Browsing by Subject "Pregnancy Outcome"
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Item The Aftermath of Conservative Management of Placenta Accreta: Can These Women and Their Uteri Handle Another Pregnancy?(2015-12-11) Knypinski, Julia; Wells, C. Edward; Pearson, Mary Jane; Mihalic, AngelaBACKGROUND: Placenta accreta, an invasion of the placenta into the myometrium of the uterus, is one of the leading causes of postpartum hysterectomies. The American Congress of Obstetrics and Gynecology (ACOG) recommends that when placenta accreta is suspected, a hysterectomy should be performed without attempting to remove the placenta. Several methods exist for the conservative management of placenta accreta, which leaves women capable of subsequent pregnancies. OBJECTIVE: The purpose of this literature review is to evaluate the fertility and pregnancy outcomes of women who undergo conservative management of placenta accreta. METHODS: An online literature search was performed looking for key works. Retrieved articles, their references, and past literature reviews on the subject were screened for relevance. RESULTS: Several studies assessing the fertility outcomes of women after conservative management of placenta accreta were found. 345 subsequent live births were documented with a recurrence rate of placenta accreta of 21%. It was found that previous C-sections and placenta previa pose the greatest statistical risk for placenta accreta. Relatively few women desired another pregnancy and postpartum hemorrhage can have a significant negative psychological impact on women. CONCLUSION: Women who undergo conservative management of placenta accreta can successfully carry pregnancies to term. Children born of these pregnancies have no neonatal morbidity. The rate of recurrence of placenta accreta and postpartum hemorrhage remains high.Item A Biopsychosocial Model of Attachment Styles and Adverse Birth Outcomes in High-Risk Pregnancies(2016-04-13) Cassedy, Hannah; Robinson, Richard C.; Frank, Blake; Bernstein, Ira; Evans, Harry M.; Stringer, Claude A.Because stress during pregnancy can contribute to preterm birth, low birth weight, and other adverse birth outcomes, there is a need for research on psychosocial factors that may mitigate this risk. Social support and attachment security have been shown to buffer the effects of stress in certain contexts. This study therefore evaluated the degree to which social support, attachment anxiety, and attachment avoidance affect stress-related birth outcomes in a sample of women with high-risk pregnancies. The study focused on women who had been hospitalized for pregnancy complications, as the population was identified as in need of further biopsychosocial research. The hypotheses were that women with more secure attachment would have greater social support, less stress, and therefore superior birth outcomes. Participants (N = 188) completed the 10-Item Perceived Stress Scale, Social Provisions Scale, and Experiences in Close Relationship Scale-Short Form, during their pregnancies. Birth outcome data (gestational age, birth weight, and Apgar scores) were extracted from their medical records after delivery. Biserial correlation analyses revealed that high stress levels were associated with more insecure attachment styles. Analysis of variance indicated that participants were more likely to have avoidant attachment if they were black, poorly educated, or unmarried. Hierarchical multiple regression analyses revealed that stress, social support, and attachment levels were not predictive of birth outcomes over and above the effects of physiological risk factors. This result diverges from research on low-risk pregnancies, where a clear link is observed between stress and adverse birth outcomes. By contrast, in this sample of high-risk pregnancies, psychosocial factors did not influence the profound effects of biological risk. In high-risk pregnancies, therefore, psychosocial interventions may be better suited to target psychosocial, rather than biological, outcomes. Furthermore, this study highlights a need for further research into demographic disparities in attachment styles, as well as the sociocultural factors that may impact them.Item Low Dose Aspirin Increases Live Birth Rate Differentially along Socioeconomic Status(2017-01-17) Agrawala, Shilpi; Schisterman, Enrique F.; Halvorson, Lisa M.; Sjaarda, Lindsey A.INTRODUCTION: Low socioeconomic status (SES) is associated with adverse pregnancy outcomes such as preterm birth and low birth weight. Lower medical advice compliance and decreased access to health care contribute to these events in this population. In addition, some studies suggest that women of low SES may have greater difficulty achieving pregnancy, although mechanisms for this phenomenon are not known. Low-dose aspirin (LDA) has been shown to increase pregnancy and live birth rates in women with elevated inflammatory markers. Since low SES is also associated with chronic, low-level inflammation, we hypothesized that low-dose aspirin may also increase live birth and pregnancy rates in low SES women. METHODS: We performed a secondary analysis of The Effects of Aspirin in Gestation and Reproduction (EAGeR) Trial, a multisite, blockrandomized, controlled trial. 1228 women were randomly allocated to either 81mg of aspirin + 400mcg of folic acid (n=615) or placebo + 400 mcg of folic acid (n=613). Participants took the study medication for six menstrual cycles or until 36 weeks' gestation if pregnancy was achieved. For this analysis, women were stratified by socioeconomic measures, which included income (low, mid, high) and a combined grouping of education and income (low-low, low-high, high-low, high-high). The effect of LDA vs. placebo was then determined within each strata. RESULTS: LDA increased live birth rates (RR 1.23, 95% CI: 1.03, 1.45) in the high-income group compared to placebo and increased pregnancy rates (RR 1.23, 95%CI: 1.06, 1.42) in the high education-high income group compared to placebo. The low-education low-income group also demonstrated an increased pregnancy rate (RR 1.22, 95% CI: 1.02, 1.46) compared to placebo, but no effects were observed among the participants grouped by low income alone. DISCUSSION: Our analysis shows high SES women consistently benefited from LDA as demonstrated by increased pregnancy and live birth rates compared to placebo. Less consistent effects of LDA in low SES women were observed, and no significant benefit of LDA was observed in mid-SES groups. Differences in factors such as underlying health risk factors and medication compliance may contribute to the different effects of LDA by SES on reproductive outcomes.Item [News](1989-02-01) Harrell, Ann