Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing

Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor. Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users’ preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor.

Studi Kasus Pada Ibu Hamil Ny K Dengan Jarak Kehamilan Dekat Dan Anemia

Anemia is defined as a condition with Hb levels in the blood below the normal 11gr/dL, anemia in Indonesia that often occurs is iron deficiency anemia. According to WHO that pregnant women who experience iron deficiency are around 35-37% and will increase with gestational age, iron deficiency anemia in pregnant women has a bad impact on both the mother and the fetus. Pregnant women with severe anemia are more likely to have premature labor and have low birth weight (LBW) babies and increase perinatal mortality. The design method used in this case describes midwifery care in pregnant women with anemia. Data was collected by anamnesis physical examination method, through inspection, palpation, auscultation, percussion. For this reason, midwives are expected to provide care to overcome anemia in pregnancy so that it does not cause ongoing problemsKeywords: Anemia; Pregnancy AbstrakAnemia didefinisikan sebagai kondisi dengan kadar Hb dalam darah di bawah normal 11gr/dL, anemia di indonesia yang sering terjadi adalah anemia defisiensi zat besi. Menurut WHO bahwa ibu hamil yang mengalami defisiensi besi sekitar 35-37% dan akan semakin meningkat seiring dengan usia kehamilan, anemia defisiensi zat besi pada ibu hamil mempunyai dampak buruk baik pada ibunya maupun pada janin yang dikandungnya. ibu hamil dengan anemia berat lebih memungkinkan terjadinya partus premature dan memiliki bayi berat badan lahir rendah (BBLR) serta meningkatkan kematian perinatal. Rancangan metode yang dilakukan pada kasus ini menggambarkan asuhan kebidanan pada kehamilan dengan anemia. Pengumpulan data dilakukan dengan metode anamnesa pemeriksaan fisik, melalui inspeksi, palpasi, auskltasi, perkusi. Untuk itu bidan di harapkan dapat memberikan asuhan untuk mengatasi anemia pada kehamilan sehingga tidak menimbulkan masalah yang berkelanjutanKata kunci: Anemia;Kehamilan

Placental markers of miscarriage

Successful implantation involves a high degree of development of spiral arteries, combined with high proliferative activity, which ensures the formation of a healthy placenta, full uterine-placental circulation, and the birth of a healthy child. The placenta is the unique organ of the biological monitoring, the mirror of pregnancy. Identification of placental markers of miscarriage is a promising direction for preventing reproductive losses. The aim of the work is to identify the markers of miscarriage and premature labor in the structures of the chorion and placenta. Materials and methods. The main group included tissue samples of the 22 chorions and 64 placentas after termination of current pregnancy from women with a history of reproductive losses. The control group included tissue samples of the 20 chorions after artificial abortion and 20 placentas after physiological pregnancy and birth. The placenta was examined according to the protocol (form No. 013-1/0). The expressions of VEGF, CD31/PECAM1, CD105/Endoglin/TGFβ 1/3 Receptor, Bcl-2α Ab-1, TNF-α, CD45/T200/LCA, CD56/NCAM1 were studied in the structures of chorion and placenta by immunohistochemistry. Results. Based on histological and immuno-histochemical study of chorion and placenta samples in women with reproductive history and termination of the current pregnancy, it was established that embryo-endometrial dysfunction is the cause of miscarriage in the first trimester, and inflammation is the precondition of preterm birth; markers of miscarriage and premature labor in the structures of the chorion and placenta have been identified. Conclusions. The markers of miscarriage are pathomorphological changes in endometrium and chorion combined with high expression of TNF-α and NK-CD56, low expression of CD31/PECAM1, negative expression of VEGF to indicate a violation of cytotrophoblast invasions. The markers of inflammation and premature labor are structural and functional changes of placenta in combination with moderate expression of TNF-α in syncytium, high expression of NK-CD56 in villous stroma, high expression of CD45/T200/LCA in the decidual membrane.

Preterm Labor and Treatment Efficacy-Safety

With medical sciences on the verge of advancement, preterm labor still remains a bothersome issue in modern obstetrics. A few therapeutic agents that suppress uterine contractile activity have gained success up to some extent. Tocolytics are medications used to suppress premature labor. These drugs can decrease the strength and frequency of uterine contractions and help in delay the onset of labor but are not able to prolong pregnancy to full-term. Presently, the choice of a best tocolytic drug remains debatable. This review discusses efficacy and safety of various useful agents which have been used so far. Further clinical trials are required to select an effective, and most importantly, safe therapy for the threatened preterm labor.

Pregnancy outcome in a bicornuate uterus with bilateral pregnancy presenting as threatened abortion: a case report

Congenital uterine anomalies or mullerian anomalies are prevalent in 0.4 to 10% of women in general and are often manifested by reproductive challenges like miscarriage, premature labor, premature rupture of membranes or malpresentation. Having a bilateral pregnancy in a bicornuate uterus is extremely rare, especially if it is a spontaneous conception.

Determinants of Psychosocial Resilience Resources in Obese Pregnant Women with Threatened Preterm Labor—A Cross-Sectional Study

Background: The purpose of the study was to assess the level of such psychosocial resilience resources as self-efficacy, dispositional optimism, and health locus of control in pregnant women with obesity with threatened premature labor. Methods: The study was performed in the years 2017–2020 in a group of 328 pregnant women hospitalized due to threatened preterm labor and diagnosed with obesity before the pregnancy. The following instruments were applied: the Life Orientation Test, the Generalized Self-Efficacy Scale, and the Multidimensional Health Locus of Control Scale. Results: Obese pregnant women with threatened premature labor have a moderate level of generalized self-efficacy (28.02) and a moderate level of dispositional optimism (16.20). Out of the three health locus of control dimensions, the highest scores were recorded in the “internal control” subscale (26.08). Statistically significant predictors for the self-efficacy variable model included: satisfactory socio-economic standing (ß = 0.156; p = 0.004), being nulliparous (ß = –0.191; p = 0.002), and the absence of comorbidities (ß = –0.145; p = 0.008). Higher levels of dispositional optimism were found in women who were married (ß = 0.381; p = 0.000), reported a satisfactory socio-economic standing (ß = 0.137; p = 0.005), were between 23 and 27 weeks pregnant (ß = –0.231; p = 0.000), and had no comorbidities (ß = –0.129; p = 0.009). Conclusions: Generalized self-efficacy in obese women with threatened preterm labor is associated with satisfactory socio-economic standing, being nulliparous, and the absence of chronic disease. Dispositional optimism in obese pregnant women with threatened preterm labor is determined by their marital status, socio-economic standing, gestational age, and the absence of comorbidities.

Trophoblasts Modulate the Ca2+ Oscillation and Contraction of Myometrial Smooth Muscle Cells by Small Extracellular Vesicle- (sEV-) Mediated Exporting of miR-25-3p during Premature Labor

The placenta could transmit information to the maternal circulation via the secretion of small extracellular vesicles (sEVs), but little is known about whether and how these sEVs participate in premature labor (PTL). We speculate that miRNA plays an important role in sEV-mediated fetal-maternal information transmission. The present study was aimed at investigating whether the placenta can regulate the contraction of the maternal myometrium via sEV-mediated transmit of miR-25-3p during PTL. The expression of miR-25-3p and its targets Cav3.2 and SERCA2a in clinical samples, cells, and animal specimens was detected. The role of miR-25-3p was observed in the LPS-induced preterm labor mouse model. The sEVs from HTR-8/SVneo cells were characterized by transmission electron microscopy and nanoparticle tracking analysis. The Ca2+ oscillation in HMSMs was analyzed by an intracellular Ca2+ change tracking assay on a confocal microscope. The contraction of HMSMs was detected by a collagen matrix contraction assay. We found that miR-25-3p can directly bind to the 3 ′ UTR of Cav3.2 and SERCA2a. The miR-25-3p level was decreased, and the expression of its targets Cav3.2 and SERCA2a was increased in the placenta and myometrium tissues of PTL patients. Forced upregulation of miR-25-3p reduced the oxidative stress and inflammation responses and the incidence of PTL in LPS-treated mice. The expression of miR-25-3p was not changed in LPS-stimulated human myometrial smooth muscle cells (HMSMs) but was strongly reduced in the trophoblast cell and its sEVs. Additionally, the trophoblast cell line HTR-8/SVneo could transmit miR-25-3p into HMSMs via sEVs. The sEVs derived from LPS-stimulated trophoblasts upregulated the expression of Cav3.2 and SERCA2a and triggered Ca2+ oscillation as well as the contraction of HMSMs; these effects were partially reversed by the overexpression of miR-25-3p in the trophoblasts. Further, the upregulation of miR-25-3p induced changes of Ca2+ oscillation and contraction of HMSMs mediated by sEVs which were also abrogated by the knockdown of miR-25-3p in HMSMs. The results demonstrated that miR-25-3p plays a crucial role in PTL via Cav3.2- and SERCA2a-mediated Ca2+ oscillation and contraction of HMSMs. PTL seems to be related to the decreased exosomal miR-25-3p content transmitted by the trophoblasts under inflammatory conditions.

Characteristics, clinical and laboratory data and outcomes of pregnant women with confirmed SARS-CoV-2 infection admitted to Al-Zahra tertiary referral maternity center in Iran: a case series of 24 patients

Background Physiological changes during pregnancy put pregnant women at higher risk for COVID-19 complications. The objective of this study was to evaluate clinical and laboratory characteristics and outcomes of 24 COVID-19 pregnant patients and their newborns referred to the Al-Zahra tertiary maternity hospital in Tabriz, Iran. Methods Clinical records of 24 COVID-19 confirmed pregnant patients were retrospectively reviewed from10 March 2020 to 15 April 2020. Vertical transition was assessed through neonatal pharyngeal swab samples. The study has been approved by the Tabriz University Medical Ethics Committee (IR.TBZMED.REC.1399.497). Results There were 24 hospitalized cases with clinical symptoms and confirmed diagnosis of COVID-19. The mean age of cases was 26.5 years; most were nulliparous (54.2%), in their third trimester (62.5%) and were in the type A blood group. Clinical symptoms in order of prevalence were cough, fever, dyspnea, myalgia, anosmia, and diarrhea. Oxygen saturation (SpO2) in 70.8% cases was in the normal range (greater than 93%). The risk of premature labor or abortion in cases showed no increase. 12 cases were in ongoing normal status; on follow up, 11 cases had delivered their babies at term and one had ended in IUFD because of pregnancy-induced hypertension. All delivered babies were healthy. Caesarean section in all cases was performed under obstetric indications or maternal demand, and no relation was found between COVID-19 and Caesarean delivery. Neonatal outcomes according to gestational age in 8 cases out of 11 (72.72%) were desirable; neonatal morbidity and mortality resulted from pregnancy complications. Blood pH in 6 neonates was assessed due to immaturity and NICU admission, all of which were in normal ranges except one case related to HELLP syndrome. There was no evidence of vertical transmission. Conclusions Findings suggest that clinical symptoms in pregnancy were similar to non-pregnant women, no rise in risk of premature labor or abortion was seen, and vertical transmission was not observed in none of cases. Lymphopenia was the leading laboratory change. Given asymptomatic cases despite severe forms of infection in pregnancies, we propose screening in all suspected cases. All placentas and newborns should be tested in the field for vertical transmission.

Causal analysis of fetal death in high-risk pregnancies

Objectives To determine the causes of fetal death among the stillbirths using two classification systems from 22 weeks of gestation in a period of three years in high-risk pregnancies. This is a retrospective observational study. Methods The National Institute of Perinatal Health in Mexico City is a Level 3 care referral center attending high-risk pregnancies from throughout the country. The population consisted of patients with fetal death during a three-year period. Between January 2016 and December 2018, all stillbirths were examined in the Pathology Department by a pathologist and a medical geneticist. Stillbirth was defined as a fetal death occurring after 22 weeks of gestation. Results Main outcome measures: Causal analysis of fetal death using the International Statistical Classification of Disease and Related Health Problems-Perinatal Mortality (ICD-PM) and initial causes of fetal death (INCODE) classification systems. A total of 297 stillborn neonates were studied. The distribution of gestational age in antepartum stillbirths (55.2%) showed a bimodal curve, 36% occurred between 24 and 27 weeks and 32% between 32 and 36 weeks. In comparison, the majority (86%) of intrapartum deaths (44.8%) were less than 28 weeks of gestation. Of the 273 women enrolled, 93 (34%) consented to a complete fetal autopsy. The INCODE system showed a present cause in 42%, a possible cause in 54% and a probable cause in 93% of patients. Conclusions The principal causes of antepartum death were fetal abnormalities and pathologic placental conditions and the principal causes of intrapartum death were complications of pregnancy which caused a premature labor and infections.

PREMATURE DELIVERY WORK: ASSOCIATED CONDITIONS

Objective: to identify which risk factors / clinical conditions are frequently associated with premature labor in a reference maternity for high risk. Method: this is a quantitative, descriptive, documentary study. In the population studied, it was understood that pregnant women diagnosed with premature labor admitted to the maternity ward of a public hospital from June to September 2018. Results: it was identified that, of the 40 pregnant women, 21 (52.5% ) were 20 to 34 years old and, in relation to parity, 24 (60%) were multigravid; of the cases that presented some clinical condition associated with the diagnosis of premature labor, Urinary Tract Infection was the most incident complication, corresponding to 27 (65%) of the cases. Conclusion: it appears that the most incident risk factors for the development of premature labor were: maternal age, parity and complications such as Urinary Tract Infection. It was seen that it is up to the professionals involved in prenatal care to provide adequate support for mothers and family members, based on solidarity and welcome, also combining technical and scientific knowledge in order to reduce morbidity and mortality.