Littérature scientifique sur le sujet « Outcome gravidici »

Objective: To examine the obstetric outcome in grand multi-parous and the effect of high parity among young women, aged 18-34 years vs. older women, aged 35years and above. Methods: This is a retrospective study done in DMCH from 1st August 2007 to 31st August 2008. For study purpose 98 patients were selected randomly whose gravidity 6th and more. To see peri-natal outcome, the cut-off point of 28 weeks was taken. Results: Mean age of the study group was 32(22-45) years. Mean gravidity and parity of the study group was 6.7 (6-11) and 4(1-8) respectively. Ninety percent pregnancy affected by different complications. Hypertensive disorder of pregnancy (14.3%) and ante-partum hemorrhage (14.3%) was more common. Bad obstetric history (12.35%), mal-presentation (11.23%) and intra-partum complications were also common. Twenty two percent (22.46%) pregnancies complicated by gestational diabetes, maternal medical disease and multi-fetal gestation. Regarding fetal outcome, peri-natal loss was 10(14%). Preterm delivery, ante partum hemorrhage, bad obstetric history, gestational diabetes and mal presentation were the cause of peri natal loss. Lack of reproductive knowledge, unmet need for contraception, poor obstetric performance and too early marriage are the main cause of grand multi-gravidity and multi-parity Conclusion: Diabetes mellitus, hypertension, ante partum hemorrhage, mal-presentation was more common in grand multi-parous irrespective of age. There was no significant difference in the incidence of obstetric complications and in perinatal outcome among both groups. DOI: http://dx.doi.org/10.3329/jdmc.v22i1.15629 J Dhaka Medical College, Vol. 22, No. 1, April, 2013, Page 67-71

Introduction: Antepartum hemorrhage is the bleeding from the genital tract following the completion of 28 weeks of pregnancy till full term. It is an obstetrical emergency and a leading cause of maternal and perinatal death and morbidity. Objectives: This study was conducted to determine the frequency of maternal and fetal complications in women with antepartum hemorrhage. Methods: It was a cross sectional study held at the Department of Gynecology and Obstetrics unit IV, Liaquat University of Medical and Health Sciences, Jamshoro between 2017 and 2019. This study enrolled 158 women with a history of antepartum hemorrhage using non- probability consecutive sampling. The fetal and maternal outcomes of the patients were recorded. Maternal outcomes were assessed according to age, gravidity and gestational week. Data was analyzed in SPSS 20. Results: The average age of the women was 25.77±4.15 years. Anemia was the most common maternal outcome 102(64.6%) followed by disseminated intravascular coagulation (DIC) 24(15.2%), shock 12(7.6%), postpartum hemorrhage (PPH) 11(7%) and maternal mortality 5 (3.1%). Preterm birth and low APGAR score were the most frequently fetal outcomes that were observed in 69 (43.7%) and 50 (31.6%) cases, respectively. There was significant association of DIC with gravidity and gestational age. Anemia was significantly associated with gestational age more frequently among mothers with <37 weeks of gestational age. Conclusion: In conclusion, anemia was the most frequently encountered complication of antepartum hemorrhage, followed by DIC and shock. Multigravidity was a significant etiological factor in antepartum hemorrhage.

This study examined acculturation status, selected demographic and pregnancy indices, and the relationship to birth outcomes and family planning patterns among a convenience sample of 63 Hispanic adolescents aged 13 to 19 years and attending community-based prenatal clinics. Findings suggest that Hispanic teenagers who are the first generation in the United States and traditional in their world view are compliant with prenatal and postpartum care and have healthy babies and birth outcomes. Gravidity and gestational age of the infant were significant predictors of birth weight, accounting for 30% of the variability in birth weight. Generation in the United States accounted for 8% of the variance in family planning compliance. Higher gravidity was associated with increased infant birth weight and a decreased likelihood for return for family planning visits during the 1st year postbirth. Teens who were first generation in the United States were more likely to return for family planning visits during the 1st year. School nurses are in a pivotal position to design intervention programs that build on traditional cultural prescriptions for healthy behaviors during and after pregnancy.

We have made a contemporary analysis of clinical presence, distinctive features of the pregnancy, delivery, post-delivery and earlier neonatal periods, morphological changes of afterbirth in 90 pregnant women examined for the presence of intrauterine infection markers. It was revealed that risk factors for the appearance and development of severe perinatal diseases of the newborns were placental insufficiency and intrauterine infection. Newborns who were born in medium and heavy asphyxia state should be examined for the presence of congenital dartrous and chlamidia infections the first hours of their lives to conduct an adequate therapy in postnatal period. Screening of women from the delivery reserve group for sexually transmitted infections, pre-gravidic preparation will allow to prevent complications of pregnancy, delivery, to reduce perinatal losses.

Aim: To find out the females practicing pica and its effects in newborns. Study Design: Cross-sectional descriptive study Place and Duration of Study: Department of Community Medicine, Kabir Medical College Peshawar from 1st May 2021 to 31st December 2021. Methodology: Three hundred and eighty six pregnant women from 15 to 49 years were enrolled. The WHO standards for new born weight were used to measure normal and underweight babies and associated factors causing anemia and pica practicing among females. A semi-structured questionnaire was used to collect data on socioeconomic conditions, family size, maternal education, parity, gravidity and complication during and after delivery. Results: The prevalence of maternal anemia 73.3% in mothers of aged 15 to 49 years. Antenatal visits, medications used during pregnancy, and intake of non-food (pica) items showed significant results with p<0.05 and showed strong association between maternal factors and newborn weight. Age, ethnicity, socioeconomic status, parity, gravidity, body mass index, history of genetic disorder factors showed non-significant results. Conclusions: The practicing pica and other factors causing anemia cause low birth weight in new born while location or place of living did not affect the weight of the new born. Keywords: Practices, Pica, Pregnant females, Outcome

Background: Inflammatory bowel disease (IBD) is mostly diagnosed in young women of fertile age, and a significant number of patients become pregnant while they have the disease. The remission of the illness, which is often achieved by intensive anti inflammatory treatment, has been found to be the most important factor of a successful pregnancy. Vedolizumab (VDZ) and ustekinumab (UST) are newer types of monoclonal antibodies with different mechanisms of effect when compared to anti-TNF treatment. VDZ is a monoclonal antibody against the α4ß7 integrin receptor, and UST against interleukin 12/23; both have expanded the spectrum of the biological treatment of IBD in recent years. Aims: To present the results of a multicentre observational study. The primary aim was to assess the safety of vedolizumab and ustekinumab for pregnancy, foetal development and the neonatal outcome. The secondary aim was to measure the drug concentration in maternal and cord blood at the time of delivery. Methods: It was a multicentre, retrospective-prospective observational study. Data on patients’ demographics, clinical characteristics and pregnancy were collected by the treating physician using a predefined questionnaire, data on newborn outcome were obtained from medical documentation. The ELISA method was used to measure the VDZ and UST concentrations. Results: The study took place in 15 IBD clinical centres in the Czech Republic. 79 women with 85 completed pregnancies were included in the study, and they were exposed to VDZ or UST during pregnancy. 36 women were treated with vedolizumab (median age 32 years) and 49 with ustekinumab (median age 30.5 years). In the group with VDZ, live births occurred with 32 women (88.9%), and there were two early spontaneous abortions up to the eighth week of gestation in addition to two instrumentally aborted pregnancies (4, 11.1%). 31 children (93.9%) in the group with VDZ were born at term with a median birth weight of 3,097.5 grams. In the ustekinumab group, 39 women (79.6%) had live births, there were nine early abortions and one instrumentally aborted pregnancy (10, 20.4%). 38 (97.4%) children were born at term with a median birth weight of 3,265 grams. The drug levels of VDZ and UST at birth were measured in 44 neonate-mother pairs (21 VDZ, 23 UST). The median level of VDZ in maternal venous blood was 7.2 mg/l, and in cord blood it was 4.7 mg/l (infant / maternal ratio 0.66). With UST, the median maternal level was 4.7 mg/l, and in neonates it was 7.9 mg/l (infant / maternal ratio 1.65). Conclusion: The results found in a group of women that were being treated for IBD and were exposed to at least one dose of biologic treatment with UST or VDZ during pregnancy are consistent with previously published evidence showing no adverse events, and they confirm the safety profile of new biologics in pregnancy. Due to the still limited number of enrolled patients, further studies are needed on the outcomes of pregnancies with new biologics drugs. Keywords vedolizumab, ustekinumab, pregnancy, transplacentární přenos

The Plasmodium falciparum protein VAR2CSA allows infected erythrocytes to accumulate within the placenta, inducing pathology and poor birth outcomes. Multiple exposures to placental malaria (PM) induce partial immunity against VAR2CSA, making it a promising vaccine candidate. However, the extent to which VAR2CSA genetic diversity contributes to immune evasion and virulence remains poorly understood. The deep sequencing of the var2csa DBL3X domain in placental blood from forty-nine primigravid and multigravid women living in malaria-endemic western Kenya revealed numerous unique sequences within individuals in association with chronic PM but not gravidity. Additional analysis unveiled four distinct sequence types that were variably present in mixed proportions amongst the study population. An analysis of the abundance of each of these sequence types revealed that one was inversely related to infant gestational age, another was inversely related to placental parasitemia, and a third was associated with chronic PM. The categorization of women according to the type to which their dominant sequence belonged resulted in the segregation of types as a function of gravidity: two types predominated in multigravidae whereas the other two predominated in primigravidae. The univariate logistic regression analysis of sequence type dominance further revealed that gravidity, maternal age, placental parasitemia, and hemozoin burden (within maternal leukocytes), reported a lack of antimalarial drug use, and infant gestational age and birth weight influenced the odds of membership in one or more of these sequence predominance groups. Cumulatively, these results show that unique var2csa sequences differentially appear in women with different PM exposure histories and segregate to types independently associated with maternal factors, infection parameters, and birth outcomes. The association of some var2csa sequence types with indicators of pathogenesis should motivate vaccine efforts to further identify and target VAR2CSA epitopes associated with maternal morbidity and poor birth outcomes.

Background: Maternal Anemia is a global health problem with adverse implications on materno-fetal outcome. Various socio-demographic and obstetric factors affect prevalence of anemia.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, age, gravidity, parity, literacy, area of residence and socioeconomic status. Hemoglobin levels in first trimester and pre delivery were measured by coulter and correlated with socio-demographic and obstetric factors.Results: Among 500 pregnant women of first trimester, 249 (49.8%) had anemia, 154 (30.8%) mild, 86 (17.2%) moderate and 9 (1.8%) severe anemia. More women with anemia were of lesser age, resided in rural area, belonged to middle and lower economic class, lived with joint families and had less than 12 years of formal education.Conclusions: Anemia is prevalent in pregnant women in this geographic region of central India. Age, higher gravidity, higher parity, rural residence, low socioeconomic status and less than 12 years of formal education, are risk factors. Appropriate age at marriage, small family norm, education of girl child, anemia prevention strategy in adolescent girls and financial empowerment of women are suggested strategies for prevention of anemia and improved maternofetal outcome.

L’artirite reumatoide (AR) è la più diffusa patologia autoimmune in Italia con elevati costi terapeutici e previdenziali associati. Questa patologia colpisce circa lo 0.5-1% della popolazione adulta, prevalentemente di genere femminile. Essendo una patologia degenerativa, i cui danni sono frequentemente irreversibili, una diagnosi precoce così come un adeguato trattamento ed un elevato livello di compliance del paziente allo stesso, potrebbero rallentare il peggioramento della malattia. Inoltre sono poco noti i possibili effetti della malattia e del suo trattamento sulle gravidanze e i successivi outcome gravidici. I principali obiettivi della tesi quindi sono: i) valutare l’aderenza alle linee guida per il trattamento dell’ AR da parte dei clinici, ii) valutare l’aderenza al trattamento per AR da parte del paziente, iii) stimare costo ed efficacia delle cure erogate nelle cliniche specializzate per il trattamento di pazienti con AR, iv) analizzare gli esiti gravidici e il raggiungimento della gravidanza in donne con AR trattate con metotrexate (MTX). La prima tematica ha riguardato la valutazione di come sono state implementate le linee guida della European Alliance of Associations for Rheumatology (EULAR) per il trattamento dell’AR e l’impatto dell’aderenza a queste linee guida sulla probabilità di ospedalizzazione. I principali risultati di questo studio hanno mostrato come i pazienti con un’ottima aderenza alle linee guida, se confrontati con quelli con bassa aderenza, abbiano un rischio del 24% inferiore di incorrere in ospedalizzazione. La seconda tematica ha riguardato la valutazione dell’impatto dell’aderenza al trattamento con Disease-Modifying Anti-Rheumatic Drugs (DMARDs), terapia suggerita dall’EULAR, sul raggiungimento della remissione clinica di malattia. I dati provengono dal database ELECTRA (con informazioni cliniche e provenienti da database amministrativi) di pazienti con AR trattati presso l’IRCCS Policlinico San Matteo (Pavia). Si è osservato che un incremento percentuale di 10 unità nella copertura al trattamento comporta un aumento della probabilità di remissione clinica del 10%. Da questi risultati sembra emergere l’importanza di riuscire a monitorare i pazienti nella pratica clinica per mantenere elevati standard di compliance. L’obiettivo della terza tematica si è focalizzato su una valutazione costo-efficacia del trattamento dei pazienti con AR erogato da cliniche specializzate (EAC), confrontandolo con quello dei pazienti trattati in cliniche non specializzate. Sono state quindi reclutate due coorti, la prima di pazienti trattati in una EAC e l’altra estratta dai database amministrativi di regione lombardia tra i soli soggetti con AR. I risultati principali di questa terza fase hanno mostrato come ad un incremento moderato dei costi si associ un incremento molto elevato dell’efficacia, specialmente se calcolata come durata di degenza e come aderenza alle linee guida EULAR. La quarta ed ultima tematica riguarda l’analisi dell’impatto del trattamento con MTX (DMARD suggerito dall’EULAR come prima linea di trattamento) nelle pazienti con AR sulla possibilità di raggiungere una gravidanza e sugli outcome gravidici conseguenti. Sono state definite tre coorti: donne con AR con esposizione incidente di MTX, donne con AR senza trattamento con MTX e donne senza AR. I risultati principali di questa analisi hanno mostrato che le donne con AR, specialmente se trattate con MTX, hanno una minor frequenza di gravidanze rispetto alle donne senza AR. Inoltre, le donne trattate con MTX sembrano avere un rischio più elevato di aborto spontaneo (circa due volte superiore) rispetto alle altre due coorti.
Rheumatoid arthritis (RA) is, in Italy, the most widespread autoimmune disease with high associated costs for the National Health Service. This disease affects about 0.5-1% of the adult population, mainly of the female gender. Being a degenerative disease, whose damages are frequently irreversible, an early diagnosis as well as an adequate treatment and a high level treatment compliance of the patient, could slow down the worsening of the disease. Furthermore, the possible effects of RA and its treatment on pregnancies and subsequent pregnancy outcomes are not well known. The main objectives of the thesis are therefore: i) to evaluate the adherence to guidelines for the treatment of RA, ii) to evaluate the patient's adherence to RA treatment, iii) to estimate the cost and effectiveness of care provided in specialized clinics for the treatment of RA patients, iv) to analyze pregnancy outcomes and the likelihood of achieving pregnancy in women with RA treated with methotrexate (MTX). The first issue concerned the assessment of how the guidelines of the European Alliance of Associations for Rheumatology (EULAR) for the treatment of RA have been implemented, and the impact of adherence to these guidelines on the probability of hospitalization. The main results of this study showed that patients with excellent adherence to guidelines, when compared with those with low adherence, have a 24% lower risk of hospitalization. The second topic concerned the evaluation of the impact of adherence to treatment with Disease-Modifying Anti-Rheumatic Drugs (DMARDs), the therapy suggested by EULAR, on the achievement of disease clinical remission (defined as a substantial decrease or absence of symptoms). The ELECTRA database, which contains clinical information and information from administrative databases of RA patients treated at the IRCCS Policlinico San Matteo (Pavia), was considered for the analysis. The main finding showed that a 10-unit percentage increase in proportion of days covered by DMARDs is associated with a 10% increase in the likelihood of clinical remission. These results show the importance of monitoring patients in clinical practice to maintain high levels of treatment compliance. The objective of the third theme focused on a cost-effectiveness evaluation, comparing RA patients treated in specialized clinics ("Early Arthritis Clinic" - EAC), with RA patients treated in non-specialized clinics. Two cohorts were recruited, the first one included patients treated in the EAC of the IRCCS Policlinico San Matteo and the other one with patients with RA extracted from the administrative databases of Lombardy region. The main results of this third phase showed that a moderate increase in costs is associated with a very high increase in effectiveness, especially if calculated as length of hospitalizations and as adherence to the EULAR guidelines. These findings could open up new scenarios in RA patient management. The fourth and final topic concerned the impact of treatment with MTX (DMARD suggested by EULAR as the first line of treatment) in RA women, on the likelihood of achieving pregnancy and on pregnancy outcomes. Three cohorts were recruited: women with RA with incident MTX exposure, women with RA without MTX treatment, and women without RA. The main results of this analysis showed that women with RA, especially when treated with MTX, have a lower frequency of pregnancies than women without RA. Furthermore, women treated with MTX have a higher risk of spontaneous abortion (about twice as high) than the other two cohorts.

UNIVERSITÀ DEGLI STUDI DI MILANO Facoltà di Medicina e Chirurgia SCUOLA DI DOTTORATO in SCIENZE FISIOPATOLOGICHE, NEUROPSICOBIOLOGICHE E ASSISTENZIALI DEL CICLO DELLA VITA DIPARTIMENTO di Scienze Biomediche e Cliniche “Luigi Sacco” CORSO DI DOTTORATO in Scienze Assistenziali del Ciclo della Vita - CICLO XXVII ABSTRACT DELLA TESI DI DOTTORATO DI RICERCA STATO DI NUTRIZIONE MATERNO, ESITI GRAVIDICI E OUTCOMES OSTETRICI: STUDIO OSSERVAZIONALE PROSPETTICO IN DONNE DI ORIGINE CAUCASICA Settore scientifico disciplinare MED/40 Ginecologia e Ostetricia Tesi di Dottorato di Elena Isabel Liguori Matricola R09522 TUTOR: Chiar.mo Prof. Enrico Mario Ferrazzi COORDINATORE: Chiar.mo Prof. Roberto Weinstein A.A. 2013/2014 ABSTRACT In the bibliography the Mediterranean diet is associated with positive health effects in the general population, such as a lower incidence of cardiovascular diseases, diabetes and obesity. There is limited data on pregnant women. The relationship between nutrition in pregnancy and obstetric outcome was investigated. In particular the adherence to the Mediterranean diet of caucasian pregnant was analyzed, because it’s already considered a positive prognostic index in the normal population, to see if the dietary pattern is correlated with a lower incidence of complications in pregnancy related to poor nutrition and excessive weight, and then to an improvement of neonatal outcomes. 127 caucasian woman were enrolled voluntarily, pertaining to outpatient of the I.C.P. Buzzi Children’s Hospital, in Milan, and these were followed in the three trimesters of pregnancy. The trend of the nutritional profile during pregnancy was analyzed with a standardized questionnaire, to be able to detect the degree of adherence to the mediterranean diet, and the maternal weight gain has been detected combined with anthropometric measurements (skinfold and circumferences). All data collected were analyzed and were related with medical history, pregnant examinations routine, obstetric and neonatal outcomes. Of the 127 women who partecipated in the first meeting 97 have completed the course. The sample of urban Caucasian women is rather uniform, mainly composed of primigravida, nonsmokers, with a high cultural level and 79.5% of the sample is normal weight, with an average BMI 21.8. The nutritional profile shows that there are not significant differences in the Mediterranean score in the three trimesters of pregnancy, but only about 16% reaches the minimum cut off of adhesion and is correlated directly and significantly with the age of the mother (r = 0:23 , p = 0.01). In particular it a low fish consumption was noted (only 4% reported consuming at least 3 times a week), legumes (only 10.6% reported consuming at least three times a week), dried fruit and nuts (only 22.4% reported consuming at least once a week). Of these women, those underweight and normal weight had an average weight gain of 13 kg and then in the range, overweight women instead took an average of 14 kg compared to 11 kg indicated by the IOM. The Mediterranean score detected at the end of pregnancy was inversely correlated (of borderline significance: 00:07) with the increase in weight, and can be correlated with the variation of the subscapular fold, which is skinfold more indicative of the change in fat mass. The weight of the newborn was correlated significantly to maternal weight, the folds of subcutaneous fat measured at the end of pregnancy and maternal waist circumference. The weight change between the first and third trimester was associated to the change of the folds and thus significantly associated to the increase in fat mass, which is in turn associated with weight. BIBLIOGRAPHY • American College of Obstetricians and Gynecologist. ACOG Committee Opinion number 315, September 2005. Obesity in pregnancy. 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ABSTRACT Background: Emesis gravidarum or nausea and vomiting has commonly occurred during pregnancy. However, excessive nausea and vomiting in early pregnancy have a potentially adverse effect on pregnancy outcomes. This study aimed to investigate the relationship between gravidity and severity of emesis gravidarum in women with first-trimester of pregnancy at PMB Fatimatu Zahrok Midwifery Care, Kediri, East Java. Subjects and Method: This was a cross-sectional study conducted at PMB Fatimatu Zahrok Midwifery Care, Kediri, East Java, from July to August 2020. A sample of 32 women with first-trimester of pregnancy was selected for this study. The dependent variable was severity of emesis gravidarum categorized into mild to moderate and severe. The independent variable was the number of gravidities categorized into primigravida and multigravida. The data were collected using questionnaire. The data were analyzed by chi-square. Results: Multigravida reduced the severity of emesis gravidarum (OR= 0.14; 95% CI= 0.02 to 0.85; p= 0.034). Conclusion: Multigravida reduces the severity of emesis gravidarum in women with first-trimester pregnancy. Keywords: emesis gravidarum, first trimester, gravidity, severity, pregnant women Correspondence: Rahma Kusuma Dewi. Faculty of Health Sciences, Universitas Kadiri. Jl. Selomangleng No 1, Kediri, East Java. Email: rahmakusumadewi@unik-kediri.ac.id. Mobile: +6281229440101. DOI: https://doi.org/10.26911/the7thicph.03.77