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Bhattacharya R, Chaudhary M, Bhattacharjee S, Kukadiya R, Shahu S, Shah D, Patel MR. Clinical Profile of Patients Presenting With Eclampsia at a Semi-urban Tertiary Care Center. Cureus 2024; 16:e65651. [PMID: 39205718 PMCID: PMC11352022 DOI: 10.7759/cureus.65651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Introduction Pregnancies complicated by hypertensive disorders contribute to enormous burden on economy and health-care facilities. Eclampsia is one of the clinical markers of near-miss mortality. To achieve optimal outcomes, efforts should be directed at both periphery and tertiary care levels. This study aimed to compare the feto-maternal outcome in patients presenting with eclampsia and a matched control population. Methodology A comparative observational study was conducted among 70 cases and 70 controls. Detailed history and general and obstetrical examinations were carried out. Data was extracted from case files, labor room, and ICU records. Maternal and fetal outcomes were noted from January 2023 to January 2024. Statistical software STATA 14.2 (StataCorp LLC, College Station, Texas, USA) was used for data analysis. Observational descriptive statistics and chi-square and Fisher extract tests were applied. Results In our study, the incidence of eclampsia was 0.7% (70 per 1000 live births). The maternal mortality rate was 102.8/100000 live births and the perinatal mortality rate was 10.2/ 1000 live births in our study. The study observed a relatively young aged population and a significant bulk of cases belonged to late gestation or post-partum. Events like HELLP syndrome, abruption, liver, and renal failure were found to be frequently linked to eclampsia. Neonatal asphyxia (P-0.005), NICU requirement 41.43% vs 29% (P<0.01) preterm delivery 45.7% vs 14% (P=<0.001), and low birth weight were more commonly observed among the cases than the controls. Conclusions Eclampsia was found to be a significant contributor to elevated rates of morbidity and mortality in mothers and newborns. Poor antenatal care, severe anemia, and late referrals were some of the modifiable risk factors. Health care and economic burden on society is immense due to the significant utilization of intensive care and high dependency units.
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Affiliation(s)
- Rumi Bhattacharya
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Milankumar Chaudhary
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | | | - Romil Kukadiya
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Sheetal Shahu
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Dipal Shah
- Obstetrics and Gynecology, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
| | - Mamta R Patel
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Karamsad, IND
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Gowtham M, Gugapriya TS, Umredkar AA, Deulkar S. The Impact of COVID-19-Related Psychological Stress on Fetoplacental Circulation: A Doppler Scan of Umbilical Vessels in Third-Trimester Antenatal Women. Cureus 2023; 15:e41517. [PMID: 37551208 PMCID: PMC10404444 DOI: 10.7759/cureus.41517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION The placenta is an important organ of pregnancy. A multitude of physiological and pathological factors influence blood flow in the placenta during pregnancy. However, the fetal effects of maternal psychological stress were inconclusive. The recent COVID-19 pandemic had unprecedented economic, social, and psychological effects. The effect of COVID-19-induced psychological stress in antenatal women and its resultant fetal impact were studied by observing the Doppler waveforms of the uterine and umbilical arteries. METHODS The cross-sectional study was conducted on 26 healthy third-trimester antenatal women who satisfied pre-set inclusion and exclusion criteria. A pandemic-related pregnancy stress scale (PREPS) was used to evaluate the stress in pregnant women and categorize it into mild, moderate, and severe levels. The Doppler ultrasound of the uterine and umbilical vessels was done along with a routine growth scan in the third trimester of pregnancy. The arterial waveforms, Pulsatility index (PI) of uterine and umbilical arteries, umbilical vein blood flow, and biometric parameters of the fetus were recorded and analyzed. RESULTS Seventeen of the 26 participants were found to be moderately stressed. Among the three dimensions of the PREPS tool, the perinatal infection stress dimension was expressed predominantly. A strong expression of the positive affirmation dimension was seen in antenatal women. The mean Pulsatility index in the mild, moderate, and severe groups was 0.74, 0.93, and 0.63, respectively. The association between the PREPS score and the Pulsatility index of the umbilical artery alone was found to be significant at p=0.02. CONCLUSION The COVID-19 pandemic caused moderate to severe levels of psychological stress in pregnant women. The statistically significant association between the PREPS score and the umbilical artery PI indicates possible fetoplacental compromise, suggesting the need for cognitive therapy to manage psychological stress in antenatal women.
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Affiliation(s)
- M Gowtham
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - T S Gugapriya
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - Ashwini A Umredkar
- Radio-diagnosis, All India Institute of Medical Sciences Nagpur, Nagpur, IND
| | - Snehal Deulkar
- Anatomy, All India Institute of Medical Sciences Nagpur, Nagpur, IND
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He X, Ding DN. Expression and clinical significance of miR-204 in patients with hypertensive disorder complicating pregnancy. BMC Pregnancy Childbirth 2022; 22:182. [PMID: 35255856 PMCID: PMC8903659 DOI: 10.1186/s12884-022-04501-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Hypertensive disorder complicating pregnancy (HDCP) is a unique and common obstetrical complication in pregnancy. The current study sought to investigate the diagnostic value of serum miR-204 in HDCP patients. Methods A total of 196 HDCP patients were enrolled, with 54 healthy pregnant women as controls. The expression levels of miR-204 and inflammatory factors in the serum were determined. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of miR-204 in HDCP patients. Person coefficient was introduced to analyze the correlation between miR-204 and inflammatory indexes. Kaplan–Meier method was employed to analyze the effect of miR-204 expression on the incidence of adverse pregnancy outcomes. Logistic regression was adopted to assess the risk factors for adverse pregnancy outcomes. Results miR-204 expression was upregulated in the serum of HDCP patients. The serum miR-204 level > 1.432 could assist the diagnosis of HDCP. miR-204 level in the serum was positively correlated with TNF-α, IL-6, and hs-CRP concentrations in HDCP patients. The risk of adverse outcomes was higher in pregnant women with high miR-204 expression. High miR-204 expression was associated with an increased risk of adverse pregnancy outcomes after adjusting the family history of HDCP, systolic pressure, diastolic pressure, AST, ALT, LDH, 24-h urinary protein, TNF-α, IL-6, and hs-CRP. Conclusion The high expression of miR-204 assists the diagnosis of HDCP and is an independent risk factor for adverse pregnancy outcomes in HDCP patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04501-9.
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Affiliation(s)
- Xin He
- Department of Obstetrics, Hunan Provincial People's Hospital, The First-Affiliated Hospital of Hunan Normal University), Jiefang Xi Lu, Changsha, 410005, Hunan, China
| | - Dan-Ni Ding
- Department of Obstetrics, Hunan Provincial People's Hospital, The First-Affiliated Hospital of Hunan Normal University), Jiefang Xi Lu, Changsha, 410005, Hunan, China.
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Gică N, Ragea C, Botezatu R, Peltecu G, Gică C, Panaitescu AM. Incidence of Emergency Peripartum Hysterectomy in a Tertiary Obstetrics Unit in Romania. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010111. [PMID: 35056419 PMCID: PMC8780271 DOI: 10.3390/medicina58010111] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/09/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Abstract
Background and Objectives: Emergency peripartum hysterectomy (EPH) is a life-saving surgical procedure performed when medical and surgical conservative measures fail to control postpartum hemorrhage. The objective of this study was to estimate the incidence of EPH and to determine the factors leading to this procedure and the maternal outcomes. Materials and Methods: A retrospective cohort study with all cases of EPH performed at Filantropia Clinical Hospital in Bucharest between January 2012 and May 2021. Results: There were 36 EPH, from a total of 36,099 births recorded. The overall incidence of EPH was 0.99 per 1000 deliveries, most cases being related to placenta accreta spectrum disorder and uterine atony. Conclusions: Peripartum hysterectomy is associated with an important maternal morbidity rate and severe complications. Efforts should be made to reduce the number of unnecessary cesarean deliveries.
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Affiliation(s)
- Nicolae Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Carina Ragea
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
| | - Radu Botezatu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Gheorghe Peltecu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Corina Gică
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
| | - Anca Maria Panaitescu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, 11171 Bucharest, Romania; (N.G.); (C.R.); (R.B.); (G.P.); (C.G.)
- Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 11171 Bucharest, Romania
- Correspondence:
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Pregnancy Complications Can Foreshadow Future Disease—Long-Term Outcomes of a Complicated Pregnancy. Medicina (B Aires) 2021; 57:medicina57121320. [PMID: 34946265 PMCID: PMC8704070 DOI: 10.3390/medicina57121320] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 01/22/2023] Open
Abstract
During gestation, the maternal body should increase its activity to fulfil the demands of the developing fetus as pregnancy progresses. Each maternal organ adapts in a unique manner and at a different time during pregnancy. In an organ or system that was already vulnerable before pregnancy, the burden of pregnancy can trigger overt clinical manifestations. After delivery, symptoms usually reside; however, in time, because of the age-related metabolic and pro-atherogenic changes, they reappear. Therefore, it is believed that pregnancy acts as a medical stress test for mothers. Pregnancy complications such as gestational hypertension, preeclampsia and gestational diabetes mellitus foreshadow cardiovascular disease and/or diabetes later in life. Affected women are encouraged to modify their lifestyle after birth by adjusting their diet and exercise habits. Blood pressure and plasmatic glucose level checking are recommended so that early therapeutic intervention can reduce long-term morbidity. Currently, the knowledge of the long-term consequences in women who have had pregnancy-related syndromes is still incomplete. A past obstetric history may, however, be useful in determining the risk of diseases later in life and allow timely intervention.
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The Psychological Impact of the COVID-19 Pandemic on Pregnant Women. Healthcare (Basel) 2021; 9:healthcare9060725. [PMID: 34204712 PMCID: PMC8231526 DOI: 10.3390/healthcare9060725] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has meant significant precautions and changes in delivering healthcare services. The aim of the study was to explore the lifestyle changes of pregnant women during the COVID-19 pandemic in Romania, the changes in prenatal care and delivery during the pandemic and the psychological impact on women and to determine how healthcare providers can help them to overcome this period. METHODS A cross-sectional survey was conducted anonymously and distributed among pregnancy-related groups from Romania, recruiting 559 study participants, between May and October 2020. A total of 559 pregnant women completed an online 26-item questionnaire but we only validated 557 responses for study. The survey included basic demographic questions, pregnancy-related questions, questions regarding the pregnant women's lifestyle changes during the pandemic and their perception of the COVID-19 pandemic and questions which evaluated the impact of the pandemic on prenatal care and delivery in Romania. RESULTS The pandemic restrictions affected women's routine activities regarding professional, familial and social life. Therefore, for pregnant women who were emotionally vulnerable, these restrictions had a great impact on their mental health. The majority of the study participants (78.8%, N = 439) were emotionally affected by the pandemic. The fear related to the possibility of having their pregnancy affected by the virus was dominant in the group (45.8%). A high number of women (69.5%) felt safe when they accessed health services, but private hospitals were considered safer (53.1%) compared to public hospitals (14.4%). The majority of participants (53.7%) used to have prenatal care in a private healthcare system. During the pandemic, preventive measures were associated with low confidence in the healthcare system. Of the total group of participants, 123 women (22.1%) gave birth during the pandemic. Of these, a majority of the study participants considered that it was very difficult for them to cope without their partner during the hospitalization and labor period. CONCLUSIONS The main anxiety of pregnant women were related to threats to their lives and their baby's health because of the uncertainty caused by pandemic. It is important to know that the restrictions and the changes in maternity care had a negative impact on them. This conclusion must be taken into account when preventive measures will be decided for helping them to get through such a period. Additionally, psychological support will be essential for improving the mental health of pregnant women and for preventing a negative outcome of the pregnancy. These feelings must be taken into account when preventive measures will be established during pandemic and a psychological support will be essential for improving their mental health for preventing negative outcome of pregnancy.
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Olié V, Moutengou E, Grave C, Deneux-Tharaux C, Regnault N, Kretz S, Gabet A, Mounier-Vehier C, Tsatsaris V, Plu-Bureau G, Blacher J. Prevalence of hypertensive disorders during pregnancy in France (2010-2018): The Nationwide CONCEPTION Study. J Clin Hypertens (Greenwich) 2021; 23:1344-1353. [PMID: 34042277 PMCID: PMC8678732 DOI: 10.1111/jch.14254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 01/19/2023]
Abstract
Hypertensive disorders of pregnancy (HDP) are one of the leading causes of maternal and fetal morbidity and mortality. We aimed to estimate the prevalence of each HDP in France and to study their associations. All pregnant women who delivered in France between 2010 and 2018 were included in a cohort and followed during their pregnancy and 6 weeks of postpartum. Each HDP occurring during the follow-up was identified. Prevalence of each HDP and cumulative incidence by gestational age were estimated. Incidence rate ratio (IRR) and 95% confidence interval (CI) for preeclampsia among women with preexisting or gestational hypertension (GH) were estimated using Poisson regression and adjusted for age were estimated. Between 2010 and 2018, 6 302 810 deliveries were included. HDP complicated 7.4% of pregnancies. Preeclampsia and GH complicated 2.0% and 4.2% of pregnancies, respectively. Most of preeclampsia cases occurred without a prior HDP. HELLP syndrome represented 10.4% of preeclampsia cases. Compared to nulliparous pregnancies without HDP prior preeclampsia, the age-adjusted IRR of preeclampsia was 6.2 [95% CI: 6.1-6.4] in nulliparous pregnancies with preexisting hypertension and 2.9 [95% CI: 2.8-3.0] in nulliparous pregnancies with GH. In France, HDP occurred in 7.4% of all pregnancies. Women with preexisting chronic hypertension are at high risk to present preeclampsia during pregnancy. Preeclampsia complicated 2.0% of pregnancies in France. Tailoring management of women according to the HDP is a major challenge to avoid complications related to these disorders.
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Affiliation(s)
- Valérie Olié
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Elodie Moutengou
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Clémence Grave
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Catherine Deneux-Tharaux
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes University, Paris, France
| | - Nolwenn Regnault
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Sandrine Kretz
- Diagnosis and Therapeutic Center, AP-HP, University Paris Descartes, Paris, France
| | - Amélie Gabet
- Santé publique France, the French Public Health Agency, Saint-Maurice, France
| | - Claire Mounier-Vehier
- Vascular Medicine and Hypertension Center, EA 2694 - Santé Publique- University Lille, Lille, France
| | - Vassilis Tsatsaris
- Paris-Descartes University, Paris, France.,Department of Obstetrics and Gynecology, APHP, Port-Royal Maternity, University Hospital Center Cochin Broca Hôtel Dieu, Groupe Hospitalier Universitaire Ouest, Paris, France
| | - Geneviève Plu-Bureau
- Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), France.,Paris-Descartes University, Paris, France.,Division of Gynaecology, APHP, Hôpital Cochin, Paris, France
| | - Jacques Blacher
- Paris-Descartes University, Paris, France.,Diagnosis and Therapeutic Center, AP-HP, University Paris Descartes, Paris, France
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Panaitescu AM, Ciobanu AM, Popa M, Duta I, Gica N, Peltecu G, Veduta A. Screening for Gestational Diabetes during the COVID-19 Pandemic-Current Recommendations and Their Consequences. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:381. [PMID: 33920937 PMCID: PMC8071285 DOI: 10.3390/medicina57040381] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/07/2021] [Accepted: 04/13/2021] [Indexed: 01/11/2023]
Abstract
Gestational diabetes mellitus (GDM) is recognized as one of the most common medical complications of pregnancy that can lead to significant short-term and long-term risks for the mother and the fetus if not detected early and treated appropriately. Current evidence suggests that, with the use of appropriate screening programs for GDM, those women diagnosed and treated have reduced perinatal morbidity. It has been implied that, when screening for GDM, there should be uniformity in the testing used and in further management. This paper summarizes and compares current screening strategies proposed by international bodies and discusses application in the context of the COVID-19 pandemic.
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Affiliation(s)
- Anca Maria Panaitescu
- Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.M.C.); (N.G.); (G.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (M.P.); (A.V.)
| | - Anca Marina Ciobanu
- Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.M.C.); (N.G.); (G.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (M.P.); (A.V.)
| | - Maria Popa
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (M.P.); (A.V.)
| | - Irina Duta
- Endocrinology and Diabetes, Southend University Hospital, Essex SS0 0RYUK, UK;
| | - Nicolae Gica
- Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.M.C.); (N.G.); (G.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (M.P.); (A.V.)
| | - Gheorghe Peltecu
- Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (A.M.C.); (N.G.); (G.P.)
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (M.P.); (A.V.)
| | - Alina Veduta
- Filantropia Clinical Hospital, 11171 Bucharest, Romania; (M.P.); (A.V.)
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