Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes

Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.

The course of labor in term patients with concomitant acute intestinal infections

BACKGROUND: Literature data on the course of labor in women with concomitant acute intestinal infections are very scarce. Individual works and articles are devoted to the coverage of this most important final stage of pregnancy. There are no developed specific tactics of labor management in patients with acute intestinal infections, therefore obstetricians and gynecologists have to use generally accepted standards of labor management in this group of patients, without having a clear idea of the frequency and nature of clinically relevant complications in childbirth. AIM: The aim of this study was to evaluate the course of labor in women with concomitant AIIs at full-term pregnancy. MATERIALS AND METHODS: We examined 120 patients aged 19 to 39 years, delivered in Clinical Infectious Disease Hospital named after S.P. Botkin, St. Petersburg in 2017-2019. The main group consisted of 60 women with concomitant acute intestinal infections who gave birth, and the comparison group comprised 60 conditionally healthy women. The spectrum of acute intestinal infection pathogens in pregnant women, the course of labor, complications during labor and the condition of newborns were evaluated. RESULTS: Women of the both study groups did not differ in the duration of labor and the anhydrous interval, the frequency of birth abnormalities, the volume of blood loss, and the frequency of maternal injury and complications in the postpartum period. The frequency of premature rupture of membranes, acute and chronic fetal hypoxia, and episiotomy was higher in patients of the main group. Asphyxia in the first minute after birth was also more common in newborns from women with concomitant acute intestinal infections. CONCLUSIONS: Acute intestinal infections may complicate the course of labor. Labor management in women with concomitant acute intestinal infections requires continuous monitoring of the condition of the fetus during labor and the provision of timely medical care to the newborn.

Younger Age in Adolescent Pregnancies Is Associated with Higher Risk of Adverse Outcomes

Adolescent pregnancy remains a health issue worldwide also in developed countries, since it has been associated with adverse maternal and neonatal outcomes. Some data suggest that very young adolescents have higher risk, likely due to immaturity. Therefore, we aimed to assess the influence of maternal age on complications during gestation and labor in pregnant women between 13 and 19 years of age. In particular, we evaluated the possible association between maternal age and obstetric, fetal and labor complications. This is a retrospective, observational and exploratory study conducted at Hospital Universitario La Paz (HULP, Madrid, Spain). The clinical history of 279 women who delivered between 2013 and 2018 was analyzed. Maternal age and the presence of maternal, fetal and labor complications, as well as risk of postpartum depression and breastfeeding intention, were recorded. General regression models were used to analyze the contribution of maternal age on each complication. The percentage of adolescent pregnancies at HULP between 2013 and 2018 was 0.9%. The risk of all the maternal complications analyzed decreased significantly with every year of age of the mother (hyperemesis, lower back pain, anemia, gestational diabetes mellitus, and threat of premature labor and premature rupture of membranes). Every year of maternal age decreased 0.8-fold [0.8; 0.9] the prevalence of fetal complications and also reduced the risk of C-section, postpartum hemorrhage and obstetrical hysterectomy. Furthermore, higher maternal age increased 1.1-fold [1.0; 1.2] the breastfeeding intention. In conclusion, young adolescents are at higher risk of complications during pregnancy and labor.

Faktor Penentu tidak diberikannya Air Susu Ibu pada Anak Baduta Sejak Lahir di Indonesia

Approximately 5% of children under-two years old in Indonesia have never been breastfed. However, globally, there is increasing trend in the future. This analysis aims to determine factors o f not giving breast milk to children in Indonesia from National Health Survey 2013. The analysis method used was binary logistics with a predictive model. There were 17 independent variables and the dependent variable is breastfeeding status. The analysis shows there are 6.7% under-two children who have never been breastfed since birth. In crude Odd Ratio (COR) the influencing factors are labor complications, length of hospitalized, Antenatal Care, frequency of ANC, Low Birth Weight infants, twins, mode of delivery, planned or unplanned child, and household economic status. Meanwhile, in Adjusted OR (AOR), the influencing factor is ANC frequency, mode of delivery, and length of infants hospitalized after birth. The number of ANC frequencies, delivery methods, and length of infants hospitalized after birth are three determining factors that influence the non-breastfeeding to infants in Indonesia. Lastly, only the mode of delivery found to be similar determining factor to other countries. Keywords: determinant, breastfeeding, under-two children, mode of delivery, Antenatal Care Abstrak Ada 5% anak baduta di Indonesia tidak pernah diberi ASI sejak dilahirkan, kejadian ini cenderung meningkat dari tahun ke tahun. Analisis ini bertujuan untuk melihat faktor yang berperan terhadap tidak diberikannya ASI pada anak sejak dilahirkan di Indonesiamenggunakan data Riskedas 2013. A nalisis i n i menggunakan Logistik Binari dengan model prediksi. Ada 17 variabel i ndependen yang dianalisis, dengan variabel dependen adalah status pemberian ASI pada anak baduta tidak diberi ASI atau diberi ASI. Dari hasil analisis ada 6,7% anak baduta tidak pernah diberi ASI sejak lahir. Secara crude OR faktor yang berpengaruh adalah komplikasi persalinan, lamanya dirawat, ANC, frekuensi ANC, bayi BBLR, kembar, cara partus, status anak diinginkan atau tidak diinginkan, dan status ekonomi rumah tangga. Sedangkan secara Adjusted OR faktor yang berpengaruh adalah frekuensi ANC, cara partus dan lamanya bayi dirawat setelah dilahirkan. Jumlah frekuensi ANC, cara partus dan lamanya bayi dirawat setelah dilahirkan merupakan tiga faktor penentu yang berpengaruh terhadap tidak diberikannya ASI pada bayi di Indonesia. Dari ke tiga faktor tersebut hanya cara partus merupakan faktor penentu yang sama ditemukan di beberapa negara lain. Kata kunci: Faktor penentu, tidak diberi ASI, anak di bawah dua tahun

Pregnancy, systemic lupus erythematosus and a short communication on labor complications as new onset of the disease

Systemic lupus erythematosus (SLE) occur frequently in women of fertile age. In the pathogenesis of SLE, estrogen plays an important role, hormonal changes such as pregnancy and the postpartum increase the risk of disease flares. Also, pregnancy in SLE patients carries a higher fetal risk compared with healthy women. Pregnancy outcome may be optimized by careful planning of the pregnancy and close follow-up of the mother and of the fetus. SLE is associated with high maternal and fetal risk especially when non-diagnosed before planning a pregnancy. Herein we present two cases of SLE manifested by preeclampsia and acute renal insufficiency during labor and postpartum period, with a difficult diagnosis after a few months of a worsening clinical situation.

KOMPLIKASI KEHAMILAN DAN PERSALINAN PADA KEHAMILAN REMAJA

AbstrakLatar Belakang: Menurut UNICEF, setiap lima kelahiran bayi terdapat satu bayi lahir dari ibu dengan usia dibawah 19 tahun. Kehamilan pada remaja usia 15-19 tahun di negara berkembang mencapai angka 21 juta. Kehamilan remaja merupkan masalah yang tersebar di seluruh dunia dan berdampak terhadap kesehatan ibu dan anak. (Mukhopadhyay, 2010), secara luas kematian yang disebabkan oleh kehamilan merupakan penyebab utama kematian anak perempuan usia 15-19 tahun (WHO, 2017). Remaja memiliki risiko komplikasi kehamilan yang tinggi, salah satunya adalah persalinan prematur, IUGR dan pre-eklamsia. (Baker, 2007).Terjadi peningkatan risiko komplikasi sebesar 2 kali lipat pada kehamilan remaja dibandingkan kehamilan pada wanita usia 20-an (Utomo I. D., 2013), Penelitian ini bertujuan untuk mencari hubungan kehamilan remaja dengan komplikasi kehamilan dan persalinan. Metode: Penelitian ini menggunakan metode analitik observasional dengan pendekatan retrospektif cross sectional dengan jumlah sampel 40 dan diambil dengan teknik cosecutive sampling. Hasil: Komplikasi pada kehamilan remaja mencapai 60%. Hasil analisis hubungan kehamilan remaja dengan komplikasi kehamilan (p value= 0,0100 OR = 6), anemia ( p value 0,013 OR=7,364), defisiensi gizi p value=0,400), prekalmisa/eklamsia (p value =0,300), komplikasi persalinan (p value =1,000), persalinan SC (p value=1,000) dan KPD (p value =1,000). Kesimpulan: Pada penelitian ini kehamilan remaja berpengaruh pada komplikasi kehamilan dengan penyulit dominan anemia dan tidak berpengaruh pada komplikasi persalinan.AbstractBackgrounds: According to UNICEF, every five babies born there is one baby born to a mother under the age of 19 years. Pregnancy in adolescents aged 15-19 years in developing countries reaches 21 million. Teenage pregnancy was a problem that spread throughout the world and had an impact on maternal and child health. (Mukhopadhyay, 2010), widely deaths caused by pregnancy are the main cause of death for girls aged 15-19 years (WHO, 2017). Adolescents had a high risk of pregnancy complications, one of which is premature labor, IUGR and pre-eclampsia. (Baker, 2007). There has been a 2-fold increase in the risk of complications in adolescent pregnancies versus pregnancies in women in their 20s (Utomo I. D., 2013). Methods: This study were observational analytic method with a retrospective cross sectional approach with 40 samples and was taken by cosecutive sampling technique. Results: Complications in adolescent pregnancy reach 60%. The results of the analysis of the relationship of adolescent pregnancies with complications of pregnancy showed (p value= 0,0100 OR = 6), anemia ( p value 0,013 OR=7,364), nutritional deficiency (p value=0,400), preeclampsia/eclampsia (p value =0,300), labor complications (p value =1,000), sectio caesaria (p value=1,000) dan premature rupture of membrane (p value =1,000)

THE FACTORS AFFECTING ANXIETY LEVEL OF MOTHER IN LABOR STAGE I AT EKA STIWAHYUNI KLINIC MEDAN DANAI 2019

The psychological problem felt by the mother during labor is anxiety. Anxiety is a feeling disorder characterized by feelings of fear and deep concern. Pregnant women who experience labor anxiety have a high risk of labor complications, namely preeclampsia and prolonged labor. This study aims to determine the factors influencing the anxiety level of 1st time maternity at Eka Sriwahyuni Clinic Medan Denai 2019. This study is a descriptive correlation study with a cross sectional approach. The populations are all 1st time maternity mothers who come to Eka Sriwahyuni Clinic in March-May 2019. The sample size is 21 respondents who are determined using the accidental sampling method. This study uses primary data and then processed with IBM SPSS Statistics 20 for Windows computer programs and presented in the form of an open table. Of the 21 respondents, the majority of respondents have moderate anxiety levels. Based on the results of the study, it is found that out of the 4 variables studied, only the knowledge variable could prove a significant relationship with the level of anxiety of the first childbearing mother labor.

Roles of Micronutrients in Pregnancy

This study assessed the roles of micronutrients in pregnancy. Micronutrients play a central part in the metabolism and maintenance of tissue functions in human beings. Sources of micronutrients include vegetables and fruits and, as such, categorized under vitamins and minerals. These are required in small amounts in the body but greatly impact healthy growth and development. In pregnancy, these micronutrients' adequate requirements are necessary as inadequate intake could result in adverse maternal conditions such as anemia, hypertension, labor complications, and even death. These could, in turn, affect the fetus resulting in stillbirth, premature delivery, intrauterine growth retardation, congenital malformations, reduced immune competence, and abnormal organ development. The micronutrients include vitamins (such as water-soluble vitamins and fat-soluble) and minerals, classified into micro and macro. Strategies for correcting deficiency of these micronutrients in pregnant women can improve pregnancy outcomes. However, it is more beneficial to consume an adequate micronutrient level before conception to minimize the likely risks associated with their mother and fetus deficiencies.