The Significance of Early Pregnancy Units in the Practice of a Busy Obstetric Unit

ABSTRACT A significant proportion of women experience bleeding in early pregnancy resulting in considerable distress. Early pregnancy unit (EPAU) should promote the sensitive and efficient management of women with early pregnancy problems and we believe this is best achieved by the establishment of a dedicated unit with dedicated staff. This paper outlines the experience of setting up an early pregnancy unit in a busy obstetrical unit.

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Miscarriage and recurrent miscarriage

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0038 ◽

2020 ◽

pp. 477-488

Author(s):

Vikram Sinai Talaulikar ◽

Mushi Matjila

Keyword(s):

Early Pregnancy ◽

Pregnancy Loss ◽

Recurrent Miscarriage ◽

Significant Proportion ◽

Phenotypic Characterization ◽

Future Research ◽

Management Options ◽

Global Consensus ◽

Comprehensive Information ◽

Definition Of

Complications of early pregnancy, including pregnancy loss and threatened miscarriage, are common. Miscarriage affects almost one in five pregnancies and accounts for utilization of a significant proportion of healthcare resources. Women presenting with miscarriage should ideally be assessed, diagnosed, and managed in early pregnancy assessment units. They should be provided with comprehensive information about expectant, medical, and surgical management options, and helped to make informed decisions about their care. Early pregnancy loss can be a source of considerable distress to women and they should be provided with appropriate support and counselling. Recurrent miscarriage (RM) remains a challenge to patients and clinicians alike. Recognition of the psychosocial impact should prompt involvement of mental health specialists, counsellors, and social workers in patient management. Inconsistencies in definition (two or three consecutive miscarriages) confound research in RM. Although endocrinological, thrombotic, autoimmune, and uterine structural perturbations have been described in association with RM, antiphospholipid syndrome and embryonic karyotype abnormalities remain the two closest conditions for which a reasonable explanation can be offered to patients along with prognostication for future pregnancies. A diagnosis of RM has additional implications, not only for previable pregnancy loss, but an association with adverse obstetric and future maternal health outcomes. A global consensus on the definition of RM, along with phenotypic characterization of this heterogeneous condition would improve interpretation of available data and future research. A thorough understanding of the underlying molecular pathophysiological mechanisms in specific phenotypic categories of RM is the fundamental requisite for the advancement of this field.

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Early Gestational Diabetes Mellitus: Diagnostic Strategies and Clinical Implications

Medical Sciences ◽

10.3390/medsci9040059 ◽

2021 ◽

Vol 9 (4) ◽

pp. 59

Author(s):

Saptarshi Bhattacharya ◽

Lakshmi Nagendra ◽

Aishwarya Krishnamurthy ◽

Om J. Lakhani ◽

Nitin Kapoor ◽

...

Keyword(s):

Diabetes Mellitus ◽

Early Pregnancy ◽

International Association ◽

Significant Proportion ◽

Perinatal Outcomes ◽

Tolerance Test ◽

Screening Tools ◽

Oral Glucose ◽

Diagnostic Strategies ◽

In Pregnancy

Preexisting diabetes mellitus (DM) should be ruled out early in pregnancy in those at risk. During screening, a significant proportion of women do not reach the threshold for overt DM but fulfill the criteria used for diagnosing conventional gestational DM (cGDM). There is no consensus on the management of pregnancies with intermediate levels of hyperglycemia thus diagnosed. We have used the term early gestational DM (eGDM) for this condition and reviewed the currently available literature. Fasting plasma glucose (FPG), oral glucose tolerance test, and glycated hemoglobin (HbA1c) are the commonly employed screening tools in early pregnancy. Observational studies suggest that early pregnancy FPG and Hba1c correlate with the risk of cGDM and adverse perinatal outcomes. However, specific cut-offs, including those proposed by the International Association of the Diabetes and Pregnancy Study Group, do not reliably predict the development of cGDM. Emerging data, though indicate that FPG ≥ 92 mg/dL (5.1 mmol/L), even in the absence of cGDM, signals the risk for perinatal complication. Elevated HbA1c, especially a level ≥ 5.9%, also correlates with the risk of cGDM and worsened outcome. HbA1c as a diagnostic test is however besieged with the usual caveats that occur in pregnancy. The studies that explored the effects of intervention present conflicting results, including a possibility of fetal malnutrition and small-for-date baby in the early treatment group. Diagnostic thresholds and glycemic targets in eGDM may differ, and large multicenter randomized controlled trials are necessary to define the appropriate strategy.

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Non-typeable Haemophilus influenzae-associated early pregnancy loss: an emerging neonatal and maternal pathogen

Infection ◽

10.1007/s15010-019-01359-6 ◽

2019 ◽

Vol 48 (2) ◽

pp. 285-288

Author(s):

Muge Cevik ◽

Olga L. Moncayo-Nieto ◽

Margaret J. Evans

Keyword(s):

Abdominal Pain ◽

Haemophilus Influenzae ◽

Pregnant Women ◽

Early Pregnancy ◽

Pregnancy Loss ◽

Significant Proportion ◽

Previous History ◽

Clinical Signs ◽

Early Pregnancy Loss ◽

Septic Abortion

Abstract Objectives There is increasing evidence indicating an association between invasive non-typeable Haemophilus influenzae (NTHi) infection in pregnancy and early pregnancy loss. As the diagnosis relies on microbiological investigation of post-mortem placental and foetal samples, a significant proportion of NTHi-related pregnancy loss remains unrecognised. To better characterise NTHi in septic abortion, we report NTHi cases associated with early pregnancy loss. Methods We reviewed all post-mortems at <24 weeks gestation with histologically proven acute chorioamnionitis on placental histology and enrolled cases with at least one matched foetal and placental sample culture positive for NTHi. The study was approved by the NHS Lothian Caldicott Guardian. Results In our cohort, invasive NTHi has accounted for 20% of infections associated with early pregnancy loss prior to 24 weeks gestation. All patients were young and healthy pregnant women at < 20 weeks' gestation who presented with abdominal pain, PV bleed /discharge and were septic at the time of presentation. One patient with previous history of miscarriage who presented with cervical incompetence had more severe pathology suggestive of early intrauterine pneumonia. Conclusion The burden of invasive NTHi disease in early pregnancy loss is likely to be much larger than currently recognised. NTHi should be considered in pregnant women presenting with abdominal pain and PV bleed/discharge in whom clinical signs of sepsis are present. Active surveillance should be considered in this patient group including septic abortion to capture the true prevalence of this emerging pathogen to inform preventative and therapeutic approaches.

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Underlying Kidney Diseases and Complications for COVID-19: A Review

Frontiers in Medicine ◽

10.3389/fmed.2020.600144 ◽

2020 ◽

Vol 7 ◽

Author(s):

Prince Dadson ◽

Comfort Dede Tetteh ◽

Eleni Rebelos ◽

Robert M. Badeau ◽

Dariusz Moczulski

Keyword(s):

Kidney Diseases ◽

Significant Proportion ◽

Kidney Injury ◽

Multiple Organ ◽

Organ Injury ◽

Angiotensin Receptors ◽

Close Monitoring ◽

Systematic Screening ◽

Therapeutic Drugs ◽

Efficient Management

There is mounting evidence supporting that patients with kidney diseases are particularly vulnerable to coronavirus disease-2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The review was conducted to examine the risk and complications of COVID-19 among patients with confirmed cases of underlying kidney disease. A search of Google Scholar, PubMed and Science direct databases to August 2020 was conducted using search terms pertaining to kidney diseases, renal insufficiency, kidney injury, angiotensin receptors, hemodialysis, and kidney transplant. We briefly reviewed COVID-19 in the context of kidney diseases. A significant proportion of hospitalized patients for COVID-19 have acute kidney injury, which further deteriorates their prognosis. COVID-19 increases morbidity and mortality among people already diagnosed with kidney disorders and obesity due to multiple organ injury caused by the SARS-CoV-2. This review supports the need for clinicians to carefully manage and monitor all patients with renal disorders in order to minimize acute kidney injuries. Although some therapeutic drugs have been suggested by some studies, treatment should be administered cautiously not to worsen the condition of the kidney. Further studies are required to highlight the efficient management of patients with underlying kidney diseases, who are infected with SARS-CoV-2. With proactive systematic screening and triaging, close monitoring and prompt management of coexisting other infections, the COVID-19 disease burden among these patients could be reduced.

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Information-Seeking on the Internet

Crisis ◽

10.1027/0227-5910/a000307 ◽

2015 ◽

Vol 36 (3) ◽

pp. 211-219 ◽

Cited By ~ 11

Author(s):

Vinod Singaravelu ◽

Anne Stewart ◽

Joanna Adams ◽

Sue Simkin ◽

Keith Hawton

Keyword(s):

At Risk ◽

Young People ◽

Information Seeking ◽

Significant Proportion ◽

The Internet ◽

Search Terms ◽

Specific Advice ◽

Restriction Sites ◽

Self Harm ◽

Negative Tone

Abstract. Background: The Internet is used by young people at risk of self-harm to communicate, find information, and obtain support. Aims: We aimed to identify and analyze websites potentially accessed by these young people. Method: Six search terms, relating to self-harm/suicide and depression, were input into four search engines. Websites were analyzed for access, content/purpose, and tone. Results: In all, 314 websites were included in the analysis. Most could be accessed without restriction. Sites accessed by self-harm/suicide search terms were mostly positive or preventive in tone, whereas sites accessed by the term ways to kill yourself tended to have a negative tone. Information about self-harm methods was common with specific advice on how to self-harm in 15.8% of sites, encouragement of self-harm in 7.0%, and evocative images of self-harm/suicide in 20.7%. Advice on how to get help was given in 56.1% of sites. Conclusion: Websites relating to suicide or self-harm are easily accessed. Many sites are potentially helpful. However, a significant proportion of sites are potentially harmful through normalizing or encouraging self-harm. Enquiry regarding Internet use should be routinely included while assessing young people at risk.

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Searching Online for Methods of Suicide

Crisis ◽

10.1027/0227-5910/a000701 ◽

2020 ◽

pp. 1-8

Author(s):

Christian Ulrich Eriksen ◽

Flemming Konradsen ◽

Thilde Vildekilde

Keyword(s):

Content Analysis ◽

English Language ◽

Significant Proportion ◽

Background Information ◽

Access To Information ◽

Online Content ◽

Negative Effects ◽

Search Terms ◽

Methods Of Suicide

Abstract. Background: Information on methods of suicide is available online, and access to information on methods of suicide appears to contribute to a small but significant proportion of suicides. There is limited documentation of how methods of suicide are being profiled, as well as what content exists in other languages than English. Aim: We aimed to analyze and compare how methods of suicide are profiled on Danish and English-language websites. Method: We applied a categorization and content analysis of websites describing methods of suicide. Sites were retrieved by applying widely used Danish and English-language search terms. Results: A total of 136 English-language websites and 106 Danish-language websites were included for analysis. Websites were more often categorized as prevention or support sites, academic or policy sites, and against suicide sites than dedicated suicide sites (i.e., pro-suicide sites), or information sites. However, information on methods of suicide was available, and 20.1% and 8.9% of the English and Danish-language sites, respectively, suggested that a particular method of suicide was quick, easy, painless, or certain to result in death. Limitations: Only one author coded and analyzed all websites. A further operationalization of the content analysis checklist is warranted to increase reliability. Conclusion: The websites primarily had a prevention or anti-suicide focus, but information on methods of suicide was available, requiring an increased focus on how to diminish the negative effects of harmful online content.

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In Search of the Prosocial Personality

Journal of Individual Differences ◽

10.1027/1614-0001/a000276 ◽

2019 ◽

Vol 40 (1) ◽

pp. 55-62 ◽

Cited By ~ 3

Author(s):

Anja Wertag ◽

Denis Bratko

Keyword(s):

Prosocial Behavior ◽

Personality Traits ◽

Significant Proportion ◽

Dark Triad ◽

Self Report ◽

Hierarchical Regression ◽

Regression Analyses ◽

The Relationship

Abstract. Prosocial behavior is intended to benefit others rather than oneself and is positively linked to personality traits such as Agreeableness and Honesty-Humility, and usually negatively to the Dark Triad traits (i.e., Machiavellianism, narcissism, and psychopathy). However, a significant proportion of the research in this area is conducted solely on self-report measures of prosocial behavior. Therefore, the aim of this study was to investigate the relationship between prosociality and the basic (i.e., HEXACO) and dark personality traits, comparing their contribution in predicting both self-reported prosociality and prosocial behavior. Results of the hierarchical regression analyses showed that the Dark Triad traits explain prosociality and prosocial behavior above and beyond the HEXACO traits, emphasizing the importance of the Dark Triad in the personality space.

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