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Abstract

Objectives

Attitudes towards labour care and women’s choices for their preferred mode of delivery are documented in studies from the around the world, however less is known about women’s birth choices in the Middle East. This study was designed with the aim of exploring beliefs and attitudes in this region.

Methods

Voluntary participation in an ethics-approved survey was offered to pregnant women attending the antenatal clinic at Sidra Medicine from August 2018 to January 2019 with no exclusion criteria.

Results

Of the 346 respondents, 58.1% were Arabic and the remainder expatriates. This group composition allowed comparison between women native and non-native to the Gulf region. Arabic and non-Arabic women differed significantly in previous birth experiences: the Arabs had had more doctor-led deliveries (45 vs. 34%), epidurals (56.6 vs. 45%) and episiotomies (65.7 vs. 54%). 70.2% of the respondents chose a normal delivery as their preferred birth mode though a smaller majority of the Arabic subgroup did (63.2 %). 60.4% preferred delivery by doctors and longer hospital stays (47.6), more so Arabic participants (64.7 and 68.6 %). Significantly less Arabs, would choose husbands as birth partners (51.2 vs. 86.2%) and more expressed a gender preference for doctors. Other group choices are presented.

Conclusions

Though women in this region made comparable choices about mode of delivery as their Western counterparts, they demonstrated an expectation of a culturally distinct and more medicalized approach to care in labour. The findings highlight the need for further studies to inform regional obstetric care and health education interventions as well as tailoring maternity care services.

Abstract

Objectives

Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency (21-OHD) is a common autosomal recessive disorder caused by defects in the CYP21A2 gene. We aimed to determine the prevalence of the most commonly reported mutations among 21-OHD Egyptian patients and correlate genotype with phenotype.

Methods

Molecular analysis of the CYP21A2 gene was performed for the detection of the six most common point mutations (p.P30L, p.I172N, p.V281L, p.Q318X, the splice site mutation Int2 [IVS2–13A/C>G], and the cluster of three mutations [p.I236N, p.V237E, and p.M239K] designed as CL6). Polymerase chain reaction–restriction fragment length polymorphism (PCR-RFLP) method was performed on 47 unrelated Egyptian 21α-OH deficiency patients and their available parents to detect the presence of the six most common point mutations.

Results

Screening for the six most common point mutations in CYP21A2 gene, revealed mutations in 87.2% (82/94) of the studied alleles corresponding to 47 Egyptian patients. The most common mutation among the studied cases was IVS2-13C/A>G that was found to be presented in a frequency of 46.8% (44/94). The genotype/phenotype correlations related to null, A, and B groups were with PPV of 100, 55.5, and 83.3%, respectively.

Conclusions

The described method diagnosed CAH in 80.8% of the studied patients. Good correlation between genotype and phenotype in salt wasting and simple virilizing forms is determined, whereas little concordance is seen in nonclassical one. Furthermore, studying the carrier frequency of 21-OHD among the normal population is of great importance.

Abstract

Exercise during pregnancy may be beneficial provided that there are no contraindications. The aim of this study was to summarize and compare recommendations regarding exercise in pregnancy. Thus, a comparative descriptive review was conducted and included guidelines by the American College of Obstetricians and Gynecologists, the Society of Obstetricians and Gynaecologists of Canada and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. All compared guidelines recommend that pregnant women without contraindications should undertake physical activities regularly, however, the type of workout performed should be adjusted based on the previous exercise experience and the physical condition of each pregnant woman. A variation among the reviewed guidelines was identified on appropriate and inappropriate activities and on indications to interrupt exercise. To summarize, the adoption of an international up-to-date consensus regarding appropriate exercise during pregnancy may be beneficial in ensuring the safety of the pregnant women while promoting their physical and mental health.

Abstract

Objectives

Coronavirus (COVID-19) is a new respiratory disease that is spreading widely throughout the world. The aim of this study was to evaluate the psychological impact of COVID-19 pandemic on pregnant women in Italy.

Methods

We considered 200 pregnancies attending our antenatal clinic. A questionnaire was sent to each woman in the days of maximum spread of COVID-19. Sectional was finalized to acquire in 18 items maternal characteristics and to test the women’s perception of infection. Section included the State–trait anxiety inventory (STAI) 40 items validated test for scoring trait anxiety (basal anxiety, STAI-T) and state anxiety (related to the ongoing pandemic, STAI-S). An abnormal value of STAI was considered when ≥40.

Results

The questionnaire was completed by 178 women (89%). Fear that COVID-19 could induce fetal structural anomalies was present in 47%, fetal growth restriction in 65% and preterm birth in 51% of the women. The median value of STAI-T was 37 and in 38.2% of the study group STAI-T score ≥40 was evidenced. STAI-S values were significantly higher with an increase of median values of 12 points (p≤0.0001). There was a positive linear correlation between STAI-T and STAI-S (Pearson=0.59; p≤0.0001). A higher educational status was associated with increased prevalence of STAI-S ≥ 40(p=0.004). Subgrouping women by the other variables considered did not show any further difference.

Conclusions

COVID-19 pandemic induces a doubling of the number of women who reached abnormal level of anxiety. These findings validate the role of the remote use of questionnaire for identifying women at higher risk of anxiety disorders allowing the activation of support procedures.

Abstract

Objectives

Extubation failure is common in infants and associated with complications.

Methods

A prospective study was undertaken of preterm and term born infants. Diaphragm electromyogram (EMG) was measured transcutaneously for 15–60 min prior to extubation. The EMG results were related to tidal volume (Tve) to calculate the neuroventilatory efficiency (NVE). Receiver operating characteristic curves (ROC) were constructed and areas under the ROCs (AUROC) calculated.

Results

Seventy-two infants, median gestational age 28 (range 23–42) weeks were included; 15 (21%) failed extubation. Infants successfully extubated were more mature at birth (p=0.001), of greater corrected gestational age (CGA) at extubation (p<0.001) and heavier birth weight (p=0.005) than those who failed extubation. The amplitude and area under the curve of the diaphragm EMG were not significantly different between those who were and were not successfully extubated. Those successfully extubated required a significantly lower inspired oxygen and had higher expiratory tidal volumes (Tve) and NVE. The CGA and Tve had AUROCs of 0.83. A CGA of >29.6 weeks had the highest combined sensitivity (86%) and specificity (80%) in predicting extubation success.

Conclusions

Although NVE differed significantly between those who did and did not successfully extubate, CGA was the best predictor of extubation success.

Abstract

Objectives

This study aimed to establish reference ranges for fetal mitral, tricuspid, and interventricular septum annular plane systolic excursions (MAPSE, TAPSE, and SAPSE) in normal pregnant women between 20 and 36 + 6 weeks of gestation.

Methods

This prospective and cross-sectional study included 360 low-risk singleton pregnancies between 20 and 36 + 6 weeks of gestation. MAPSE, TAPSE, and SAPSE were measured by M-mode in real time in an apical or basal four-chamber view through placing the cursor at the atrioventricular junction, marked by the valve rings at the tricuspid, mitral, and basal septum, respectively. A regression analysis was done to determine the appropriate polynomial equation model for both measurements and standard deviation (SD) values in relation to gestational age (GA). The intra- and inter-observer reproducibility was evaluated using the concordance correlation coefficient (CCC) and limits of agreement (LoA).

Results

There was a significant positive correlation between MAPSE (r=0.705, p<0.0001), TAPSE (r=0.804, p<0.0001), and SAPSE (r=0.690, p<0.0001) and GA. The mean of each parameter ranged as follows: 2.87–5.56 mm, MAPSE; 3.98–8.07 mm, TAPSE; and 2.34–4.21 mm, SAPSE. Poor/moderate intra- and inter-observer reliability (CCC between 0.70 and 0.90) and poor/moderate agreement of all the tested parameters were evaluated (LoA between 10 and 50%).

Conclusions

Reference values were established for the fetal MAPSE, TAPSE, and SAPSE between 20 and 36 + 6 weeks of gestation in low-risk pregnant women. These parameters showed poor/moderate reproducibility.

Abstract

Objectives

Shoulder dystocia (SD) is an obstetrical emergency with well-recognized risk factors. We aimed to identify trends of changes in the specific contribution of risk factors for SD over time.

Methods

A nested case control study comparing all singleton deliveries with and without SD was undertaken. A multivariable logistic regression model was used in order to identify independent risk factors for SD and a comparison of the prevalence and the specific contribution (odds ratio (OR)) of the chosen risk factors in three consecutive eight-year intervals from 1988 to 2014 was performed.

Results

During the study period, there were 295,946 deliveries. Of them 514 (0.174%) were complicated with SD. Between 1988 and 2014 the incidence of SD has decreased from 0.3% in 1988 to 0.1% in 2014. Using a logistic regression model grandmultiparity, diabetes mellitus (DM), fetal weight, and large for gestational age (LGA) were found to be independent risk factors for SD (OR 1.25 95% CI 1.04–1.51, p=0.02; OR 1.53 95% CI 1.19–1.97, p=0.001; OR 1.002 95% CI 1.001–1.002, p < 0.001; OR 3.88 95% CI 3.09–4.87, p < 0.001; respectively). While the OR for grandmultiparity, fetal weight, and LGA has significantly changed during the study period with a mixed trend, the OR of DM has demonstrated a significant linear increase over time.

Conclusions

The individual contribution of selected risk factors for the occurrence of SD has significantly changed throughout the years. The contribution of DM has demonstrated a linear increase over time, emphasizing the great impact of DM on SD.

Abstract

Background

The pandemic caused by the new coronavirus SARS-CoV-2 (Covid-19) is quite a challenging experience for the world. At the moment of birth, the fetus is prepared to face the challenge of labor and the exposure to the outside world, meaning that labor and birth represent the first extrauterine major exposure to a complex microbiota. The vagina, which is a canal for reproduction, is by evolution separated (but not far) from the anus and urethra. Passing through the birthing canal is a mechanism for intergenerational transmission of vaginal and gut microorganisms for the vertical transmission of microbiota not only from our mothers and grandmothers but also from earlier ancestors.

Methods

Many national and international instructions have been developed since the beginning of the Covid-19 outbreak in January 2020 in Wuhan in China. All of them pointed out hygiene measures, social distancing and avoidance of social contacts as the most important epidemiological preventive measures. Pregnancy and neonatal periods are considered as high risk for Covid-19 infection.

Results

The instructions defined the care for pregnant women in the delivery room, during a hospital stay and after discharge. The controversial procedures in the care of Covid-19-suspected or -positive asymptomatic women in labor were: mode of delivery, companion during birth and labor, skin-to-skin contact, breastfeeding, and visits during a hospital stay.

Conclusion

There is a hope that instruction on coping with the coronavirus (Covid-19) infection in pregnancy with all proposed interventions affecting mothers, babies and families, besides saving lives, are beneficial and efficient by exerting no harm.