Exercise and Physical Activity Levels and Associated Factors Among High-Risk Pregnant Women / Fatores associados com o nível de atividade física e a prática de exercício em gestantes de alto risco

Abstract Objective To assess the levels of physical activity and exercise practice, and examine the associated maternal characteristics; as well as the anxiety levels of high-risk pregnant women. Methods A cross-sectional study conducted with pregnant women at a High-risk Prenatal Clinic (HRPC) in a tertiary maternity. Pregnant women of 18 to 40-years-old, with a single fetus, and with gestational age up to 38 weeks were included. The level of physical activity and exercise practice of the study's participants were investigated using the Pregnancy Physical Activity Questionnaire (PPAQ). Maternal sociodemographic, anthropometric, and medical data were investigated using a specific form. For anxiety levels, the short version of the State-Trait Anxiety Inventory (STAI) was applied. We used the Student t-test, chi-square test, odds ratio (OR) with 95% confidence interval (95% CI) and multiple logistic regression. The significance level was 5%. Results Among the 109 pregnant women included, 82 (75.2%) were classified as sedentary/little active. The higher energy expenditure were for domestic activities (133.81±81.84 METs), followed by work-related activities (40.77±84.71 METs). Only 19.3% women exercised during pregnancy (4.76±12.47 METs), with slow walking being the most reported exercise. A higher level of education was the most important factor associated with women being moderately or vigorously active (OR=29.8; 95% CI 4.9-117.8). Nulliparity (OR=3.1; 95% CI 1.0-9.1), low levels of anxiety (OR=3.6; 95% CI 1.2-10.7), and unemployment (OR=4.8; 95% CI 1.1-19.6) were associated with the practice of exercise during pregnancy. Conclusion Most women with high-risk pregnancies exhibited a sedentary pattern, with low prevalence of physical exercise practice. Recognizing factors that hinder the adoption of a more physically active lifestyle is essential for an individualized guidance regarding exercise during pregnancy.

Resumo Objetivo Analisar o nível de atividade física e a prática de exercício físico, examinar as características maternas associadas, assim como níveis de ansiedade de gestantes de alto risco. Métodos Estudo observacional, transversal e quantitativo, realizado no ambulatório de Pré-Natal de Alto Risco (PNAR) de uma maternidade terciária. Foram incluídas gestantes comidade entre de 18 e 40 anos; feto único e comidade gestacional (IG) até 38 semanas.O nível de atividade física e prática de exercício físico das participantes do estudo foram investigados usando o Questionário de Atividade Física na Gestação (QAFG). Os dados sociodemográficos, antropométricos e médicos maternais foram investigados usando um formulário específico. Para níveis de ansiedade, a versão curta do Inventário de Ansiedade Traço-Estado (STAI) foi aplicado. Usamos o teste t de Student, teste qui-quadrado, razão de chances (OR) com um intervalo de confiança de 95% (IC 95%) e regressão logística multinomial. O nível de significância considerado foi 5%. Resultados Das 109 gestantes incluídas no estudo, 82 (75,2%) foi classificada como sedentária/pouco ativa. Os maiores gastos energéticos foram em atividades domésticas (133.81±81.84 METs), seguidas pelas atividades ocupacionais (40.77±84.71 METs). Apenas 19.3% praticaram exercício físico durante a gravidez (4.76±12.47 METs), sendo a caminhada lenta a atividade mais relatada. Maior grau de escolaridade foi o fator mais importante associado a gestante ser moderadamente ou vigorosamente ativa (OR=29,8; IC 95% 4,9-117,8) . Nuliparidade (OR=3,1; IC 95% 1,0-9,1), baixos níveis de ansiedade (OR=3,6; IC 95% 1,2-10,7) e não trabalhar na gestação (OR=4,8; IC 95% 1.1-19,6) foram associados à prática de exercício físico durante a gestação. Conclusão A maioria das gestantes de alto risco desenvolveram um padrão sedentário, com baixa prevalência da prática de exercício físico. Reconhecer os fatores que dificultam a adoção de um estilo de vida mais ativo fisicamente é fundamental para a orientação adequada e individualizada acerca da prática de exercício físico durante a gestação.

Labor interventions in low- and high-risk parturients in a university hospital

SUMMARY OBJECTIVE: The main aim of this study was to evaluate the impact of using interventions in low- and high-risk parturients on maternal and perinatal adverse outcomes during labor. METHODS: This is a prospective study. The analyzed variables were obtained through a questionnaire with puerperal women (between 1- and 48-h postpartum) and through medical record searches. The study population was divided into two groups as follows: Group I included parturients who underwent at least one type of obstetric intervention and Group II included parturients who did not undergo any type of obstetric intervention. RESULTS: Most parturients (75.3%) underwent at least one type of intervention, with oxytocin being the most prevalent intervention (49.5%), followed by misoprostol use (28.7%), elective cesarean section at the request of the patient (23.0%), amniotomy (21.2%), and episiotomy (21.0%). Regarding the adverse perinatal outcomes related to low-risk pregnancies, the prevalence of the second- or third-degree perineal tears (17.8% vs. 36.7%, p=0.001) was lower in Group I than in Group II. Moreover, in high-risk pregnancies, the prevalence of hospitalization in the neonatal intensive care unit (2.8% vs. 16.7%, p<0.001), adult intensive care unit admission (0.8% vs. 3.9%, p=0.004), and the need for oxygen therapy (26.8% vs. 40.4%, p<0.001) was lower in Group I than in Group II. CONCLUSIONS: In low-risk parturients, the interventions performed were associated with lower prevalence of second- or third-degree perineal tears. There was a lower prevalence of neonatal and adult intensive care unit admissions, the need for oxygen therapy, intracranial hemorrhage, and neonatal infection among high-risk parturients.

Study of fetal doppler velocimetry versus non stress test as predictors of adverse perinatal outcome in high risk pregnancies

Background: Pregnancy is a unique, physiologically normal event in a women’s life. Objective of this study was to compare the efficacy of the doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies.Methods: This is a prospective study conducted in the department of obstetrics and gynaecology, Narayana Medical College and Hospital. 100 women with high risk pregnancy were recruited. All were examined systematically, and Doppler velocimetry and non-stress test were done.Results: All cases were divided into four groups based on NST and doppler velocimetry of umbilical artery and middle cerebral artery. 10% of women had abnormal doppler. Middle cerebral artery doppler abnormality was noted in 3% and CPR abnormality in 3% of women in the study group. 15% had abnormal NST. In Group A, out of 88 patients 9 had fetal compromise. In Group B, out of 5 patients all had fetal compromise. In Group C, out of 4 patients none had fetal compromise. In Group D, all 3 patients had fetal compromise. In Group D, all 3 had neonatal deaths. Average birth weights in Group A was 2.7 kg, in Group B was 2 kg, in Group C was 2.5 kg, in Group D was 1.4 kg. Two (2.2%) newborn in Group A, 4 (80%) newborns in Group B, 3 (100%) in Group had Apgar < 7 at 5 minutes. 4 (4.5%) babies in Group A, 5 (100%) babies in Group B, 3 (100%) babies in Group D were admitted in NICU. Umbilical artery doppler was found to have sensitivity 46.6%, specificity - 94%, PPV - 93%, NPV - 54%. Middle cerebral artery doppler was found to have sensitivity 73.3%, specificity - 90%, PPV - 91.6%, NPV- 69.3%.Conclusions: In present study, highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal tests of NST and velocimetry. Group D had the worst perinatal outcome.

Adherence to recommended intra-partum guidelines of high risk pregnancies: a study in North Bengal Medical College, Darjeeling district, West Bengal, India

Background: High risk pregnancies in intra-partum period are vulnerable, and if not appropriately attended, may roll on to maternal death or dreaded maternal near-miss cases. Despite the presence of a number of standard treatment guidelines designed to address most of the high risk conditions, their adherence and implementation continues to be uncommon. To assess the adherence to recommended guidelines during referral of high risk pregnancies in labour in mothers of the difficult terrains of eastern Himalaya. Methods: A descriptive epidemiological study with cross-sectional design was conducted among mothers with high risk pregnancies admitted in the labour ward, North Bengal Medical College Hospital, Darjeeling. 433 subjects were studied using complete enumeration technique. Results: Anaemia in pregnancy (22%), obstructed labour (19%), pre-term rupture of membranes (15%) and pregnancy induced hypertension (15%) were the high risk conditions identified. Referral linkage existed in most (70.7%) but no pre-referral treatment was given to 61.4% of the intra-partum mothers. Multivariate analysis shows mothers with age more than 35 years (AOR 4.97), bad obstetric history (AOR 2.40) & not attended by doctors (AOR 5.02) were found to be having more odds of missing the pre-referral treatment. About 86% of the gaps in pre-referral treatment were due to doctors not attending patients, lack of referral communication, not providing JSSK facilities and non-maintenance of Partograph as per Pareto analysis. Conclusions: Most of the non-adherence to standard treatment guidelines in high risk intra-partum mothers are related to health service delivery and can be ameliorated through proper administrative measures.

Fetomaternal outcome in post dated pregnancy

Background: The risks to the fetus increase after 41 weeks mainly due to increasing fetal weight, decline in placental function, oligohydramnios which increase chances of cord compression, and meconium aspiration. Perinatal mortality after 42 weeks is twice as compared to the perinatal mortality at 40 weeks and by 44 weeks the rate is increased up to threefold. In cases of prolonged pregnancy, fetus is more at risk of hypoxia during labor than a fetus at term.Methods: This cross sectional observational study of feto-maternal outcome in post dated pregnancy (Women beyond 40 weeks of gestation) was carried out in the department of obstetrics and gynaecology in a rural based tertiary care centre from October 2016 to September 2018, willing to participate and fulfilling the inclusion and exclusion criteria in the study period.Results: Majority i.e. 45 patients (46.9%) went into spontaneous labour and delivered vaginally, whereas 16 patients (16.7%) required caesarean section. Among all 45 participants who were given induction, maximum 26 (57.78%) were induced by Dinoprostone gel, 4 patients (8.89%) were induced by Tab. Misoprostol.Conclusions: The present study, we conclude that, the post dated pregnancy can be considered as a high risk factor from the point of view of fetal outcome as there is more fetal morbidity.

Prevalence of Viral Infections in High Risk Pregnancies

Introduction: Prevalence of viral infections in high riskpregnancies has not been studied so far in our population.Current research aimed to study the prevalence of viralinfections in high risk pregnancies.Material and methods: The Study was prospective fora period of one and a half year. Hundred high risk patientswith hundred controls were studied. The viral infectionsstudied included Rubella, Herpes Simplex Type 1 and Type 2,Cytomegalovirus (CMV), HBsAg, HCV, HIV-1 and 2Results: The mean age of the women in the study group was25.2+4 years and in the controls was 25.2+4 years Out of100 cases studied 29% were positive for CMV, vs 6% controlgroup (p < 0.05), 19% were positive for Rubella IgM, vs 1% incontrols. 21% cases were positive for HSV-1/ HSV-2 IgM, vs7% in controls, 5% were positive for HbsAg, vs nil in controls.7% were positive for HEV IgM, vs nil in controls. No case ofHCV IgM was found in study or control group. One case ofHIV IgM was found in study group and none in control group.Conclusion: The seroprevalence of viral infections issignificantly higher in high risk pregnancies as compared tocontrols. CMV infection was the most prevalent viral infectionin our studied population.

Morphological changes in placentas of normal and high risk pregnancies – 2 years study in MGM hospital

Background: Placenta-related disorders of pregnancy are almost unique to human species. These disorders, which affect around a third of pregnancies, primarily include miscarriage and preeclampsia. Aim and objectives: The aim of the present study was to examine the morphological changes in placentas of normal and high risk pregnancies, and to evaluate the fetal outcome in these cases, which in turn will improve the quality of placental diagnosis. The objectives were to know the extent of the gross and microscopic placental changes that occur in normal pregnancies and to study the placentas of high risk pregnancies. Materials and methods: A study of 132 placentas in normal and high risk pregnancies was conducted in the Department of Pathology, Kakatiya Medical College, MGM Hospital, Warangal, from 1st September 2014 to 31st August 2016. The materials included in this study were placentas from thirty females with normal pregnancies (controls) and one hundred thirteen with high risk pregnancies (cases) comprising anemia (27), pregnancy-induced hypertension (38), intrauterine growth retardation (15), diabetes mellitus (13), and twins (9). Results: In high risk cases, women in the age group 21-25 years were 66.6% in anemia, 60.5% in PIH, and 60% in IUGR 69.2% in diabetes mellitus, and 33.3% in twin pregnancies. Only a few cases Samala Raghuram Mohan, Jyosna, Sandhya Anil, S. Chandra Sekhar. Morphological changes in placentas of normal and high risk pregnancies - 2 years study in MGM hospital. IAIM, 2017; 4(5): 61-78. Page 62 were seen in the age group of 26-30 in both controls and cases. Seventy percent of the controls belonged to primigravida and 30% were multiparous women. In high risk cases, 66.6% were primigravida and 33.3% multipara. Majority of the multiparous mothers were seen in anemia constituting 48.1%. High risk cases exhibited exaggerated changes, except for calcification, which was seen equally in both the groups. Infarction was seen in 50% cases of PIH. Single case of retroplacental hematoma was also observed in PIH. Subchorionic fibrinoid was seen in 53.4% of IUGR placentas. Maternal floor infarction was seen in 4 cases of PIH and 3 cases of IUGR placentas. Subchorionic hematoma was seen in 1 case of IUGR placenta. IUGR placentas were small in size and weight for the gestational age and twin placentas were of diamniotic dichorionic type. The most prominent microscopic features were syncytiotrophoblastic knot formation and calcification. The high risk groups were showing prominent infarcts, fibrinoid necrosis, and stromal fibrosis more than those of control group. Conclusion: The present study has highlighted the importance of examination of placenta in normal as well as high risk pregnancies. The placental changes are essential to correlate the fetal outcome, as it provides the information for the cause of death. Hence, it has an effective role in planning prenatal monitoring of a future pregnancy.