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Introduction: Efficient care by labour monitoring tools manages labour, identifies the abnormalities and avoids the fatalities. Various studies are being undertaken by the researchers to understand the limited use of these therapeutic tools. The present study aimed to develop a novel labour monitoring instrument after understanding the barriers and enablers of the currently used tools and using it in the health setting for improving clinical outcomes. Materials and Methods: Methodological research design was adopted to develop the novel tool. Item pool was generated by literature review, focus group discussions and retrospective observations of the partographs. Developed tool was evaluated by various experts by undergoing three rounds and was found to be reliable in terms of stability and equivalency. After undergoing pilot runs by researcher and nurses, tool was found to be feasible and understandable. The developed novel labour monitoring tool was used on 200 intranatal women. Results: Focus group discussions revealed various barriers in the current labour tools, such as lack of clarity, complexity, staff shortage, workload etc. Retrospective observation of filled partographs revealed the incomplete recording of the components of the partograph. The prepared first draft underwent rigorous review by the experts. The prepared novel tool, after being used on 200 intranatal women resulted in 90% of normal vaginal deliveries. Duration of 1st stage of labour was around 5 hours. Conclusion: A novel labour monitoring tool was developed after methodological approach resulting in adequate monitoring and improved labour outcomes. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare pregnancy outcomes in pregnant women in the third trimester with and without anemia. Methods: A case-control study was conducted, involving 144 pregnant women with anemia (case group) and 144 pregnant women without anemia (control group) receiving prenatal care in the third trimester between April 2021 and March 2022. Various maternal and neonatal clinical outcomes, such as response to iron intake, incidence of preeclampsia during delivery, rates of cesarean section, postpartum infections, small for gestational age (SGA) infants, Apgar scores at 1 and 5 minutes, and birth weight, were recorded and compared between the two groups. Results: Mean hemoglobin and hematocrit levels were significantly lower in women with anemia compared to those in the control group (p<0.001). The response rate to iron supplementation was 21.5% in anemic women and 97.2% in non-anemic women (p<0.001). SGA incidence in the case group was 7.6% (11 cases), while it was 2.1% (3 cases) in the control group (p=0.028). Although pre-eclampsia, cesarean section rates, and infant birth weights were lower in the case group compared to the control group, these differences were not statistically significant. No significant differences were observed in the rates of cesarean section, episiotomy site infections, Apgar scores at 1 and 5 minutes between the two groups. Conclusion: The results of this study indicate a correlation between maternal anemia and adverse neonatal and maternal outcomes, with a significantly higher incidence of SGA among anemic women. Therefore, healthcare providers in preconception care settings should identify anemic women prior to pregnancy initiation and provide appropriate interventions through dietary adjustments and supplements to mitigate adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The utilization of the maternal and newborn health services has increased, but mere increase in utilization of services does not ensure that quality services are being provided. The aim of the study was to assess the quality of maternal and newborn services and their impact on maternal and neonatal outcome at a primary health center of Western Rajasthan in India. Materials and Methods: An exploratory study was undertaken at a conveniently selected primary health center providing 24-hour delivery services. Information regarding the availability of services was collected from the available medical officer in charge using an Indian Public Health Standards (IPHS) Proforma. Assessment of quality of services was performed by using WHO standards of care based on assessment of quality of maternal and newborn services tool by the perspectives of the provider as well as the mothers utilizing the services. 36 mothers who delivered at the selected PHC were interviewed. Results: All basic obstetric care services were available at the selected primary health centers including the 24 × 7 delivery services. The assessment of quality by provider's perspective revealed that the system of referral could be improved. Quality of maternal and newborn services assessment revealed that the practice of skin to skin contact between the mother and newborn just after the delivery was not being followed and few (30%) mothers informed that they could not start breastfeeding within 1 hours of birth. 47% mothers reported that they were not given the freedom to ask questions during delivery. Maternal and newborn outcome revealed that all mothers (100%) had a normal vaginal delivery, and 22% mothers had an episiotomy. All (100%) newborns cried immediately after birth, and average birthweight was 2.89 kg. Conclusion: PHCs are the first point of contact of mothers and healthcare delivery system. Assessment of quality of services is an important tool for quality assurance. Inclusion of evidence-based practices like skin-to-skin contact and early initiation of breastfeeding is important to improve the maternal and newborn well-being. [ABSTRACT FROM AUTHOR]

Background and Objectives: ABO and Rh blood types are known to have associations with health and disease, but studies on their relationship to pregnancy outcomes have been largely inconclusive. We aimed to examine the associations between ABO and Rh blood groups in pregnant women with maternal-neonatal characteristics and outcomes including hypertensive disorders of pregnancy, gestational diabetes, cesarean section rate, preterm birth, postpartum quantitative blood loss, birth weight, and appearance, pulse, grimace, activity, and respiration scores. Methods: At the time of delivery, 2497 consecutive patients were tested for ABO and Rh blood groups. Only those who delivered singleton infants were included in the analysis (2392 patients, 95.8%). Demographic and clinical data were obtained from the electronic medical record. Associations between blood groups and maternal-neonatal characteristics and outcomes were assessed using logistic regression models. A significance threshold of 0.05 was used for all comparisons. Results: Of the 2392 delivering patients, 46.9% were blood group O, 37.5% were blood group A, 12.2% were blood group B, and 3.4% were blood group AB. In addition, 85.9% were Rh-positive and 14.1% Rh-negative. A total of 2127 (88.9%) women delivered at term. The cesarean section rate was 32.4%, 183 (7.7%) had chronic hypertension, 275 (11.5%) had gestational diabetes, and 396 (16.6%) had a postpartum hemorrhage. The median birth weight was 3330 g (interquartile range 2940-3640). No blood groups were significantly associated with these characteristic and outcome measures. Conclusion: At the time of delivery, no significant associations were identified between ABO and Rh blood groups and maternal-neonatal characteristics and outcomes in this delivery cohort of over 2000 women. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. Aim: The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. Objectives: 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. Materials and Methods: This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Result: Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Conclusion: Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases. [ABSTRACT FROM AUTHOR]

Purpose: Management of delivery in pregnant women with coronavirus disease 2019 (COVID-19) is mainly based on extrapolated evidence or expert opinion. This study aimed to assess the clinical manifestations and maternal and perinatal outcomes of COVID-19 during pregnancy. Methods: We retrospectively reviewed the cases of 20 pregnant women infected with the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Their demographic data and clinical characteristics, including symptoms, laboratory examination, and imaging findings, were evaluated. We also assessed the delivery method and timing and clinical courses of mothers, including oxygenation and treatment for COVID-19, as well as neonatal outcomes. Results: The most common symptoms were fever (65%) followed by cough (45%). Seven cases (35%) of preterm birth were observed. Eight patients (40%) required oxygen administration during pregnancy. Among them, two patients (10%) required a high-flow nasal cannula, and one patient (5%) required venovenous extracorporeal membrane oxygenation (VV-ECMO). No maternal death was observed; however, one instance of severe neonatal asphyxia and one intrauterine fetal death were observed. Conclusion: Although most pregnant women with COVID-19 were discharged without any major complications, some cases became severe. Therefore, the timing and method of delivery should be considered for each case to control maternal and infant respiratory conditions. [ABSTRACT FROM AUTHOR]

Background: Due to its physiologic immune suppression, pregnancy is a vulnerable time for severe respiratory infections including COVID-19. However, information regarding the effect of COVID-19 during pregnancy is limited. Objectives: To study the clinical profile of patients suffering from coronavirus disease-2019 (COVID-19) during pregnancy and to evaluate the effect of COVID-19 on maternal, perinatal, and neonatal outcomes. Methodology: This is a cross-sectional observational study over a period of one year from June 2020 to May 2021, in Level-3 Covid facility in Ghaziabad. All pregnant females with confirmed positive for Corona virus infection admitted to the covid ward under the department of Obstetrics & Gynecology were included in the study. Results: A total of 233 pregnant women were included in the study. Maximum patients were from age group 21-30 years (53.2), multigravida (62.7%), and presented in the third trimester (80.7%). On admission, 198 patients (85%) had no covid related symptoms and only three patients had severe symptoms requiring ICU care. Total 102 patients delivered (43.77%), out of whom 40 had a normal vaginal delivery and 62 had a cesarean section. The incidence of preterm birth was 22.5% and maternal death was in three patients (1.3%). Conclusion: The common presentation of COVID-19 during pregnancy is either a mild disease or even asymptomatic. The maternal outcomes observed in late pregnancy and fetal and neonatal outcomes appear good in most cases. Further studies are required to know long-term outcomes and potential intrauterine vertical transmission. [ABSTRACT FROM AUTHOR]

Introduction: Safe motherhood ensures safe pregnancy and childbirth. One of the noteworthy causes of maternal morbidity and mortality is the complications arising from prolonged or obstructed labour. World Health Organization recommends the use of partograph to significantly reduce the maternal mortality crisis. This study aimed to evaluate the effectiveness of a novel partograph in terms of maternal and perinatal outcomes along with its utility. Materials and Methods: A total of 400 intranatal women were selected in a non-randomized control trial to evaluate the effectiveness of novel partograph on selected maternal and perinatal outcomes. Subjects in experimental group (n=200) received care with newly developed partograph whereas subjects in control group (n=200) received standard care. Effectiveness was determined at a significance level of α ≤ 0.05. Utility of the novel partograph was determined as perceived by nurses. Results: There was significant reduction in the duration of the 1st and 2nd stage of labour (P=0.023 and 0.006 respectively) and number of vaginal examinations performed during labour (P=0.017) among mothers in the experimental group. Significant improvement in the Apgar score (P=0.005) was also observed among the infants of mothers in experimental group. Novel partograph was considered as of having extreme utility by 71% nurses. Conclusion: Study concluded that subjects monitored by the partograph experienced improved maternal and perinatal outcomes. It was found to be having extreme utility. [ABSTRACT FROM AUTHOR]

Pregnancy-induced hypertension (PIH) is one of the main causes of maternal mortality. Many first- and second-line drugs are available to treat the condition. Labetalol lowers blood pressure by blocking both α and β adrenergic receptors. It preserves uteroplacental blood flow efficiently. A systemic review was carried out to find the efficacy and safety of labetalol in the treatment of PIH. Three thousand twenty-six studies were retrieved in 20 years. Finally, 28 studies were selected after applying the review criteria. Twenty-three studies detected that labetalol had superior or similar action compared to other drugs in controlling hypertension in patients with preeclampsia and eclampsia. The systematic review concluded that labetalol is a safe, effective, first-choice of drug with few side effects in treating PIH. [ABSTRACT FROM AUTHOR]

Aim: This study aims to describe the clinical characteristics, maternal and neonatal outcome of pregnancies complicated with COVID-19 infection. Methods: This is a retrospective, single center, observational study conducted on all COVID-19 positive pregnant women who were admitted in our institution from 1st April 2020 to 30th November 2020. During the study period, a total of 201 pregnant and postpartum women with COVID-19 infection confirmed by RT-PCR test, regardless of their symptoms, were admitted and included in the study. Data were collected from hospital records about the demographic profile, clinical characteristics, maternal and neonatal outcomes. Results: The mean age was 26 years (SD = 5.21). Majority patients (71.6%) were asymptomatic and 22.3% had mild symptoms. Only 4 (1.99%) women had severe COVID pneumonia. Majority (75.62%) were admitted in 3rd trimester. Cesarean section rate in COVID-19 infected pregnant women was 53.8%, which was almost similar to 52.8% rate in COVID-19 negative pregnant population. Incidence of preterm birth was 11%. Most neonate were asymptomatic and only 2 of them tested positive on testing within 48 h of birth. Conclusion: There is no major effect of COVID-19 infection during pregnancy on maternal and neonatal outcome. The incidence of preterm birth and cesarean section is similar to COVID-19 negative pregnant population. [ABSTRACT FROM AUTHOR]

Background: Despite maternal iron deficiency anemia being a worldwide medical complication, very few studies have been performed to evaluate the efficacy of iron supplementations for treating and preventing adverse pregnancy sequelae. This study attempts to show the impact of maternal iron deficiency anemia on the mother and the fetus and whether treatment can reverse the physiological and pathological effects of anemia on the mother as well as the fetus. Objective: To evaluate the effect of vascular adaptation and extent of compensatory changes in the fetus with the change in maternal hemoglobin (Hb) levels and to study maternal and perinatal outcomes after treatment of maternal iron deficiency anemia. Methodology: The present study was an observational prospective study conducted on 50 pregnant women in GMC, Srinagar from January 2016 to June 2017. The study population was divided into two groups-Group A-Patients with moderate anemia – Hb 7–9 g/dl and Group B-Patients with severe anemia – Hb <7 g/dl. Group A received parenteral iron preparation and Group B received blood transfusion or packed red blood cells until Hb exceeded 7 g/dL, then parenteral iron was used. Maternal Hb and color Doppler were performed before and after treatment of anemia. Results: There was a decrease in the umbilical artery resistivity index (RI) after treatment of maternal anemia in both the groups and the decrease was more in those who received blood transfusion. There was an improvement in middle cerebral artery RI in both the groups after treatment and the increase was statistically significant. The C/U ratio was normalized to >1.1 in both the study groups after treatment of anemia. Conclusion: Our data support the fact that maternal Hb content of <7 g/dl is strongly associated with marked fetal hemodynamic adaptation and must be treated with acute red cell transfusion. Moderate anemia (>7 g/dl) is not sufficient to trigger fetal blood flow redistribution and can be treated with parenteral iron. Close monitoring of the fetal umbilical and cerebral circulation by Doppler examination in anemic pregnancies allows the measurement of the amplitude of fetal vascular response, early assessment of fetal damage and helps in improving fetal outcome as well. [ABSTRACT FROM AUTHOR]

Background: Women with Extra hepatic portal vein obstruction (EHPVO) are mostly young and belong to Asian countries. In the Indian subcontinent, 20–30% variceal bleeds are caused by EHPVO. Hence pregnancy is a concern in such patients. The objective of this study is to observe the maternal and neonatal outcomes in women with EHPVO. Materials and Method: Extra hepatic portal vein obstruction was studied retrospectively in 28 pregnancies in 20 women from Jan 2011 to July 2018 at a tertiary hospital in South India and the pregnancy outcomes were observed during this period. Institutional Review Board approval obtained. Results: The mean age of the women was 24.3 years and the mean age of diagnosis was 18.5 years. Splenomegaly, thrombocytopenia and anaemia were seen in 22 (78.5%), 17 (60.7%) and 8 (28.5%) of pregnancies, respectively. Rate of abortions and preterm deliveries were 2 (7.1%,n=28) and 10 (35.7%,n=28). There was one stillbirth (3.6%) in the study group. EHPVO was diagnosed in 25 (89.3%) women prenatally in our series. During pregnancy only one woman had variceal bleed, which was managed conservatively. Blood and blood product transfusion was required in 7(25%) of women and there was no maternal mortality. Conclusion: Pregnancies in EHPVO have good maternal and neonatal outcomes, provided they are taken care of by a multidisciplinary approach in a tertiary care centre. [ABSTRACT FROM AUTHOR]

Background and Aim: Severe maternal illness is a life-threatening condition for pregnant women and often requires admission into the ICU. The aim was to evaluate the performance of maximum sequential organ failure assessment (SOFA) score to predict the outcome of patients admitted to ICU. Material and Methods: This prospective study was done on 121 consecutive women with severe obstetric illness admitted to the ICU during one year. Basic demographic, obstetrical data, indication of admission to ICU and interventions done were noted. SOFA score was evaluated according to the worst score for each of its six components every 24 hr till discharge or death in ICU. The receiver-operator characteristic (ROC) curve was constructed to predict the outcome of ICU. For analysis, patients were categorized as survivors and non-survivors. Results: Out of 121 patients admitted, 65 survived and 56 died with mortality rate of 45.9%. There were no differences among survivor and non-survivor patients regarding demographic data, obstetrical data and interventions done, but anaemia and inadequate ante natal care was more common in non survivors. ICU utilisation rate of obstetric patients was 1.9%. Most patients were admitted due to obstetric causes (87.6%), mainly for hypertensive disorders (46%) and were post caesarean (84.29%). Total maximum SOFA scores were higher in non-survivors than in survivors (14.09 ± 5.53 vs 7.47 ± 4.58, P < 0.001). Area under curve (AUC) for SOFA score was 0.859, standard error 0.035, P < 0.001, showing good discriminatory power for predicting mortality in ICU. Conclusion: SOFA score is an effective tool to predict outcome of severely ill obstetric patients admitted to ICU. [ABSTRACT FROM AUTHOR]

Background: The role of amniotic fluid is to provide a protective environment for fetus growth. The low volume of amniotic fluid (oligohydramnios) has been reported to associate with perinatal and neonatal outcomes. Objectives: The aim of this study was to explore the effect of oligohydramnios on fetal outcomes at intrapartum and early neonate, including fetal distress. Materials and Methods: In the present investigation, the pregnant women who attended the labor ward of Duhok Maternity Hospital were consecutively screened for eligibility criteria. The patients presented with oligohydramnios from 37 to 40 weeks of gestation to labor room were included in this study and were followed up for neonatal outcomes. The diagnosis of oligohydramnios was established as an amniotic fluid index of 5 cm or less by the ultrasound examination. Results: The mean age of the women with oligohydramnios was 26.10 ± 5.20 years ranged between 16 and 40. The mean age of the gestational age was 38.54 ± 1.13 weeks ranging from 37 to 40. The previous history of a dead newborn was so low (mean: 0.02 ± 0.14). Half of the patients delivered their pregnancies by cesarean section (C/S) (50.5%), and most of them had a good Apgar score value (98.8%). The study showed that women who had a past medical history or delivered by C/S, their newborns were more likely to admit to neonatal intensive care unit (NICU), 36.8% versus 12.1% (P = 0.017) and 78.9% versus 21.1% (P = 0.010), respectively. Conclusions: The present study recommends that pregnant patients diagnosed with oligohydramnios are at a higher risk of C/S and NICU admission. [ABSTRACT FROM AUTHOR]

Introduction: Gestational diabetes mellitus (GDM) is common and is accompanied with other comorbidities. Challenges to treatment exist at our institute as it serves women with low income. This study assessed the burden of comorbidities and the outcome of GDM. Methods: This was a prospective, observational study of women with gestational diabetes attending the obstetrics department from September 2012 to April 2014. GDM was diagnosed based on the International Association of Diabetes and Pregnancy Study Groups criteria. Medical comorbidities were noted, and lipid profile was done. All the women were followed up till delivery, and the complications were recorded. Age- and parity-matched pregnant women with normal oral glucose tolerance test were recruited as controls. Results: One hundred and thirty-nine women were followed up till delivery. The average age was 28 years. Eighteen percent had bad obstetric history. The average body mass index was 28.8. Twenty-five percent had gestational hypertension (HTN), and 6.4% had chronic HTN. Thirty percent had hypothyroidism. 65% women received insulin. The glucose values were within the recommended range in 60% of the women. Maternal hypoglycemia occurred in 7 (5%) women. Forty-four percent of the women required cesarean section and 34% had complications either during pregnancy or labor. Three neonates had macrosomia. Twenty-six neonates (20%) required admission to the Neonatal Intensive Care Unit. Four neonates (3%) died. Newborns of mothers whose GDM optimally treated had less complications. Conclusion: Gestational diabetes is associated with HTN, hypothyroidism, obesity, and lipid abnormalities. The majority of women required insulin for treatment and optimal control of blood glucose resulted in lower neonatal complications. [ABSTRACT FROM AUTHOR]

Background and Aims: The American College of Obstetricians and Gynecologists (ACOG) committee on professional standards and the National Institute of Clinical Excellence (NICE) guidelines suggest that decision-to-delivery interval (DDI) and emergency cesarean section (CS) should not be more than 30 min, and a delay of more than75 min in the presence of maternal or fetal compromise can lead to poor outcome. This prospective 1-year study was conducted on emergency CS in a tertiary care hospital to evaluate the DDI, factors affecting it and to analyze their effects on maternal and neonatal outcome. Material and Methods: A structured proforma was used to analyze the data from all women undergoing emergency CS, during a 1-year period, included in Category 1 and 2 of NICE guidelines for CS. Results: A total of 453 emergency CSs were evaluated, with a mean DDI of 36.3 ± 17.2 min for Category 1 CS and 38.1 ± 17.7 min for Category 2 CS (P > 0.05). Only 42.4% emergency CSs confirmed to the 30 min DDI while 57.6% had a DDI of more than 30 min. Reasons of delay were identified as a delay in shifting the patient to operation theater (22.1%), anesthesia factors (18.1%), and lack of resources or manpower (16.1%). Maternal complications occurred in 15 (3.3%) patients with 3 (0.7%) nonsurvivors having a DDI of 91.0 ± 97.0 min as compared to survivors with a DDI of 36.8 ± 15.7 min, P = 0.001. There was no significant association between DDI and occurrence of neonatal complications. Conclusion: Failure to meet the current recommendations was associated with adverse maternal outcomes, but not with adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population. Materials and Methods: This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus. Results: Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26-30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%). Conclusions: Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes. [ABSTRACT FROM AUTHOR]

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance occurring first time during pregnancy. Its prevalence is simultaneously increasing with the global rise of diabesity. GDM commonly develops, when maternal glucose metabolism is unable to compensate for the progressive development of insulin resistance, arising primarily from the consistently rising diabetogenic placental hormones. It classically develops during the second or third trimester. Theoretically, insulin sensitizers should have been the ideal agent in its treatment, given the insulin resistance, the major culprit in its pathogenesis. Fortunately, majority of women can be treated satisfactorily with lifestyle modification, and approximately 20% requires more intensive treatment. For several decades, insulin has been the most reliable treatment strategy and the gold standard in GDM. Metformin is effective insulin sensitizing agent and an established first line drug in type 2 diabetes currently. As it crosses the placenta, a safety issue remains an obstacle and, therefore, metformin is currently not recommended in the treatment of GDM. Nevertheless, given the emerging clinically equivalent safety and efficacy data of metformin compared to insulin, it appears that it may perhaps open a rather new door in managing GDM. The aim of this review is to critically analyze, the safety and efficacy data of metformin regarding its use in GDM and pregnant mothers with polycystic ovarian disease, which has emerged in past decades. [ABSTRACT FROM AUTHOR]

PURPOSE: To date, there has been no comparison of outcomes in women undergoing anesthesia for in vitro fertilization (IVF) oocyte retrieval for the purpose of pre-implantation genetic diagnosis (PGD) because of their or their partner's genetic disease relative to the outcome in women requiring IVF because of fertility issues. MATERIALS AND METHODS: A prospective observational study, wherein all demographic and anesthetic management data were collected from IVF and PGD units' records for a 6-month period. Descriptive analyses and parametric tests were employed. RESULTS: There were 307 cases IVF and 76 cases PGD: most (97.4% and 99.7%, respectively) received general anesthesia with propofol and fentanyl ± dipyrone (90.5% and 93.3%, respectively) with no adverse effects. The only statistically significant difference between IVF and PGD groups that was potentially clinically significant was post-procedure recovery time (23.0 ± 20.4 vs. 29.4 ± 35.8 min, respectively; P < 0.0001), but is explainable as greater caution by Anesthesiologists for higher-risk PGD cases having autosomal dominant diseases that may impact anesthesia management (myotonic dystrophy, neurofibromatosis, Marfan's); two of these cases also recovered in the general post-anesthesia care unit, as a precaution for early diagnosis and treatment of potential post-procedural complication. CONCLUSIONS: Results of this first-ever survey of anesthesia for PGD compared with IVF cases imply that propofol-and-fentanyl-based anesthesia is safe and can be recommended, bearing in mind that with patients who have autosomal dominant diseases impacting anesthetic management it is prudent to be more cautious post-recovery. [ABSTRACT FROM AUTHOR]

Background: As women increasingly delay child bearing, the proportion of women having their first delivery at ''advanced maternal age'' is expected to rise. These elderly primigravidae have traditionally been considered to be at increased risk of adverse maternal and perinatal outcomes because of associated pregnancy and labor complications and, therefore, need to be evaluated. Aim: To determine the prevalence of elderly primigravidae and compare their pregnancy outcome with that in younger primigravid mothers in Port Harcourt. Materials and Methods: It was a two-year retrospective case-controlled study. The study population consisted of all primigravid mothers aged 35 years and above (elderly primigravidae) who delivered at the University of Port Harcourt Teaching Hospital (UPTH) between 1st January, 2005 and 31st December 2006, and the control group consisted of all other primigravid women less than 35 years of age. Selected maternal and perinatal sociodemographic characteristics and other outcome variables were extracted from patients' case notes. The data were entered into a personal computer and analyzed using SPSS version 11.0. The χ² - test was used for comparison of both groups and statistical significance set at P < 0.05. Results: Of the 5147 parturients who delivered during the study period, 74 (1.4%) were elderly primigravidae. They constituted 4.7% of all primigravidae. The caesarean delivery rate (58.1% vs 32.1%, P = 0.001), preterm delivery rate (10.8% vs 5.1%, P = 0.03), and fetal macrosomia rate (16.2% vs 6.6%, P = 0.002) were significantly higher in the elderly primigravidae than the younger primigravid controls. There were no significant differences in the other maternal and perinatal outcome measures. Conclusion: The prevalence of elderly primigravidae in our centre is 1.4%. The elderly primigravidae are at increased risk of preterm, macrosomic, and caesarean deliveries compared to their younger primigravid counterparts. [ABSTRACT FROM AUTHOR]