High-Risk Pregnancy

"But I'm not a professional" - How women with high-risk pregnancies voice the experiences of home-based telemonitoring; a qualitative interview study

OBJECTIVES

Telemonitoring of high-risk pregnancy complications is a new approach that offers remote obstetric caregiving using mobile and wireless technologies. New evidence shows that home-based obstetric telemonitoring is not only feasible but also a safe alternative to inpatient or frequent outpatient care. As little is known how performing obstetric telemonitoring is perceived, this study examined how women with pregnancy complications experienced performing home-based telemonitoring.

METHODS

A qualitative, semi-structured interview study was conducted with women with ongoing experience in performing home-based telemonitoring procedures for high-risk pregnancy complications. Purposeful sampling strategy and data saturation were applied followed by verbatim transcription. The data were analyzed using systematic text condensation.

RESULTS

Fifteen informants participated in the study and four major themes emerged. The study revealed that performing telemonitoring was overall positively experienced as an 'Empowering yet challenging responsibility' as well as an 'Extended patient-clinician partnership.' There were pros and cons as to the influence of telemonitoring in everyday life; 'Tele-comfort yet ambivalence' and that it could be accompanied by annoying practical issues; 'Accompanying remote issues.'

CONCLUSIONS

Performing obstetric telemonitoring was experienced as an empowering yet challenging responsibility as well as an extended partnership between the clinician and the pregnant woman. Pros and cons were voiced as to the influence and ambivalence of telemonitoring in everyday life, and that it could be accompanied by annoying practical issues. Patient aspects and experiences of telemonitoring are important clinical knowledge that must be considered when a telemonitoring plan is tailored preferably in a shared decision-making process.

The dyadic associations among self-efficacy, dyadic coping, and health-related quality of life between high-risk pregnant women and spouses: a cross-sectional study

AIM

Health-related quality of life(HRQoL) is essential for high-risk pregnant women and their spouses. This study aimed to explore the dyadic associations (including actor and partner effects) among self-efficacy, dyadic coping, and HRQoL of high-risk pregnant women and their spouses and examine the mediating effect of dyadic coping.

METHODS

This cross-sectional study recruited participants from two Grade A tertiary hospitals in China from October 2022 to September 2023. A questionnaire including the Chinese version of the General Self-Efficacy Scale, Dyadic Coping Inventory, and 12 Short Form Health Survey Scales was used for the survey. The actor-partner interdependence mediation model was constructed to test dyadic associations and mediating effects.

RESULTS

In the actor effects, self-efficacy was positively associated with dyadic coping and HRQoL (P < 0.05). Regarding partner effects, pregnant women's self-efficacy was positively associated with spouses' dyadic coping and physical health (P < 0.05). Dyadic coping partially mediated the relationship between self-efficacy and HRQoL for both groups(P < 0.05).

CONCLUSION

The HRQoL of high-risk pregnant women and their spouses requires urgent attention. Enhancing self-efficacy and dyadic coping in these couples is related to their improved physical and mental health. Healthcare professionals should consider interactions between couples and include them together in perinatal care. Intervention programs for couples or families based on existing positive psychology and dyadic interventions may work together to improve the HRQoL of couples.

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions.  Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period. According to modified Coopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Disrupted mother-fetus dyad risk in high-risk pregnancies: a Middle-Range Theory

OBJECTIVES

to develop and evaluate a Middle-Range Theory for the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" in high-risk pregnancies.

METHODS

this methodological study was conducted in two stages: theory development and evaluation. Dorothea Orem's General Nursing Model was used as the theoretical-conceptual foundation. Evaluation was conducted using the Delphi method with seven judges, and consensus was achieved when the Content Validity Index of the evaluated items was ≥ 0.80.

RESULTS

the theory identified 20 elements of the nursing diagnosis "Disrupted Mother-Fetus Dyad Risk" (10 risk factors, 4 at-risk populations, and 6 associated conditions), 14 propositions, and 1 pictogram. After two rounds of evaluation, the theory was considered consistent, with consensus reached for all items, each achieving a Content Validity Index ≥ 0.80.

CONCLUSIONS

the Middle-Range Theory included biopsychosocial factors explaining the nursing phenomenon "Disrupted Mother-Fetus Dyad Risk," which aids in nurses' diagnostic reasoning.

Burden of multiple high-risk factors in pregnancy before and after the universal two-child policy in Chinese women: An observational study

Background

The prevalence of high-risk pregnancy increased after the implementation of two-child policy in China, but the impact of this policy change on the burden and profile of multiple high-risk factors in pregnancy (MHFP) has been insufficiently explored. We hypothesised that the profile of MHFP might have changed after the two-child policy was implemented and aimed to estimate the prevalence, intercorrelation, and outcomes of MHFP before and after its introduction.

Methods

We obtained data on the population of pregnant women before (2015) and after (2020/2021) the implementation of universal two-child policy in Huai'an. We then included 33 risk factors in our analysis based on the Five-Colour Management framework and defined MHFP as an individual having two or more of these factors. We also estimated the changes of the prevalence of each single factor and their coexistence. Lastly, we performed a network analysis to assess the intercorrelations across these factors and used logistic regression models to evaluate MHFP-related pregnancy outcomes.

Results

We observed an increase in the prevalence of MHFP after the implementation of the universal two-child policy (25.8% in 2015 vs 38.4% in 2020/2021, P < 0.01). Chronic conditions (e.g. gestational diabetes mellitus, abnormal body mass index) had the largest increase among the included factors, while cardiovascular disease and hypertensive disorders were central factors of the network structures. The correlations of advanced maternal age with abnormal pregnancy histories and scarred uteri increased significantly from 2015 to 2020/2021. MHFP was associated with multiple pregnancy outcomes, including preterm birth (adjusted odds ratio (aOR) = 2.57; 95% confidence interval (CI) = 2.39-2.75), low birthweight (aOR = 2.77; 95% CI = 2.54-3.02), low Apgar score (aOR = 1.41; 95% CI = 1.19-1.67), perinatal death (aOR = 1.75; 95% CI = 1.44-2.12), and neonatal death (aOR = 1.76; 95% CI = 1.42-2.18). Moreover, an increasing number and certain combinations of MHFP were associated with higher odds of pregnancy outcomes. For example, the aOR of preterm birth increased from 1.67 (95% CI = 1.52-1.87) for one risk factor to 8.03 (95% CI = 6.99-9.22) for ≥4 risk factors.

Conclusions

Chinese women experienced a higher burden of multiple high-risk factors after the introduction of the two-child policy, particularly those with advanced maternal age, obesity, and chronic conditions. Strategies targeting chronic conditions for women with MHFP should be prioritised and a shift to a multiple-factor-oriented framework is needed in the expanding Chinese maternal health care system.

Factors associated with depression during pregnancy in women receiving high- and low-risk prenatal care: a predictive model

Introduction

Depression during pregnancy can put strain on pregnant women's interpersonal relationships, the formation of emotional bonds with the fetus, and the adaptation to the new routine and social role post-pregnancy. Some studies have associated socioeconomic factors, emotional factors, interpersonal relationships, perceived social support, gestational risk, and the occurrence of certain diseases during pregnancy with higher risk of depression.

Objectives

This study aimed to investigate the prevalence of depression during pregnancy and associated factors in low- and high-risk prenatal patients at a Brazilian university hospital.

Methods

This study presents a retrospective and prospective cross-sectional design. A total of 684 prenatal psychological analysis records from a Brazilian tertiary university service were retrospectively evaluated to assess depression through the PRIME-MD questionnaire between 2002-2017. Between 2017 and 2018, 76 patients treated at the same service were prospectively evaluated with the aforementioned instrument. Medical records were accessed to obtain labor and birth data. Multivariate analyses assessed the association between sociodemographic, gestational or obstetric, and health variables and the presence of depression during pregnancy.

Results

A total of 760 pregnant women were included in the study, with a depression prevalence of 20.66% (n = 157). At the time of assessment, 48 (21.05%) women from the low-risk pregnancy group and 109 (20.49%) from the high-risk pregnancy group were depressed. The mean age was 30.01 ± 6.55 years in the group with depression and 29.81 ± 6.50 years in the group without depression. In the univariate analysis, there was an association of risk for depression with absence of paid work, absence of a partner, low family income and diagnosis of epilepsy, being a protective factor the presence of diabetes during pregnancy. However, in the multivariate analysis, a lower family income, not having a partner at the time of the assessment, and the prevalence of epilepsy were independently associated with an increased risk of depression during pregnancy.

Conclusion

This study showed that 1 in 5 women had depression during pregnancy, with no association with obstetric risk, but those women living in unfavorable economic conditions, without a partner, and having epilepsy were at increased risk of depression.

Dyadic coping and associated factors in women with high-risk pregnancy and their spouses: Do they interact?

OBJECTIVE

The objective of this study was to examine the present situation of dyadic coping in pregnant women with high-risk pregnancy and their spouses, as well as the relevant factors and the interactions between partners.

METHODS

From October 2022 to September 2023, a cross-sectional survey was undertaken, involving 460 pairs of pregnant women with high-risk pregnancy who were hospitalized for childbirth and their accompanying spouses. These participants completed self-assessments on dyadic coping, marital satisfaction, perceived stress, and self-efficacy through the completion of paper questionnaires. The collected data was then subjected to analysis utilizing correlation analysis and multiple linear regression. The actor-partner interdependence model (APIM) was then developed using the structural equation modeling(SEM) to test the binary association.

FINDINGS

Pregnant women preferred to utilize stressful communication, whereas their spouses employed supportive and delegated coping. Both external (such as education level, employment status, and medical insurance) and internal (such as marital satisfaction, perceived stress, and self-efficacy) factors were associated with pregnant women's dyadic coping. Education level and internal factors were also associated with the spouses' dyadic coping. In contrast to spouses, who can only have a partner effect on pregnant women through marriage satisfaction, all pregnant women's internal elements played the partner effect on the spouses' dyadic coping.

IMPLICATIONS

The study's findings help identify populations with inadequate coping ability. Promoting marital satisfaction, self-efficacy, and reducing perceived stress are associated with enhancing the dyadic coping ability of pregnant women with high-risk pregnancy and their spouses. It also suggests that antenatal care should intervene with pregnant women with high-risk pregnancy and their spouses as a whole, and emphasize collaborative coping and effective mutual support between couples rather than spousal support alone.

Quantifying the Occurrence of High-Risk Pregnancy: A Comprehensive Survey

Background High-risk pregnancies are characterized by various factors that pose potential risks to maternal and newborn health outcomes. Early detection of these high-risk pregnancies serves as a crucial initial step in preventing maternal mortality and morbidity, thereby promoting the overall health of both mother and baby. This study sought to assess the occurrence of high-risk pregnancy and investigate the factors associated with it among pregnant women. Methods A descriptive survey was undertaken at the Obstetrics and Gynaecology outpatient department of a District Government Hospital in Tamil Nadu, involving 1889 pregnant women in their second and third trimesters. A structured questionnaire, constructed following the Indian standard criteria outlined by the National Health Portal of India, served as the data collection tool. The survey was conducted in February and March 2022, during which pregnant women were interviewed. Subsequently, the collected data underwent descriptive and inferential statistical analysis. Results Among the 1889 pregnant women surveyed, 29% (n=530) were classified as high-risk pregnancies. Within this group, 34.3% (n=182) were diagnosed with hypothyroidism, while 23.2% (n=123) experienced pregnancy-induced hypertension. Significant associations with high-risk pregnancy were observed for factors such as age, education status, occupation, family income, socioeconomic status, and gravida among the pregnant women. Conclusion Policymakers must urgently implement evidence-based interventions aimed at early detection and treatment of high-risk pregnancies. This proactive approach is essential in preventing maternal mortality and morbidity.

Pregnancy outcome in patients with a medical history of immunoglobulin A vasculitis: a case-control study

OBJECTIVE

Data on obstetric outcomes in patients with a history of immunoglobulin A vasculitis (IgA-V) are lacking. The aim of this study was to assess maternal, neonatal, and vasculitis outcomes during pregnancy.

METHOD

We conducted a French retrospective case-control study. Pregnancies of patients with a history of IgA-V (cases) were retrospectively studied and compared to pregnancies in women who developed IgA-V after their pregnancies and to pregnancies in healthy women (controls).

RESULTS

Twenty-six pregnancies in patients with a history of IgA-V were included and compared to 15 pregnancies in women who later developed IgA-V and 52 pregnancies in healthy women. Both gestational hypertension and pre-eclampsia were more frequent in the case group than in the other groups (23% vs 0% vs 0%, p < 0.01; 12% vs 7% vs 0%, p = 0.04). Hypertensive disorder of pregnancy occurred more frequently in patients with pre-existing kidney disease (78% vs 12%, p < 0.01). Caesarean section was more often performed in the case group than in the other groups (27% vs 0% vs 10%, p = 0.04). No foetal loss or maternal deaths occurred. There were no differences in delivery term or birth weight. No vasculitis flares were observed during pregnancy.

CONCLUSION

Women with a history of IgA-V appear to be at higher risk for gestational hypertension and pre-eclampsia, especially in cases with renal involvement; however, both mother and newborn outcomes appear to be favourable.

Effect of Internet + continuous midwifery service model on psychological mood and pregnancy outcomes for women with high-risk pregnancies

BACKGROUND

There are many drawbacks to the traditional midwifery service management model, which can no longer meet the needs of the new era. The Internet + continuous midwifery service management model extends maternal management from prenatal to postpartum, in-hospital to out-of-hospital, and offline to online, thereby improving maternal and infant outcomes. Applying the Internet + continuous midwifery service management model to manage women with high-risk pregnancies (HRP) can improve their psycho-emotional opinion and, in turn, minimize the risk of adverse maternal and/or fetal outcomes.

AIM

To explore the effectiveness of a midwife-led Internet + continuous midwifery service model for women with HRP.

METHODS

We retrospectively analyzed the clinical data of 439 women with HRP who underwent prenatal examination and delivered at Shanghai Sixth People's Hospital (affiliated to the Shanghai Jiao Tong University School of Medicine) from April to December 2022. Among them, 239 pregnant women underwent routine obstetric management, and 200 pregnant women underwent Internet + continuous midwifery service mode management. We used the State-Trait Anxiety Inventory, Edinburgh Postnatal Depression Scale, and analysis of delivery outcomes to compare psychological mood and the incidence of adverse delivery outcomes between the two groups.

RESULTS

The data showed that in early pregnancy, the anxiety and depression levels of the two groups were similar; the levels gradually decreased as pregnancy progressed, and the decrease in the continuous group was more significant [31.00 (29.00, 34.00) vs 34.00 (32.00, 37.00), 8.00 (6.00, 9.00) vs 12.00 (10.00, 13.00), P < 0.05]. The maternal self-efficacy level and strategy for weight gain management were better in the continuous group than in the traditional group, and the effective rate of midwifery service intervention in the continuous group was significantly higher than in the control group [267.50 (242.25, 284.75) vs 256.00 (233.00, 278.00), 74.00 (69.00, 78.00) vs 71.00 (63.00, 78.00), P < 0.05]. The incidence of adverse delivery outcomes in pregnant women and newborns and fear of maternal childbirth were lower in the continuous group than in the traditional group, and nursing satisfaction was higher [10.50% vs 18.83%, 8.50% vs 15.90%, 24.00% vs 42.68%, 89.50% vs 76.15%, P < 0.05].

CONCLUSION

The Internet + continuous midwifery service model promotes innovation through integration and is of great significance for improving and promoting maternal and child health in HRP.

Evaluation of a telehealth program for high-risk pregnancy in a health service provider institution

INTRODUCTION

eHealth offers a solution to current challenges in maternal health. Telemonitoring can rethink antenatal care, achieving more personalized medicine, especially in high-obstetric risk conditions. A home care model mediated by the development of a mobile and web application that seeks support in clinical decision-making was created in our institution. The software architecture consists of an information system (HCIS, Health Care Information System), a database, an authentication server, and an interoperability bus.

METHODS

The usability of the software by patients was assessed using the Information Systems Usability Questionnaire (CSUQ) version 3, as well as the satisfaction of the care model designed through a survey in a prospective observational study in 62 patients with a high-risk pregnancy. Participants were monitored in real-time through blood glucose, blood pressure, and weight measurements, and attended telemedicine appointments with an obstetrician from admission to six weeks postpartum.

RESULTS

The CSUQ results show a good acceptance of the use of the application by patients both in the global score and the different domains, Global, System utility (SYSUSE), Information Quality (INFOQUAL), and Interface quality (INTERQUAL). The satisfaction survey also shows good results in general and by domains.

CONCLUSION

The findings of this study provide some suggestions for the implementation of a technological development and a care model from the patient's perspective.

Anxiety and Depression Symptoms in At-Risk Pregnancy: Influence on Maternal-Fetal Attachment in Tunisia

OBJECTIVES

To investigate maternal prenatal anxiety and depression in high-risk pregnancies and examine their influence on maternal-fetal attachment.

METHODS

We included 95 hospitalized high-risk pregnant women. The Hospital Anxiety and Depression Scale (HADS) and the Prenatal Attachment Inventory (PAI) were used to assess the primary objective. Internal consistency and construct validity of the PAI were investigated.

RESULTS

The average age was 31 years and gestational age ranged from 26 to 41 weeks. Prevalence of depressive symptoms was 20% and anxiety symptoms 39%. Cronbach alpha coefficient of the PAI Tunisian version was 0.8 and the construct validity in favour of one factor model. PAI scores correlated negatively and significatively with the HADS total score (r = - 0.218, p = 0.034) and was attributed to the depression dimension only (r = - 0.205, p = 0.046).

CONCLUSIONS FOR PRACTICE

Emotional wellbeing of pregnant women especially in high-risk pregnancies should be explored in order to prevent consequences on women, their growing fetus, and prenatal attachment.

Differences in Determinants: Racialized Obstetric Care and Increases in U.S. State Labor Induction Rates

Induction of labor (IOL) rates in the United States have nearly tripled since 1990. We examine official U.S. birth records to document increases in states' IOL rates among pregnancies to Black, Latina, and White women. We test if the increases are associated with changes in demographic characteristics and risk factors among states' racial-ethnic childbearing populations. Among pregnancies to White women, increases in state IOL rates are strongly associated with changes in risk factors among White childbearing populations. However, the rising IOL rates among pregnancies to Black and Latina women are not due to changing factors in their own populations but are instead driven by changing factors among states' White childbearing populations. The results suggest systemic racism may be shaping U.S. obstetric care whereby care is not "centered at the margins" but is instead responsive to characteristics in states' White populations.

Environmental Exposure: Effect on Maternal Morbidity and Mortality and Neonatal Health

Environmental factors are important causes that impair global pregnancy outcomes and are, importantly, responsible for maternal morbidity and mortality. However, apart from the direct reasons for maternal deaths, mainly obstetric and neonatal complications, such factors are ignored or given less importance. The recent surge in research on the impact of various environmental factors on pregnancy outcomes suggests the need for immediate attention to such factors and device-specific policies to counter the situation. Moreover, the recent coronavirus disease of 2019 (COVID-19) pandemic, global warming, and climate change showed a lack of preparedness to counter the impact of such events on maternal survival and safe and successful pregnancy outcomes. In the present review, we have emphasized the specific factors responsible for increased maternal and neonatal deaths and their association with specific environmental factors. Increased attention on maternal healthcare, preparedness to counter sudden environmental challenges and improvement of the conventional requirement for better maternal healthcare access and nutrition at a global level may improve the scenario.

Fetal and Neonatal Adverse Drug Reactions Associated with Biologics Taken During Pregnancy by Women with Autoimmune Diseases: Insights from an Analysis of the World Health Organization Pharmacovigilance Database (VigiBase®)

INTRODUCTION

Published data on the safety of biologics other than tumor necrosis factor (TNF) inhibitors during pregnancy are limited.

OBJECTIVE

The aim was to detect pharmacovigilance signals for fetal and neonatal adverse drug reactions (ADRs) to biologics taken by pregnant women with autoimmune diseases.

METHODS

We performed a disproportionality analysis of the World Health Organization's VigiBase^® pharmacovigilance database from 1968 to June 1, 2021. Data were collected in June 2021. By using terms for different hierarchical levels of the Medical Dictionary for Regulatory Activities, we selected the following fetal or neonatal ADRs: stillbirth, premature birth, low birth weight, small for gestational age, and congenital malformations. The frequency of all identified ADRs for biologics of interest (adalimumab, infliximab, golimumab, certolizumab, etanercept, anakinra, canakinumab, tocilizumab, sarilumab, ustekinumab, guselkumab, secukinumab, ixekizumab, belimumab, abatacept, and rituximab) was compared with that of all other reports for all other drugs and quoted as the reporting odds ratio (ROR) [95% confidence interval]. Reports with known concomitant use of teratogenic drugs were excluded from the main analysis. Other analyses included ROR stratifications by therapeutic indication in the periods 1968-2021 and 2001-2021, and an analysis after excluding reports with steroids.

RESULTS

In the main analysis, the RORs were particularly high for musculoskeletal malformations with anakinra (7.18 [3.50-14.73]), canakinumab (19.54 [12.82-29.79]), and abatacept (5.09 [2.77-9.33]), and for immune system disorders with canakinumab (347.88 [217.9-555.50]) and rituximab (9.27 [2.95-29.15]). After the exclusion of reports with steroids, the ROR was significant for neonatal infections with belimumab (28.49 [5.75-141.25]).

CONCLUSION

We identified possible associations with some adverse fetal and neonatal outcomes, suggesting that vigilance is required when prescribing certain biologics during pregnancy.

Prenatal exposure to heavy metal mixtures and anthropometric birth outcomes: a cross-sectional study

BACKGROUND

Numerous studies have suggested significant associations between prenatal exposure to heavy metals and newborn anthropometric measures. However, little is known about the effect of various heavy metal mixtures at relatively low concentrations. Hence, this study aimed to investigate associations between prenatal exposures to a wide range of individual heavy metals and heavy metal mixtures with anthropometric measures of newborns.

METHODS

We recruited 975 mother-term infant pairs from two major hospitals in Israel. Associations between eight heavy metals (arsenic, cadmium, chromium, mercury, nickel, lead, selenium, and thallium) detected in maternal urine samples on the day of delivery with weight, length, and head circumference at birth were estimated using linear and Bayesian kernel machine regression (BKMR) models.

RESULTS

Most heavy metals examined in our study were observed in lower concentrations than in other studies, except for selenium. In the linear as well as the BKMR models, birth weight and length were negatively associated with levels of chromium. Birth weight was found to be negatively associated with thallium and positively associated with nickel.

CONCLUSION

By using a large sample size and advanced statistical models, we could examine the association between prenatal exposure to metals in relatively low concentrations and anthropometric measures of newborns. Chromium was suggested to be the most influential metal in the mixture, and its associations with birth weight and length were found negative. Head circumference was neither associated with any of the metals, yet the levels of metals detected in our sample were relatively low. The suggested associations should be further investigated and could shed light on complex biochemical processes involved in intrauterine fetal development.

Development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index in Mashhad: a methodological study

BACKGROUND

Assessment of well-being in high-risk pregnancy (HRP) is the key to achieve positive maternal and fetal outcomes. Although there are a wide range of instruments for well-being assessment, none of them is comprehensive for well-being assessment in HRP. The present study aimed at the development and psychometric evaluation of the High-Risk Pregnancy Well-Being Index (HRPWBI).

METHODS

This methodological study was conducted using the Waltz's four-step method. The dimensions of well-being in HRP were determined based on a conceptual model and the blueprint and the item pool of HRPWBI were developed. Then, the face and the content validity were assessed and item analysis was performed. Construct validity was also assessed through exploratory factor analysis with principal component analysis on the data obtained from 376 women with HRP in Mashhad, Iran. Finally, internal consistency, test-retest stability, sensitivity, and interpretability of HRPWBI were assessed.

RESULTS

The scale- content validity index (SCVI) of HRPWBI was 0.91. In factor analysis, 33 items were loaded on seven factors which explained 53.77% of the total variance. Internal consistency, relative stability, absolute stability, sensitivity, and interpretability of HRPWBI were confirmed with a Cronbach's alpha of 0.84, a test-retest intraclass correlation coefficient of 0.97, a standard error of measurement of 0.92, a minimal detectable change of 8.09, and a minimal important change of 2.92, respectively.

CONCLUSION

HRPWBI is a valid and reliable instrument for well-being assessment among women with HRP. It can be used to assess well-being and the effects of well-being improvement interventions on well-being among women with HRP.

Prevalence of adverse birth outcomes and associated factors in Jazan, Saudi Arabia: A cross-sectional study

This study aimed to measure the prevalence of adverse birth outcomes and associated factors among mothers from the Jazan region in Saudi, Arabia. This was a cross-sectional investigation where data was collected via a semi-structured questionnaire. The questionnaire was completed during interviews to assess data regarding the participants' demographics, morbidity, the reported adverse birth outcomes, and maternal complications during pregnancy. Chi-squared and Fisher's Exact tests were both used to compare the distribution of demographic and obstetric risk factors according to the historical presence of adverse birth outcomes. A total of 1315 women with a combined history of 4950 pregnancies were involved in the current investigation. The mean age of the participants was 33.1 years. The total number of adverse birth outcomes was 1009. The most frequently reported adverse birth outcome was miscarriage (12.1%), followed by premature birth (2.3%) and underweight birth (1.9%). Reports of a minimum of 1 adverse birth outcome were higher among women who reported family incomes of more than 10,000 Saudi Arabian Riyal (SAR), women who were first-degree cousins of their husbands, and women with less than a secondary level education (P values <.05). This study found a relatively high prevalence of miscarriage. Further investigations are needed to assess factors associated with this high frequency level of miscarriage. Furthermore, these findings have preventive and clinical implications concerning pregnant women with a history of obesity, anemia, consanguinity, and hypertension. The goal is to target them with a better range of antenatal care services to reduce the incidence of potential adverse birth outcomes.

A Novel, Cardiac-Derived Algorithm for Uterine Activity Monitoring in a Wearable Remote Device

Background: Uterine activity (UA) monitoring is an essential element of pregnancy management. The gold-standard intrauterine pressure catheter (IUPC) is invasive and requires ruptured membranes, while the standard-of-care, external tocodynamometry (TOCO)’s accuracy is hampered by obesity, maternal movements, and belt positioning. There is an urgent need to develop telehealth tools enabling patients to remotely access care. Here, we describe and demonstrate a novel algorithm enabling remote, non-invasive detection and monitoring of UA by analyzing the modulation of the maternal electrocardiographic and phonocardiographic signals. The algorithm was designed and implemented as part of a wireless, FDA-cleared device designed for remote pregnancy monitoring. Two separate prospective, comparative, open-label, multi-center studies were conducted to test this algorithm.

Methods: In the intrapartum study, 41 laboring women were simultaneously monitored with IUPC and the remote pregnancy monitoring device. Ten patients were also monitored with TOCO. In the antepartum study, 147 pregnant women were simultaneously monitored with TOCO and the remote pregnancy monitoring device.

Results: In the intrapartum study, the remote pregnancy monitoring device and TOCO had sensitivities of 89.8 and 38.5%, respectively, and false discovery rates (FDRs) of 8.6 and 1.9%, respectively. In the antepartum study, a direct comparison of the remote pregnancy monitoring device to TOCO yielded a sensitivity of 94% and FDR of 31.1%. This high FDR is likely related to the low sensitivity of TOCO.

Conclusion: UA monitoring via the new algorithm embedded in the remote pregnancy monitoring device is accurate and reliable and more precise than TOCO standard of care. Together with the previously reported remote fetal heart rate monitoring capabilities, this novel method for UA detection expands the remote pregnancy monitoring device’s capabilities to include surveillance, such as non-stress tests, greatly benefiting women and providers seeking telehealth solutions for pregnancy care.

Effect of Oxytocin Combined with Different Volume of Water Sac in High-Risk Term Pregnancies

Objective

The study estimated the impacts of water sac of different capacities combined with oxytocin (OXT) on pregnant women with high-risk term pregnancies.

Methods

Women with high-risk term pregnancies who received OXT were enrolled to perform labor induction using 30  mL (group A), 80 mL (group B), and 150  mL (group C), followed by the comparisons regarding to the success rate of labor induction, cesarean section rate, duration of induced labor to labor, duration of the first stage of labor, postpartum blood loss, the incidence of adverse reactions, and the assessment of cervical ripening using Bishop Score. Besides, neonatal weight, Apgar score, as well as psychological status, and satisfaction of patients were compared among these groups.

Results

As compared with group A, the success rate of induced labor was higher in groups B and C with lower cesarean section rate and shorter duration of induced labor to labor, but the duration of the first stage of labor in group B was the shortest among the three groups. The amount of postpartum hemorrhage decreased stepwise from groups A to B to C. In addition, groups A and B showed a reduced incidence of adverse reactions than group C, but the highest level of cervical ripening and highest patient satisfaction was revealed in group C and group B, respectively. Furthermore, the highest patient satisfaction was found in group B.

Conclusion

The usage of an 80  mL water sac combined with OXT  in high-risk term pregnancy has ideal induction effects, which can guarantee maternal cervical maturity and shorten the time of the first stage of labor.

Women who smoke during pregnancy are more likely to be referred to an obstetrician during pregnancy and birth: results from a cohort study

Background

Women who smoke during pregnancy make less use of prenatal care; the relation of smoking behavior with the use of other forms of maternal healthcare is unknown. The objective of this study is to investigate the association between women’s smoking behavior and their use of healthcare during pregnancy, birth and six weeks postpartum.

Methods

We analyzed data from the Dutch Midwifery Case Registration System (VeCaS), period 2012–2019. We included women with a known smoking status, singleton pregnancies, and who had their first appointment before 24 weeks of gestation with the primary care midwife. We compared three groups: non-smokers, early stoppers (stopped smoking in the first trimester), and late- or non-stoppers (stopped smoking after the first trimester or continued smoking). Descriptive statistics were used to report maternal healthcare utilization (during pregnancy, birth and six weeks postpartum), statistical differences between the groups were calculated with Kruskal–Wallis tests. Multivariable logistic regression was conducted to assess the association between smoking behavior and referrals to primary, secondary or tertiary care.

Results

We included 41 088 pregnant women. The groups differed significantly on maternal healthcare utilization. The late- or non-stoppers initiated prenatal care later and had less face-to-face consultations with primary care midwives during pregnancy. Compared to the non-smokers, the early- and late- or non-stoppers were statistically signficiantly more likely to be referred to the obstetrician during pregnancy and birth. Postpartum, the early- and late- or non-stoppers were statistically signficantly less likely to be referred to the obstetrician compared to the non-smokers.

Conclusions

Although the early- and late- or non-stoppers initiated prenatal care later than the non-smokers, they did receive adequate prenatal care (according to the recommendations). The results suggest that not smoking during pregnancy may decrease the likelihood of referral to secondary or tertiary care. The large population of smokers being referred during pregnancy underlines the important role of the collaboration between healthcare professionals in primary and secondary or tertiary care. They need to be more aware of the importance of smoking as a medical and as a non-medical risk factor.

The effect of individual counseling based on the GATHER principles on perceived stress and empowerment of the mothers with high-risk pregnancies: an experimental study

BACKGROUND

High-risk pregnancy causes different responses, including negative emotions, feelings of vulnerability and psychological stress in the mother. The aim of this study was to investigate the effect of individual counseling on the empowerment and the perceived stress of high-risk pregnant mothers.

METHODS

This study was a two-group experimental study. The study was performed on 82 high-risk pregnant women hospitalized in Fatemieh Hospital in Hamadan, Iran. Inclusion criteria were high-risk pregnancy, being literate, gestational age 24 to 36 weeks. The samples were divided into experimental and control groups using randomized block design. Data were collected using Cohen's perceived stress scale and Kameda empowerment questionnaires. For the experimental group, four sessions of individual counseling according to GATHER principles (Greet, Ask, Tell, Help, Explain, and Return) were performed for 45-60 minutes for two consecutive weeks. SPSS 25 software was used for data analysis.

RESULTS

The mean score of the perceived stress after the intervention in the control and experimental groups were 27.07(5.80) and 25.30(4.95), respectively (P = 0.097). There was a substantial difference in the mean score of empowerment 84.76)9.14) and 88.75 (6.17) (P < 0.001) and different dimensions of empowerment (self-efficacy, Future image, self-esteem, Support and assurance from others) between the control and intervention groups after the intervention.

CONCLUSIONS

The findings of this study indicate individual counseling is effective in empowering the mothers with high-risk pregnancy but has no significant effect on their perceived stress.

The Effect of Oxytocin plus Carboprost Methylate in Preventing Postpartum Hemorrhage in High-Risk Pregnancy and Its Effect on Blood Pressure

Objective. This study aimed to explore and analyze the effectiveness of oxytocin plus carboprost methylate in preventing postpartum hemorrhage in high-risk pregnancies and its effect on blood pressure. A total of 60 women with high-risk pregnancies who gave birth in our hospital from January 2020 to May 2021 were recruited and assigned via random number table method (1 : 1) to receive either oxytocin (control group) or oxytocin plus carboprost methylate (observation group). Outcome measures included hemorrhage and blood pressure. The bleeding volume of the women in the observation group (210.55 ± 45.98, 45.21 ± 9.27, and 73.74 ± 12.18) was significantly less than that in the control group during delivery and 2h and 24h after the delivery (276.91 ± 49.21, 72.98 ± 19.68, and 92.61 ± 15.67) (all P < 0.05). The observation group showed a significantly lower bleeding rate (6.67%) than the control group (16.67%) (P < 0.05). The two groups showed similar diastolic and systolic blood pressures (P > 0.05). Oxytocin plus carboprost methylate suppository effectively prevents postpartum hemorrhage in high-risk pregnancies, significantly reduces the amount of postpartum hemorrhage in high-risk pregnancies, and has little effect on the blood pressure of patients. Given its favorable treatment efficiency and high safety profile, this treatment protocol shows great potential for clinical application.

The Influence of Maternal Factors on Neonatal Intensive Care Unit Admission and In-Hospital Mortality in Premature Newborns from Western Romania: A Population-Based Study

Background and Objectives: Neonatal mortality is a global public health issue, disproportionately affecting low- and middle-income nations. Although Romania is a high-income nation, according to the European Union’s most recent demographic data, it had the second-highest infant death rate in 2019. Although significant progress has been made in the last three decades in lowering newborn mortality, more initiatives to accelerate progress are required to meet the 2030 Sustainable Development Goals (SDG) objective. Therefore, we aimed to develop an observational study to determine the influence of maternal factors on in-hospital neonatal intensive care unit admission and mortality in premature infants born in western Romania. While newborn mortality has decreased globally, the pace of decline is far less than what is desired. Materials and Methods: A retrospective study comprising 328 premature patients and 422 full-term newborns, was developed at a tertiary obstetrics and gynecology clinic in western Romania, comprising the period of the last 24 months before the COVID-19 pandemic and the first 24 months of the pandemic. Results: The following variables were identified as statistically significant risk factors for neonatal intensive care unit admission: age > 35 years, OR = 1.59; twin births, OR = 1.14; low gestational age, OR = 1.66; preeclampsia, OR = 2.33; and peripartum infection, OR = 2.25. The same risk factors, with the exception of twin births, were significantly associated with in-hospital neonatal mortality. Except for a longer duration of maternal hospitalization and neonatal therapy with surfactant, steroids, and antibiotics, the COVID-19 pandemic did not cause significant differences in the evolution and outcomes of preterm newborns. Conclusions: The major maternal risk factors for NICU admission were advanced age, twin pregnancy, low gestational age, preeclampsia, and peripartum infection. Additionally, these characteristics contributed to a high likelihood of death, despite adequate access to medical care and advanced life support for the neonates. Understanding the causes of morbidity and death in neonates admitted to the neonatal intensive care unit enables better prioritization and planning of health services, resource reallocation, and care quality improvement.

High-risk pregnant women's experiences of the receiving prenatal care in COVID-19 pandemic: a qualitative study

BACKGROUND

Women with high-risk pregnancies are among the most vulnerable groups that require additional precautionary measures against the spread of COVID-19 plus receiving prenatal care. Yet, there is limited information on the status of prenatal care in women with high-risk pregnancies. The purpose of this study was to explore the experiences of women with high-risk pregnancies who were receiving prenatal care during the COVID-19 pandemic.

METHODS

The present qualitative study was conducted on mothers with high-risk pregnancies from September 2020 to March 2021. Purposeful sampling continued until achieving data saturation. Ghaem, Ommolbanin, and Imam Reza in Mashhad, Iran served as the research environment. Face-to-face and semi-structured interviews were effective data collection methods. Each interview lasted between 20 to 45 min (on average 30). The total number of participants was 31. Data analysis was carried out simultaneously with data collection using the qualitative content analysis method developed by Granheim and Landman (2004).

RESULTS

Following the reduction and analysis of data from women in high-risk pregnancies, as well as their perceptions and experiences with health services during the COVID-19 pandemic, eight subcategories and three main categories were identified, including 1) "Negative psychology responses," 2) "Adoption behavior," and 3) "Adjustment of health services in mutual protection." Fear, anxiety, stress, feelings of loneliness, sadness, depression, guilt, doubt and conflict in receiving services were examples of negative psychological responses. The adaptive behaviors' category reflected the behaviors of women with high-risk pregnancies in the context of the COVID COVID-19 pandemic. The Adjustment of health services in mutual protection indicated that health workers took preventive and protective measures against COVID-19, which, in addition to protecting themselves and their clients against COVID-19, gave women a sense of security.

CONCLUSION

Receiving prenatal care during the COVID-19 pandemic presents challenges for women with high-risk pregnancies, negatively impacting their psychological state and health-seeking behavior. Supportive and preventive care can ensure that women with high-risk pregnancies receive optimal prenatal care that focuses on COVID-19 prevention. We recommend implementing screening, psychological counseling, and education for women with high-risk pregnancies, as well as ensuring that they have access to women-centered health care services.

Exercise and Physical Activity Levels and Associated Factors Among High-Risk Pregnant Women

OBJECTIVE

 To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women.

METHODS

 A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study's participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%.

RESULTS

 Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81 ± 81.84 METs), followed by work-related activities (40.77 ± 84.71 METs). Only 19.3% women exercised during pregnancy (4.76 ± 12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR = 29.8; 95% CI 4.9-117.8). Nulliparity (OR = 3.1; 95% CI 1.0-9.1), low levels of anxiety (OR = 3.6; 95% CI 1.2-10.7), and unemployment (OR = 4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy.

CONCLUSION

 Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy.

The effect of nonpharmacological interventions on the mental health of high-risk pregnant women: A systematic review

OBJECTIVES

To evaluate the effect of nonpharmacological interventions on the mental health of high-risk pregnant women.

METHODS

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 (PRISMA) statement. The Cochrane Library, Embase, CINAHL, PubMed and Web of Science databases were systematically searched for randomized controlled trials and quasi-randomized controlled trials from inception to April 2021. The quality of the studies was assessed using the Cochrane Risk of Bias Tool 2.0. Data were independently extracted and narratively synthesized.

RESULTS

Fifteen studies involving 1723 pregnant women were selected. Nonpharmacological interventions included cognitive behavioral interventions, yoga, relaxation interventions, psychological and educational support interventions, and acupressure. Cognitive behavioral interventions and yoga for high-risk pregnant women had potential benefits on the symptoms of anxiety, stress and depression. There was insufficient evidence that relaxation interventions, psychological and educational support interventions and acupressure had positive effects on these women's mental health.

CONCLUSIONS

This review showed that cognitive behavioral interventions and yoga during pregnancy may benefit women with high-risk pregnancies. However, due to methodological limitations of this review, further studies with robust methodological designs are needed to verify the efficacy.

Audio-vestibular disorders and pregnancy: A systematic review

PURPOSE

During pregnancy a woman's body undergoes many physiological changes that involve all systems and organs, including sensory ones. We conducted this systematic review to highlight current evidence and treatment options in pregnant women with audio-vestibular disorders.

MATERIALS AND METHODS

A search was made on the following databases: PubMed, PubMed Central, Web of Science and Scopus. This research protocol was deposited in the PROSPERO Database.

RESULTS

After application of inclusion-exclusion criteria, 30 manuscripts were included in the review. Many authors (14/15) found a slight alteration of audiometric tests during pregnancy, with a reported recovery postpartum in most of the studies (5/7). Regarding sudden sensorineural hearing loss (SSNHL), we found four articles for a total of 69 patients: the treatment of choice was intravenous Dextran 40 and intra-tympanic corticosteroids. Most included studies (4/6) found neither clinical nor epidemiological associations between otosclerosis and pregnancy in large-based sample studies. Few investigations regarded Eustachian tube function and vertigo.

CONCLUSIONS

According to our results, many variations of hearing acuity during pregnancy are slight and transient and require only clinical observation. In large samples, otosclerosis appeared not to be associated with pregnancy. Clinicians should consider intra-tympanic steroids in managing SSNHL during pregnancy. Further more accurate research is needed to deepen and clarify the association between pregnancy and audio-vestibular disorders.

Risk perceptions among high-risk pregnant women in Nepal: a qualitative study

BACKGROUND

A woman's perception of risk affects her decisions about seeking obstetric care and following prescribed regimens of care. This study explored the perceptions of high-risk pregnancy among women with high-risk factors.

METHODS

A qualitative study was conducted in the Morang district, Nepal. A phenomenological approach was used. In-depth interviews were conducted with 14 participants. Postpartum women with one risk factor for high-risk pregnancy who non-adhere to referral hospital birth were selected purposively. Thematic analysis was done to generate themes and categories.

FINDINGS

Two main themes emerged in this study: (i) knowledge and understanding of risk and (ii) normalizing and non-acceptance of risk. The participants had inadequate knowledge of risk in pregnancy and childbirth. Their information source was their personal experiences of risk, witnessing their close relatives, and community incidents. The participants perceived pregnancy as a normal event and did not consider themselves as at risk. They tended to deny risk and perceived that everything was fine with their pregnancy.

CONCLUSIONS

The findings of this study provide a glimpse into how women perceived risk and the reasons that lead them to deny the risks and gave home birth. In the presence of risk factors in pregnancy, some women were not convinced that they were at risk. An antenatal check-up should be utilized as a platform to educate women, explore their intentions, and encourage safer births.

Are birth outcomes in low risk birth cohorts related to hospital birth volumes? A systematic review

Background

There is convincing evidence that birth in hospitals with high birth volumes increases the chance of healthy survival in high-risk infants. However, it is unclear whether this is true also for low risk infants. The aim of this systematic review was to analyze effects of hospital’s birth volume on mortality, mode of delivery, readmissions, complications and subsequent developmental delays in all births or predefined low risk birth cohorts. The search strategy included EMBASE and Medline supplemented by citing and cited literature of included studies and expert panel highlighting additional literature, published between January/2000 and February/2020. We included studies which were published in English or German language reporting effects of birth volumes on mortality in term or all births in countries with neonatal mortality < 5/1000. We undertook a double-independent title-abstract- and full-text screening and extraction of study characteristics, critical appraisal and outcomes in a qualitative evidence synthesis.

Results

13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive.

Conclusion

Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries.

Systematic review registration

PROSPERO: CRD42018095289

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03988-y.

The Effect of Midwife-led Psycho-Education on Parental Stress, Postpartum Depression and Parental Competency in High Risk Pregnancy Women: A Randomized Controlled Trial

Introduction: Women with high-risk pregnancy are at increased risk of depression and anxiety during pregnancy, as well as a less favorable parent-infant interaction. This study aimed to investigate the effect of midwife-led psycho-education intervention on parental stress, competency, and postpartum depression in nulliparous women hospitalized with high-risk pregnancy.

Methods: This randomized controlled trial was carried out on 66 nulliparous women admitted to the high-risk pregnancy ward of Kamali Hospital, Karaj, Iran. Using convenient sampling method, the mothers were randomly assigned to control and intervention groups. In addition to routine care, the intervention group received four sessions of midwife-led psycho-education intervention in two group sessions in pregnancy and two individual sessions immediately after delivery. The parental stress, parental competency, and postpartum depression questionnaires were used for data collection before, after, and one month after the intervention. Data were analyzed using SPSS software ver. 13.0. Repeated-measures ANOVA test was used for comparing the mean scores of parenting stress, parental competency, and depression between and within both study groups before, after, and one month after delivery.

Results: While postpartum depression and parental stress decreased in intervention group, parental competency increased.

Conclusion: Our findings indicated that midwife-led psycho-education was effective on parental stress, competency, and postpartum depression in high-risk pregnancy mothers. Accordingly, prenatal distress in high-risk pregnancies should be assessed routinely.

Early AGEing and metabolic diseases: is perinatal exposure to glycotoxins programming for adult-life metabolic syndrome?

Perinatal early nutritional disorders are critical for the developmental origins of health and disease. Glycotoxins, or advanced glycation end-products, and their precursors such as the methylglyoxal, which are formed endogenously and commonly found in processed foods and infant formulas, may be associated with acute and long-term metabolic disorders. Besides general aspects of glycotoxins, such as their endogenous production, exogenous sources, and their role in the development of metabolic syndrome, we discuss in this review the sources of perinatal exposure to glycotoxins and their involvement in metabolic programming mechanisms. The role of perinatal glycotoxin exposure in the onset of insulin resistance, central nervous system development, cardiovascular diseases, and early aging also are discussed, as are possible interventions that may prevent or reduce such effects.

Content validation of the nursing diagnosis Risk for disturbed maternal-fetal dyad

OBJECTIVE

To validate the content of the diagnosis Risk for disturbed maternal-fetal dyad in high-risk pregnant women.

METHOD

Nursing diagnosis content analysis study in which 48 nurses evaluated agreement regarding title, definition, class, and domain of the studied nursing diagnosis, as well as the relevance of its antecedents. The items were considered relevant when the Confidence Interval of the Content Validity Index was 0.8 or higher. When lower, the item was modified or excluded according to the experts' suggestions.

RESULTS

Out of 21 antecedents, 14 were considered relevant. The labels of five elements considered irrelevant were changed, and one item was excluded. The experts did not choose the title and definition proposed by NANDA-I, preferring instead the ones suggested in this study. The experts agreed with the class and domain proposed by the taxonomy.

CONCLUSION

Ten risk factors, four populations at risk, and six associated conditions for this nursing diagnosis were maintained; these may provide a basis for nursing practice. The phase of clinical validation is suggested to be conducted to corroborate this study's results.

The role of high-risk pregnancy in childbearing tendency in Tehran

Background and purpose:

The decreased tendency toward childbearing is considered as one of the most social issues. High-risk pregnancy problems and the fear of recurrence can reduce the desire for re-pregnancy. The purpose of this study was to determine the relationship between high-risk pregnancies in childbearing tendency.

Materials and Methods:

This descriptive study was cross-sectional. The statistical population included married women aged 15–49 years with at least one previous pregnancy. 928 women with histories of low-risk and high-risk pregnancy were selected by applying a continuous sampling method. The demographic information form and childbearing desire questionnaire were used. The data were analyzed by SPSS-16 and applying descriptive statistics tests, mean and standard deviation, inferential statistics, regression, independent t-test.

Findings:

The mean of childbearing tendency in mothers with a history of high-risk pregnancy and low-risk pregnancy were 3.25 ± 5.43 and 8.65 ± 3.96, respectively. Before modifying the intervention variables, the mean scores of childbearing desire were significantly different in mothers with a history of low-risk pregnancy and high-risk pregnancy; it was higher in mothers with a history of low-risk pregnancy (P < 0.001). After modifying the variables of the ideal number of children, the mothers' attitude toward childbearing desire, and the number of natural childbirths, stillbirths, and miscarriages. The difference was not significant (P = 0.263).

Conclusion:

Childbearing tendency was not different in women with a history of low-risk pregnancy and those with a history of high-risk pregnancy.

The impact of advanced maternal age on pregnancy and offspring health: A mechanistic role for placental angiogenic growth mediators

The birth rates among women of advanced maternal age (AMA) have risen over the last two decades; yet, pregnancies with AMA are considered high-risk and are associated with a significant increase in pregnancy complications. Although the mechanisms leading to pregnancy complications in women with AMA are not fully understood, it has been well established in the literature that offspring exposed to unfavorable environmental conditions in utero, such as gestational diabetes, preeclampsia, and/or intrauterine growth restriction during the early stages of development are subject to long-term health consequences. Additionally, angiogenic growth mediators, which drive vascular development of the placenta, are imbalanced in pregnancies with AMA. These same imbalances also occur in pregnancies complicated by preeclampsia, gestational diabetes, and obesity. This review discusses the impact of AMA on pregnancy and offspring health, and the potential mechanistic role of placental angiogenic growth mediators in the development of pregnancy complications at AMA.

High-risk pregnancies and their association with severe maternal morbidity in Nepal: A prospective cohort study

Background

The early identification of pregnant women at risk of developing complications at birth is fundamental to antenatal care and an important strategy in preventing maternal death. This study aimed to determine the prevalence of high-risk pregnancies and explore the association between risk stratification and severe maternal morbidity.

Methods

This hospital-based prospective cohort study included 346 pregnant women between 28–32 gestational weeks who were followed up after childbirth at Koshi Hospital in Nepal. The Malaysian antenatal risk stratification approach, which applies four color codes, was used: red and yellow denote high-risk women, while green and white indicate low-risk women based on maternal past and present medical and obstetric risk factors. The World Health Organization criteria were used to identify women with severe maternal morbidity. Multivariate confirmatory logistic regression analysis was performed to adjust for possible confounders (age and mode of birth) and explore the association between risk stratification and severe maternal morbidity.

Results

The prevalence of high-risk pregnancies was 14.4%. Based on the color-coded risk stratification, 7.5% of the women were categorized red, 6.9% yellow, 72.0% green, and 13.6% white. The women with high-risk pregnancies were 4.2 times more likely to develop severe maternal morbidity conditions during childbirth.

Conclusions

Although smaller in percentage, the chances of severe maternal morbidity among high-risk pregnancies were higher than those of low-risk pregnancies. This risk scoring approach shows the potential to predict severe maternal morbidity if routine screening is implemented at antenatal care services. Notwithstanding, unpredictable severe maternal morbidity events also occur among low-risk pregnant women, thus all pregnant women require vigilance and quality obstetrics care but high-risk pregnant women require specialized care and referral.

Analysis of the NANDA-I taxonomy "maternal-fetal dyad" concept in high-risk pregnancy: integrative review

OBJECTIVE

to analyze the NANDA-I taxonomy "maternal-fetal dyad" concept in high-risk pregnancy.

METHOD

an integrative literature review based on the Conceptual Analysis model proposed by Walker and Avant. It was conducted at PUBMED, CINAHL, SCOPUS, LILACS and SciELO, with the descriptors: Complications of pregnancy, Risk Factors, and Pregnancy, High-Risk (from 2008-2020).

RESULT

the sample consisted of 44 articles, which identified two attributes and 21 antecedents of the concept.

CONCLUSION

concept analysis allowed to identify the attributes and antecedents of the "maternal-fetal dyad" concept in high-risk pregnancy, in addition to raising and clarifying ideas. It was possible to identify 12 antecedents that are not included in NANDA-I as well as the need to review the definition of the diagnosis proposed by the taxonomy.

Breaking Bad News: A Study on Formal Training in a High-Risk Obstetrics Setting

Background: Breaking bad news is a frequent task in high-risk obstetrics clinics. Few studies have examined the role of training in improving such a difficult medical task. Aim: To evaluate the influence of a training program on the participants' perceptions of bad news communication at a high-risk obstetrics center. Design: This prospective study was conducted at the Department of Obstetrics/Gynecology, Hospital das Clinicas, from March 2016 to May 2017. Setting/Participants: Maternal-fetal health specialists were invited to complete an institutional questionnaire based on the SPIKES protocol for communicating bad news before and after training. The training consisted of theoretical lectures and small group practice using role play. The questionnaire responses were compared using nonparametric tests to evaluate the differences in physicians' perceptions at the two timepoints. The questionnaire items were evaluated individually and in groups following the communication steps of the SPIKES protocol. Results: In total, 110 physicians were invited to participate. Ninety completed the pretraining questionnaire and 40 answered the post-training questionnaire. After training, there were significant improvements in knowing how to prepare the environment before delivering bad news (p = 0.010), feeling able to transmit bad news (p < 0.001), and to discuss the prognosis (p = 0.026), feeling capable of discussing ending the pregnancy (p = 0.003), and end-of-life issues (p = 0.007) and feeling confident about answering difficult questions (p = 0.004). The comparison of the grouped responses following the steps of the SPIKES protocol showed significant differences for "knowledge" (p < 0.001), "emotions," (p = 0.004) and "strategy and summary" (p = 0.002). Conclusion: The implementation of institutional training in breaking bad news changed the perception of the physicians in the communication setting.

Iodine Status, Thyroid Function, and Birthweight: A Complex Relationship in High-Risk Pregnancies

(1) Background: The consequences of iodine deficiency and/or thyroid dysfunction during pregnancy have been extensively studied, emphasizing on infant neurodevelopment. However, the available information about the relationship between iodine, thyroid hormones, and fetal growth in high-risk pregnancies is limited. We aim to investigate if iodine metabolism and/or thyroid parameters can be affected by adverse antenatal/perinatal conditions. (2) Methods: A cross-sectional study examined differences in iodine status, thyroid function, and birthweight between high-risk (HR group; n = 108)) and low-risk pregnancies (LR group; n = 233) at the time of birth. Urinary iodine concentration (UIC), iodine levels in amniotic fluid, and thyroid parameters [thyroid-stimulating hormone (TSH), free thyroxine (FT4)] were measured in mother–baby pairs. (3) Results: There were significant differences between HR and LR groups, free thyroxine (FT4) concentration in cord blood was significantly higher in the LR group compared with HR pregnancies (17.06 pmol/L vs. 15.30 pmol/L, respectively; p < 0.001), meanwhile iodine concentration in amniotic fluid was significantly lower (13.11 µg/L vs. 19.65 µg/L, respectively; p < 0.001). (4) Conclusions: Our findings support the hypothesis that an adverse intrauterine environment can compromise the availability of FT4 in cord blood as well as the iodine metabolism in the fetus. These differences are more noticeable in preterm and/or small fetuses.

Analysis of Sociodemographic and Information Factors on Family Behaviour in Early Detection of High-Risk Pregnancy

Introduction: Pregnancy and childbirth are physiological processes experienced by women, but they sometimes have risky conditions. There are still many pregnant women and their families who are unable to detect a high-risk of pregnancy early. This study aims to determine family behaviour in conducting early detection of a high-risk of pregnancy in terms of sociodemographic and information factors.Methods: This study uses an explanatory survey design with a cross sectional design. The sample size of this study was 146, with simple random sampling. The independent variables were sociodemographic factors (age, gender, ethnicity, education, income and religion) and information factors (experience, and media exposure) while the dependent variable is family behaviour. The instrument with the questionnaire used the Likert scale. The data was analysed using partial least square.Results: The results showed that Structural Equation Modelling-Partial least square (SEM-PLS) statistical analysis, through Confirmatory Factor Analysis (CFA), obtained sociodemographic factors on family behaviour of 1,999, and information factors on family behaviour of 13,78. The value of the influence of sociodemographic factors (0.102) and the value of the influence of information factors (0.754). R2 (0.63) and Q2 value of 0.65.Conclusion: Sociodemographic  factors and information factors significantly influenced family behaviour factors in early detection of high-risk of pregnancy. Information factors have a greater effect on family behaviour than sociodemographic factors. Midwives as health service providers at the health care centre need to optimize family empowerment through health information efforts in health promotion efforts. Further research requires the involvement of other factors to improve family behaviour, especially in the ability of families to detect early high-risk pregnancies. 

Clinical evaluation of anesthesia for high-risk cesarean section at a tertiary medical center: retrospective study for 8 years (2009-2016)

Objective

The number of high-risk pregnancies is increasing in tertiary medical centers. Therefore, we investigated perioperative outcomes based on risk factors to ascertain proper maternal and neonatal management.

Methods

We reviewed the medical records of patients receiving cesarean sections over an 8-year period. Clinical parameters for anesthesia and the neonatal outcome were compared among high-risk groups after subdivision by the number of clinical risk factors. The groups were as follows: group A (one risk factor), group B (two risk factors), and group C (three or more risk factors).

Results

Patient age, estimated blood loss (EBL), and volume of transfused red blood cell (RBC) were higher in group B than group A. Birth weight, 1- and 5-minute Apgar scores, and gestational age were lower while the frequency of neonatal intensive care unit (NICU) admission was higher in group B than group A. Group C patients were significantly older than group A or B patients. Birth weight, 1- and 5-minute Apgar scores and gestational age were significantly lower while frequency of NICU admission was higher in group C than group A and B.

Conclusion

The number of maternal risk factors was positively associated with adverse outcomes in the neonates.