Obstetric Complications

Background. The process of pregnancy by physiological type depends on many factors, among which the leading ones are the premorbid background against which pregnancy occurred, and the influence of epigenetic negative environmental factors of the woman’s place of residence.

Objective of the study: to study the influence of environmental factors on compensatory-adaptive changes in the body of pregnant women during the period of full-scale war.

Materials and methods. 60 pregnant women were observed. Anamnestic data were studied, anxiety and psycho-emotional state were assessed. Levels of cortisol, progesterone, magnesium, iron, vitamin D, ferritin, hemoglobin, and glucose were determined. The algorithm of therapeutic tactics of the examined women was personalized depending on the assessment of the general condition, mental health, anamnestic data, laboratory test results, etc.

Results. The somatic anamnesis of the study participants indicates a high frequency of hypothyroidism. In the vast majority of women, the highest level of anxiety was in the first trimester. From the second trimester, the condition of pregnant women stabilized against the background of the recommended personalized therapy. Pregnancy, childbirth, postpartum periods took place against the background of significant psychoemotional stress, tension, and increased somato-vegetative function. The severity of these processes depends largely on the individual characteristics of the mental and physical state of the woman. Higher levels of anxiety led to higher levels of cortisol and lower levels of progesterone, magnesium, vitamin D, hemoglobin, and ferritin. The level of glucose tended to increase by trimester of gestation.

Conclusions. Adverse environmental factors during pregnancy lead to disruption of compensatory and adaptive mechanisms and development of gestational complications. The pregnancy process reasonably requires a personalized algorithm for managing the each woman separately with the determination of the levels of cortisol, progesterone, vitamin D, magnesium, hemoglobin, iron, ferritin and correction of vitamin, macro-, microelement metabolism, progesterone content, as well as stabilization of psycho-emotional status, rational balanced nutrition, drinking regimen, prevention of hypodynamia.

Vanishing Twin Syndrome (VTS) is a distinctive obstetric phenomenon characterized by the spontaneous reduction of a multifetal pregnancy to a singleton following intrauterine demise and resorption of one or more embryos. First recognized in the mid-20th century and better defined with the advent of ultrasonography, VTS is now understood to occur in up to 36% of twin gestations, 50% of higher-order multiple pregnancies, and 20–30% of assisted reproductive technology (ART)-conceived pregnancies. Etiological factors include advanced maternal age, chromosomal abnormalities, abnormal placentation, and increased rates of multiple embryo transfer in ART.
Pathophysiologically, embryonic demise is usually attributable to intrinsic developmental abnormalities rather than acute insults, leading to outcomes such as resorption, blighted ovum, or fetus papyraceous. Evaluation relies heavily on serial ultrasonography, supported by biochemical markers such as human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein-A (PAPP-A). Placental histopathology after delivery provides confirmatory morphological evidence.
Management strategies vary according to gestational age at fetal demise. First-trimester losses are typically benign, requiring only reassurance and routine prenatal follow-up. Conversely, second- or third-trimester losses necessitate classification as high-risk pregnancies due to increased risks of intrauterine growth restriction, preterm labor, congenital anomalies, and neurodevelopmental impairment such as cerebral palsy in the surviving twin.
Prognosis is excellent for early losses but guarded for late gestational losses. Complications may affect both maternal and neonatal outcomes, including gestational diabetes, oligohydramnios, premature rupture of membranes, low birth weight, and adverse perinatal outcomes. Effective deterrence rests not on prevention but on anticipatory counseling, prenatal monitoring, and psychological support.
The condition underscores the necessity of interprofessional collaboration involving obstetricians, gynecologists, radiologists, nurses, mental health professionals, and bioethical teams, particularly in complex ART pregnancies. Improved communication and shared decision-making optimize maternal and neonatal outcomes while addressing the psychological impact on families

Oxidative stress is present in pregnancy complications. However, it is unknown if early maternal antioxidant status could influence later development of complications. The use of assisted reproduction techniques (ART) is rising due to the delay of first pregnancy and there is scarce information on its influence on oxidative balance. Objective: To assess the possible relationship between maternal plasma antioxidant status in first trimester of gestation with later development of pregnancy complications, evaluating the influence of ART and nutrition. Methods: Plasma from 98 healthy pregnant women was obtained at week 10, nutrition questionnaires filled and women were followed until delivery. We evaluated biomarkers of oxidative damage (carbonyls, malondialdehyde-MDA), antioxidants (thiols, reduced glutathione, phenolic compounds, catalase, superoxide dismutase activities) by spectrophotometry/fluorimetry and melatonin (ELISA). Antioxidant status score (Antiox-S) was calculated as the computation of antioxidants. Diet-antioxidants relationship was evaluated through multiple correspondence analysis. Results: Melatonin and carbonyls exhibited a negative correlation. No difference in oxidative damage was found between groups, but Antiox-S was significantly lower in women who developed complications. No differences in oxidative damage or Antiox-S were found between ART and no-ART pregnancies. High consumption of foods of vegetable origin cluster with high plasma levels of phenolic compounds and with high Antiox-S score. Conclusions: In early normal gestation, low plasma antioxidant status, assessed through a global score, associates with later development of pregnancy complications. Larger population studies could help to determine the value of Antiox-S as predictive tool and the relevance of nutrition on maternal antioxidant status.

Improving maternal health is a global public health priority. Despite overall maternal health improvement over decades, almost 295,000 maternal deaths still occur annually. Almost 99 per cent of these deaths are in high-poverty and low-resource countries in Sub-Saharan Africa and South Asia. Within South Asia, India alone accounts for an estimated 10-15 per cent (29,500-45,000) of global maternal deaths annually. While India has prioritised institutional birth through conditional cash transfer schemes, substantial gaps persist in the early identification and care of maternal complications between rural and urban populations, especially in the antenatal and postnatal periods that disproportionately impact poor families with low literacy. found that the inadequacies of the health system are compounded by community-related delays in seeking care and reaching health facilities due to financial barriers and low awareness of pregnancy complications and complication readiness. Recently, a novel, rapidly scalable community-based program combining maternal health literacy delivery through microfinancebased women-only self-help groups (SHG) targeted women in low-income rural households across less-developed districts in India's most populated state, Uttar Pradesh. This research evaluates the impact of membership in the Integrated Microfinance and Health Literacy (IMFHL) program on key maternal health outcomes. It first examines the determinants and duration of SHG membership. Next, it evaluates the program's effect on the level of knowledge of maternal danger signs relating to obstetric complications and the adoption of birth preparedness and complication readiness (BPCR) practice among SHG members and nonmembers. The study also examines the diffusion effect of acquired knowledge and practice from SHG members to non-members in program villages. ii This research project uses secondary data collected from an IMFHL program that was implemented in rural Uttar Pradesh between 2012 and 2017. Under the program, a quasiexperimental survey design was used to collect cross-sectional survey data in two rounds (2015 and 2017) to evaluate the program's impact on the knowledge of maternal danger signs and health behaviours of pregnant and newly delivered women. The following methods were used to answer the three study aims of the research project, with all analyses performed using the quantitative data analysis software STATA (STATA version 16, USA): i. The determinants of SHG membership and the duration of membership in the IMFHL program were evaluated using multivariable logistic and hurdle negative binomial regression models on a sample of 15,300 women, adjusting for a range of economic-, socio-demographic-and area-level potential confounders. ii. The effect of the IMFHL intervention on knowledge of maternal danger signs among women from households that were either SHG members or non-members was evaluated using multivariable logistic regression models on a sample of 17,232 women, adjusting for individual-, household-and community-level confounders. iii. The impact of the IMFHL intervention program on women's BPCR practice among program members and non-members was evaluated using multivariable logistic regression models on a sample of 17,244 women, while adjusting for other individual-, household-and community-level confounders. The results from the study of determinants of membership revealed that, while in general poor women were more likely to be SHG program members based on an income threshold limit iii (government-sponsored 'below poverty line' cards), women from the poorest households were more likely to become members, but less likely to stay members when further classified using asset-based wealth quintiles. The study found that women who were SHG members and received health literacy were more likely to know all danger signs as well as practice BPCR compared to women who did not receive any program support. The results also showed that the SHG network facilitated the diffusion of knowledge of maternal danger signs and BPCR practice from SHG members receiving health literacy to non-members in IMFHL program villages. More importantly, the study found that the magnitude of the program's impact on both outcomes remained stable, even after controlling for other confounding effects, suggesting that the health literacy messages delivered through the SHG program reached all women uniformly, irrespective of their other socio-economic and health system characteristics. The research project findings show that SHGs exert a dissemination effect of planned health knowledge and behaviour within members and also facilitate a diffusion effect on the natural transfer of knowledge and BPCR practice from members to non-members when SHGs are enriched with health literacy components. The inclusion of health literacy on a microfinance platform presents an example of novel community-based strategies that have the potential to interrupt the mutually reinforcing cycles of poverty and reduced health care-seeking. Beyond India, microfinance has been promoted globally as a poverty alleviation program in settings that account for most of the global burden of unmet maternal health goals. Lessons from the implementation of the IMFHL program in India provide the opportunity to adapt SHG models and enrich them with health literacy components in other low-resource settings to accelerate global targets towards maternal health goals. Future research can explore pathways leading to improved maternal care-seeking during complications and corresponding improvement in iv newborn health. Subsequent implementation research on the integration of the health literacy component into other SHG platforms in India and other countries can also be conducted.

Background: Several studies present evidence of the perceptions of pregnant women on the procedures and barriers in
the care of obstetric complications, but there are few involving physicians. This qualitative study reports the perceptions of
physicians on the processes of care of pregnant women with obstetric complications, and it identifies the barriers that result
in delays in providing care as well as the strategies to prevent them.
Methods: Two focal groups with guided discussion were conducted with nine physicians in charge of the care of pregnant
women with obstetric complications. The data were interpreted using an inductive analysis.
Results: Our data showed that the procedures in terms of the management of obstetric complications vary according to the
health facility. Even though there are guidelines and manuals, the processes are adapted in accordance with the available
resources. The main barriers resulting in delays have to do with clinical, socio-cultural and administrative issues. The ones
that stand out at a hospital level are the clinical and administrative problems.
Conclusion: Strategies in terms of participation, education, media-campaign, infrastructure and resources, aimed at building a community model focused on prevention and involving people in every locality, were proposed.

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica­tion is prescribed, with second‐generation antipsychotics usually preferred to first‐generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence‐based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians...

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica tion is prescribed, with secondgeneration antipsychotics usually preferred to firstgeneration ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidencebased family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recoveryoriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological compo nents, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, selfcare, social relationships and education, and offers a focus on identity, meaning and resilience.

Background: Uterine myomas co-existing with pregnancy could cause obstetric complications. Objectives: To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy. Methods: A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented. Results: Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1 st scan sequence to the 2 nd scan sequence and a reduction from 63mm to 59mm in the 3 rd scan sequence. Myoma growth rate was 0.667mm per week. Myomas in pregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas. Conclusion: Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.

Objective of the study: to investigate the content of vitamin D and the trace element magnesium in the blood of women of reproductive age with adenomyosis of the I–II and III–IV degrees after the COVID-19 disease depending on the algorithm of their management at 3, 6 and 12 months, as well as assess the general condition of patients.
Materials and methods. 150 women after the COVID-19 disease were under observation: 30 practically healthy women (control group A), 60 patients with adenomyosis of the I–II degree (group B) and 60 patients with adenomyosis of the III–IV degree (group C). Observation continued for 3, 6 and 12 months after the COVID-19 disease.
Results. Deterioration of well-being in patients with adenomyosis in the first months after COVID-19 has been proven. The frequency of complaints increased significantly: lethargy (55.0%), headache (36.7%), joint pain (41.7%), muscle pain (40.8%), pelvic pain (38.3%), dyspareunia (100%), etc. According to the scale of verbal assessment of pelvic pain, moderate pain (2 points) was experienced by 30.0% of patients of group B and 43.3% in group C, at the same time, severe (3 points) – 33.3%, very strong
(4 points) – 20.0%.
A significant decrease in the level of vitamin D and Mg was detected in women after the COVID-19 disease (p < 0.05): in almost all healthy women (group A) and in patients with adenomyosis (groups B and C). A significantly lower content of vitamin D and Mg was found in groups B and C compared to group A (p < 0.05), and in group C compared to group B.
The effectiveness of taking vitamin D and magnesium preparations in patients with adenomyosis after the COVID-19 disease was confirmed: a significant difference in the frequency of symptoms characterizing the general condition of patients after 3, 6 and 12 months was obtained: a decrease in the frequency of neuroses, headaches, muscle pain, constant lower abdominal pain, dyspareunia, etc.
Conclusions. The effectiveness of taking vitamin D and magnesium preparations by women with adenomyosis after the COVID-19 disease has been confirmed.

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

Oxidative stress is present in pregnancy complications. However, it is unknown if early maternal antioxidant status could influence later development of complications. The use of assisted reproduction techniques (ART) is rising due to the delay of first pregnancy and there is scarce information on its influence on oxidative balance. Objective: To assess the possible relationship between maternal plasma antioxidant status in first trimester of gestation with later development of pregnancy complications, evaluating the influence of ART and nutrition. Methods: Plasma from 98 healthy pregnant women was obtained at week 10, nutrition questionnaires filled and women were followed until delivery. We evaluated biomarkers of oxidative damage (carbonyls, malondialdehyde-MDA), antioxidants (thiols, reduced glutathione, phenolic compounds, catalase, superoxide dismutase activities) by spectrophotometry/fluorimetry and melatonin (ELISA). Antioxidant status score (Antiox-S) was calculated as the computation of antioxidants. Diet-antioxidants relationship was evaluated through multiple correspondence analysis. Results: Melatonin and carbonyls exhibited a negative correlation. No difference in oxidative damage was found between groups, but Antiox-S was significantly lower in women who developed complications. No differences in oxidative damage or Antiox-S were found between ART and no-ART pregnancies. High consumption of foods of vegetable origin cluster with high plasma levels of phenolic compounds and with high Antiox-S score. Conclusions: In early normal gestation, low plasma antioxidant status, assessed through a global score, associates with later development of pregnancy complications. Larger population studies could help to determine the value of Antiox-S as predictive tool and the relevance of nutrition on maternal antioxidant status.

One measure of the effectiveness of a carrier screen program is the impact on birth incidence of the disorder. In this study involving geographically and demographically distinct regions in Italy, the part of the country where carrier screening was introduced experienced a significant reduction in birth incidence from 1993-2007, as shown in Fig 1 in the original article. The newborn incidence decreased from around 4/10 000 to about 1.5/10 000 newborns affected at the end of the study interval. No such decrease was noted in the region where no carrier screening was performed. The uptake of cystic fibrosis carrier screening in the United States varies among different regions and populations, but as shown here, where uptake is high, birth incidence is affected. At least part of the decrease in birth incidence is a result of termination of affected pregnancies, as reported by the authors. Similar results would be expected in countries where carrier screening is routinely implemented into prenatal care.

This study investigated possible use of gentamicin and magnesium chloride as antidotes of dichlorvos pesticide poisoning. Thirty albino rats were randomly divided into 5 groups (n = 6). Group 1 served as negative control and received distilled water only. Group 2 served as positive control and was treated with 2.5 mg/kg body weight dichlorvos intraperitoneally. Group 3 was post-treated with 0.5 mg atropine following intraperitoneal 2.5 mg/kg dichlorvos while groups 4 and 5 were post-treated with 28 mg/kg intramuscular magnesium chloride and 5 mg/kg intramuscular gentamicin respectively following intraperitoneal 2.5 mg/ kg dichlorvos. Plasma and red blood cell acetylcholinesterase activities were estimated. Total ATPase, Na + / K +-ATPase, Ca 2+-ATPase, and Mg 2+-ATPase activities were estimated in the brain. Results showed significant (P < 0.05) increase in acetylcholinesterase activities in rats post treated with atropine, MgCl 2 and gentamicin when compared with acetylcholinesterase activities in rats treated with dichlorvos only. There is significant (P < 0.05) increase in the activities of Ca 2+ , Mg 2+-ATPases, Na + /K +-ATPase and total ATPase activities in the brain of rats post treated with atropine, magnesium chloride and gentamicin. Dichlorvos significantly (P < 0.05) reduced plasma and red blood cell cholinesterase activities, and brain ATPases activities. we concluded that dichlorvos toxicity inhibited cholinesterase, Na + /K +-ATPase and Ca 2+ ,Mg 2+-ATPases activities. Magnesium chloride and gentamicin on the other hand reduced effects of dichlorvos poisoning by promoting normal ATPase activities and inhibiting release of acetylcholine from cell. we proposed that both magnesium chloride and gentamicin can be co-administered in future as antidotes to patients with dichlorvos poisoning. K e y w o r d s: dichlorvos (ddVP), gentamicin, magnesium chloride, acetylcholinesterase, ATPases P-type.

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

Кальцитріол [1,25-дигідроксихолекальциферол (1,25(OH) 2 D)] є активною (гормональною) формою вітаміну D. За своєю дією він належить до широкої групи гормональних речовин, транскрипційних факторів генів білків-мішеней. На відміну від інших гормонів, що належать до цієї групи (андрогенів, естрогенів, глюкокортикоїдів, мінералокортикоїдів та прогестерону), синтез кальцитріолу обмежується наявністю/відсутністю його субстрату, 25-гідроксивітаміну D (25(OH)D). 25(OH)D є найбільш поширеним метаболітом вітаміну D. Його концентрація в сироватці крові визначає статус вітаміну D в ор-ганізмі. Тому вітамін D вважається прогормоном, а назва вживається як на позначення ергокальциферолу (вітамін D 2), так і холекальциферолу (вітамін D 3), продуктів перетворення ергостеролу й 7-дегідрохолестеролу (7-DHC). Біологічна дія кальцитріолу реалізується за посередництва внутрішньоклітинного, вузькоспецифічного рецептора вітаміну D (VDR), транскрипційного фактора, що модулюється лігандом із родини геномних рецепторів стероїдів, тиреоїдних гормонів і ретиноїдів. Огляд літератури показує, що дефіцит вітаміну D є проблемою в усіх країнах та групах пацієнтів незалежно від місця їх проживання, віку, статі й ра

Abstract

Introduction: In multiple gestations, Fetus papyraceous is a rare obstetric complication, the occurrence of which in twin cases is 1 in 12,500. It may be associated with elevated maternal and foetal complications, including death caused by disseminated intravascular coagulation and organ damage.
Objective : To record a case of uniovular twin pregnancy in the early third trimester with one twin foetus papyraceous, and pregnancy continued until term with a good outcome of co-twin survival.
Materials and Methods: A 25-year-old Gravida 2, Para 1, Living 1 woman with a previous usual vaginal delivery and twin pregnancy with Fetus papyraceous was referred to our hospital at 39 weeks for healthy institutional delivery.
Results : she was admitted and induction of labour done with stripping of membrance and watched the progression of labour along with strict maternal and fetal monitoring. She was monitored by serial ultrasounds with doppler, coagulation profile throughout the pregnancy once the fetus papyraceous was diagnosed which was showing with in normal limits. She delivered vaginally of an alive healthy male baby of birth weight 2.5kg with APGAR score- at 1min-8 and at 5min-10.
Conclusion : Routine ultrasound testing with improved training and the use of modern ultrasound machines with good resolution are needed for the detection of multiple gestations. This would allow for early detection of papyraceous foetuses during pregnancy, potentially avoiding obstetric complications and lowering the risk of mortality.

Keywords: Fetus papyraceous, Uniovular twins, Third trimester, obstetric complications, Maternal coagulopathy, Twin pregnancy

Background: Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. Methods: A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m 2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. Results: 370 super-obese women with a median BMI of 52.8 kg/m 2 (range 40.9-79.9 kg/m 2) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socioeconomically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77-3.29) and medical (AOR: 2.89, 95 % CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3-28.0) versus 6.6 (95 % CI: 2.6-16.8) per 1 000 singleton births). Conclusions: Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.

Optimal magnesium supply during pregnancy and overcoming magnesium deficiency is essential due to its physiological role in many metabolic processes. Metabolic transformations with magnesium are necessary for the vitamin D activation, energy supply for homocysteine restoration, and regulation of nitric oxide synthesis. Magnesium deficiency increases the risk of premature birth, and the diffusion of magnesium to the fetus increases precisely from the second trimester of pregnancy, therefore, its deficiency can adversely affect neonatal adaptation. The aim of this work was to investigate the relationship between the serum magnesium level and markers of endothelial dysfunction and the clinical features of the early neonatal period course. Results. The average level of serum magnesium in 58 premature birth neonates was 1.21 ± 1.09 mg/dl on the first day. A borderline low level of serum magnesium (less than 1.2 mg/dl) was found in 72.41% of the examined children. Statistical analysis did...

Background: Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low-and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. Methods: The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. Discussion: Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. Systematic review registration: PROSPERO CRD42017080092

This study investigated possible use of gentamicin and magnesium chloride as antidotes of dichlorvos pesticide poisoning. Thirty albino rats were randomly divided into 5 groups (n = 6). Group 1 served as negative control and received distilled water only. Group 2 served as positive control and was treated with 2.5 mg/kg body weight dichlorvos intraperitoneally. Group 3 was post-treated with 0.5 mg atropine following intraperitoneal 2.5 mg/kg dichlorvos while groups 4 and 5 were post-treated with 28 mg/kg intramuscular magnesium chloride and 5 mg/kg intramuscular gentamicin respectively following intraperitoneal 2.5 mg/ kg dichlorvos. Plasma and red blood cell acetylcholinesterase activities were estimated. Total ATPase, Na + / K +-ATPase, Ca 2+-ATPase, and Mg 2+-ATPase activities were estimated in the brain. Results showed significant (P < 0.05) increase in acetylcholinesterase activities in rats post treated with atropine, MgCl 2 and gentamicin when compared with acetylcholinesterase activities in rats treated with dichlorvos only. There is significant (P < 0.05) increase in the activities of Ca 2+ , Mg 2+-ATPases, Na + /K +-ATPase and total ATPase activities in the brain of rats post treated with atropine, magnesium chloride and gentamicin. Dichlorvos significantly (P < 0.05) reduced plasma and red blood cell cholinesterase activities, and brain ATPases activities. we concluded that dichlorvos toxicity inhibited cholinesterase, Na + /K +-ATPase and Ca 2+ ,Mg 2+-ATPases activities. Magnesium chloride and gentamicin on the other hand reduced effects of dichlorvos poisoning by promoting normal ATPase activities and inhibiting release of acetylcholine from cell. we proposed that both magnesium chloride and gentamicin can be co-administered in future as antidotes to patients with dichlorvos poisoning. K e y w o r d s: dichlorvos (ddVP), gentamicin, magnesium chloride, acetylcholinesterase, ATPases P-type.

Severe obstetric complications are not extensively studied and individual cases are used too little and inappropriately in quality improvement activities, due to limited numbers and prioritization of quantitative research. Nordic and European experts performed a qualitative pilot study using anonymized cases of peripartum hysterectomy. It was feasible to anonymize narratives and we learned lessons in the form of themes for improved clinical care and future research. Therefore, we plan a Nordic anonymized review of the care of women who have undergone peripartum hysterectomy based on narratives. The qualitative outcomes of clinically relevant themes for quality improvement and research will add value to the quantitative analyses from the Nordic medical birth registries. In the longer term, we believe that qualitative audits should be an essential part of the process of continuing improvement in maternity care.

Severe obstetric complications are not extensively studied and individual cases are used too little and inappropriately in quality improvement activities, due to limited numbers and prioritization of quantitative research. Nordic and European experts performed a qualitative pilot study using anonymized cases of peripartum hysterectomy. It was feasible to anonymize narratives and we learned lessons in the form of themes for improved clinical care and future research. Therefore, we plan a Nordic anonymized review of the care of women who have undergone peripartum hysterectomy based on narratives. The qualitative outcomes of clinically relevant themes for quality improvement and research will add value to the quantitative analyses from the Nordic medical birth registries. In the longer term, we believe that qualitative audits should be an essential part of the process of continuing improvement in maternity care.

Background Pregnant and postpartum women were identified as having particular vulnerability to severe symptomatology of SARS-CoV-2 infection, so maternity services significantly reconfigured their care provision. We examined the experiences and perceptions of maternity care staff who provided care during the pandemic in South London, United Kingdom-a region of high ethnic diversity with varied levels of social complexity. Methods We conducted a qualitative interview study, as part of a service evaluation between August and November 2020, using in-depth, semi-structured interviews with a range of staff (N = 29) working in maternity services. Data were analysed using Grounded Theory analysis appropriate to cross-disciplinary health research. Analysis & findings Maternity healthcare professionals provided their views, experiences, and perceptions of delivering care during the pandemic. Analysis rendered three emergent themes regarding decision-making during reconfigured maternity service provision, organised into pathways: 1) 'Reflective decision-making'; 2) 'Pragmatic decision-making'; and 3) 'Reactive decision-making'. Whilst pragmatic decision-making was found to disrupt care, reactive-decision-making was perceived to devalue the care offered and provided. Alternatively, reflective decisionmaking, despite the difficult working conditions of the pandemic, was seen to benefit services, with regards to care of high-quality, sustainability of staff, and innovation within the service. Conclusions Decision-making within maternity care was found to take three forms-where at best changes to services could be innovative, at worst they could cause devaluation in care being delivered, and more often than not, these changes were disruptive. With regard to positive changes, healthcare providers identified staff empowerment, flexible working patterns (both for themselves and collectively as teams), personalised care delivery, and changemaking in general, as key areas to capitalise on current and ongoing innovations borne out of the pandemic. Key learnings included a focus on care-related, meaningful listening and engagement of staff at all levels, in order to drive forward high-quality care and avoid care disruption and devaluation.

Background: Given the current changes in obstetric practices and in mother profiles, monitoring severe acute maternal morbidity (SAMM) appears essential to optimize care and inform policies. International comparisons may provide useful information to identify national specificities and suggest areas for improvement. However, the comparability of indicators across countries should first be assessed. Objective: To assess the feasibility of monitoring SAMM according to a common definition from hospital discharge databases across Europe. Research design: We conducted a comparative study using hospital discharge data in eight European countries (3,000,000 deliveries). Women with SAMM were identified among all hospitalisations of women of reproductive age admitted for antenatal or delivery care. The rates of five SAMM indicators were calculated and variations were described across countries, and within countries by mode of delivery. The validity of results was assessed by comparisons with population-based studies. Results: In a context of obstetric hemorrhage, the ratios across countries between the highest and lowest rates for hysterectomy and red blood cell (RBC) transfusion were respectively 1:2.1 and 1:3.5. Countries with high hysterectomy rates and low RBC transfusion rates also had the highest rates of maternal mortality from hemorrhage (France, Italy, Portugal). Ratios across countries were low for eclampsia (1:3.4) and high for septicaemia (1:22.5) with highest rates in the UK. Eclampsia was overreported in hospital discharge databases whereas the two indicators of severe hemorrhage had good validity. Conclusions: Monitoring some SAMM indicators from European hospital databases is feasible. In association with obstetric hemorrhage, hysterectomy and RBC transfusion appear to be good candidates for maternal morbidity surveillance.

Severe obstetric complications are not extensively studied and individual cases are used too little and inappropriately in quality improvement activities, due to limited numbers and prioritization of quantitative research. Nordic and European experts performed a qualitative pilot study using anonymized cases of peripartum hysterectomy. It was feasible to anonymize narratives and we learned lessons in the form of themes for improved clinical care and future research. Therefore, we plan a Nordic anonymized review of the care of women who have undergone peripartum hysterectomy based on narratives. The qualitative outcomes of clinically relevant themes for quality improvement and research will add value to the quantitative analyses from the Nordic medical birth registries. In the longer term, we believe that qualitative audits should be an essential part of the process of continuing improvement in maternity care.

Introduction: Oxidative stress is present in pregnancy complications. However, it is unknown if early maternal antioxidant status could influence later development of complications. The use of assisted reproduction techniques (ART) is rising due to the delay of first pregnancy and there is scarce information on its influence on oxidative balance. Objective: To assess the possible relationship between maternal plasma antioxidant status in first trimester of gestation with later development of pregnancy complications, evaluating the influence of ART and nutrition. Methods: Plasma from 98 healthy pregnant women was obtained at week 10, nutrition questionnaires filled and women were followed until delivery. We evaluated biomarkers of oxidative damage (carbonyls, malondialdehyde-MDA), antioxidants (thiols, reduced glutathione, phenolic compounds, catalase, superoxide dismutase activities) by spectrophotometry/fluorimetry and melatonin (ELISA). Antioxidant status score (Antiox-S) was calculated as the computation of antioxidants. Diet-antioxidants relationship was evaluated through multiple correspondence analysis. Results: Melatonin and carbonyls exhibited a negative correlation. No difference in oxidative damage was found between groups, but Antiox-S was significantly lower in women who developed complications. No differences in oxidative damage or Antiox-S were found between ART and no-ART pregnancies. High consumption of foods of vegetable origin cluster with high plasma levels of phenolic compounds and with high Antiox-S score. Conclusions: In early normal gestation, low plasma antioxidant status, assessed through a global score, associates with later development of pregnancy complications. Larger ACCEPTED MANUSCRIPT population studies could help to determine the value of Antiox-S as predictive tool and the relevance of nutrition on maternal antioxidant status.

Background: Super-obesity is associated with significantly elevated rates of obstetric complications, adverse perinatal outcomes and interventions. The purpose of this study was to determine the prevalence, risk factors, management and perinatal outcomes of super-obese women giving birth in Australia. Methods: A national population-based cohort study. Super-obese pregnant women (body mass index (BMI) >50 kg/m 2 or weight >140 kg) who gave birth between January 1 and October 31, 2010 and a comparison cohort were identified using the Australasian Maternity Outcomes Surveillance System (AMOSS). Outcomes included maternal and perinatal morbidity and mortality. Prevalence estimates calculated with 95 % confidence intervals (CIs). Adjusted odds ratios (ORs) were calculated using multivariable logistic regression. Results: 370 super-obese women with a median BMI of 52.8 kg/m 2 (range 40.9-79.9 kg/m 2) and prevalence of 2.1 per 1 000 women giving birth (95 % CI: 1.96-2.40). Super-obese women were significantly more likely to be public patients (96.2 %), smoke (23.8 %) and be socioeconomically disadvantaged (36.2 %). Compared with other women, super-obese women had a significantly higher risk for obstetric (adjusted odds ratio (AOR) 2.42, 95 % CI: 1.77-3.29) and medical (AOR: 2.89, 95 % CI: 2.64-4.11) complications during pregnancy, birth by caesarean section (51.6 %) and admission to special care (HDU/ICU) (6.2 %). The 372 babies born to 365 super-obese women with outcomes known had significantly higher rates of birthweight ≥4500 g (AOR 19.94, 95 % CI: 6.81-58.36), hospital transfer (AOR 3.81, 95 % CI: 1.93-7.55) and admission to Neonatal Intensive Care Unit (NICU) (AOR 1.83, 95 % CI: 1.27-2.65) compared to babies of the comparison group, but not prematurity (10.5 % versus 9.2 %) or perinatal mortality (11.0 (95 % CI: 4.3-28.0) versus 6.6 (95 % CI: 2.6-16.8) per 1 000 singleton births). Conclusions: Super-obesity in pregnancy in Australia is associated with increased rates of pregnancy and birth complications, and with social disadvantage. There is an urgent need to further address risk factors leading to super-obesity among pregnant women and for maternity services to better address pre-pregnancy and pregnancy care to reduce associated inequalities in perinatal outcomes.

Background: Improving maternal health is a global public health priority. Despite overall maternal health improvement over decades, almost 295,000 maternal deaths still occur annually. Almost 99 per cent of these deaths are in high-poverty and low-resource countries in Sub-Saharan Africa and South Asia. Within South Asia, India alone accounts for an estimated 10-15 per cent (29,500-45,000) of global maternal deaths annually. While India has prioritised institutional birth through conditional cash transfer schemes, substantial gaps persist in the early identification and care of maternal complications between rural and urban populations, especially in the antenatal and postnatal periods that disproportionately impact poor families with low literacy. Studies found that the inadequacies of the health system are compounded by community-related delays in seeking care and reaching health facilities due to financial barriers and low awareness of pregnancy complications and complication readiness. Recently, a novel, rapidly scalable community-based program combining maternal health literacy delivery through microfinancebased women-only self-help groups (SHG) targeted women in low-income rural households across less-developed districts in India's most populated state, Uttar Pradesh. This research evaluates the impact of membership in the Integrated Microfinance and Health Literacy (IMFHL) program on key maternal health outcomes. It first examines the determinants and duration of SHG membership. Next, it evaluates the program's effect on the level of knowledge of maternal danger signs relating to obstetric complications and the adoption of birth preparedness and complication readiness (BPCR) practice among SHG members and nonmembers. The study also examines the diffusion effect of acquired knowledge and practice from SHG members to non-members in program villages. ii Methods This research project uses secondary data collected from an IMFHL program that was implemented in rural Uttar Pradesh between 2012 and 2017. Under the program, a quasiexperimental survey design was used to collect cross-sectional survey data in two rounds (2015 and 2017) to evaluate the program's impact on the knowledge of maternal danger signs and health behaviours of pregnant and newly delivered women. The following methods were used to answer the three study aims of the research project, with all analyses performed using the quantitative data analysis software STATA (STATA version 16, USA): i. The determinants of SHG membership and the duration of membership in the IMFHL program were evaluated using multivariable logistic and hurdle negative binomial regression models on a sample of 15,300 women, adjusting for a range of economic- ,

Background This study aims to explore the stories of three women from Zanzibar, Tanzania, who survived life-threatening obstetric complications. Their narratives will increase understanding of the individual and community-level burden masked behind the statistics of maternal morbidity and mortality in Tanzania. In line with a recent systematic review of women-centred, qualitative maternal morbidity research, this study will contribute to guidance of local and global maternal health agendas. Methods This two-phased qualitative study was conducted in July-August 2017 and July-August 2018, and involved three key informants, who were recruited from a maternal near-miss cohort in May 2017 in Mnazi Mmoja Hospital, Zanzibar. The used methods were participant observation, interviews (informal, unstructured and semi-structured), participatory methods and focus group discussions. Data analysis relied primarily on grounded theory, leading to a theoretical model, which was validated repeatedly ...

The article describes a rare clinical case of hyperkalemia backgrounded by type 1 diabetes mellitus with signs of acute cardiovascular insufficiency, arrhythmia and QRST disturbances which was primarily diagnosed as acute coronary syndrome with ST elevation. Coronary angiography excluded pathology of the coronary arteries. Hyperkalemia, as the cause of ECG changes, was suspected in the hospital treatment. Stabilization of the patient’s condition, renewal of heart rhythm and conduction was obtained against the background of infusion support and insulin therapy. The pathogenesis of arrhythmia and QRST complex had a secondary genesis in relation to fluid and electrolyte metabolism disorders, so the restoration of sinus rhythm occurred without usage of antiarrhythmics. The usage of antiarrhythmic drugs according to the guideline of management of patients with ACS can deepen electrolyte shifts and lead to fatal arrhythmias in conditions of insulin deficiency and hyperkalemia. This exampl...

Early detection of gestational complications is a priority in obstetrics. In our social context, this is linked to maternity age. Most studies are focused on biological factors. However, pregnancy is also influenced by social and psychological factors, which have not been deeply explored. We aimed to identify biopsychosocial risk and protective factors associated with the development of maternal and fetal complications. We enrolled 182 healthy pregnant women, and plasma melatonin and cortisol levels were measured in the first trimester by chemiluminescent immunoassays. At different time points along gestation, women answered several questionnaires (positive and negative affect schedule, hospital anxiety and depression scale, pregnancy concerns scale, life orientation test, resilience scale, life satisfaction scale and life–work conflicts scale). They were followed up until delivery and categorized as normal pregnancy, maternal or fetal complications. Maternal complications were asso...

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

Endometriosis may compromise the physiological course of pregnancy. The aim of this prospective observational study was to evaluate whether endometriosis causes a higher prevalence of obstetric and neonatal complications as well as a higher risk of caesarean section and to detect a possible correlation between the presence, type, and location of endometriosis and obstetric complications, previous surgery, and pregnancy outcome, as well as the influence of pregnancy on the course of the disease. We compared two cohorts of women with spontaneous pregnancy, with and without endometriosis. Obstetric and neonatal outcomes, mode of delivery, presence, type, and location of endometriotic lesions and the effect of pregnancy on the disease were analyzed. A total of 425 pregnancies were evaluated: 145 cases and 280 controls. Patients with endometriosis showed a higher incidence of miscarriage, threatened miscarriage, threatened preterm labor, preterm delivery, placental abruption, and a highe...

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

To compare the fetal loss rate Ͻ24 weeks and the preterm premature rupture of the membranes Ͻ34 weeks' gestation according to type of invasive procedure and to sampling techniques in twins. STUDY DESIGN: Retrospective cohort study of 204 twin pregnancies, who underwent amniocentesis (100) or chorionic villus sampling (104). RESULTS: Fetal loss rate Ͻ4 weeks was 3.85% in chorionic villus sampling group and 4.00% in amniocentesis group (P value not significant). According to sampling technique, fetal loss rate was 4.17% (chorionic villus sampling 1 puncture), 2.70% (amniocentesis 1 puncture), 3.75% (chorionic villus sampling 2 punctures), and 4.76% (amniocentesis 2 punctures), (P values not significant). Preterm premature rupture of the membranes rate Ͻ34 weeks was 8.2% chorionic villus sampling group and 10% in amniocentesis group (P value not significant). According to sampling technique, preterm premature rupture of the membranes rate was 12.5% (chorionic villus sampling 1 puncture), 8.1% (amniocentesis 1 puncture), 6.9% (chorionic villus sampling 2 punctures), and 11.1 % (amniocentesis 2 punctures), (P values not significant). CONCLUSION: Double entry technique does not affect significantly the outcomes evaluated, in both amniocentesis and chorionic villus sampling.

In the last decade, pregnancy was considered as a therapeutic period for patients affected by endometriosis and painful symptoms. However, several studies have taken into consideration how endometriosis affects pregnancy achievement and pregnancy development, including obstetric complications. The adverse effects of endometriosis on the development of pregnancy include miscarriage, hypertensive disorders and pre-eclampsia, placenta previa, obstetric hemorrhages, preterm birth, small for gestational age, and adverse neonatal outcomes. The aim of this review is to analyze the current literature regarding the relationship between different forms of endometriosis (endometrioma, peritoneal endometriosis, deep endometriosis) and infertility, and the impact of endometriosis on pregnancy outcomes.

Background: The purpose of this study was to investigate predictors of uterine rupture in a large sample of sub-Saharan African women. Uterine rupture is rare in high-income countries, but it is more common in low-income settings where health systems are often under-resourced. However, understanding of risk factors contributing to uterine rupture in such settings is limited due to small sample sizes and research rarely considers system and individual-level factors concomitantly. Methods: Cross-sectional data analysis from the pre-intervention period (Oct. 1, 2007-Oct. 1, 2008) of the QUARITE trial, a large-scale maternal mortality study. This research examines uterine rupture among 84,924 women who delivered in one of 46 referral hospitals in Mali and Senegal. A mixed-effects logistic regression model identified individual and geographical risk factors associated with uterine rupture, accounting for clustering by hospital. Results: Five hundred sixty-nine incidences of uterine rupture (0.67% of sample) were recorded. Predictors of uterine rupture: grand multiparity defined as > 5 live births (aOR = 7.57, 95%CI; 5.19-11.03), prior cesarean (aOR = 2.02, 95%CI; 1. 61-2.54), resides outside hospital region (aOR = 1.90, 95%CI: 1.28-2.81), no prenatal care visits (aOR = 1.80, 95%CI; 1.44-2. 25), and birth weight of > 3600 g (aOR = 1.61, 95%CI; 1.30-1.98). Women who were referred and who had an obstructed labor had much higher odds of uterine rupture compared to those who experienced neither (aOR: 46.25, 95%CI; 32.90-65.02). Conclusions: The results of this large study confirm that the referral system, particularly for women with obstructed labor and increasing parity, is a main determinant of uterine rupture in this context. Improving labor and delivery management at each level of the health system and communication between health care facilities should be a priority to reduce uterine rupture.

This study aimed to explore and describe midwives' experiences with OBT in Bojanala district. Setting: This study was conducted in Bojanala district of the North West Province. Two public healthcare facilities were selected where midwifery care and OBT services are rendered. Methods: A qualitative, descriptive, explorative research design was followed. Nine purposefully sampled midwives participated in a one-on-one in-depth interview. Data were analysed using Collaizi's descriptive method based on the themes and categories that emerged. Results: Three themes emerged. Midwives experienced the OBT tool to be inadequate; and that the low staff number contributes to an imbalance in the midwife-patient ratio. Midwives were also dissatisfied with less support they receive from their management. Conclusion: The study highlighted midwives' experiences of the use of OBT, as presented through their lived experiences. The midwives experienced challenges, which hindered them from practicing OBT to the best of their abilities. Contribution: The study highlighted challenges experienced by midwives regarding OBT, which directly influence the outcomes of pregnancy and labour.

Abstract: Women with antiphospholipid syndrome (APS) and antiphospholipid antibodies (aPL) are at a high risk of re-current spontaneous miscarriages and late pregnancy complications. The prevalence of obstetric complications in aPL positive women is about 15-20%. The APS is defined by the combination of a clinical venous or arterial thrombotic event or a pregnancy complication and the laboratory detection of aPL. Adverse obstetric events include: recurrent miscarriages, late loss or early delivery due to preeclampsia or placental insufficiency. Although many of the clinical manifestations of the APS can be related to thrombotic events other non-thrombotic mechanisms have been proposed to explain the obstet-rical manifestations. Though heparin and aspirin are indicated for the treatment of recurrent pregnancy loss, there is a pau-city of randomized trials in this area. The therapeutic management of other obstetric complications, such as preeclampsia and intrauterine growth restrictio...

Perinatal asphyxia constitutes a prototype of obstetric complications occurring when pulmonary oxygenation is delayed or interrupted. The primary insult relates to the duration of the period lacking oxygenation, leading to death if not re-established. Re-oxygenation leads to a secondary insult, related to a cascade of biochemical events required for restoring proper function. Perinatal asphyxia interferes with neonatal development, resulting in long-term deficits associated to mental and neurological diseases with delayed clinical onset, by mechanisms not yet clarified. In the experimental scenario, the effects observed long after perinatal asphyxia have been explained by overexpression of sentinel proteins, such as poly(ADP-ribose) polymerase-1 (PARP-1), competing for NAD + during re-oxygenation, leading to the idea that sentinel protein inhibition constitutes a suitable therapeutic strategy. Asphyxia induces transcriptional activation of pro-inflammatory factors, in tandem with PARP-1 overactivation, and pharmacologically induced PARP-1 inhibition also down-regulates the expression of proinflammatory cytokines. Nicotinamide has been proposed as a suitable PARP-1 inhibitor. Its effect has been studied in an experimental model of global hypoxia in rats. In that model, the insult is induced by immersing rat fetus into a water bath for various periods of time. Following asphyxia, the pups are delivered, treated, and nursed by surrogate dams, pending further experiments. Nicotinamide rapidly distributes into the brain following systemic administration, reaching steady state concentrations sufficient to inhibit PARP-1 activity for several hours, preventing several of the long-term consequences of perinatal asphyxia, supporting the idea that nicotinamide constitutes a lead for exploring compounds with similar or better pharmacological profiles.

Early detection of gestational complications is a priority in obstetrics. In our social context, this is linked to maternity age. Most studies are focused on biological factors. However, pregnancy is also influenced by social and psychological factors, which have not been deeply explored. We aimed to identify biopsychosocial risk and protective factors associated with the development of maternal and fetal complications. We enrolled 182 healthy pregnant women, and plasma melatonin and cortisol levels were measured in the first trimester by chemiluminescent immunoassays. At different time points along gestation, women answered several questionnaires (positive and negative affect schedule, hospital anxiety and depression scale, pregnancy concerns scale, life orientation test, resilience scale, life satisfaction scale and life–work conflicts scale). They were followed up until delivery and categorized as normal pregnancy, maternal or fetal complications. Maternal complications were asso...

This comparative research is aimed to study the effect of perindopril and metformin on the levels of biochemical markers of endothelial dysfunction in rats with type 2 diabetes mellitus (T2DM) complicated by a brain hemorrhage. The study was carried out on 30 white male Wistar rats. T2DM was simulated by a single intraperitoneal injection of nicotinamide and streptozotocin (NA/STZ). Intracerebral hemorrhage (ICH) was induced by microinjection of 1 μL of bacterial collagenase 0.2 IU/μL into the striatum on the 60th day of the experiment. Animals were randomized into 5 groups: A – negative control (intact, n=6); B – positive control 1 (NA/STZ, n=6); C – positive control 2 (NA/STZ+ICH, n=6); D – perindopril (“Prestarium”, 2 mg/kg+NA/STZ+ICH, n=6); E – metformin (“Siofor”, 250 mg/kg+NA/STZ+ICH, n=6). The studied drugs were administered intragastrically for 20 days, starting from the 50th day after the induction of T2DM. Endothelial function was assessed by the content of homocysteine (H...