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Products of Conception
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Nasser Al-Asmar, Marcia Riboldi
Miscarriage is defined as gestational loss that occurs before a fetus is viable. This includes losses during pregnancy that occur before the 20th week of gestation or the loss of a fetus whose weight is less than 500 g. An estimated 23 million miscarriages occur every year worldwide, translating to 44 pregnancy losses each minute. Despite advances in obstetric care, miscarriage is the most common complication observed during the first trimester of pregnancy, and the overall risk of miscarriage is 15.3% (95% CI 12.5–18.7%) among recognized pregnancies. The frequency of women who have had one miscarriage is 10.8% (10.3–11.4%), two miscarriages is 1.9% (1.8–2.1%), and three or more miscarriages is 0.7% (0.5–0.8%) worldwide (1).
COVID-19 and reproductive injustice
Published in J. Michael Ryan, COVID-19, 2020
Research demonstrates that support persons, particularly doulas, improve birth outcomes in hospital settings by minimizing unnecessary medical interventions that place women at greater risk of birthing complications (Gruber, Cupito, and Dobson 2013). Doulas also play an especially vital role in shielding women of color from obstetric racism (Oparah et al. 2018). Obstetric racism, defined by Davis (2019) as the racism experienced by women during maternal healthcare processes, comes in many forms, including “critical lapses in diagnosis, being neglectful, dismissive, or disrespectful; causing pain; and engaging in medical abuse through coercion to perform procedures or performing procedures without consent” (Davis 2019, 562). Doulas can provide a vital buffer between birthing women and providers by supporting mothers in self-advocacy (Oparah et al. 2018; Wint et al. 2019). Benefits to doula-assisted births include a decreased risk of cesarean surgeries and birthing complications, a decrease in reported birth trauma, and greater likelihood of initiating breastfeeding (Gruber, Cupito, and Dobson 2013). Doulas also serve as witnesses for women of color, often the only birth workers to report incidences of obstetric abuse during labor and delivery (Morton et al. 2018).
Birth plans
Published in Sheila Broderick, Ruth Cochrane, Trauma and Birth, 2020
Sheila Broderick, Ruth Cochrane
Some women will employ a doula as a second source of support during labour. The Greek word doula means ‘female servant’, and doulas have been present during childbirth for centuries. A doula traditionally is someone, usually a woman, with no medical training, but who would usually have had babies herself, who gives emotional support and encouragement to women in labour. Doulas first came to obstetric notice in the 1980s when research in Guatemala (Sosa et al 1980) showed that the presence of a doula in the labour room provided a number of beneficial effects for both mother and baby. The research was undertaken in a busy unit where it was normal practice for women to go through the first stage of labour unattended, to be helped by a midwife only when they started pushing in the second stage. The researchers found that women who had a doula with them during the labour had shorter labours and used less pain relief compared with women who did not have a doula.
Efficacy and safety of broad spectrum penicillin with or without beta-lactamase inhibitors vs first and second generation cephalosporins as prophylactic antibiotics during cesarean section: a systematic review and meta-analysis
Published in Journal of Obstetrics and Gynaecology, 2023
Qianqian Song, Jingjing Yan, Na Bu, Ying Qian
Cesarean section is a routine surgery in critical obstetric cases. With the development of cesarean section, the rate of cesarean delivery continues to increase worldwide (Abdel Jalil et al.2017). However, cesarean section is considered to be a clean-contaminated procedure and one of the most important risk factors for postpartum infection, with a global infection range of 2.5%–20.5% (Conroy et al.2012), the risk of infections is 5–20-fold higher for women who have a cesarean delivery than for vaginal births (Van Schalkwyk and Van Eyk 2017). Good surgical technique is important for reducing infections. Additionally, guidelines of the American College of Obstetricians and Gynecologists (Committee on Practice Bulletins-Obstetrics 2018) recommend that the use of prophylactic antibiotics before cesarean section to reduce postoperative endometritis, wound infection, fever and severe infectious complications including pelvic abscess, bacteremia and sepsis, these more serious complications can lead to maternal deaths. Prophylactic antibiotics can decrease the risk of postoperative infections by >50% (Lamont et al.2011). However, antibiotics can have adverse effects on the mother and infant. Antibiotics administered to women during delivery may have a direct impact on the offspring’s microbiota and interfere with the development of the infant’s immune system (Mutic et al.2017, Stinson et al.2018). Therefore, the selection of effective and safe prophylactic antibiotics is particularly important.
Use of FMF algorithm for prediction of preeclampsia in high risk pregnancies: a single center longitudinal study
Published in Hypertension in Pregnancy, 2021
Petar Cabunac, Nataša Karadžov Orlić, Daniela Ardalić, Barbara Damnjanović Pažin, Srđan Stanimirović, Gorica Banjac, Aleksandra Stefanović, Vesna Spasojević- Kalimanovska, Amira Egić, Nina Rajović, Nataša Milić, Željko Miković
This was a prospective cohort study following adverse obstetric outcomes in high-risk women who were attending to their routine first hospital visit in pregnancy at Department of High-Risk Pregnancies, Gynecology and Obstetrics Clinic “Narodni Front” in Belgrade, Serbia and followed throughout their pregnancy. The women were screened between January 2016 and August 2018 and gave written informed consent to participate in the study, which was approved by the Ethics Committee of GAK “Narodni Front” (24/55-5). Women over 18 years old, having singleton pregnancy and at least one high-risk factor and/or two moderate-risk factors (16,18) were included in the study. Exclusion criteria were: twin pregnancy, fetal aneuploidies, and structural anomalies. Clinical examination and biochemical measurements were performed at first (11–14th g.w.), second (22–24th g.w.), early third (28–32th g.w.), and late third trimester (36–38th g.w.). During the first examination of the pregnant women, anamnestic data about the presence of preexisting or pregnancy-associated hypertension and related disorders were collected.
Trajectories of Insomnia Symptoms and Associations with Mood and Anxiety from Early Pregnancy to the Postpartum
Published in Behavioral Sleep Medicine, 2021
Ivan D. Sedov, Lianne M. Tomfohr-Madsen
Further, an important direction of future research includes an examination of the connection between trajectories of prenatal insomnia symptomology and birth and postnatal outcomes. Sleep disruptions in pregnancy have been linked to adverse outcomes (Chang et al., 2010; Lawson et al., 2015; Ross et al., 2005), but the mechanisms driving the association are unclear and the extent to which these findings hold after controlling for comorbid depression and anxiety is largely untested. It seems likely that the small group of women who report high levels of insomnia symptoms are at risk for adverse outcomes (Felder et al., 2017). What is less clear is whether the group of women who reported subclinical levels of symptomology throughout the course of pregnancy are similarly at risk of adverse postpartum outcomes. It is possible that this pattern of symptoms is distressing but does not increase the risk of adverse obstetric and postpartum conditions, although our findings suggest that rates of postpartum depression were elevated within the subclinical insomnia group. Research examining how this pattern of symptomology is related to adverse outcomes is of importance as it has implications for screening and treatment.