Association of Differential Metabolites With Small Intestinal Microflora and Maternal Outcomes in Subclinical Hypothyroidism During Pregnancy

ObjectiveTo investigate the association of differential metabolites with small intestinal microflora and maternal outcomes in subclinical hypothyroidism (SCH) during pregnancy.MethodsThe plasma of pregnant women in the SCH group and control group was analyzed by liquid chromatography-mass spectrometry (LC-MS), obtaining differential metabolites. Then, methane and hydrogen breath tests were performed in both groups, and basic clinical data and maternal outcome information were collected. Finally, differential metabolites were analyzed for small intestinal bacterial overgrowth (SIBO) and pregnancy outcomes using Spearman correlation analysis.Results(1) Multivariate statistics: There were 564 different metabolites in positive ion mode and 226 different metabolites in negative ion mode. (2) The positive rate of the methane hydrogen breath test in the SCH group was higher than that in the control group (p<0.05). (3) KEGG pathway analysis revealed that differential metabolites were mainly involved in bile secretion, cholesterol metabolism, and other pathways. (4) Serum cholesterol (TC) and triglyceride (TG) levels and hypertensive disorder complicating pregnancy (HDCP) were higher in the SCH group (p<0.05), and newborn birth weight (BW) was lower than that in the control group (p<0.05). (5) SIBO was negatively correlated with glycocholic acid and BW, and positively correlated with TC. Glycocholic acid was negatively correlated with TG but positively correlated with BW. TG was positively correlated with HDCP.ConclusionDifferential metabolites in the SCH group during pregnancy were disordered with small intestinal bacteria, which may affect pregnancy outcomes, and bile acids and cholesterol may be potential biomarkers for studying their mechanism of action.

Knowledge, Attitude and Practices on Maternal Hypertensive Disorder Among Mothers in Kuantan, Pahang, Malaysia

Maternal hypertensive disorder (MHD) complicates 10% of pregnancy worldwide. In Malaysia, the percentage of maternal deaths due to MHD increased from 2012 to 2017 and did not show any decline yet. Hence, this study was aimed to develop and validate the questionnaires, to measure the level of knowledge, attitude and practices (KAP) on MHD, to evaluate the associated factors and any correlation between KAP on MHD. A cross-sectional study was conducted in Kuantan, Pahang between January 2020 and March 2020. A convenience sampling was used, and self-administered questionnaires were distributed to 100 respondents that fulfil the criteria. The questionnaire was developed through literature review and validated by five medical experts. Then, the pilot study validation was resulted in 0.894 of Cronbach’s Alpha test, which achieved the reliability between the questions. Most of the respondents had a moderate knowledge (n=63; 63.0%), moderate attitude (n=66; 66.0%) and high practices (n=61; 61.0%) on MHD. There was no significant association between socio-demographic factors and KAP of the respondents. A significant correlation is identified between knowledge and attitude (r=0.613, p<0.001) and knowledge and practice (r =0.326, p=0.001) but no significant association between attitude and practice (r=0.183, p=0.068). In conclusion, this study has revealed that majority of the respondents possess moderate knowledge and attitude, and excellent practice on MHD. Hence, future studies that related to KAP on maternal mortality and morbidity across setting should be done so that the early prevention steps can be taken to accommodate the possible problems that may arise in the future.

Serum Lactate Dehydrogenase Level in Pregnancy Induced Hypertension and Fetomaternal Outcome

Hypertensive disorders complicate 5-10% of all pregnancies and associated with potentially dangerous maternal and fetal complications. Studies have shown that pre-eclamptic patients with higher levels of lactate dehydrogenase (LDH) are at high risk of developing subsequent complications with poor maternal and fetal outcome. So with the aim to correlate serum LDH level in pregnancy induced hypertension (PIH) with fetomaternal outcome this hospital based observational descriptive study was done at Tribhuvan University Teaching Hospital (TUTH) for the duration of 1 year from 15th May, 2018 to 14th May, 2019. Women with PIH fulfilling inclusion criteria were enrolled in the study. Serum LDH level was measured and severity of PIH, maternal and perinatal outcome were studied according to the levels of LDH. Results were analyzed using SPSS 18. The incidence of hypertensive disorder in pregnancy was 4.74% in this study and total 180 cases were enrolled. The mean serum LDH level increased with increase in severity of PIH. Thirty two (17.7%) cases had maternal complications and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome was most common complication. More than 2/3rd (62.5%) of cases with LDH level >800 IU/L had complications. The most common perinatal complication was intrauterine growth restriction (IUGR). The perinatal morbidity and mortality were significantly high in patients with PIH with LDH level >800 IU/l. As with the increase in serum LDH level increase in maternal and fetal complications was observed, LDH can be a useful biochemical marker that reflects the severity of PIH.

Maternal mortality in the city of Berlin: consequences for perinatal healthcare

Objectives The fifth of the United Nations’ Millennium Development Goals proposed for 2000–2015 was to improve maternal health, which has only partially been achieved. Worldwide, the maternal mortality ratio is currently estimated at 216/100.000 livebirths, compared to 380/100,000 in 1990. As yet, there has been no published comprehensive analysis of maternal mortality data as it pertains to Berlin and by extension Germany. Aim of the study was to evaluate and analyze the maternal mortality rate of Berlin as a result of shortcomings in healthcare provision and identify possible solutions. Methods The Institute for Quality and Transparency in the Healthcare Sector sourced external quality control from the Qualitätsbüro Berlin to provide maternal mortality data from Berlin hospitals from 2007 to 2020. Results Nineteen maternal deaths were registered between 2007 and 2020 in total. Case analysis shows that two main events occur: thrombosis and hemorrhage at 31.6%, respectively, followed by hypertensive disorder (15.8%), and sepsis (15.8%). After detailed analysis of each case report, we determined 8/19 (42.1%) maternal deaths as being potentially preventable given slightly altered circumstances. Consequences The system of registration of perinatal data in Germany does not allow for a comprehensive recording of maternal death and requires alteration to provide a more accurate picture of the phenomenon of maternal mortality; presumably, there exist twice as many unreported cases. Conclusions Symptoms, risks, and primary prevention tactics of thromboembolism during pregnancy and birth should be imparted to every licensed professional in individual hospital settings, along with evidence-based simulation training for the event of obstetric or prepartum hemorrhage.

Overview of obstetric patients and their outcome in a tertiary hospital of Bangladesh

Background: In developing countries like Bangladesh major population lives in rural areas, lacking access to essential obstetric facilities. Timely referral can reduce maternal morbidity and avoid maternal death in many instances. However lack of structured referral system is a major hurdle that delays proper management of such cases. The objective of the study was to review the pattern of obstetric cases admitted in our hospital, to study the clinical course and management of women during the hospital stay and to study the maternal and perinatal outcomes in terms of live birth or still birth, intra uterine fetal death and neonatal admission. Methods: It is a retrospective observational study conducted in the department of Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka, from July 2018 to June 2019, including2880 obstetric cases admitted in the hospital. Detailed history of the patients were taken, frequency of each disease was calculated separately. Management of the patient and mode of delivery were noted. Fetal outcome parameters like live or still birth and intra uterine fetal death were noted. Results: Among 3953 admitted patients, obstetric cases were 2880 (73%).Maximum number of patients were booked cases(84.09%) and 75% were from urban area. The patients were in the age group from 18 to 40 years,32% were primigravida and 68% were multi gravida. Majority of our admitted patients had either diabetes mellitus or gestational diabetes mellitus, 58.19% and 23.95% respectively. Common co morbidities and obstetric complications were hypertensive disorder of pregnancy, anaemia, premature rupture of membrane, oligohydramnios and fetal growth restriction. Among the 2084 delivered cases were delivered by ceasarean section (86.42%) 13.53% were delivered vaginally. Commonest indication for cesarean delivery was history of previous cesarean section. Conclusion: Wide spectrum of complicated obstetric cases were admitted to our tertiary care hospital. Many complicated patients were referred from different centers for special management. But delayed referral sometimes could not help properly and also resulted in a high number of cesarean section. BIRDEM Med J 2022; 12(1): 41-44

Preeclampsia: From Etiopathology to Organ Dysfunction

Preeclampsia is a hypertensive disorder of pregnancy affecting 6–12% of the population. There are various risk factors for the development of preeclampsia, ranging from advanced maternal age to genetics. The proposed etiologies for preeclampsia are abnormal placentation, immunological intolerance, endothelial damage, and genetic inheritance. The pathogenesis includes endothelial activation and dysfunction leading to vasospasm. Preeclampsia is divided into two stages: asymptomatic and symptomatic stages. Preeclampsia causes multiple organ involvement, namely central nervous system, respiratory, cardiovascular, hematological dysfunction, HELLP (hemolysis elevated liver enzymes, low platelets) syndrome, endocrine, renal, hepatic, and uteroplacental dysfunction. These organ dysfunctions increase morbidity and mortality in preeclamptic pregnant patients.

The Role of The Doppler Study (Umbilical, Middle, Cerebral Arteries and Ductus Venosus) to Predict General Adverse Pregnancy Outcomes in Patients With Hypertensive Diseases in The Third Trimester

Background: The hypertensive pregnancies complicated by preeclampsia show an increase in maternal and perinatal morbidity and mortality.Color Doppler ultrasound has been employed for fetal surveillance. Objective: To evaluate the role of Doppler study in the prediction of adverse pregnancy outcomes in hypertensive pregnant women at the third trimester of pregnancy. Patients and Methods: A clinical prospective follow up study conducted in Outpatient Ultrasound Clinic at Al-Imamein Kadhimein Medical City, Baghdad, Iraq from 1st July, 2018 till 31st of July 2019 included 50 pregnant women with hypertensive disorder of pregnancy at the third trimester. The fetal and neonatal outcome was reported poor when intrauterine fetal death occurs during follow-up of pregnant women or more than two of the reported neonatal complications were poor. Results: Means of the middle cerebral artery and umbilical artery-resistance and pulasatility indices ratio were significantly decreased among pregnant women with poor neonatal outcomes. Similarly, the umbilical artery end-diastolic flow and Ductus Venousu waveforms were Conclusion: The middle cerebral artery and umbilical artery indices of pregnant women with hypertensive disorders are good predictors for neonatal outcomes. Keywords: Hypertensive disorder, Middle cerebral artery, Umbilical artery, Ductus venosus

Elevated IL-6 in Pre-Eclampsia Increases Neurite Growth and Mitochondrial Respiration in an in vitro Model of Neuronal Development

Pre-eclampsia (PE) is a common and serious hypertensive disorder of pregnancy, which affects 3-5% of first-time pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. Prenatal exposure to PE is associated with an increased risk of neurodevelopmental disorders in affected offspring, although the cellular and molecular basis of this are largely unknown. In this study we examined the effects of exposure to maternal serum from women with PE or a healthy uncomplicated pregnancy on the survival, neurite growth and mitochondrial function of SH-SY5Y cells. We report that cells exposed to PE serum exhibited increased neurite growth and mitochondrial respiration, two important neurodevelopmental parameters, compared to those treated with control serum. Levels of the pleiotropic cytokine IL-6 were significantly elevated in the PE sera, and cells exposed to PE serum displayed increased phospho-STAT3 levels which is a key intracellular mediator of IL-6 signalling. Finally, we show that treating these cells with IL-6 alone is sufficient to induce a similar neurite growth and respiratory phenotype to PE serum-exposed cells. This suggests that elevated IL-6 seen in maternal serum in PE may be responsible at least in part for its inducing increased neurite growth and mitochondrial respiration in SH-SY5Y cells. Overall, this study demonstrates that there are circulating factors in the serum of women with pre-eclampsia that affect neuronal development and oxygen consumption differently to that of a healthy uncomplicated pregnancy, and that immune dysregulation via elevated IL-6 may be important in mediating these effects.

Efectos adversos perinatales asociados a adiposidad materna durante la gestación

Objective: To determine perinatal adverse effects associated with maternal adiposity during pregnancy between November 2017 and October 2018, in the Obstetrics and Gynecology Service at the University Hospital: Dr. Jesús María Casal Ramos, Acarigua – Araure, Edo. Portuguesa. Methods: Descriptive, retrospective cross-sectional with a sample consisting of 115 clinical records of overweight and obese pregnant women. Results: No early adolescent primigestas were found. Among the 67 overweight and type I obese patients, women aged 26-30 years (22/32.8 % and 10/34.5 %) predominated, followed by the 21-25 group (18/26.9 % and 8/27.6 %). Patients with type II and III obesity had a more homogeneous distribution. Weight gain during pregnancy was less than 10 kg in 85 patients (73.9 %). Full-term pregnancies predominated in all groups (91 %, 82.2 %, 80% and 88.9 %). Delivery was predominantly vaginal in overweight and obese patients type I (70.1% and 51.7%), cesarean section was more frequent in typi II and III obesity (60 % and 55.6 %). The most frequent maternal complications in overweight patients were: vaginal infections (25.4 %), urinary tract infections (14.9%) and anemia (14.9 %). Among obese women there was a higher frequency of hypertensive disorder of pregnancy (24.1 %, 50 % and 55.6 % in obesity I, II and III, respectively). Among the neonatal complications, low weight and prematurity predominated. Conclusions: Overweight and obesity are factors related to maternal and perinatal adverse effects. Key words: Adiposity, Perinatal effects, Overweight.

Perinatal Death Surveillance and Response: A Secondary Analysis of Nepal’s Efforts

This paper presents Nepal’s experience regarding perinatal death surveillance and the country’s response in reducing preventable perinatal deaths. In developing this paper, evidence of perinatal mortality in Nepal is brought from secondary sources, mainly the assessment report of Maternal and Perinatal Death Surveillance and Response (MPDSR) system. As of 2019, this initiative has been implemented in 77 hospitals across Nepal. Challenges and barriers in implementing the MPDSR system need to be brought to attention, as the system is being scaled up to 110 hospitals. Data from the Perinatal Death Review revealed that 72% of the maternal deaths occurred during the post-partum period, due to (i) post-partum haemorrhage, (ii) hypertensive disorder, (iii) pregnancy-related infections, and (iv) non-obstetric causes. In 70% of the cases such deaths could have been prevented. Majority of perinatal deaths, at 71%, were stillbirths, mainly due to low child weight of less than 2500 grams. In conclusion, there is urgent need for the national guidelines for MPDSR system to be amended, additional and continued training provision to the health workforce, improvement in the coordination and feedback mechanism, and strengthening of the information management system. Key words: MPDSR system; Perinatal Death Review; Nepal; Perinatal Mortality; Stillbirth