scholarly journals What is the Impact of Abnormal Amniotic Fluid Volumes on Perinatal Outcomes in Normal Compared with At-Risk Pregnancies?

2020 ◽  
Vol Volume 12 ◽  
pp. 805-812
Author(s):  
Pamela M Simmons ◽  
Julie R Whittington ◽  
Sarah M Estrada ◽  
Songthip T Ounpraseuth ◽  
Kelsey B Shnaekel ◽  
...  
Keyword(s):  
At Risk ◽  
Amniotic Fluid ◽  
Perinatal Outcomes ◽  
The Impact

scholarly journals The association between isolated oligohydramnios at term and pregnancy outcome and perinatal outcome in case of isolated oligohydramnosis: a retrospective analysis

2021 ◽  
Vol 11 (1) ◽  
pp. 136
Author(s):  
Vijay M. Kansara ◽  
Kunal D. Kadakar ◽  
Akash S. Chikani ◽  
Pinal A. Pateliya
Keyword(s):  
Amniotic Fluid ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Labour Induction ◽  
Control Group ◽  
Amniotic Fluid Index ◽  
Observational Cohort ◽  
Adverse Perinatal Outcomes ◽  
The Impact

Background: Current study was carried out to assess the impact of isolated oligohydramnios on perinatal outcomes and mode of delivery.Methods: A retrospective observational cohort study was conducted at term pregnancy with sonographic finding of isolated oligohydramnios (AFI <5 cm) were recruited for the study. Uterine anomaly and high risk pregnancies were excluded from the study. The mode of delivery and perinatal outcome were compared with control group of pregnancy with normal amniotic fluid (AFI >5-25 cm).Results: When compared to the normal AFI, women with oligohydramnios had significantly lower birth weight babies and were delivered at a significantly earlier gestational age. However there was no difference in the APGAR scores at birth and NICU admissions between the two groups. Reactive NST had more chances of good APGAR score at 1 and 5 minute and that lower the AFI more the probability of nonreactive NST and abnormal Doppler. The number of inductions and caesareans done for foetal reasons were significantly higher in the exposed group.Conclusions: Obstetric and perinatal outcome remains similar in both isolated oligohydramnios with reactive NST as well as in patients with normal amniotic fluid index. Isolated oligohydramnios is not associated with adverse perinatal outcomes. However, it increases the risk for labour induction and caesarean section.

scholarly journals COVID-19 in Pregnancy—Perinatal Outcomes and Vertical Transmission Preventative Strategies, When Considering More Transmissible SARS-CoV-2 Variants

2021 ◽  
Vol 10 (16) ◽  
pp. 3724
Author(s):  
Marcin Januszewski ◽  
Laura Ziuzia-Januszewska ◽  
Malgorzata Santor-Zaczynska ◽  
Alicja A. Jakimiuk ◽  
Tomasz Oleksik ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Amniotic Fluid ◽  
Pregnant Women ◽  
Vertical Transmission ◽  
Health Care Systems ◽  
Perinatal Outcomes ◽  
Nasopharyngeal Swab ◽  
Physical And Mental Health ◽  
Study Results ◽  
The Impact

The COVID-19 pandemic affected the physical and mental health of people around the world and left unprepared health care systems struggling to mount an adequate response. Understanding the impact of COVID-19 on pregnancy in terms of perinatal and fetal outcomes is essential to propose strategies for mminimising viral transmission. Overall, 91 pregnant women in labour, or with indication for induction of labour, with COVID-19 were admitted to hospital. On the day of admission, each pregnant woman underwent a nasopharyngeal swab to validate SARS-CoV-2 infection. Whenever delivery was by caesarean section, an amniotic fluid sample was collected after uterus incision. Neonates were tested twice: first by nasopharyngeal swab at birth and secondly either at 24 h after (when babies were isolated) or at discharge (when rooming-in). All samples underwent rRT-PCR testing for SARS-CoV-2. The SARS-CoV-2 RNA tests by nasopharyngeal swab of the pregnant women produced positive results in 47 patients. This cohort gave birth to 48 infants who were double tested by nasopharyngeal swab and included in the prospective observational study. Moreover, in this same cohort, 39 amniotic fluid samples were taken during caesarean section. All samples underwent rRT-PCR testing for SARS-CoV-2 and came back negative. The study results suggest a low risk of vertical transmission of COVID-19 and favourable perinatal outcomes due to adequate preventative strategies. This approach may prove to be more beneficial in the new SARS-CoV-2 variants era.

The Democratic Costs of Constitutionalization— The European Case

2017 ◽  
Author(s):  
Dieter Grimm
Keyword(s):  
At Risk ◽  
Economic Integration ◽  
Fundamental Rights ◽  
European Law ◽  
European Court ◽  
Political Implications ◽  
The Impact ◽  
The Relationship ◽  
The Eu

This chapter examines the democratic costs of constitutionalization by focusing on the European case. It first considers the interdependence of democracy and constitutionalism before discussing how constitutionalization can put democracy at risk. It then explores the tension between democracy and fundamental rights, the constitutionalization of the European treaties, and the European Court of Justice’s (ECJ) two separate judgments regarding the relationship between European law and national law. It also assesses the impact of the ECJ’s jurisprudence on democracy, especially in the area of economic integration. The chapter argues that the legitimacy problem the EU faces is caused in part by over-constitutionalization and that the remedy to this problem is re-politicization of decisions with significant political implications.

scholarly journals Adolescent, Pregnant, and HIV-Infected: Risk of Adverse Pregnancy and Perinatal Outcomes in Young Women from Southern Mozambique

2021 ◽  
Vol 10 (8) ◽  
pp. 1564
Author(s):  
Clara Pons-Duran ◽  
Aina Casellas ◽  
Azucena Bardají ◽  
Anifa Valá ◽  
Esperança Sevene ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Maternal Morbidity ◽  
Low Birthweight ◽  
Negative Binomial ◽  
Perinatal Outcomes ◽  
Sub Saharan Africa ◽  
P Value ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Sub-Saharan Africa concentrates the burden of HIV and the highest adolescent fertility rates. However, there is limited information about the impact of the interaction between adolescence and HIV infection on maternal health in the region. Data collected prospectively from three clinical trials conducted between 2003 and 2014 were analysed to evaluate the association between age, HIV infection, and their interaction, with the risk of maternal morbidity and adverse pregnancy and perinatal outcomes in women from southern Mozambique. Logistic regression and negative binomial models were used. A total of 2352 women were included in the analyses; 31% were adolescents (≤19 years) and 29% HIV-infected women. The effect of age on maternal morbidity and pregnancy and perinatal adverse outcomes was not modified by HIV status. Adolescence was associated with an increased incidence of hospital admissions (IRR 0.55, 95%CI 0.37–0.80 for women 20–24 years; IRR 0.60, 95%CI 0.42–0.85 for women >25 years compared to adolescents; p-value < 0.01) and outpatient visits (IRR 0.86, 95%CI 0.71–1.04; IRR 0.76, 95%CI 0.63–0.92; p-value = 0.02), and an increased likelihood of having a small-for-gestational age newborn (OR 0.50, 95%CI 0.38–0.65; OR 0.43, 95%CI 0.34–0.56; p-value < 0.001), a low birthweight (OR 0.40, 95%CI 0.27–0.59; OR 0.37, 95%CI 0.26–0.53; p-value <0.001) and a premature birth (OR 0.42, 95%CI 0.24–0.72; OR 0.51, 95%CI 0.32–0.82; p-value < 0.01). Adolescence was associated with an increased risk of poor morbidity, pregnancy and perinatal outcomes, irrespective of HIV infection. In addition to provision of a specific maternity care package for this vulnerable group interventions are imperative to prevent adolescent pregnancy.

scholarly journals Food Insecurity in the United States: Identification, Treatment, and Implications

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 772-773
Author(s):  
Rose Ann DiMaria-Ghalili ◽  
Connie Bales ◽  
Julie Locher
Keyword(s):  
United States ◽  
Older Adults ◽  
At Risk ◽  
Food Insecurity ◽  
Well Being ◽  
The United States ◽  
Health Clinic ◽  
High Risk Population ◽  
Geriatric Syndrome ◽  
The Impact

Abstract Food insecurity is an under-recognized geriatric syndrome that has extensive implications in the overall health and well-being of older adults. Understanding the impact of food insecurity in older adults is a first step in identifying at-risk populations and provides a framework for potential interventions in both hospital and community-based settings. This symposium will provide an overview of current prevalence rates of food insecurity using large population-based datasets. We will present a summary indicator that expands measurement to include the functional and social support limitations (e.g., community disability, social isolation, frailty, and being homebound), which disproportionately impact older adults, and in turn their rate and experience of food insecurity and inadequate food access. We will illustrate using an example of at-risk seniors the association between sarcopenia, the age-related loss of muscle mass and function, with rates of food security in the United States. The translational aspect of the symposium will then focus on identification of psychosocial and environmental risk factors including food insecurity in older veterans preparing for surgery within the Veterans Affairs Perioperative Optimization of Senior Health clinic. Gaining insights into the importance of food insecurity will lay the foundation for an intervention for food insecurity in the deep south. Our discussant will provide an overview of the implications of these results from a public health standpoint. By highlighting the importance of food insecurity, such data can potentially become a framework to allow policy makers to expand nutritional programs as a line of defense against hunger in this high-risk population.

scholarly journals The impact of the COVID-19 pandemic on wellbeing and cognitive functioning of older adults

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sarah De Pue ◽  
Céline Gillebert ◽  
Eva Dierckx ◽  
Marie-Anne Vanderhasselt ◽  
Rudi De Raedt ◽  
...  
Keyword(s):  
Mental Health ◽  
Older Adults ◽  
At Risk ◽  
Sleep Quality ◽  
Cognitive Functioning ◽  
Online Survey ◽  
Activity Level ◽  
The Impact

AbstractCOVID-19 took a heavy toll on older adults. In Belgium, by the end of August, 93% of deaths due to COVID-19 were aged 65 or older. Similar trends were observed in other countries. As a consequence, older adults were identified as a group at risk, and strict governmental restrictions were imposed on them. This has caused concerns about their mental health. Using an online survey, this study established the impact of the COVID-19 pandemic on adults aged 65 years or older, and which factors moderate this impact. Participants reported a significant decrease in activity level, sleep quality and wellbeing during the COVID-19 pandemic. Depression was strongly related to reported declines in activity level, sleep quality, wellbeing and cognitive functioning. Our study shows that the COVID-19 pandemic had a severe impact on the mental health of older adults. This implies that this group at risk requires attention of governments and healthcare.

scholarly journals Fetal movement counting is associated with the reduction of delayed maternal reaction after perceiving decreased fetal movements: a prospective study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shigeki Koshida ◽  
Shinsuke Tokoro ◽  
Daisuke Katsura ◽  
Shunichiro Tsuji ◽  
Takashi Murakami ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Maternal Behavior ◽  
Multivariable Analysis ◽  
Perinatal Outcomes ◽  
Fetal Movement ◽  
Post Intervention ◽  
Fetal Movements ◽  
Adverse Perinatal Outcomes ◽  
The Impact ◽  
Maternal Reaction

AbstractMaternal perception of decreased fetal movement is associated with adverse perinatal outcomes. Although there have been several studies on interventions related to the fetal movements count, most focused on adverse perinatal outcomes, and little is known about the impact of the fetal movement count on maternal behavior after the perception of decreased fetal movement. We investigated the impact of the daily fetal movement count on maternal behavior after the perception of decreased fetal movement and on the stillbirth rate in this prospective population-based study. Pregnant women in Shiga prefecture of Japan were asked to count the time of 10 fetal movements from 34 weeks of gestation. We analyzed 101 stillbirths after the intervention compared to 121 stillbirths before the intervention. In multivariable analysis, maternal delayed visit to a health care provider after the perception of decreased fetal movement significantly reduced after the intervention (aOR 0.31, 95% CI 0.11–0.83). Our regional stillbirth rates in the pre-intervention and post-intervention periods were 3.06 and 2.70 per 1000 births, respectively. Informing pregnant women about the fetal movement count was associated with a reduction in delayed maternal reaction after the perception of decreased fetal movement, which might reduce stillbirths.

scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Shakespeare ◽  
Handsome Dube ◽  
Sikhangezile Moyo ◽  
Solwayo Ngwenya
Keyword(s):  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Before And After ◽  
The Mean ◽  
Significant Change ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

European Respiratory Society Statement on Sleep Apnoea, Sleepiness and Driving Risk

2020 ◽  
pp. 2001272
Author(s):  
Maria R Bonsignore ◽  
Winfried Randerath ◽  
Sofia Schiza ◽  
Johan Verbraecken ◽  
Mark W Elliott ◽  
...  
Keyword(s):  
At Risk ◽  
Motor Vehicle ◽  
Task Force ◽  
Present Report ◽  
Sleep Apnoea ◽  
Accident Risk ◽  
European Respiratory Society ◽  
Obstructive Sleep ◽  
Patients At Risk ◽  
The Impact

Obstructive sleep apnoea (OSA) is highly prevalent and is a recognised risk factor for motor vehicle accidents (MVA). Effective treatment with continuous positive airway pressure (CPAP) has been associated with a normalisation of this increased accident risk. Thus, many jurisdictions have introduced regulations restricting the ability of OSA patients from driving until effectively treated. However, uncertainty prevails regarding the relative importance of OSA severity determined by the apnoea-hypopnoea frequency per hour and the degree of sleepiness in determining accident risk. Furthermore, the identification of subjects at risk for OSA and/or accident risk remains elusive. The introduction of official European regulations regarding fitness to drive prompted the European Respiratory Society to establish a Task Force to address the topic of sleep apnoea, sleepiness and driving with a view to providing an overview to clinicians involved in treating patients with the disorder. The present report evaluates the epidemiology of MVA in patients with OSA, the mechanisms involved in this association, the role of screening questionnaires, driving simulators and other techniques to evaluate sleepiness and/or impaired vigilance, the impact of treatment on MVA risk in affected drivers, and highlights the evidence gaps regarding the identification of OSA patients at risk for MVA.

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