysisNegative binomial regression model was used to analyse the data. The adjusted incidence risk ratio (AIRR) with 95% CI was reported in the final model.ResultsA total of 782 pregnant women were followed up and included in the final analysis (254 in the exposed group and 528 non-exposed). Complete adherence to the guidelines during first visit reduced the risk of neonatal complications (AIRR 0.56; 95% CI 0.39 to 0.79). However, complete adherence to the guidelines was not found to have a statistically significant effect on maternal complications (AIRR 0.84; 95% CI 0.67 to 1.05) during the intrapartum and the postpartum periods.ConclusionsThe group that received care from providers who completely adhered to the ANC guidelines during the first antenatal visit showed significantly improved neonatal outcomes. However, it did not show a significant improvement in maternal outcomes. Hence, focusing on safe motherhood programmes like training that gears provider’s conformity to ANC guideline is quite crucial to improve neonatal outcomes.

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