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Obstetrics/Gynecology

• Case Records of the Massachusetts General Hospital
• Aug 07, 2024

A Woman with Postpartum Anxiety and Intrusive Thoughts

A 30-year-old woman was evaluated 4 weeks after the birth of her first child because of anxiety and intrusive thoughts of stabbing the infant and visual hallucinations of herself holding a knife. What is the diagnosis?

• Correspondence
• Aug 21, 2024

Second Cancer after Epigenetic Therapy

A woman with a rare ovarian tumor driven by EZH2 activity responded to tazemetostat, an EZH2 inhibitor, but T-cell acute lymphoblastic leukemia later developed.

• Clinical Practice

Sexual Dysfunction in Women

Sexual dysfunction in women impairs quality of life and is determined by multiple factors. Treatment includes lifestyle modification, counseling and psychosexual therapies, and pharmacotherapy.

• Images in Clinical Medicine
• Jul 24, 2024

Congenital Syphilis

A preterm baby boy was noted to have hepatomegaly on the first day of life. Radiographs of the baby’s legs showed periostitis and alternating dense and radiolucent bands in the distal femur.

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• Obstetrics/Gynecology General 2935
• Complications of Pregnancy 1045
• Gynecologic Oncology (Obstetrics/Gynecology) 420
• Birth Defects 235
• Research 1173
• Commentary 580
• Clinical Cases 279
• Perspective 216
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• VOL. 391 NO. 9
• Sep 05, 2024

A Late-Arriving but Welcome Advance in Sarcoma Therapy

• Original Article

Doxorubicin–Trabectedin with Trabectedin Maintenance in Leiomyosarcoma

• Perspective
• Aug 28, 2024

Mpox in Pregnancy — Risks, Vertical Transmission, Prevention, and Treatment

• VOL. 391 NO. 8
• Aug 22, 2024

Epigenetic Therapy in a Rare Ovarian Cancer — A Double-Edged Sword

• VOL. 391 NO. 6
• Aug 08, 2024

Nipocalimab in Early-Onset Severe Hemolytic Disease of the Fetus and Newborn

Case 24-2024: a 30-year-old woman with postpartum anxiety and intrusive thoughts, science behind the study: inhibiting igg in hemolytic disease of the fetus, ensuring a safe and sufficient global blood supply.

• VOL. 391 NO. 5
• Aug 01, 2024

Intention to Treat: Race-Based Diagnosis, Part 3 — ITT Episode 35

• VOL. 391 NO. 4
• Jul 25, 2024

Intention to Treat: Race-Based Diagnosis, Part 2 — ITT Episode 34

Rape, homicide, and abortion bans — the abandonment of people subjected to sexual and intimate partner violence.

• VOL. 391 NO. 3
• Jul 18, 2024

Case 22-2024: A 30-Year-Old Woman with Postpartum Fever, Abdominal Pain, and Skin Ulcers

• VOL. 391 NO. 2
• Jul 11, 2024

Rare Autosomal Trisomies and Adverse Perinatal Outcomes

Lipschütz’s ulcer.

• VOL. 391 NO. 1
• Jul 04, 2024

Tisotumab Vedotin as Second- or Third-Line Therapy for Recurrent Cervical Cancer

• VOL. 390 NO. 23
• Jun 20, 2024

The Maternal Crossroad

• VOL. 390 NO. 22
• Jun 13, 2024

Efforts toward Equity: Expect With Me — Group Prenatal Care to Reduce Disparities

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The Rise of Congenital Syphilis as a Public Health Emergency

O&G Open. 1(2):014, June 2024.

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Safety of Monoclonal Antibodies as Treatment for Coronavirus Disease 2019 (COVID-19) During Pregnancy: A Systematic Review

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Exploring Patient–Clinician Trust During Pregnancy Care: A Qualitative Study With Latine Patients

O&G Open. 1(2):006, June 2024.

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An Argument for Decentralized Clinical Trials in Gynecologic Oncology

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Obstetrics & Gynecology

• Frontiers in Medicine
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Insights in Obstetrics and Gynecology: 2023

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Obstetric and Gynecological Nursing Research Paper Topics

The diverse array of obstetric and gynecological nursing research paper topics underscores the critical importance of this specialized field of nursing. Obstetric and gynecological nursing encompasses a wide range of topics that address the health and wellness of women from adolescence through menopause and beyond. This includes the management of pregnancy and childbirth, preventive care, and the diagnosis and treatment of diseases and disorders specific to women. As the healthcare needs of women continue to evolve, so does the need for ongoing research and development of evidence-based practices in obstetric and gynecological nursing. This article provides a comprehensive list of research paper topics that will be of interest to students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

100 Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is a specialized field of nursing that focuses on the health and well-being of women throughout their lifespan. It encompasses a wide range of topics including pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, reproductive health, maternal and newborn health, high-risk pregnancy, women’s health across the lifespan, menopausal health, and ethical and legal issues in obstetric and gynecological nursing. The significance of this field cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. This article provides a comprehensive list of obstetric and gynecological nursing research paper topics, divided into 10 categories, each containing 10 topics.

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Pregnancy and Prenatal Care:

• The role of prenatal vitamins in preventing birth defects.
• The effects of maternal stress on fetal development.
• The impact of prenatal exercise on maternal and fetal health.
• The role of routine ultrasound examinations in prenatal care.
• The effectiveness of non-pharmacological interventions for nausea and vomiting during pregnancy.
• The impact of maternal obesity on pregnancy outcomes.
• The role of folic acid supplementation in the prevention of neural tube defects.
• The effectiveness of smoking cessation interventions during pregnancy.
• The impact of maternal alcohol consumption on fetal development.
• The role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery:

• The effectiveness of epidural analgesia in managing labor pain.
• The impact of birthing positions on labor outcomes.
• The role of continuous support during labor and delivery.
• The effectiveness of non-pharmacological pain relief methods during labor.
• The impact of induced labor on maternal and neonatal outcomes.
• The role of midwives in managing labor and delivery.
• The effectiveness of water birth in reducing labor pain.
• The impact of cesarean section on maternal and neonatal outcomes.
• The role of intrapartum fetal monitoring in preventing adverse outcomes.
• The effectiveness of active management of the third stage of labor in preventing postpartum hemorrhage.

Postpartum Care:

• The role of breastfeeding support in promoting successful breastfeeding.
• The impact of postpartum depression on mother-infant bonding.
• The effectiveness of skin-to-skin contact in promoting neonatal thermoregulation.
• The role of postpartum exercise in promoting maternal physical and mental health.
• The impact of early postpartum discharge on maternal and neonatal outcomes.
• The effectiveness of postpartum contraceptive counseling in preventing unplanned pregnancies.
• The role of routine newborn screening in the early detection of congenital disorders.
• The impact of maternal-infant rooming-in on breastfeeding success.
• The effectiveness of postpartum home visits in promoting maternal and newborn health.
• The role of pelvic floor exercises in preventing postpartum urinary incontinence.

Gynecological Disorders:

• The effectiveness of hormonal therapy in managing polycystic ovary syndrome.
• The impact of lifestyle modifications on the management of endometriosis.
• The role of screening in the early detection of cervical cancer.
• The effectiveness of non-surgical interventions for uterine fibroids.
• The impact of human papillomavirus vaccination on the incidence of cervical cancer.
• The role of hormonal replacement therapy in managing menopausal symptoms.
• The effectiveness of conservative management for ovarian cysts.
• The impact of early detection and treatment on the prognosis of ovarian cancer.
• The role of lifestyle modifications in the prevention of gynecological cancers.
• The effectiveness of surgical interventions for pelvic organ prolapse.

Reproductive Health:

• The role of contraceptive counseling in preventing unplanned pregnancies.
• The impact of long-acting reversible contraceptives on reducing the rate of unintended pregnancies.
• The effectiveness of fertility awareness-based methods in preventing pregnancy.
• The role of preconception care in promoting healthy pregnancies.
• The impact of sexually transmitted infections on reproductive health.
• The effectiveness of barrier methods in preventing sexually transmitted infections.
• The role of hormonal contraceptives in managing menstrual disorders.
• The impact of infertility on mental health.
• The effectiveness of assisted reproductive technologies in managing infertility.
• The role of male involvement in promoting reproductive health.

Maternal and Newborn Health:

• The impact of gestational diabetes on maternal and neonatal outcomes.
• The effectiveness of kangaroo mother care in promoting neonatal health.
• The role of antenatal corticosteroids in preventing neonatal respiratory distress syndrome.
• The impact of maternal anemia on neonatal outcomes.
• The effectiveness of newborn resuscitation in preventing neonatal mortality.
• The role of immunization in promoting maternal and newborn health.
• The impact of maternal mental health on neonatal outcomes.
• The effectiveness of neonatal intensive care in improving the survival of preterm infants.
• The role of early intervention services in promoting the development of high-risk infants.
• The impact of maternal-infant bonding on neonatal outcomes.

High-Risk Pregnancy:

• The role of antenatal care in managing high-risk pregnancies.
• The impact of multiple pregnancies on maternal and neonatal outcomes.
• The effectiveness of nutritional interventions in managing gestational diabetes.
• The role of bed rest in managing preterm labor.
• The impact of advanced maternal age on pregnancy outcomes.
• The effectiveness of antihypertensive medications in managing preeclampsia.
• The role of fetal surveillance in managing intrauterine growth restriction.
• The impact of preconception care on the outcomes of high-risk pregnancies.
• The effectiveness of interventions for preventing recurrent preterm birth.
• The role of specialist care in managing high-risk pregnancies.

Women’s Health Across the Lifespan:

• The impact of lifestyle modifications on the prevention of cardiovascular diseases in women.
• The effectiveness of breast cancer screening in early detection and treatment.
• The role of hormone replacement therapy in managing menopausal symptoms.
• The impact of osteoporosis on women’s health.
• The effectiveness of interventions for preventing urinary incontinence in women.
• The role of regular exercise in promoting mental health in women.
• The impact of domestic violence on women’s health.
• The effectiveness of interventions for promoting healthy eating in women.
• The role of stress management in preventing chronic diseases in women.
• The impact of depression on women’s health.

Menopausal Health:

• The impact of menopause on cardiovascular health.
• The effectiveness of hormonal replacement therapy in managing menopausal symptoms.
• The role of lifestyle modifications in managing menopausal weight gain.
• The impact of menopause on mental health.
• The effectiveness of non-hormonal interventions for managing hot flashes.
• The role of regular exercise in preventing osteoporosis in postmenopausal women.
• The impact of menopause on sexual health.
• The effectiveness of dietary interventions in managing menopausal symptoms.
• The role of stress management in promoting menopausal health.
• The impact of menopause on the risk of developing gynecological cancers.

Ethical and Legal Issues in Obstetric and Gynecological Nursing:

• The role of informed consent in obstetric and gynecological procedures.
• The impact of religious and cultural beliefs on women’s health decisions.
• The effectiveness of mandatory reporting of domestic violence in promoting women’s safety.
• The role of confidentiality in obstetric and gynecological care.
• The impact of legal restrictions on abortion services.
• The effectiveness of legal interventions in preventing female genital mutilation.
• The role of ethical considerations in assisted reproductive technologies.
• The impact of legal and ethical issues on the practice of obstetric and gynecological nursing.
• The effectiveness of legal interventions in promoting maternal and newborn health.
• The role of ethical considerations in the management of high-risk pregnancies.

The importance of research in obstetric and gynecological nursing cannot be overstated as it plays a crucial role in ensuring the health and well-being of both women and newborns. The diverse range of topics listed above provides a comprehensive overview of the various aspects of obstetric and gynecological nursing. It is our hope that this list will serve as a valuable resource for students and professionals seeking to expand their knowledge and contribute to the body of knowledge in this vital area of healthcare.

The Range of Obstetric and Gynecological Nursing Research Paper Topics

Obstetric and gynecological nursing is an essential branch of healthcare that focuses on the well-being of women during pregnancy, childbirth, and the postpartum period, as well as the diagnosis and treatment of diseases of the female reproductive system. The significance of this field is immense, as it plays a crucial role in ensuring the health and safety of both mothers and newborns, and in managing and preventing gynecological disorders. The scope of obstetric and gynecological nursing research paper topics is vast, encompassing a wide range of issues from pregnancy and prenatal care, labor and delivery, postpartum care, gynecological disorders, and much more.

Pregnancy and Prenatal Care

Proper care during pregnancy is essential for the health and well-being of both the mother and the baby. Prenatal care involves a series of regular check-ups and screenings to monitor the health of the mother and the developing fetus. Obstetric nurses play a crucial role in providing this care, educating expectant mothers about proper nutrition, exercise, and lifestyle habits, monitoring the progress of the pregnancy, and identifying and managing any potential complications. Some obstetric and gynecological nursing research paper topics in this area could include the effectiveness of different prenatal screening tests, the impact of maternal lifestyle habits on fetal development, or the role of prenatal education in preparing expectant mothers for childbirth.

Labor and Delivery

The process of labor and delivery is a critical period that requires skilled care and management to ensure the safety of both the mother and the baby. Obstetric nurses are involved in every stage of this process, from monitoring the progress of labor, providing pain relief, assisting with the delivery, and caring for the mother and newborn immediately after birth. Research topics in this area could include the effectiveness of different pain relief methods during labor, the impact of birthing positions on labor outcomes, or the role of continuous support during labor and delivery.

Postpartum Care

The postpartum period, or the time after childbirth, is a crucial time for both the mother and the newborn. Obstetric nurses provide care to the mother as she recovers from childbirth, monitor the newborn’s health and development, provide breastfeeding support, and educate the new parents on infant care. Some potential obstetric and gynecological nursing research paper topics in this area could include the impact of postpartum depression on mother-infant bonding, the effectiveness of skin-to-skin contact in promoting neonatal thermoregulation, or the role of postpartum exercise in promoting maternal physical and mental health.

Gynecological Disorders

Gynecological nursing involves the diagnosis and treatment of diseases of the female reproductive system. Gynecological nurses provide care to women with a variety of gynecological disorders such as polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, cervical cancer, and more. Research topics in this area could include the effectiveness of hormonal therapy in managing PCOS, the impact of lifestyle modifications on the management of endometriosis, or the role of screening in the early detection of cervical cancer.

The diverse range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore a variety of issues that affect women’s health. By conducting research in this field, nurses can contribute to the body of knowledge that informs clinical practice and helps improve outcomes for women and newborns.

In conclusion, obstetric and gynecological nursing is a vital field that plays a crucial role in ensuring the health and well-being of women and newborns. From pregnancy and prenatal care, labor and delivery, postpartum care, and the management of gynecological disorders, the scope of this field is vast. The wide range of obstetric and gynecological nursing research paper topics provides an opportunity for researchers to explore various aspects of this field and contribute to the improvement of women’s health.

iResearchNet’s Custom Writing Services

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Every nursing student understands the importance of submitting high-quality research papers. Not only do they contribute significantly to your final grade, but they also reflect your understanding and knowledge of the subject matter. Obstetric and gynecological nursing is a crucial area of study that demands thorough research and a comprehensive understanding of various topics. As a student, you may sometimes find yourself overwhelmed with multiple assignments, leaving you with limited time to complete your research paper. This is where iResearchNet comes in. We are here to support you in your academic journey by providing custom obstetric and gynecological nursing research papers that will not only earn you top grades but also enhance your understanding of the subject matter.

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Fixing women: the birth of obstetrics and gynecology in Britain and America

By marcia d. nichols, san francisco, university of california medical humanities press, 2021, 229 pp., $19.95, isbn 978–1–7355423–0–0.

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• https://doi.org/10.1080/09612025.2024.2395079

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1 Lyle Massey, ‘Pregnancy and Pathology: Picturing Pregnancy in Eighteenth-Century Obstetric Atlases,’ The Art Bulletin 87, no. 1 (2015): 73–91.

2 Margaret Carlyle, ‘Phantoms in the Classroom: Midwifery Training in Enlightenment Europe,’ KNOW: A Journal on the Formation of Knowledge 2, no. 1 (2018): 111–136.

3 Emily Martin, ‘The Egg and the Sperm: How Science Has Constructed a Romance Based on Stereotypical Male-Female Roles,’ Signs 16, no. 3 (1991): 485–501.

4 Though books like Roberta McGrath’s Seeing Her Sex: Medical Archives and the Female Body (Manchester: Manchester University Press, 2002) provide helpful accounts of how the modern male medical gaze has contributed to the objectification of the female reproductive body.

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Clinical course of novel COVID-19 infection in pregnant women

Roman g. shmakov.

a Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Andrey Prikhodko

b Department of Maternity, Institute of Obstetrics, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Evgeniya Polushkina

Elena shmakova.

c National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Aleksey Pyregov

d Institute of Anesthesiology and Intensive Care National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Vladimir Bychenko

e Department of Radiology, National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Tatyana V. Priputnevich

f Department of Microbiology and Clinical Pharmacology and Epidemiology National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Grigory O. Dolgushin

Ekaterina yarotskaya.

g Department of International Cooperation National Medical Research Center for Obstetrics, Gynecology and Perinatology Ministry of Healthcare of Russian Federation, Moscow, Russia

Oleg Pekarev

Nikolai bolibok, dmitriy degtyarev, gennady t. sukhikh.

Evaluation of clinical course of COVID-19 during pregnancy and maternal and perinatal outcomes of this pregnancy.

66 women with polymerase chain reaction (PCR) – confirmed SARS-CoV-2 and their 42 neonates were included in the prospective observational study. Demographic, epidemiological, clinical, laboratory and instrumental data of pregnancy, delivery, postpartum period, including pharmacotherapy and neonatal outcomes were analyzed.

15 (22.7%) women were asymptomatic, 25 (38%) had mild disease, while moderate and severe forms were detected in 20 (30.2%) and 6 (9.1%) cases, respectively. Additional oxygenation was required in 6 (9%) cases: 4 (6%) received CPAP therapy and 2 (3%) – mechanical ventilation. Main clinical symptoms were cough (51.5%), anosmia (34.9%), and hyperthermia (33.3%). Laboratory changes included increased levels of lactate dehydrogenase (LDH), creatinine, d -dimer, and C-reactive protein (CRP), anemia, and leukopenia. All pregnant women received low molecular weight heparin and interferon alfa-2b according to the National clinical recommendations. Antimicrobial drugs included Amoxicillin/Clavulanic acid (46%) and macrolides (28%) or carbapenems in severe cases of disease. Spontaneous abortion was reported in 6.1% of cases. Eight preterm (19%) and 34 term deliveries (81%) occurred. The mean weight of neonates was (3283 ± 477) g, 1- and 5-min Apgar score was (7.8 ± 0.6) and (8.7 ± 0.5), respectively. No cases of neonatal COVID-19 infection were reported.

Conclusions

Mostly, the manifestations of COVID-19 were mild. However, 9% of cases were severe, and could contribute to preterm delivery or maternal morbidity. Main predictors of severe COVID-19 course in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and increase in the levels of alanine aminotransferase and CRP. Elimination of the virus in pregnant women required more time due to altered immunity. No evidence of vertical transmission during pregnancy and delivery was found. However, the possibility of this cannot be excluded.

Introduction

Pregnancy is characterized by altered immunity with predisposition to respiratory viral infections [ 1 ]. In previous years, infection caused by the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) in pregnant women led to an increased rate of admissions to an intensive care unit. The reported rate of lethal outcomes from SARS-CoV was up to 25% [ 2 , 3 ].

In course of pregnancy transverse diameter of the thorax increases, diaphragm is displaced upwards; this decreases maternal tolerance to hypoxia [ 4 ]. Moreover, alteration of the lung capacity and vasodilation may lead to swelling of the mucous membrane and increase in secretion within upper respiratory tract that contributes to development of respiratory failure [ 5 ].

Possibility of transplacental transmission of SARS-CoV-2, which may lead to negative neonatal outcomes remains unclear [ 6 , 7 ].

Considering controversial data about the course of COVID-19 in pregnant women and neonates [ 8–11 ], evaluation of clinical manifestations, maternal and perinatal outcomes in pregnant women with COVID-19 were the main goals of this research.

Materials and methods

Research was carried out at the National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of Russian Federation. From the onset of pandemic all women admitted to the Center for treatment and/or labor were tested on COVID-19. 66 women with PCR – confirmed SARS-CoV-2 and their 42 neonates were included in the prospective observational study. COVID-19 testing was performed in women admitted to the hospital (due to the threatening miscarriage and preterm labor, for preinduction, etc.). When a woman appeared to be PCR positive she was admitted to a special medical unit for treatment of COVID-19 positive patients. Nasopharyngeal swabs were collected from all pregnant women and neonates and then were tested using reverse transcriptase real-time PCR. The same method was used for the virus detection in vaginal discharge in women during labor, amniotic fluid, placenta, and colostrum

All women underwent the following tests: blood test, urine test, CRP, coagulogram, biochemical blood test, and computed tomography (CT) in cases where moderate or severe forms of COVID-19 were suspected.

In this study, CO-RADS system and RSNA consensus were used to interpret the laboratory changes [ 12 ]. Moreover, during the pandemic, a simplified semi-quantitative evaluation system of affected lung tissue volume was introduced in Russian Federation, which scored the degree of lung tissue damage by a scale of CT-0 to CT-4. CT-0 was scored when no lung tissue was affected (0%). CT-1 (mild) category was attributed to < = 25% of lung tissue damage; CT-2 (moderate), CT-3 (severe) and CT-4 (critical) were scored when 25–50%, 50–75%, and > = 75% of lung tissue were affected, respectively. Introduction of this system allowed to standardize and accelerate interpretation of data as well as to convert it into an understandable format for the clinicians [ 13 ].

Patients were either asymptomatic or had clinical manifestations of various degree. By the severity of symptoms and results of tests they were categorized into mild, moderate or severe form of COVID-19. Mild form of COVID-19 was characterized by the fever with body temperature below 38.5 °C, cough, fatigue, sore throat and absence of clinical signs of moderate and severe disease. Moderate form was determined as fever 38.5 °C and higher, respiratory rate more than 22 per minute, shortness of breath during physical activity, pneumonia confirmed by CT scan, oxygen saturation more than 95%. The disease was considered severe with respiratory rate more than 30 per minute, oxygen saturation 94% and lower, PaO 2 /FiO 2 300 mm. hg and lower, progression of lung damage (increase of damaged tissue by 50% or more in a 24–48 h), decreased consciousness, unstable hemodynamics. arterial blood lactate more than 2 mmol/l, qSOFA more than 2.

Women were tested for SARS-CoV-2 infection once each week. Virus elimination was assumed when two negative PCR tests performed within a 24-h interval. Diagnostics, clinical management and treatment of pregnant women with COVID-19 were carried out according to National clinical recommendations “Organisation of Medical Care for Pregnant Women, Women in Labour, Postpartum Women and Neonates with a Novel Coronavirus Infection COVID-19” [ 14 ]. Data were collected from April 2020 to June 2020.

The assessment of demographic, epidemiological, clinical, laboratory and instrumental parameters of pregnancy, birth and postpartum period as well as pharmacotherapy and neonatal outcomes was performed. The research was IRB approved. All women have signed an informed consent.

Statistical analysis

The statistical analysis was performed with “GraphPad Prism 6” (GraphPad Software, San Diego, CA). D’Agostino–Pearson omnibus test was used to assess normality of distribution. Parametric data were presented as mean value ± standard deviation. Nonparametric data were presented as median (interquartile range). Qualitative data were presented as absolute value ( n ) and %. T -test (for parametric data), Mann–Whitney U test (for nonparametric data) and Fisher’s exact test (for qualitative data) were used for value comparison. The two-sided p <.05 was considered to indicate statistical significance.

The mean age of patients was (30.3 ± 6.25) years, the mean height was (166 ± 6.8) cm, the mean body mass index was (27.1 ± 4.6) kg/m 2 . The mean gestational age was (31.3 ± 10.4) weeks ranging from 5 to 38 weeks. 5 (7.6%) patients were COVID-19 positive in the Ist trimester, while in IInd and IIIrd trimesters the disease diagnosed in 7 (10.6%) and 54 (81.8%) cases, respectively. The mean duration of the disease was 17.6 (6–34) days. Hospital stay was 14.9 (4–30) days. PCR tests for SARS-CoV-2 became negative on average after 15.6 (6–31) days. The main clinical symptoms were cough (51.5%), loss of smell (34.9%), and hyperthermia (33.3%) ( Table 1 ). Asymptomatic course of COVID-19 was reported in 15 (22.7%) of cases. Mild, moderate, or severe COVID-19 accounted for 25 (38%), 20 (30.2%), and 6 (9.1%), respectively ( Table 2 ).

Clinical symptoms of novel coronavirus infection in pregnant women.

The forms of novel coronavirus infection in pregnant women.

The laboratory changes most often included the increased levels of LDH, creatinine, d -dimer, and CRP, anemia, and leukopenia ( Tables 3 and ​ and4). 4 ). Lymphopenia featured the viral infection in 42 cases (63.6%). CRP level as the main laboratory marker of inflammation activity, indicator of the antibacterial therapy necessity and criterion of treatment efficacy was measured in patients with pneumonia every 3 days.

Main laboratory data of pregnant women with novel coronavirus infection.

PCT: procalcitonin; CRP: C-reactive protein; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; INR: International Normalized Ratio; PR: prothrombin ratio. Data are shown as the mean value and standard deviation (M ± SD).

*Data are shown as the median value and interquartile range (Me (IQR)).

Laboratory changes reported in pregnant women with novel coronavirus infection.

CRP: C-reactive protein; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; PCT: procalcitonin.

d -dimer levels, along with the patient’s clinical condition and severity of pneumonia according to CT data, were used to determine the dosage of low molecular weight heparins (LMWH).

Laboratory changes were analyzed in accordance with the severity of the disease. Main predictors of severe COVID-19 course in pregnant women were the decrease in the levels of erythrocytes and lymphocytes and increase in the levels of ALT and CRP ( Table 5 ).

Main parameters of laboratory tests of pregnant women with novel coronavirus infection.

CRP: C-reactive protein; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; PCT: procalcitonin. Data are shown as the mean value and standard deviation (M ± SD).

*Data are shown as the median value and interquartile range (Me(IQR)).

CT showed no features of viral pneumonia (COVID-19 Reporting and Data System-1-2 (CO-RADS-1-2)) with 0% of affected lung tissue (CT-0) in 5 cases (25%). High probability of viral pneumonia (CO-RADS-4-6) with minimal (<25%) volume of lung tissue affected (CT-1) was reported in 8 women (40%). High probability of viral pneumonia (CO-RADS-4-6) with moderate (25-50%) volume of lung tissue affected (CT-2) was reported in 2 women (10%). High probability of viral pneumonia (CO-RADS-4-6) with significant (50–75%) volume of lung tissue affected (CT-3) was reported in two cases (10%). High probability of viral pneumonia (CO-RADS-4-6) with critical (>75%) volume of lung tissue affected (CT-4) was reported in three cases (15%).

All pregnant women received LMWH and interferon alfa-2b according to National clinical recommendations and international experience [ 14 , 15 ]. Antimicrobial drugs included Amoxicillin/Clavulanic acid (46%) and macrolides (28%). Carbapenems were the antibiotics of choice in severe cases of disease. Side effects of Lopinavir/Ritonavir, risk of intrauterine growth restriction as well as an unproved efficacy of this group of drugs in COVID-19 treatment were the reasons for their limited application in our study. Lopinavir/Ritonavir was used in the severe cases of disease only.

Additional oxygenation was required in six cases (9%): four (6%) patients received CPAP therapy and two (3%) – mechanical ventilation. Corticosteroids (dexamethasone 12 mg/day for 3–4 days) and immunoglobulin therapy (0.5 g/kg for 3–4 days) were also prescribed.

In the majority of cases, prophylactic doses of LMWH (Enoxaparin or Nadroparin Calcium) were administered. However, therapeutic doses of LMWH were given to the patients under mechanical ventilation who had high of d -dimer levels (up to 34,280 ng/l).

Abortions before 20 weeks of gestation occurred in 4 cases (6.1%) out of 66: 2 spontaneous abortions before 12 weeks of gestation in women with mild form of Covid-19, one spontaneous abortion at 18th week in a woman with severe Covid-19 infection, and one medical abortion at 19 th week for fetal abnormalities. Births and on-going pregnancy were reported in 42 (63.6%) and 20 (30.3%) cases respectively. Eight preterm (19%) and 34 term deliveries (81%) occurred. 6 preterm operative deliveries were performed due to obstetric conditions (a scar after previous cesarean section, increase in severity of preeclampsia, placenta accreta). Seven women who delivered preterm had mild form of infection and one had a moderate form of the disease. Due to fetal distress, cesarean section was performed in 17 (40.5%) cases, vacuum extraction – in 2 (4.8%) cases, normal vaginal delivery accounted for 23 cases (54.7%). Cesarean section was performed due to fetal conditions including malformations in 7 cases (41.2%) and due to maternal obstetric conditions (cephalopelvic disproportion, previous cesarean section, placenta previa, etc.) in 10 cases (58.8%). The mean birth weight in neonates was (3283 ± 477) g. The mean length was (52 ± 2.75) cm. The 1-min Apgar score was 7.8 ± 0.6 and 5-min Apgar score was 8.7 ± 0.5.

Neonates after birth were immediately isolated from their mothers until 2 negative SARS-CoV-2 results were obtained. After that the breastfeeding was allowed. All neonates were tested for SARS-CoV-2 immediately after birth and on the 3rd and 10th days after birth. In all newborns the tests appeared negative, and no clinical signs of COVID-19 were documented. No cases of perinatal death were reported.

One case of maternal death occurred on the 33rd day after the patient’s admission to the hospital. The patient aged 40 years old was hospitalized on the 19–20th week of gestation and had primary myelofibrosis, portal hypertension with a history of bleeding from esophageal varices grade 2 on the 18th week of gestation. The patient was admitted with bilateral pneumonia caused by coronavirus infection (CO-RADS-5), with up to 90% affected volume of lung tissue according to CT (CT-4) and type 2 respiratory failure of stage 2. On the 3rd day her medical condition worsened and required transfer to the ICU and mechanical ventilation. Spontaneous abortion with fetal death occurred on the 21–22nd week of gestation. Pulmonary embolism and progression of multiple organ failure on the background of severe hematologic disease were the causes of death.

The PCR results were SARS-CoV-2-negative for all samples of vaginal discharge, amniotic fluid, placenta, and colostrum obtained from 32 women. However, in 11(34,4%) patients SARS-CoV-2 was revealed in rectal swabs.

Principal findings

Even though previous outbreaks of coronavirus infection (SARS and MERS) were associated with the growth of maternal mortality up to 25% [ 2 , 3 ], according to our research the rate of severe cases of novel form of coronavirus infection accounted for 9.1% and mechanical ventilation was required in 3% of the cases. Main clinical symptoms included cough (51.5%), loss of smell (34.9%) and hyperthermia (33.3%); this corresponds to other literature reports [ 16 , 17 ]. Asymptomatic course of COVID-19 was found in 22.7% of cases, which is significantly lower than in general population (50–75% of cases) [ 18 ].

There was an inverse correlation between the elimination of the virus from the body and severity of the disease. The process took more time in asymptomatic carriers than in patients with severe course of the disease, lasting in average 11 days (8.5–18) versus 20 days (16–27), respectively. PCR-positive tests persisted on average for 15.6 days. This significantly exceeds average time required for virus elimination reported by Gautret et al., which was 6 days for 70–100% of patients who received medical treatment (hydroxychloroquine and azithromycin) and only for 12.5% of patients in the control group without these medications [ 19 ].

According to several communications cesarean section was the most often method of delivery due to high rates of fetal distress [ 20 , 21 ]. In our study, normal vaginal delivery prevailed (54.7%). Operative delivery (including vacuum extraction) due to fetal hypoxia was performed in four cases (9.5%) which is slightly more than previously reported in other publications (4–6%) [ 22–24 ].

Though our study did not demonstrate strong correlation between COVID-19 severity and adverse perinatal outcomes, possibly due to a small patients sample and/or timely and appropriate medical care at mild/moderate stages of the disease, other publications do, rising awareness on this issue [ 25–27 ].

Clinical implications

Main predictors of severe COVID-19 course in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and an increase in the levels of ALT and CRP; further research may contribute to better understanding of the mechanism and value of this correlation. The main cause of maternal death with COVID-19 was a severe comorbid disease.

Research implications

In our study, all neonates were SARS-CoV-2-negative. We have also found no evidence of the virus in the amniotic fluid and placenta (similarly to Schwartz et al. [ 28 ]), as well as in the vaginal discharge of women in labor; these observations may reduce the concerns of vertical transmission of the infection during pregnancy and labor, but still are subject to further investigation in larger populations.

Although we found non SARS-CoV-2 in the colostrum, Wu et al. detected virus in breast milk by PCR [ 29 ]. Therefore, the issue of the mother to baby virus transmission through breastfeeding should be carefully addressed.

Herein we demonstrate the data obtained during the "first wave" of COVID-19 in Russia, indicating that there is no risk of transmission of the virus to the babies born from the mothers infected with SARS-CoV-2 shortly before the childbirth managed with appropriate precautions. Early publications also suggested a low risk of intrauterine transmission of COVID-19 from infected pregnant women to their fetuses. Karimi-Zarchi reported about 31 infected pregnant mothers with COVID-19, with no infection detected in the newborns and placenta [ 30 ]. Later, several observational studies on the possibility of vertical transmission of infection during pregnancy were published [ 31–33 ].

Strengths and limitations

Our study is the first experience in Russian Federation in analysis of the clinical course of novel COVID-19 infection in pregnant women. We managed to correlate laboratory findings with the clinical characteristics of the disease. The main limitations of the study were small patients sample from one center and the absence of comparative group (e.g. pregnant women with other respiratory infections).

Mostly, the manifestations of COVID-19 were mild. However, 9% of cases were severe, and could contribute to preterm delivery, abortion or maternal and fetal morbidity. Main clinical predictors of severe COVID-19 outcomes in pregnant women were a decrease in the levels of erythrocytes and lymphocytes and an increase in the levels of ALT and CRP. Elimination of the virus in pregnant women required more time due to physiological immunosuppression. No evidence of vertical transmission during pregnancy and delivery was found; however, such possibility cannot be excluded.

Disclosure statement

The authors report no conflict of interest.

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Low-impact yoga and exercise found to help older women manage urinary incontinence

Stanford Medicine-led research finds that 12 weeks of low-impact exercise classes reduced daily episodes of urinary incontinence by more than half.

September 3, 2024 - By Erin Digitale

Stanford Medicine researchers and their colleagues have found that low-impact yoga helps older women with incontinence. David L/peopleimages.com

Older women struggling with urinary incontinence can benefit from regular, low-impact exercise, with yoga as well as stretching and strengthening showing benefits in a new study published Aug. 27 in Annals of Internal Medicine .

The research, led by scientists at Stanford Medicine and the University of California, San Francisco, is part of a larger effort to identify low-risk, low-cost ways to treat one of the most common health problems women face as they age.

After 12 weeks of a low-impact yoga program, study participants had about 65% fewer episodes of incontinence. Women in a control group doing stretching and strengthening exercises experienced a similar benefit over the same time period. The benefits are on par with the effects of medications used to address incontinence, the researchers said.

“Our study was testing the kind of yoga that just about anyone can do, with modifications for different physical abilities,” said the study’s senior author, Leslee Subak , MD, chair of obstetrics and gynecology at Stanford Medicine. “What I love about it is that it’s safe, inexpensive, doesn’t require a doctor and accessible wherever you live.” Because the trial was conducted partly during the COVID-19 pandemic, many participants received their yoga or exercise instruction via online meetings, exercising in their own homes, she noted.

The study’s lead author is Alison Huang, MD, professor of medicine, urology, and epidemiology and biostatistics at UCSF.

Urinary incontinence, which affects more than half of middle-aged women and up to 80% of 80-year-olds, can lead to a variety of other problems, from social isolation to bone fractures caused by falls. But there is help.

“Part of the problem is that incontinence is stigmatized; we don’t talk about it,” said Subak, the Katharine Dexter McCormick and Stanley McCormick Memorial Professor III. “Or we hear folklore about this being normal when you get older. In fact, it’s very common but it’s not inevitable, and we have very effective ways of treating it.”

Addressing a common problem

Incontinence deserves good treatment because of the many ways it interferes with people’s lives.

“It takes away independence,” Subak said. “My patients will say, ‘I can’t stay with my kids or grandkids because I’m afraid I’ll wet the bed, and I can’t talk about it; it’s too embarrassing.’”

Leslee Subak

Patients may avoid activities that could boost their well-being, such as exercising and seeing friends. They are more likely to be admitted to a nursing home and to suffer certain serious medical problems such as hip fractures.

“Incontinence and overactive bladder are among the biggest risk factors for falls and fractures among older women,” Subak said. “You’re rushing to the bathroom at night — with the lights off — tripping and falling, and breaking a hip.”

Some factors that contribute to risk for incontinence can’t be changed, such as aging or having had children. But others are modifiable.

“A lot of my research has focused on weight loss and physical activity, which in fact are effective treatments,” Subak said. She became interested in studying yoga as a treatment after some of her patients told her it helped them.

Being active helps

The study compared two 12-week exercise programs: 121 participants were randomly assigned to yoga, and 119 to a physical conditioning control group. The participants were women with urinary incontinence that caused symptoms at least once a day. They were 45 to 90 years old, with a mean age of 62.

In the yoga program, participants learned 16 hatha yoga poses intended to strengthen the pelvic floor, via two 90-minute sessions per week. The pelvic floor consists of the muscles that form the base of the pelvis and hold its organs — including the bladder and urethra — in place. Participants were also asked to practice yoga for at least one hour per week outside of class and to maintain a practice log.

Participants in the control group spent an equal amount of time in exercise classes, but their classes focused on nonspecific stretching and strengthening exercises that did not engage the pelvic floor. They were also asked to practice for an additional hour per week and keep a practice log.

The study began with in-person classes, then transitioned to a videoconference format when the COVID-19 pandemic lockdowns began.

Participants recorded when they leaked urine and classified whether each episode was urgency incontinence, when an overactive bladder causes a person to feel the need to urinate more often than usual, or stress incontinence, in response to pressure in the abdomen, such as from coughing or sneezing. They also answered standard questionnaires about their bladder function.

At the beginning of the study, the participants had an average of 3.4 episodes of urinary incontinence per day, including 1.9 urgency-type episodes and 1.4 stress-type episodes.

By the end of the 12-week programs, participants in the yoga group were experiencing 2.3 fewer episodes of incontinence per day, on average. Those in the physical conditioning group were experiencing 1.9 fewer episodes per day.

The two treatments are about equally effective, with both approaches reducing episodes of incontinence by around 60%, and the benefits from both treatments are meaningful, Subak said.  Patients who would like to try these approaches can search for low-impact Iyengar yoga or low-impact exercise classes in their communities or online, she said, adding that instructors should be able to adapt the activity to participants’ physical limitations.

“I’m impressed that exercise did so well and impressed that yoga did so well,” Subak said. “One of the take-home messages from this study is ‘Be active!’”

Other nonsurgical treatments for incontinence, including medications, typically result in a 30% to 70% improvement in symptoms, she noted.

If a patient asked whether yoga could help with incontinence, “I would say that I think it’s a great idea to try it if you’re interested,” Subak said. “It’s very low risk, and there’s potential for benefit not only for incontinence but also for your general well-being.”

The study was funded by the National Institutes of Health (grants R01AG050588, R01DK116712-04S1 and K24AG068601). Researchers from Yale University and San Francisco State University also contributed to the study.

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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Maternity Care in Russia: Issues, Achievements, and Potential

Affiliations.

• 1 Department of Medical and Social Researches, Federal State Budget Institution, Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
• 2 Department of International Cooperation, Federal State Budget Institution Research, Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
• 3 Department of Scientific Planning and Audit, Federal State Budget Institution, Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
• 4 Department of Child Healthcare and Delivery Service, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
• 5 Director of Federal State Budget Institution, Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Healthcare of the Russian Federation, Moscow, Russia.
• PMID: 26606698
• DOI: 10.1016/s1701-2163(16)30019-6

Abstract in English, French

In this review, we provide basic facts about maternity care services within the health care system in Russia. We give a short overview of such key aspects as the demographic situation, reproductive behaviour, regulatory framework for providing health care for women and children, maternal and perinatal mortality, and the availability of medical personnel. In 2012, Russia began registration of births in accordance with the WHO recommendations (births with weight ≥ 500 g at ≥ 22 weeks' gestation). Introduction of this new registration system increased the completeness and quality of the collected information and expanded possibilities for future international comparative assessments. A three-level system of specialized medical care has been introduced in Russia for women and newborns during pregnancy, childbirth, and the postpartum period. In 2014, the system included 1942 state (public) maternity hospitals providing 20 obstetric beds per 10 000 women aged 15 to 49 years. More than 100 perinatal centres (level III) are currently functioning in the country, with 32 new perinatal centres planned to open by 2016. The total number of obstetrician-gynaecologists in Russia is approximately 44 000, providing a ratio of 5.7 specialists per 10 000 women. The total number of midwives is 62 000, providing a ratio of 8.1 midwives per 10 000 women. In recent years we have succeeded in optimizing the maternity care system by increasing its accessibility and quality. This was achieved through qualitative and quantitative progress in the training of neonatologists, the development of intensive care technologies and neonatal critical care, capacity building of medical-genetic services and counselling, prenatal diagnosis, and the standardization of health care with data collection.

Dans le cadre de cette analyse, nous fournissons des faits de base au sujet des soins de maternité offerts par le système de santé en Russie. Nous y offrons un bref survol de certains aspects clés : situation démographique, comportements génésiques, cadre réglementaire de l’offre de soins de santé aux femmes et aux enfants, mortalité maternelle et périnatale, et disponibilité du personnel médical. En 2012, la Russie a commencé à enregistrer les naissances en fonction des recommandations de l’OMS (naissances en présence d’un poids ≥ 500 g à ≥ 22 semaines de gestation). La mise en œuvre de ce nouveau système d’enregistrement a accru l’exhaustivité et la qualité des renseignements recueillis, en plus d’élargir les possibilités en ce qui concerne la future tenue d’évaluations comparatives internationales. Un système de soins médicaux spécialisés à trois paliers offerts pendant la grossesse, l’accouchement et la période postpartum a été mis en œuvre en Russie pour les femmes et les nouveau-nés. En 2014, le système comptait 1 942 hôpitaux de maternité d’état (publics) offrant 20 lits en obstétrique par 10 000 femmes âgées de 15 à 49 ans. Plus de 100 centres périnataux (niveau III) sont actuellement en fonction dans le pays; l’ouverture de 32 nouveaux centres périnataux est prévue pour 2016. En Russie, le nombre total d’obstétriciens-gynécologues s’élève à environ 44 000, soit 5,7 spécialistes par 10 000 femmes. Le nombre total de sages-femmes s’élève à 62 000, soit 8,1 sages-femmes par 10 000 femmes. En accroissant l’accessibilité et la qualité du système de soins de maternité au cours des dernières années, nous avons réussi à en optimiser le fonctionnement. Nous y sommes parvenus grâce à l’évolution qualitative et quantitative de la formation des néonatologistes, à l’élaboration de technologies des soins intensifs et à la mise sur pied de soins intensifs néonataux, au renforcement des capacités en matière de counseling et de services médico-génétiques, au diagnostic prénatal et à la standardisation des soins de santé grâce à la collecte de données.

Keywords: Russia; health service organization; maternal mortality; maternity service; obstetric care; perinatal mortality.

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