حاملگی پرخطر

The purpose of this research was to determine the predictability of low values of “Pregnancy Associated Plasma Protein A” (PAPP A) in the first trimester of pregnancy in biometric indicators, as well as the resistance and pulsatility Indices of the umbilical arteries, fetal middle brain, and uterine arteries in Doppler ultrasound in the third trimester of pregnancy.

In a cohort study during 2020-2022, a number of 120 pregnant women who had PAPP A ≤ 0.4 in the first trimester of pregnancy were included in the study and then underwent biometric sonography assessment at the 28th to 32nd week of pregnancy. Also, Doppler sonography was performed simultaneously. The study measured the relationship between clinical signs, Doppler sonographic indices, biometry, and PAPP A ≥ 0.4 and the potential to predict these indicators in the occurrence of fetuses with growth restriction.

No statistically significant relationship between PAPP A≤0.4 and SGA and FGR was observed. However, components such as the S/D Ratio and AC revealed a predictive role in the occurrence of SGA, and components such as pregnancy age, AC, and HC showed a significant predictive role in the occurrence of FGR.

In pregnant women with PAPP A values ≤0.4 in the first trimester, the occurrence of SGA can be predicted based on the following components: fetal abdominal circumference and systolic to diastolic ratio. Factors such as gestational age, fetal abdominal circumference, and fetal head circumference significantly played a role in predicting the occurrence of FGR.

Considering the prevalence of high-risk pregnancies in developing countries, the increase in maternal and fetal morbidity and mortality, as well as the adverse effects of these pregnancies on the mental health of couples، it is necessary to understand the experience of high-risk pregnancy in couples. Since one of the most realistic ways to achieve the challenges ahead is to use people's own experiences, this study was conducted with aim to explain the experience of couples with high-risk pregnancies.

 This qualitative study was conducted in 2018 on couples with high-risk pregnancies in the health centers and Sayad Hospital in Gorgan. The participants were selected in a purposeful way and with maximum diversity for structured in-depth interviews. Guba and Lincoln criteria were used for data accuracy. The data collection and analysis was done simultaneously based on the contract qualitative content analysis process based on Granheim's method and by MAXQDA software (version 10).

 Totally, 23 couples with high-risk pregnancies participated. The age range of women was 20-45 years and men were 22-52 years. The contents included the concern and fear of couples for maternal and fetal health, the way to deal with the problem, and need to comprehensive services and support of the relatives.

 Considering the worry about maternal and fetal health and the lack of comprehensive services, paying attention to increasing information and acquiring skills to cope with problems and a healthy lifestyle in couples, as well as providing comprehensive supportive services and support of the relatives is required in order to couples have a good experience of high-risk pregnancy by reducing high-risk pregnancy complications.

Takayasu arteritis, a so-called pulseless disease, is a very rare disease in young people. The first symptoms appear at the age of 5 to 40 years. Although both sexes may be affected, 80-90% of patients are female. It is a chronic inflammatory arthritis that affects the large arteries. This form of arthritis can be associated with abnormal angiography of the upper aorta and its main branches, which disrupts blood flow to the arteries of the upper extremities. Pregnancy with a history of Takayasu arteritis is considered a high-risk pregnancy and the risk increases depending on the progression of the disease and the extent of vascular damage. The purpose of this article is to report the case of a successful and uncomplicated pregnancy in a patient with Takayasu arteritis. A 36-year-old woman in her third pregnancy with two healthy children, with a gestational age of 38 weeks was referred to us with labor pains. The patient had a 8-year history of Takayasuchr('39')s arteritis. She did not follow-up and received no treatment during her current pregnancy. Her first visit in week 38 was due to the onset of labor pains. Emergency evaluation and procedures were performed. Finally, due to arrest dilatation, an emergency cesarean section was performed. She delivered a healthy boy weighing 4300 g with an Apgar score of 9-10.

A pregnancy can be considered high-risk if there are conditions that put the mother or the baby at higher-than-average risk of morbidity or mortality. Neonatal mortality rate is one of the most important indices of children's health status. The present study was conducted to evaluate the effects of high-risk states on neonatal mortality.

We performed a nested case-control study in the rural areas of Kohgiluyeh and Boyerahmad province. Within the study cohort, 97 cases and 97 controls were selected by a risk-set sampling method. Data were analyzed with univariate and multivariate conditional logistic regression models.

Neonatal mortality was shown to increase significantly in high-risk pregnancies. There were no substantial differences between crude odds ratios and those adjusted for the presence of other risk factors (crude odds ratio decreased from 5.5 to an adjusted figure of 3.25 for pregnancies with one risk factor and from 5.21 to adjusted level of 4.80 for pregnancies with more than one risk factor).

High-risk pregnancies need great attention in family health and prenatal care programs, especially in remote rural areas. Within our rural health network there are potential cohorts for use in nested case-control studies, especially in the evaluation of neonatal mortality risk factors.