Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. ...Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.展开更多
Background:Intrahepatic cholestasis of pregnancy(ICP)increases the risk of adverse pregnancy outcomes.This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinata...Background:Intrahepatic cholestasis of pregnancy(ICP)increases the risk of adverse pregnancy outcomes.This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid(UDCA).Methods:This prospective,case control study included 88 pregnant women(44 women with ICP and 44 healthy controls).The primary end points were the perinatal outcome and the response to UDCA therapy.A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy.Results:Women with ICP had significantly higher serum syndecan-1(1.27±0.36 ng/m L vs.0.98±0.50 ng/m L;P=0.003),glypican-3(1.78±0.13 ng/m L vs.1.69±0.16 ng/m L;P=0.004),AST(128.59±1.44 vs.13.29±1.32 U/L;P<0.001),and ALT(129.84±1.53 vs.8.00±3.67 U/L;P<0.001)levels compared with the controls.The increased levels of syndecan-1(OR=4.715,95%CI:1.554–14.310;P=0.006),glypican-3(OR=8.465,95%CI:3.372–21.248;P=0.007),ALT(OR=1.382,95%CI:1.131–1.690;P=0.002),and postprandial bile acid(PBA)(OR=3.392,95%CI:1.003–12.869;P=0.026)were correlated to ICP.The adverse neonatal outcome was related to increased glypican-3(OR=4.275,95%CI:2.726–5.635;P=0.039),and PBA(OR=3.026,95%CI:1.069–13.569;P=0.037).Increases of syndecan-1(OR=7.464,95%CI:2.130–26.153,P=0.017)and glypican-3(OR=6.194,95%CI:2.951–13.002;P=0.025)were the risk factors of decreased response to UDCA treatment.Conclusion:Syndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP,and they can be used to predict the response to the UDCA treatment.展开更多
BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomar...BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.展开更多
文摘Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.
基金the Ethics Committee of the Liv Hospital Affiliated to University of I˙stinye,Turkey(2018-003/015).
文摘Background:Intrahepatic cholestasis of pregnancy(ICP)increases the risk of adverse pregnancy outcomes.This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid(UDCA).Methods:This prospective,case control study included 88 pregnant women(44 women with ICP and 44 healthy controls).The primary end points were the perinatal outcome and the response to UDCA therapy.A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy.Results:Women with ICP had significantly higher serum syndecan-1(1.27±0.36 ng/m L vs.0.98±0.50 ng/m L;P=0.003),glypican-3(1.78±0.13 ng/m L vs.1.69±0.16 ng/m L;P=0.004),AST(128.59±1.44 vs.13.29±1.32 U/L;P<0.001),and ALT(129.84±1.53 vs.8.00±3.67 U/L;P<0.001)levels compared with the controls.The increased levels of syndecan-1(OR=4.715,95%CI:1.554–14.310;P=0.006),glypican-3(OR=8.465,95%CI:3.372–21.248;P=0.007),ALT(OR=1.382,95%CI:1.131–1.690;P=0.002),and postprandial bile acid(PBA)(OR=3.392,95%CI:1.003–12.869;P=0.026)were correlated to ICP.The adverse neonatal outcome was related to increased glypican-3(OR=4.275,95%CI:2.726–5.635;P=0.039),and PBA(OR=3.026,95%CI:1.069–13.569;P=0.037).Increases of syndecan-1(OR=7.464,95%CI:2.130–26.153,P=0.017)and glypican-3(OR=6.194,95%CI:2.951–13.002;P=0.025)were the risk factors of decreased response to UDCA treatment.Conclusion:Syndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP,and they can be used to predict the response to the UDCA treatment.
基金the ethical committee of Mustansiriyah University(No.160).
文摘BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.
