Maternity Foundation

IntroductionResidual urinary incontinence (UI) following anatomically successful vesicovaginal fistula (VVF) repair remains a major postoperative challenge, often compromising quality of life despite surgical closure. Persistent UI arises from a combination of anatomical, obstetric, and sociodemographic influences, which differ across patient populations.ObjectiveThe objective of this study is to determine the prevalence and identify the risk factors associated with UI after successful VVF repair.MethodsThis descriptive study was conducted in the Department of Obstetrics and Gynecology Unit-II, Isra University Hospital, Hyderabad, over 12 months (August 2021 to August 2022). Ninety women who underwent anatomically successful VVF repair were enrolled using nonprobability consecutive sampling. Data regarding demographic, obstetric, and fistula-related variables were collected. Bivariate, stratified, and multivariable logistic regression analyses were performed. Continuous variables were summarized as mean ± SD or median (IQR), and categorical variables as n (%). A p-value <0.05 was considered statistically significant.ResultsThe mean age of participants was 37.04 ± 6.79 years, and the mean BMI was 22.25 ± 2.13 kg/m². Most women were from rural areas (77.8%), illiterate (61.1%), and of low socioeconomic status (73.3%). Postoperative UI occurred in seven (7.78%) women. Among evaluated factors, only fistula type showed a significant association (p = 0.005), with circumferential fistulae exhibiting the highest risk. Multivariable analysis confirmed fistula type as an independent predictor (adjusted odds ratio (aOR) = 6.82, p = 0.017). ConclusionPost-repair UI predominantly depends on fistula complexity, especially circumferential configuration, whereas demographic and socioeconomic factors exert indirect effects. Timely management and skilled surgical expertise remain critical for achieving optimal continence outcomes.

The coexistence of Intellectual Disability (ID) and Autism Spectrum Disorder (ASD) presents a complex clinical scenario that requires comprehensive and personalized interventions. This article explores the neurobiological mechanisms underlying the comorbidity of ID and ASD, highlighting the shared genetic and synaptic pathways that contribute to both conditions. The discussion also covers the prevalence of comorbidities such as epilepsy, sleep disorders, and gastrointestinal issues, which exacerbate the challenges in diagnosis and treatment. A multidisciplinary approach, combining behavioral, educational, and pharmacological interventions, is essential for addressing the unique needs of individuals with ID and ASD. Future directions point to the use of advanced neuroimaging, artificial intelligence, and personalized therapies based on genetic markers, which promise to revolutionize treatment strategies. Emphasis is placed on the importance of early intervention and lifelong support to improve functional outcomes and quality of life. The need for ongoing research, policy development, and family involvement is underscored as critical factors in optimizing care and inclusion for this population.

This study employs a mixed-methods approach to evaluate integrating the Safe Delivery App into catchment-based clinical mentorship in Ethiopia’s Afar and Somali regions. In the Afar region, knowledge increased from baseline to end line (58.6±26.2% to 87±15.5%), along with skills in hypertension (66.2±24% to 92.3±10.8%), postpartum hemorrhage (58.1±15.9% to 85.7±9.7%), and new-born care (64.1±15.2% to 89.3±6.6%). Similarly, in the Somali region, knowledge improved (51.5±18.7% to 75.8±21%), as did skills in hypertension (42.9±30.4% to 94.5±8.6%), postpartum hemorrhage (36.4±25.2% to 87.5±10.4%), and new-born care (57.5±24% to 89.4±9.1%). Qualitative insights from participants highlighted increased knowledge, confidence, and improved service delivery, along with positive perceptions of mentorship. However, challenges such as resource shortages and infrastructure gaps were also noted.

IntroductionAround 20–30% of pregnant women experience pregnancy complications and loss (PCL), such as hypertensive disorders in pregnancy, gestational diabetes, miscarriage or stillbirth. A history of PCL can provide an early warning of subsequent increased risk of cardiovascular disease (CVD). Communicating CVD risk with women in the years after PCL depends on transparency around the limitations of current evidence, emphasising the universality of preventive health messages and translating research findings into information that is meaningful to a broad audience. People with lived experience have rarely been involved in the design of interventions to raise awareness of CVD prevention following PCL.MethodsA participatory, qualitative approach that engaged a Lived Experience Expert (n=7) group to codesign a series of virtual workshops with women with a history of PCL (anticipating n=48–80).ResultsThe presentation will describe the process and outcomes of the codesign process, including the design of the resultant workshops to elicit women’s views, preferences and experiences of preventive healthcare in the months and years after PCL. Key ingredients of success as well as challenges will be discussed.DiscussionResearchers and people with lived experience have competing needs and preferences for risk communication. By prioritising women’s preferences, risk communication can avoid unintentionally adding to a stigmatising and victim blaming view of PCL.1 Authentically involving people with lived experience can inform possible future research, intervention design and dissemination strategies. Such involvement is valued by people with lived experience and may lead to the new research priorities, more appropriate patient education resources or preventive health pathways.Conclusion(s)Close collaboration with patient advocates can produce meaningful risk information that is both faithful to research findings and appropriate to people with lived experience of PCL.ReferenceQuigley P. Infertility, recurrent pregnancy loss, and risk of stroke: engage people with lived experience for more sensitive communication. BMJ 2022;379:o2821. DOI: 10.1136/bmj.o2821.

O leite materno (LM) é um alimento muito rico e completo e propõe quantidades ideais de nutrientes que o bebê precisa para o desenvolvimento correto. A OMS recomenda o aleitamento materno exclusivo nos primeiros seis meses e o aleitamento materno complementar por até dois anos ou mais. O leite humano apresenta inúmeros benefícios e vantagens em relação a qualquer substituto do leite materno, incluindo a prevenção da obesidade. O objetivo do presente estudo é verificar, a partir da literatura científica, possíveis correlações entre o aleitamento materno (AM) e a diminuição da obesidade infantil em crianças amamentadas exclusivamente com leite materno (LM) até os 6 meses de idade. Trata-se de uma revisão integrativa de literatura, onde a coleta de dados deu-se através da busca de estudos científicos atuais de ensaio clínico sobre o efeito protetor do aleitamento materno exclusivo (AME) contra a obesidade infantil. Com base de dados do PubMed e MEDLINE, foram encontrados 20 artigos no total, sendo que da base de dados do PubMed foram utilizados 3 artigos acadêmicos, e da base de dados do MEDLINE foram utilizados 17 artigos acadêmicos, e 4 artigos foram utilizados de maior relevância para o estudo. Conforme a literatura, a maioria dos artigos abordam alguma relação para eficácia do aleitamento materno exclusivo na prevenção da obesidade infantil. Podemos concluir que sim, o aleitamento materno exclusivo nos primeiros seis meses de vida previne a obesidade infantil.

Introduction. Antiphospholipid antibodies (APAs) exert multifaceted effects on the course of pregnancy by disrupting microcirculation, affecting the hemostasis, as well as damaging the endothelial membranes, leading to early reproductive loss and development of placenta-associated complications depending on the affected gestation stage. Planning and management of pregnancy in women in the absence of criteria for complete antiphospholipid syndrome (APS) currently remains unresolved issue. The absence of generally accepted treatment standards for this category of patients and inability to substantiate the diagnosis according to the APS classification criteria complicate selection of therapeutic tactics.Aim: to conduct a comparative analysis of therapy-based complications and outcomes of pregnancy in APA carriers.Materials and Methods. During the period 2019–2021 a prospective study of 150 patients who entered pregnancy with aggravated obstetric and gynecological history, serum APA level was examined. Considering the risks of developing obstetric and thrombotic complications, all patients were prescribed prophylactic doses of low molecular weight heparins (LMWHs) and low doses of acetylsalicylic acid (ASA). The patients were divided into 3 groups using a random number generator. Group 1 (n = 50), in addition to the prescribed LMWH (enoxaparin sodium 40 mg 1 time per day) and ASA (150 mg 1 time per day), also underwent plasmapheresis (PF) 4 sessions per 1 course in 6–8, 12–14 and 22–24 weeks of pregnancy; group 2 (n = 50) received courses of intravenous immunoglobulins (IVIG) at a course dose of 300 ml (15 g) simultaneously; group 3 (n = 50) received no additional therapies. Rate of pregnancy complications was comparatively assessed – development of fetal growth retardation (FGR), low birth weight fetus, gestational arterial hypertension (AH), moderate and severe preeclampsia (PE), anemia and delivery outcomes.Results. It was found that in group 3 there was a higher incidence of gestational hypertension (p2,3 &lt; 0.0001), moderate PE (p 1,3 =0.071; p 2,3 = 0.0019), low weight fetus for gestational age (p2,3 = 0.0002) and FGR (p2,3 = 0.003). In group 1, compared with group 2, there were more often observed small weight for gestational age fetus (p1,2 = 0.018) and FGR (p1,2 = 0.024), gestational hypertension (p1,2 = 0.0008), anemia (p1,2 &lt; 0.0001) and latent iron deficiency (p1,2 &lt; 0.0001). Also, groups 2 and 3 vs. group 1 were more likely to have intrahepatic cholestasis during pregnancy (p1,2 = 0.013; p1,3 = 0.003).Conclusion. In the group of patients receiving complex therapy consisting of LMWHs prophylactic doses, low ASA doses and IVIG courses, the risks of developing placenta-associated complications and iron deficiency were reduced compared to other groups indicating about a higher efficiency of this therapy regimen. However, the development of intrahepatic cholestasis during pregnancy was less common in the group of patients receiving PF courses, in contrast to using IVIG courses, which can be accounted for by additional effect of efferent therapeutic methods and should be taken into account in a differentiated approach for management of patients with liver and gallbladder pathology.

IntroductionThe velocity of fetal deterioration in fetal growth restriction is extremely variable, which makes monitoring and counseling very challenging. The soluble fms‐like tyrosine kinase to placental growth factor (sFlt1/PlGF) ratio provides a readout of the vasoactive environment that correlates with preeclampsia and fetal growth restriction and that could be useful to predict fetal deterioration. Previous studies showed a correlation between higher sFlt1/PlGF ratios and lower gestational ages at birth, although it is unclear whether this is due to the increased incidence of preeclampsia. Our goal was to evaluate whether the sFlt1/PlGF ratio predicts faster fetal deterioration in early fetal growth restriction.Material and methodsThis was a historical cohort study in a tertiary maternity hospital. Data from singleton pregnancies with early fetal growth restriction (diagnosed before 32 gestational weeks) confirmed after birth monitored between January 2016 and December 2020 were retrieved from clinical files. Cases of chromosomal/fetal abnormalities, infection and medical terminations of pregnancy were excluded. The sFlt1/PlGF ratio was acquired at diagnosis of early fetal growth restriction in our unit. The correlation of log10 sFlt1/PlGF with latency to delivery/fetal demise was assessed with linear, logistic (positive sFlt1/PlGF if >85) and Cox regression excluding deliveries for maternal conditions and controlling for preeclampsia, gestational age at time of ratio test, maternal age and smoking during pregnancy. Receiver‐operating characteristic (ROC) analysis tested the performance of sFlt1/PlGF ratio in predicting delivery for fetal reasons in the following week.Results125 patients were included. Mean sFlt1/PlGF ratio was 91.2 (SD 148.7) and 28% of patients had a positive ratio. A higher log10 sFlt1/PlGF ratio predicted shorter latency for delivery/fetal demise in linear regression after controlling for confounders, β = −3.001, (−3.713 to −2.288). Logistic regression with ratio positivity confirmed these findings (latency for delivery 5.7 ± 3.32 weeks for ratios ≤85 vs 1.9 ± 1.52 weeks for ratios >85); β = −0.698 (−1.064 to −0.332). Adjusted Cox regression showed that a positive ratio confers a significantly positive hazard ratio (HR) for earlier delivery/fetal demise, HR 9.869 (5.061–19.243). ROC analysis showed an area under the curve of 0.847 (SE ± 0.06).ConclusionssFlt1/PlGF ratio is correlated with faster fetal deterioration in early fetal growth restriction, independently of preeclampsia.

Foreign body in the esophagus is a common emergency presentation. A thorough history and systematic examination are followed by relevant investigations in the treatment of a patient with a foreign body in the esophagus. However, there is considerable disagreement about which treatment option is best for such patients. This review aims to develop a comprehensive approach towards patients presenting with foreign body ingestion by creating clinical practice guidelines. These guidelines, which are based on a review of the literature, cover not only the initial assessment of the patient but also the various management options and their benefits, limitations, and suitability for use in different situations.