Management of High-Risk Pregnancies: Current Trends and Future Perspectives

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Obstetrics and Gynecology".

Deadline for manuscript submissions: 31 May 2024 | Viewed by 2538

Special Issue Editors


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Guest Editor
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: high–risk pregnancy; maternal–fetal medicine
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: fetal medicine; obstetric medicine
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I am pleased to invite you to contribute to the Special Issue "Management of High-Risk Pregnancies: Current Trends and Future Perspectives".

High-risk pregnancies affect a relatively high proportion of women and are mainly attributed to advancing maternal age, high BMI and the use of assisted reproductive technology. They are associated with a high economic burden, but they also have a significant impact on the psychological status of those affected. Congenital anomalies, recurrent miscarriages, hypertensive disorders in pregnancy, fetal growth restriction, preterm birth, gestational diabetes, stillbirth and postpartum hemorrhage represent the most common complications of pregnancy. Aging and associated maternal morbidity may also affect the pregnancy outcomes.

The aim of this Special Issue is to present recent research findings on the diagnosis and management of high-risk pregnancies, to evaluate the aspects in need of further consideration.

Studies reporting high-risk pregnancies, including maternal and fetal morbidity and pregnancy complications, are of particular interest.

All types of articles are welcome. Articles on less common conditions are particularly encouraged.

Dr. Ioannis Tsakiridis
Dr. Themistoklis Dagklis
Guest Editors

Manuscript Submission Information

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Keywords

  • high-risk pregnancy
  • obstetric medicine
  • pregnancy complications
  • perinatal comorbidities

Published Papers (3 papers)

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Research

13 pages, 1173 KiB  
Article
The Impact of Platelet-Rich Plasma Application during Cesarean Section on Wound Healing and Postoperative Pain: A Single-Blind Placebo-Controlled Intervention Study
by Michał Barwijuk, Katarzyna Pankiewicz, Aleksander Gałaś, Filip Nowakowski, Patrycja Gumuła, Artur J. Jakimiuk and Tadeusz Issat
Medicina 2024, 60(4), 628; https://doi.org/10.3390/medicina60040628 (registering DOI) - 13 Apr 2024
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Abstract
Background/Objectives: The aim of this study was to evaluate if platelet-rich plasma (PRP) application into the wound during cesarean delivery improves wound healing and reduces pain in the postoperative period. Materials and Methods: A total of 46 patients undergoing cesarean section [...] Read more.
Background/Objectives: The aim of this study was to evaluate if platelet-rich plasma (PRP) application into the wound during cesarean delivery improves wound healing and reduces pain in the postoperative period. Materials and Methods: A total of 46 patients undergoing cesarean section (CS) were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 in the placebo group. Every patient was asked to evaluate pain by using the Visual Analogue Scale (VAS) immediately after surgery, as well as 6 and 12 h after the surgery. The use of analgetics was also recorded. The postoperative scar was assessed using the Patient and Observer Scar Assessment Scale (POSAS). Results: There was no case of wound dehiscence in either group. Significant differences between the groups in the scar quality assessment were detected in both patient and doctor POSAS results on days 8, 30 and 90 after surgery in the favor of the PRP group. There was no difference in the pain intensity assessment on the VAS recorded after surgery, but PRP patients required fewer paracetamol doses per day than the control group. Conclusions: PRP application during CS significantly improved wound healing in both short- and long-term assessment. Although it did not influence postoperative pain intensity, it may reduce the use of analgetics after surgery. Full article
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11 pages, 277 KiB  
Article
Mode of Delivery and Neonatal Outcomes of Preterm Deliveries: A Retrospective Study in Greece
by Kyriaki Mitta, Ioannis Tsakiridis, Georgios Kapetanios, Antigoni Pavlaki, Efthymios Tarnanidis, Themistoklis Dagklis, Apostolos Athanasiadis and Apostolos Mamopoulos
Medicina 2024, 60(1), 10; https://doi.org/10.3390/medicina60010010 - 20 Dec 2023
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Abstract
Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. [...] Read more.
Background and Objectives: Preterm birth is a significant concern in obstetrics and neonatology since preterm neonates are at higher risk of various health complications and may require specialized care. The optimal mode of delivery in preterm birth is a matter of debate. This study aimed to evaluate the mode of delivery in preterm neonates and the associated neonatal outcomes. Material and Methods: This was a retrospective cohort study including all preterm neonates born between January 2010 and December 2020 at the 3rd Department of Obstetrics & Gynecology of Aristotle University of Thessaloniki, Greece. The mode of delivery in relation to gestational age groups and the cause of preterm birth were analyzed. Neonatal outcomes were also evaluated according to gestational age, indication and mode of delivery. Results: A total of 1167 preterm neonates were included in the study; the majority of them were delivered via cesarean section (76.1%). Most of the preterm neonates (n = 715; 61.3%) were delivered at 32+0–36+6 weeks, while cesarean section was the most common mode of delivery after 28+0 weeks. Furthermore, spontaneous onset of labor (OR: 6.038; 95% CI: 3.163–11.527; p < 0.001), multiple gestation (OR: 1.782; 95% CI: 1.165–2.227; p = 0.008) and fetal distress (OR: 5.326; 95% CI: 2.796–10.144; p < 0.001) were the main causes of preterm delivery at 32+0–36+6 weeks. The overall mortality rate was 8.1% among premature neonates. Regarding morbidity, 919 (78.7%) neonates were diagnosed with respiratory disorders, 129 (11.1%) with intraventricular hemorrhage and 30 (2.6%) with necrotizing enterocolitis. Early gestational age at delivery was the main risk factor of neonatal morbidity and mortality. Notably, the mode of delivery did not have any impact on neonatal survival (OR: 1.317; 95% CI: 0.759–2.284; p = 0.328), but preterm neonates born via cesarean section were at higher risk of respiratory disorders, compared to those born via vaginal delivery (OR: 2.208; 95% CI: 1.574–3.097; p < 0.001). Conclusions: Most preterm deliveries occurred in the moderate-to-late preterm period via cesarean section. Early gestational age at delivery was the main prognostic factor of neonatal morbidity and mortality, while the mode of delivery did not have any impact on neonatal survival. Future research on the mode of delivery of the preterm neonates is warranted to establish definitive answers for each particular gestational age. Full article
15 pages, 848 KiB  
Article
Gestational Diabetes Mellitus: Association with Maternal and Neonatal Complications
by Rebecca Karkia, Tara Giacchino, Saadia Shah, Andrew Gough, Ghada Ramadan and Ranjit Akolekar
Medicina 2023, 59(12), 2096; https://doi.org/10.3390/medicina59122096 - 29 Nov 2023
Cited by 1 | Viewed by 1058
Abstract
Background and objectives: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in recent clinical practice, especially after the introduction of strict guidelines for the management of pregnancies [...] Read more.
Background and objectives: Gestational diabetes mellitus (GDM) is known to be associated with pregnancy complications but there is limited evidence about the strength of these associations in recent clinical practice, especially after the introduction of strict guidelines for the management of pregnancies with GDM in a multidisciplinary team setting. The objectives of our study were to first compare the rates of complications in pregnancies with GDM with those that had pre-existing diabetes mellitus and those without diabetes; and second, to derive measures of effect size expressed as odds ratios after adjustment for confounding factors to assess the independent association of GDM in prediction of these pregnancy complications. Materials and Methods: This was a prospective cohort study undertaken at a large maternity unit in the United Kingdom between January 2010 and June 2022. We included singleton pregnancies that were booked at our unit at 11–13 weeks’ gestation. Multivariate regression analysis was carried out to determine the risks of complications in pregnancies with GDM after adjusting for pregnancy characteristics. Risks were expressed as odds ratio (OR) (95% confidence intervals [CI]) and expressed graphically in forest plots. Results: The study population included 53,649 singleton pregnancies including 509 (1%) with pre-existing DM, 2089 (4%) with GDM and 49,122 (95%) pregnancies without diabetes. Multivariate regression analysis demonstrated that there was a significant independent contribution from GDM in the prediction of adverse outcomes, including maternal complications such as preterm delivery, polyhydramnios, preeclampsia and delivery of large for gestational age neonates and elective caesarean section (CS); and neonatal complications including admission to neonatal intensive care unit, hypoglycaemia, jaundice and respiratory distress syndrome. Conclusions: GDM is associated with an increased rate of pregnancy complications compared to those without diabetes, even after adjustment for maternal and pregnancy characteristics. GDM does not increase the risk of stillbirth, hypoxic ischaemic encephalopathy or neonatal death. Full article
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