Machine learning models for predicting preeclampsia: a systematic review

BACKGROUND

This systematic review provides an overview of machine learning (ML) approaches for predicting preeclampsia.

METHOD

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. We searched the Cochrane Central Register, PubMed, EMBASE, ProQuest, Scopus, and Google Scholar up to February 2023. Search terms were limited to "preeclampsia" AND "artificial intelligence" OR "machine learning" OR "deep learning." All studies that used ML-based analysis for predicting preeclampsia in pregnant women were considered. Non-English articles and those that are unrelated to the topic were excluded. The PROBAST was used to assess the risk of bias and applicability of each included study.

RESULTS

The search strategy yielded 128 citations; after duplicates were removed and title and abstract screening was completed, 18 full-text articles were evaluated for eligibility. Four studies were included in this review. Two studies were at low risk of bias, and two had low to moderate risk. All of the study designs included were retrospective cohort studies. Nine distinct models were chosen as ML models from the four studies. Maternal characteristics, medical history, medication intake, obstetrical history, and laboratory and ultrasound findings obtained during prenatal care visits were candidate predictors to train the ML model. Elastic net, stochastic gradient boosting, extreme gradient boosting, and Random forest were among the best models to predict preeclampsia. All four studies used metrics such as the area under the curve, true positive rate, negative positive rate, accuracy, precision, recall, and F1 score. The AUC of ML models varied from 0.860 to 0.973 in four studies.

CONCLUSION

The results of studies yielded high prediction performance of ML models for preeclampsia risk from routine early pregnancy information.

Maternal and Neonatal Outcomes of Iron Deficiency Anemia: A Retrospective Cohort Study

INTRODUCTION

Understanding the outcomes of anemia in pregnancy is critical. Since no study has been conducted regarding the maternal and neonatal outcomes of iron-deficiency anemia in Hormozgan province of Iran, this study aims to assess the maternal and neonatal outcomes of iron-deficiency anemia in women who gave birth in Hormozgan province from January 2020 to January 2022.

METHODS

 We retrospectively assessed all singleton pregnant women who gave birth at a tertiary hospital in Bandar Abbas, Hormozgan province, Iran, for two years. We divided all women into iron-deficiency anemic and non-iron-deficiency anemic women. Iron-deficiency anemia was defined as hemoglobin less than 10.5 mg/dl at the time of admission without any other hemoglobinopathy, such as sickle cell anemia or thalassemia. Using electronic patient records, data were extracted from the Iranian Maternal and Neonatal Network (IMaN Net), a valid national system. Since the information of birth under 24 weeks of gestation is not recorded in this system, we excluded all deliveries under 24 weeks of gestation. The outcome measures of the study were demographic factors (age, education, residency place, access to prenatal care, smoking), obstetrical factors (parity, labor induction, fetal presentation, mode of delivery), and maternal and neonatal outcomes (the incidence of preeclampsia, gestational diabetes, placenta abruption, postpartum hemorrhage, maternal need for blood transfusion, maternal need for intensive care unit, preterm birth, low birth weight, intrauterine growth retardation, birth asphyxia, stillbirth, and neonatal intensive care admission). Chi-square tests were used to compare differences between iron-deficiency anemic and non-iron-deficiency anemic women. Logistic regression models were used to assess the effect of iron-deficiency anemia on maternal and neonatal outcomes. The result was presented as odds ratio (OR) or adjusted odds ratio (aOR) after adjusting for covariates and a 95% confidence interval (CI).  Results: The incidence of iron-deficiency anemia was 2.97%. Education and residency were among the demographic factors that differed significantly between groups. Iron-deficiency anemia was more frequent in those with higher education and women who lived in rural areas. In terms of obstetrical factors, method of delivery was the only significantly different factor between groups. Iron-deficiency anemic mothers had substantially more instrumental deliveries than non-iron-deficiency anemic mothers (4.3% vs. 0.8%), while the incidence of cesarean section was lower. Based on logistic regression in terms of maternal and neonatal outcomes, iron-deficiency anemic women had a substantially higher risk of the need for maternal blood transfusion (aOR: 6.54, 95%CI: 4.72-8.15), postpartum hemorrhage (aOR: 1.54, 95%CI: 0.71-2.11), preterm birth (aOR: 0.98, 95%CI: 0.45-1.13), low birth weight (aOR: 1.04, 95%CI: 0.78-2.01), intrauterine growth retardation (aOR: 1.30, 95%CI: 0.99-2.10), and neonatal intensive care admission (aOR: 1.06, 95%CI: p.52-2.72), after adjusting for educational level, residency place, and method of delivery.

CONCLUSIONS

Despite the higher incidence of postpartum hemorrhage and maternal blood transfusion, we found no increase in maternal intensive care unit admission risk. Regarding neonatal outcomes, iron-deficiency anemia was linked to preterm birth, low birth weight, intrauterine growth retardation, and neonatal intensive care admission.

Machine learning-based approach for predicting low birth weight

BACKGROUND

Low birth weight (LBW) has been linked to infant mortality. Predicting LBW is a valuable preventative tool and predictor of newborn health risks. The current study employed a machine learning model to predict LBW.

METHODS

This study implemented predictive LBW models based on the data obtained from the "Iranian Maternal and Neonatal Network (IMaN Net)" from January 2020 to January 2022. Women with singleton pregnancies above the gestational age of 24 weeks were included. Exclusion criteria included multiple pregnancies and fetal anomalies. A predictive model was built using eight statistical learning models (logistic regression, decision tree classification, random forest classification, deep learning feedforward, extreme gradient boost model, light gradient boost model, support vector machine, and permutation feature classification with k-nearest neighbors). Expert opinion and prior observational cohorts were used to select candidate LBW predictors for all models. The area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1 score were measured to evaluate their diagnostic performance.

RESULTS

We found 1280 women with a recorded LBW out of 8853 deliveries, for a frequency of 14.5%. Deep learning (AUROC: 0.86), random forest classification (AUROC: 0.79), and extreme gradient boost classification (AUROC: 0.79) all have higher AUROC and perform better than others. When the other performance parameters of the models mentioned above with higher AUROC were compared, the extreme gradient boost model was the best model to predict LBW with an accuracy of 0.79, precision of 0.87, recall of 0.69, and F1 score of 0.77. According to the feature importance rank, gestational age and prior history of LBW were the top critical predictors.

CONCLUSIONS

Although this study found that the extreme gradient boost model performed well in predicting LBW, more research is needed to make a better conclusion on the performance of ML models in predicting LBW.

Effects of Single-Course Betamethasone on the Outcomes of Late Preterm Neonates

Background Prenatal glucocorticoids are commonly used in pregnancies before 34 weeks of gestation in women at risk of preterm delivery; however, the effects of these drugs on late preterm infants (those born after the 34th week of pregnancy) are controversial. As a result, we aimed to investigate the effect of a single course of betamethasone (two doses of betamethasone every 24 hours) on the neonatal outcome of late preterm births. Methods We retrospectively assessed all spontaneous late preterm births (34-36+6 weeks of gestation) at a tertiary hospital in Iran over a period of two and a half years. Exclusion criteria included multiple pregnancies, induced labor, and fetal malformations identified in sonograms. Neonatal outcome measures encompassed first and five-minute Apgar scores, respiratory distress syndrome, neonatal death, birth asphyxia, and the need for positive pressure ventilation, continuous positive airway pressure, tracheal intubation, and surfactant. Baseline characteristics, such as maternal age, parity, fetal gender, and high-risk pregnancy, were considered confounding variables. High-risk pregnancies were defined as any cases involving prolonged rupture of membranes or maternal comorbidities such as severe anemia, preeclampsia, diabetes, or COVID-19. Results During the study period, there were 830 spontaneous preterm births at our center. Of these, only 195 (23.5%) received complete doses of betamethasone. Low birth weight was more common in mothers who did not receive betamethasone compared to those who did (63.6% vs. 41.2%). The mean gestational age was lower in mothers who received betamethasone than in those who did not. Respiratory distress syndrome was more common in mothers who received betamethasone (P<0.001, RR 2.11, 95% CI (0.98-4.18)). However, after adjusting for confounding factors, such as gestational age and birth weight, betamethasone did not increase the risk of respiratory distress syndrome. Other adverse neonatal outcomes did not differ significantly. Conclusions There were no differences in neonatal outcomes between those who received betamethasone and those who did not.

Machine learning models for predicting pre-eclampsia: a systematic review protocol

INTRODUCTION

Pre-eclampsia is one of the most serious clinical problems of pregnancy that contribute significantly to maternal mortality worldwide. This systematic review aims to identify and summarise the predictive factors of pre-eclampsia using machine learning models and evaluate the diagnostic accuracy of machine learning models in predicting pre-eclampsia.

METHODS AND ANALYSIS

This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This search strategy includes the search for published studies from inception to January 2023. Databases include the Cochrane Central Register, PubMed, EMBASE, ProQuest, Scopus and Google Scholar. Search terms include 'preeclampsia' AND 'artificial intelligence' OR 'machine learning' OR 'deep learning'. All studies that used machine learning-based analysis for predicting pre-eclampsia in pregnant women will be considered. Non-English articles and those that are unrelated to the topic will be excluded. PROBAST (Prediction model Risk Of Bias ASsessment Tool) will be used to assess the risk of bias and the applicability of each included study.

ETHICS AND DISSEMINATION

Ethical approval is not required, as our review will include published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-review journal.

PROSPERO REGISTRATION NUMBER

This review is registered with PROSPERO (ID: CRD42023432415).

Manifestation of Spontaneous Rupture of the Urinary Bladder in Pregnancy: A Systematic Review of the Literature

Spontaneous rupture of the urinary bladder (SRUB) during pregnancy is a potentially fatal event that necessitates immediate surgery. The aim of this systematic review is to determine the symptoms, causes, associated factors, and prognosis of SRUB in pregnancy. We searched the literature from inception until December 2022 using the Cochrane Central Register, PubMed, EMBASE, ProQuest, Scopus, and Google Scholar. Articles not in English and those unrelated to the topic were excluded. The JBI Critical Appraisal Checklist for case reports was employed for the risk of bias assessment. The search strategy yielded 312 citations; 29 full-text articles were evaluated for eligibility after screening. Five case reports were included in this review. The age range of the cases was 27-39 years. Four cases were in their second trimester of pregnancy, and one was in her third. Two cases had undergone previous cesarean sections, and one had an appendectomy and salpingectomy due to an ectopic pregnancy. One case reported a history of alcohol and drug abuse. The most common symptoms were abdominal pain, abdominal distension, oliguria, voiding difficulty, hematuria, fever, and vomiting. The diagnosis of SRUB was primarily made via emergency laparotomy due to the patients' critical conditions. Beyond its diagnostic role, laparotomy was also the treatment method in all cases. Tear repair, antibiotic therapy, and urinary catheterization were all integral parts of the treatment. Four cases resulted in an uneventful pregnancy and a healthy, full-term baby. In one case, a hysterectomy was performed due to a combined uterus and bladder rupture. SRUB often presents with non-specific symptoms, leading to a delayed diagnosis. A high index of suspicion is essential when a pregnant woman exhibits urinary symptoms and severe abdominal pain, especially in those with a history of previous surgery. Early detection and treatment of SRUB are critical for an uneventful recovery.

Maternal and Neonatal Outcomes of Sub-clinical Hypothyroidism Treated With Levothyroxine in Pregnancy: A Retrospective Cohort Study

INTRODUCTION

The effect of sub-clinical hypothyroidism (SCH) in pregnancy has been controversial. Furthermore, the impact of levothyroxine replacement on improving outcomes in pregnant women with SCH is unknown. This study aimed to assess the maternal and neonatal outcomes of pregnant women with SCH who were treated with levothyroxine replacement.

METHODS

This retrospective chart review was conducted at a tertiary hospital in Iran between 2020 and 2022. All pregnant women who had given birth during the study period were recruited. Those who did not have thyroid function test results within 10-12 weeks, as well as those with SCH who did not have levothyroxine replacement, were excluded. The subjects were divided into two groups based on the 2017 American Thyroid Association (ATA) criteria: non-SCH (TSH values 0.27-2.5 mIU/L) and SCH (TSH values more than 4.0 mIU/L). The demographic, obstetric, maternal, and neonatal outcomes of both groups were compared. The Chi-square test was used to compare the categorical variables. Binary logistic regression was used to assess differences in categorical variables.

RESULTS

With a frequency of 10.5%, 935 women out of 8888 were diagnosed with SCH. In terms of age, educational level, living residency, medical insurance, access to prenatal care, and smoking status, there were no differences between the two groups. In terms of gestational age, parity, onset of labor, history of infertility, hypertension, cardiovascular disease, anemia, and overt diabetes, there were no differences between the two groups; however, gestational diabetes was more common in those with SCH. Compared with the non-SCH group, the prevalence and risks of gestational diabetes [19.8 vs. 14.2, odds ratio (OR) = 1.14, 95% confidence interval (CI) = 1.72-3.95] were significantly higher in the SCH group after controlling for confounding factors. There were no differences in neonatal outcomes between the two groups.

CONCLUSIONS

Except for gestational diabetes, we found no significant adverse events in terms of maternal and neonatal outcomes among women with SCH who were treated with levothyroxine.

Analysis of Cesarean Section Rates in a Public Tertiary Hospital During Teaching and Non-teaching Periods Using the Robson Ten Group Classification System

INTRODUCTION

The rising cesarean section (CS) rate is a global concern. One of the hospital characteristics that may explain the variation in CS among hospitals is hospital teaching status. This study aims to assess the rate of CS in a tertiary hospital during the teaching and non-teaching periods and to conduct an analysis using the Robson ten-group classification system.

METHODS

This study is a retrospective cohort that assessed pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas. The study population was divided into two groups: those who gave birth during the hospital's teaching period (November 1st, 2019 to October 30th, 2020) and those who gave birth after that (November 1st, 2020 to October 30th, 2021). The primary outcome was the rate of CS according to Robson's classification system. The secondary outcome was the contributions of each group of Robson to the overall CS rate. Data were extracted by trained collectors from the "Iranian Maternal and Neonatal Network (IMaN Net)," a valid national system, using electronic patient records.

RESULTS

Of the total number of births (8382), 62.9 % occurred during the teaching period and 37.1 % during the non-teaching period. A 7% increase in CS was observed during the teaching period of the hospital compared to the non-teaching period (p<0.01). CS rate in Robson groups 1,2,4,7, and 10 differs significantly between teaching and non-teaching periods. According to the findings, Groups 5, 10, and 2 were the three most significant contributors to overall CS in our hospital during the study period.

CONCLUSION

The efforts to reduce the overall CS rate should be focused on groups 2,5, and 10 of Robson.

Machine Learning-Based Approach to Predict Intrauterine Growth Restriction

INTRODUCTION

Creating a prediction model incorporating multiple risk factors for intrauterine growth restriction is vital. The current study employed a machine learning model to predict intrauterine growth restriction.

METHODS

This cross-sectional study was carried out in a tertiary hospital in Bandar Abbas, Iran, from January 2020 to January 2022. Women with singleton pregnancies above the gestational age of 24 weeks who gave birth during the study period were included. Exclusion criteria included multiple pregnancies and fetal anomalies. Four statistical learning algorithms were used to build a predictive model: (1) Decision Tree Classification, (2) Random Forest Classification, (3) Deep Learning, and (4) the Gradient Boost Algorithm. The candidate predictors of intrauterine growth restriction for all models were chosen based on expert opinion and prior observational cohorts. To investigate the performance of each algorithm, some parameters, including the area under the receiver operating characteristic curve (AUROC), accuracy, precision, and sensitivity, were assessed.

RESULTS

Of 8683 women who gave birth during the study period, 712 were recorded as having intrauterine growth restriction, with a frequency of 8.19%. Comparing the performance parameters of different machine learning algorithms showed that among all four machine learning models, Deep Learning had the greatest performance to predict intrauterine growth restriction with an AUROC of 0.91 (95% confidence interval, 0.85-0.97). The importance of the variables revealed that drug addiction, previous history of intrauterine growth restriction, chronic hypertension, preeclampsia, maternal anemia, and COVID-19 were weighted factors in predicting intrauterine growth restriction.

CONCLUSIONS

A machine learning model can be used to predict intrauterine growth restriction. The Deep Learning model is an accurate algorithm for predicting intrauterine growth restriction.

Timing of Urinary Catheter Removal After Urethroplasty: A Systematic Review

OBJECTIVE

To synthesize existing evidence to evaluate the outcomes of different urinary catheter removal timing (early vs late) after urethroplasty.

METHODS

We performed a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science from inception to August 7, 2022. Articles were initially screened by title, abstract, and subsequently by a full paper review before being included in the final analysis. All comparative studies that assessed the association between urethral catheterization duration and frequency of extravasation and recurrence rate in patients who underwent urethroplasty were included in the analysis. Exclusion criteria were case reports, case series, letters to editors, and non-English studies. The risk of bias was assessed using the Newcastle-Ottawa Scale.

RESULTS

Of the 439 relevant records in the literature databases, 5 studies involving 634 patients were included. In all 5 studies, the extravasation rate was not significantly different between the early and late catheter removal groups. Among the 3 studies that reported recurrence rates, the recurrence rate was low, with no statistically significant difference between the early and late catheter removal groups. Wound and urinary tract infections were among the most common complications, with a higher rate in patients with late catheter removal.

CONCLUSION

Early catheter removal following urethroplasty does not increase the rate of extravasation or recurrence during long-term follow-up. The existing evidence can serve as the foundation for additional research with a larger sample size.

Prediction of postpartum hemorrhage using traditional statistical analysis and a machine learning approach

BACKGROUND

Early detection of postpartum hemorrhage risk factors by healthcare providers during pregnancy and the postpartum period may allow healthcare providers to act to prevent it. Developing a prediction model that incorporates several risk factors and accurately calculates the overall risk for postpartum hemorrhage is necessary.

OBJECTIVE

This study used a traditional analytical approach and a machine learning model to predict postpartum hemorrhage.

STUDY DESIGN

Women who gave birth at the Khaleej-e-Fars Hospital in Bandar Abbas, Iran, were evaluated retrospectively between January 1, 2020, and January 1, 2022. These pregnant women were divided into 2 groups, namely those who had postpartum hemorrhage and those who did not. We used 2 approaches for the analysis. At the first level, we used the traditional analysis methods. Demographic factors, maternal comorbidities, and obstetrical factors were compared between the 2 groups. A bivariate logistic regression analysis of the risk factors for postpartum hemorrhage was done to estimate the crude odds ratios and their 95% confidence intervals. In the second level, we used machine learning approaches to predict postpartum hemorrhage.

RESULTS

Of the 8888 deliveries, we identified 163 women with recorded postpartum hemorrhage, giving a frequency of 1.8%. According to a traditional analysis, factors associated with an increased risk for postpartum hemorrhage in a bivariate logistic regression analysis were living in a rural area (odds ratio, 1.41; 95% confidence interval, 1.08-1.98); primiparity (odds ratio, 3.16; 95% confidence interval, 1.90-4.75); mild to moderate anemia (odds ratio, 5.94; 95% confidence interval 2.81-8.34); severe anemia (odds ratio, 6.01; 95% confidence interval 3.89-11.09); abnormal placentation (odds ratio, 7.66; 95% confidence interval, 2.81-17.34); fetal macrosomia (odds ratio, 8.14; 95% confidence interval, 1.02-14.47); shoulder dystocia (odds ratio, 7.88; 95% confidence interval, 1.07-13.99); vacuum delivery (odds ratio, 2.01; 95% confidence interval, 1.15-5.98); cesarean delivery (odds ratio, 1.86; 95% confidence interval, 1.12-3.79); and general anesthesia during cesarean delivery (odds ratio, 7.66; 95 % confidence interval, 3.11-9.36). According to machine learning analysis, the top 5 algorithms were XGBoost regression (area under the receiver operating characteristic curve of 99%), XGBoost classification (area under the receiver operating characteristic curve of 98%), LightGBM (area under the receiver operating characteristic curve of 94%), random forest regression (area under the receiver operating characteristic curve of 86%), and linear regression (area under the receiver operating characteristic curve of 78%). However, after considering all performance parameters, the XGBoost classification was found to be the best model to predict postpartum hemorrhage. The importance of the variables in the linear regression model, similar to traditional analysis methods, revealed that macrosomia, general anesthesia, anemia, shoulder dystocia, and abnormal placentation were considered to be weighted factors, whereas XGBoost classification considered living residency, parity, cesarean delivery, education, and induced labor to be weighted factors.

CONCLUSION

Risk factors for postpartum hemorrhage can be identified using traditional statistical analysis and a machine learning model. Machine learning models were a credible approach for improving postpartum hemorrhage prediction with high accuracy. More research should be conducted to analyze appropriate variables and prepare big data to determine the best model.

Application of machine learning to identify risk factors of birth asphyxia

BACKGROUND

Developing a prediction model that incorporates several risk factors and accurately calculates the overall risk of birth asphyxia is necessary. The present study used a machine learning model to predict birth asphyxia.

METHODS

Women who gave birth at a tertiary Hospital in Bandar Abbas, Iran, were retrospectively evaluated from January 2020 to January 2022. Data were extracted from the Iranian Maternal and Neonatal Network, a valid national system, by trained recorders using electronic medical records. Demographic factors, obstetric factors, and prenatal factors were obtained from patient records. Machine learning was used to identify the risk factors of birth asphyxia. Eight machine learning models were used in the study. To evaluate the diagnostic performance of each model, six metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity, specificity, and F1 score were measured in the test set.

RESULTS

Of 8888 deliveries, we identified 380 women with a recorded birth asphyxia, giving a frequency of 4.3%. Random Forest Classification was found to be the best model to predict birth asphyxia with an accuracy of 0.99. The analysis of the importance of the variables showed that maternal chronic hypertension, maternal anemia, diabetes, drug addiction, gestational age, newborn weight, newborn sex, preeclampsia, placenta abruption, parity, intrauterine growth retardation, meconium amniotic fluid, mal-presentation, and delivery method were considered to be the weighted factors.

CONCLUSION

Birth asphyxia can be predicted using a machine learning model. Random Forest Classification was found to be an accurate algorithm to predict birth asphyxia. More research should be done to analyze appropriate variables and prepare big data to determine the best model.

Machine learning approach to predict postpartum haemorrhage: a systematic review protocol

INTRODUCTION

Postpartum haemorrhage (PPH) is the most serious clinical problem of childbirth that contributes significantly to maternal mortality worldwide. This systematic review aims to identify predictors of PPH based on a machine learning (ML) approach.

METHODS AND ANALYSIS

This review adhered to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol. The review is scheduled to begin on 10 January 2023 and end on 20 March 2023. The main objective is to identify and summarise the predictive factors associated with PPH and propose an ML-based predictive algorithm. From inception to December 2022, a systematic search of the following electronic databases of peer-reviewed journal articles and online search records will be conducted: Cochrane Central Register, PubMed, EMBASE (via Ovid), Scopus, WOS, IEEE Xplore and the Google Scholar search engine. All studies that meet the following criteria will be considered: (1) they include the general population with a clear definition of the diagnosis of PPH; (2) they include ML models for predicting PPH with a clear description of the ML models; and (3) they demonstrate the performance of the ML models with metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity and specificity. Non-English language papers will be excluded. Data extraction will be performed independently by two investigators. The PROBAST, which includes a total of 20 signallings, will be used as a tool to assess the risk of bias and applicability of each included study.

ETHICS AND DISSEMINATION

Ethical approval is not required, as our review will include published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-review journal.

PROSPERO REGISTRATION NUMBER

The protocol for this review was submitted at PROSPERO with ID number CRD42022354896.

The Incidence and Outcomes of Late-Term Pregnancy

BACKGROUND

Little is known about the outcomes of late-term pregnancy. In this study, we aim to assess the incidence and adverse prenatal outcomes associated with late-term pregnancy.

METHODS

We retrospectively assessed all singleton pregnant mothers who gave birth at Khalij-e-Fars Hospital in Bandar Abbas, Iran, between January 2020 and 2022. All preterm and post-term deliveries were excluded. Mothers were divided into two groups: late-term mothers (41 0/7-41 6/7 weeks of gestation) and term mothers (37 0/7-40 6/7 weeks of gestation). Demographic factors, obstetric factors, maternal comorbidities, and prenatal outcomes were extracted from the electronic data of each mother. The incidence of late-term births was calculated. The chi-squared test was used to compare differences between the groups. Logistic regression models were used to assess the association of prenatal outcome with late-term pregnancy.

RESULTS

There were 8,888 singleton deliveries during the study period, and 1,269 preterm and post-term pregnancies were ruled out. Of the 7,619 deliveries, 309 (4.1%) were late-term, while 7,310 (95.9%) were term. There were no sociodemographic differences between term and late-term mothers. The late-term group had a higher prevalence of primiparous mothers, and the term group had a higher prevalence of diabetes. Late-term mothers had a higher risk of macrosomia (adjusted odds ratio (aOR): 2.24 (95% confidence interval (CI): 1.34-3.01)), meconium amniotic fluid (aOR: 2.32 (95% CI: 1.59-3.14)), and fetal distress (aOR: 2.38 (95% CI: 1.54-2.79)). When compared to term pregnancy, the risk of low birth weight (LBW) was lower in late-term pregnancy (aOR: 0.69 (95% CI: 0.36-0.81)).

CONCLUSIONS

Late-term pregnancy was found to be more likely to be associated with macrosomia, meconium amniotic fluid, and fetal distress, but serious maternal and neonatal adverse events were comparable to term pregnancy.

The incidence and risk factors of meconium amniotic fluid in singleton pregnancies: an experience of a tertiary hospital in Iran

BACKGROUND

Several common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development; however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies.

METHODS

This study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors.

RESULTS

Of 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20-34 years old (aOR: 3.07, 95% CI: 1.87-4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76-8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92-9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11-4.99).

CONCLUSIONS

Adolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.

Vaginal Laser Therapy for Stress Urinary Incontinence: A Systematic Review of Prospective Randomized Clinical Trials

The most common type of urinary incontinence in women is stress urinary incontinence (SUI) which negatively impacts several aspects of life. The newly introduced vaginal laser therapy is being considered for treating SUI. This systematic review aimed to evaluate the efficacy of vaginal laser therapy for stress urinary incontinence in menopausal women. We searched the following databases: MEDLINE (via PubMed), EMBASE, Cochrane Library databases, Web of Science, clinical trial registry platforms, and Google Scholar, using the MeSH terms and keywords [Urinary Incontinence, Stress] and [(lasers) OR laser]. In our systematic review, prospective randomized clinical studies on women diagnosed with SUI as per the International Continence Society's diagnostic criteria were included. The Cochrane Risk-of-Bias assessment tool for randomized clinical trials was used to evaluate the quality of studies. A total of 256 relevant records in literature databases and registers and 25 in additional searches were found. Following a review of the titles, abstracts, and full texts, four studies involving 431 patients were included. Three studies used CO2-lasers, and one used Erbium: YAG-laser. The results of all four studies revealed the short-term improvement of SUI following both the Erbium: YAG-laser and CO2-laser therapy. SUI treatment with CO2-laser and Erbium: YAG-laser therapy is a quick, intuitive, well-tolerated procedure that successfully improves incontinence-related symptoms. The long-term impact of such interventions has not been well established as most trials focused on the short-term effects.

Spontaneous bladder rupture and associated factors during pregnancy:a systematic review and metanalysis protocol

INTRODUCTION

Spontaneous bladder rupture during pregnancy is a potentially life-threatening event requiring immediate surgery to reduce morbidity and mortality. This systematic review aims to identify associated factors of spontaneous bladder rupture during pregnancy and propose a diagnostic and therapeutic algorithm.

METHODS AND ANALYSIS

To improve the reporting of this protocol, the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 statement was used. The primary objective is to identify and summarise the associated factors with spontaneous bladder rupture during pregnancy. The secondary outcome was to determine the diagnostic and treatment approach. From inception to June 2022, a systematic search of the following electronic databases of peer-reviewed journal articles and online search records will be conducted: the Cochrane Central Register, PubMed, Medline (Via PubMed), Embase (Via Ovid), ProQuest, Scopus, WOS and search engine Google Scholar. All types of studies focusing on spontaneous bladder rupture during pregnancy will be included. Two authors will review the studies based on inclusion and exclusion criteria. Three authors will independently extract data using a researcher-created checklist. In the event of a disagreement, an external reviewer will be used. The Newcastle-Ottawa Scale checklist will be used by two authors to assess the quality of the studies independently. Data analysis will be carried out using STATA V.16.

ETHICS AND DISSEMINATION

Ethical approval is not required, as our review will include published and publicly accessible data. Findings from this review will be disseminated via publication in a peer-review journal.

PROSPERO REGISTRATION NUMBER

The protocol for this review was submitted at PROSPERO on 20 March 2022 with ID number CRD42022319511.

Efficacy of the Complementary and Alternative Therapies for the Management of Psychological Symptoms of Menopause: A Systematic Review of Randomized Controlled Trials

Menopause is not a high-risk period for psychiatric illness but can cause psychological issues; the most common of which are anxiety and depression, which can impair coping and reduce women’s quality of life. Thus, many women have leaned toward complementary and alternative medicine (CAM) for the relief of menopause-related symptoms. No rigorous study exists in the literature on the effects of CAMs on the psychological symptoms of menopause despite this growing patient interest. This systematic review aimed to assess the efficacy of CAM interventions on psychological symptoms of menopause. Databases (PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar) were searched from January 2000 to May 2021 using the keywords: menopause, menopausal symptoms, psychological symptoms, and complementary and alternative medicine. The quality of the included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) for randomized clinical trials. Of the 704 articles found, 33 articles with 3,092 participants entered the final review. Aromatherapy, massage, yoga, and acupuncture, as well as some dietary and herbal supplements improved psychological symptoms during menopause based on the findings of the current study. However, the effectiveness of reflexology and exercise was debatable. However, necessary precautions should be taken when using them in clinical settings despite the positive effect of various CAM interventions on reducing psychological symptoms. More studies with a higher methodology quality are required to make better decisions about the effect of various CAM interventions on the psychological symptoms of menopause.

Effect of oral consumption of vitamin D on uterine fibroids: A randomized clinical trial

BACKGROUND

and purpose: Uterine fibroids are common tumors of the female reproductive system. Symptomatic uterine fibroids require surgical or medical therapy depending on the severity of the symptoms. This study was conducted to investigate the effect of vitamin D on uterine fibroids.

MATERIALS AND METHODS

A randomized clinical trial was conducted from June to November 2018. Eligible women were randomly assigned to receive vitamin D or a placebo for 12 weeks. The change in the volume of fibroids was considered to be the main variable in the efficacy evaluation.

RESULTS

No statistically significant decrease in the volume of fibroids was observed in the experimental group [mean difference (MD): -0.71, 95% confidence interval (CI): -0.1 to 1.53, P = 0.085], and a significant increase was observed in the size of fibroids in the control group (MD: 2.53, 95% CI: 1.9 to 4.05, p = 0.001).

CONCLUSION

Vitamin D consumption might inhibit growth of uterine fibroids; however, the long-term effects remain unclear.

B Butterfly Campaign: A social marketing campaign to promote normal childbirth among first-time pregnant women

PROBLEM

The steep increase and inappropriateness of caesarean birth represent a healthcare problem in Iran.

AIM

The purpose of study was to evaluate the effect of a campaign based on social marketing to promote normal childbirth.

METHOD

The study was designed as a prospective case control study. The social marketing campaign was implemented from March 2016 to January 2017. A demographic data questionnaire, obstetrical history questionnaire, maternal knowledge assessment questionnaire, and maternal health belief questionnaire comprised the instruments for this study. Only women planning a caesarean birth without any medical indications for the caesarean were enrolled in the study as a case. Those who met the same inclusion criteria and did not want to participate in the campaign were assigned to the control group.

FINDINGS

In total, 350 first-time pregnant women who composed the campaign group (n=194) and control group (n=156) completed the study. The mean baseline level of knowledge and Health Belief Model component score did not differ between the two groups at baseline. However, after the campaign, knowledge scores, perceived severity, perceived susceptibility, self-efficacy, and cues to action scores differed significantly between the campaign and control groups. The follow-up of all participants in both groups showed that 35.6% (n=69) of participants in the campaign group chose natural birth as their birth method, whereas only 13.5% (n=21) in the control group delivered their newborn vaginally.

CONCLUSION

The B Butterfly social marketing campaign successfully targeted first-time pregnant women who chose to have unnecessary elective cesarean births.

Exploring First-time Pregnant Women's Motivations for Planning Vaginal Delivery: A Qualitative Study

Background:

In spite of medical indications, preferences for the mode of delivery are influenced by several factors. However, as the literature suggests, the underlying motivation of women choosing vaginal delivery is rarely attended to. The current study aimed to explore first-time pregnant women's motivation for planning vaginal delivery.

Materials and Methods:

An exploratory design with in-depth interviews was employed from September 2015 to March 2016. Participants were asked key questions about their beliefs about vaginal delivery, perceived outcomes of vaginal delivery, the impact of others perspectives on their decision, and factors that might inhibit or facilitate vaginal delivery. A community advertisement was placed in obstetricians' offices, public health departments, as well as beauty salons throughout the city of Bandar Abbas, Iran, to enroll target participants. All interviews were tape-recorded, transcribed, and subsequently analyzed.

Results:

Twelve pregnant women within the age range of 19–33 years volunteered to participate. Ninety four initial codes were obtained. These codes were then summed up into three themes as well as six subthemes. The three themes specified were personal beliefs, deliberation and risk assessment, and personal autonomy.

Conclusions:

A number of key motivating factors such as fast recovery after vaginal delivery, immediate breastfeeding, and powerful bonding were identified, which were influential in choosing vaginal delivery. Awareness of the fact that the provided information shapes women's beliefs and can lead to attitude changes, midwives played a key role in shaping positive and healthy attitudes toward natural birth giving as well as empower them to make autonomous decision.

Determinants of caesarean birth on maternal demand in the Islamic Republic of Iran: a review

The phenomenon of caesarean birth on demand has gained attention, particularly as a first caesarean birth appears to be strongly predictive of subsequent caesareans. Identification of reasons behind caesarean birth on demand is important for planning effective interventions. Therefore, this review reports the factors involved in the tendency of women to undergo caesarean birth, based on studies in the Islamic Republic of Iran. Several keywords including caesarean delivery, childbirth, causes, maternal request/demand, and patient choice were used to search Medline, PubMed, Ovid, Scientific Information Database, Magiran, Google and Google Scholar. The search was conducted on Persian and English language articles, with no time limitation. Using content analysis, the factors influencing caesarean section were divided into 3 categories: maternal, social and healthcare giver. According to the high prevalence of caesarean section, it is important to design and implement effective programmes and interventions with consideration of the key reasons that lead women to opt for unnecessary caesarean section.

The differences between pregnant women who request elective caesarean and those who plan for vaginal birth based on Health Belief Model

BACKGROUND

Although vaginal birth is the safest type of childbirth, sometimes caesarean is necessary for the safety of the mother or the infant. The problem is that low-risk, healthy women are choosing caesarean as a birth option despite the fact that it is fraught with possible complications.

AIM

To determine the differences and identify the predictors for the way women plan their childbirth based on Health Belief Model.

METHODS

A cross-sectional study was conducted in Bandar abbas city, Iran, from May to October 2015. The study recruited eligible women who self identified themselves as requesting a caesarean or vaginal birth in their response to a questionnaire.

FINDINGS

Of 470 recruited women, 183 (38.9%) planned to have a caesarean without medical indication. Maternal characteristics (age, level of education, occupational status, involvement in a medical profession, and household income) and obstetric variables (health provider type, place of prenatal care, and the number of children planned for the future) influenced the decisions made by the women. There was a significant difference between women planning a caesarean and those planning vaginal birth in terms of childbirth knowledge. Significant differences were observed regarding maternal self-efficacy, with women planning a caesarean reporting significantly lower self-efficacy than women planning a vaginal birth. Women planning a caesarean birth were also significantly less likely to perceive themselves as being at risk for caesarean-related side effects than women planning a vaginal birth.

CONCLUSION

Comprehensive childbirth knowledge can lead to positive maternal attitude towards vaginal birth and may improve birth confidence.

The effect of aromatherapy massage on the psychological symptoms of postmenopausal Iranian women

BACKGROUND

Menopausal symptoms experienced by women vary widely, and while many women transition through menopause with manageable symptoms, others experience severe symptoms, which may impair their quality of life.

OBJECTIVES

A randomized clinical trial was conducted to determine the effect of aromatherapy massage on psychological symptoms during menopause.

METHODS

The study population comprised 90 women. Each subject in the aromatherapy massage group received 30 min aromatherapy sessions with aroma oil, twice a week, for four weeks; each subject in the massage therapy group received the same treatment with odorless oil, while no treatment was provided to subjects in the control group. The outcome measures were psychological symptoms, as obtained through the psychological subscale of the Menopause Rating Scale.

RESULTS

A total of 87 women were evaluated. A statistically significant difference was found between the participants' pre- and post-application psychological score in intervention groups, whereas the score in the control group did not differ significantly. Aromatherapy massage decreased the psychological score MD: -3.49 (95% Confidence Interval of Difference: -4.52 to -2.47). Massage therapy also decreased the psychological score MD: -1.20 (95% Confidence Interval of Difference: -2.19 to -0.08). To distinguish the effect of aromatherapy from massage separately, we compared the reduction in the psychological score. Aromatherapy massage decreased the psychological score more than massage therapy MD: -2.29 (95% Confidence Interval of Difference: -3.01 to -0.47).

CONCLUSION

Both aromatherapy massage and massage were effective in reducing psychological symptoms, but, the effect of aromatherapy massage was higher than massage.