Search

Objective To assess associations of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and pregnancy outcomes considering testing policy and test‐positivity‐to‐delivery interval. Design Nationwide cohort study. Setting Sweden. Population From the Pregnancy‐Register we identified 88 593 singleton births, 11 March 2020–31 January 2021, linked to data on SARS‐CoV‐2‐positivity from the Public Health Agency, and information on neonatal care admission from the Neonatal Quality Register. Adjusted odds ratios (aORs) were estimated stratified by testing‐policy and test‐positivity‐to‐delivery interval. Main outcome measures Five‐minute Apgar score, neonatal care admission, stillbirth and preterm birth. Results During pregnancy, SARS‐CoV‐2 test‐positivity was 5.4% (794/14 665) under universal testing and 1.9% (1402/73 928) under non‐universal testing. There were generally lower risks associated with SARS‐CoV‐2 under universal than non‐universal testing. In women testing positive >10 days from delivery, generally no significant differences in risk were observed under either testing policy. Neonatal care admission was more common (15.3% versus 8.0%; aOR 2.24, 95% CI 1.62–3.11) in women testing positive ≤10 days before delivery under universal testing. There was no significant association with 5‐minute Apgar score below 7 (1.0% versus 1.7%; aOR 0.64, 95% CI 0.24–1.72) or stillbirth (0.3% versus 0.4%; aOR 0.72, 95% CI 0.10–5.20). Compared with term births (2.1%), test‐positivity was higher in medically indicated preterm birth (5.7%; aOR 2.70, 95% CI 1.60–4.58) but not significantly increased in spontaneous preterm birth (2.3%; aOR 1.12, 95% CI 0.62–2.02). Conclusions Testing policy and timing of test‐positivity impact associations between SARS‐CoV‐2‐positivity and pregnancy outcomes. Under non‐universal testing, women with complications near delivery are more likely to be tested than women without complications, thereby inflating any association with adverse pregnancy outcomes compared with findings under universal testing. Tweetable abstract Testing policy and time from SARS‐CoV‐2 infection to delivery influence the association with pregnancy outcomes., Tweetable abstract Testing policy and time from SARS‐CoV‐2 infection to delivery influence the association with pregnancy outcomes.

Florczyk Weronika, Weber-Nowakowska Katarzyna, Gębska Magdalena. The influence of thyroid function disorders on pregnant women on the Apgar scale and psychomotor development of the child in the first 18 months of life. Journal of Education, Health and Sport. 2020;10(4):99-112. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.04.012 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.04.012 https://zenodo.org/record/3749858 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 20.03.2020. Revised: 25.03.2020. Accepted: 13.04.2020. The influence of thyroid function disorders on pregnant women on the Apgar scale and psychomotor development of the child in the first 18 months of life Weronika Florczyk1, Katarzyna Weber-Nowakowska2, Magdalena Gębska2 1) A Student of Physiotherapy at the Pomeranian Medical University in Szczecin 2) Department of Rehabilitation Musculoskeletal System, Pomeranian University of Medical in Szczecin. Unii Lubelskiej 1, 71-252 Szczecin Correspondence address Gębska Magdalena, Doctor of Health Sciences, e-mail: mgebska@pum.edu.pl ABSTRACT Introduction. In the prenatal period, there are many exogenous and endogenous factors, which adversely affect the normal development of the fetus and may affect the further development of the child. The impaired reference level of thyroid hormones pregnant woman may entail a number of complications, especially in the first trimester of pregnancy, wherein the process takes place organogenesis and the formation of the nervous system. Goal. The overall objective of the work is to verify the correlation between hypothyroidism and child developmental problems in the first eighteen months of life and the Apgar scale. Materials and methods. The study included 200 pregnant women aged 17 to 40 years of age. The research tool was an online, proprietary questionnaire, which has been placed in social groups, which included pregnant women struggling with hypothyroidism. Conclusions. Developmental disorders up to 18 months of children age occurred in 45% of women with thyroid dysfunction, of which 43% related to symptoms of neurological problems including 56% of impaired muscle tone. The present study demonstrates that the final outcome Apgar does not forecast problems in the course of further development of the child up to 18 months of age. Significant further research, which will help establish the presence of mechanisms adverse impact on offspring and pregnancy outcomes. Keywords: hypothyroidism; pregnancy; Apgar; physiotherapy; child development; dysfunction of the child.

The use of additives such as ractopamine (Rac) in pregnant sows during early-mid pregnancy is an alternative to increase foetal and progeny growth and development. However, Rac supplementation in finishing pigs can lead to behavioural and physiological changes similar to the typical stress responses. The objective of this study was to evaluate the effects of dietary supplementation with Rac in pregnant sows from day 25 to 50 of gestation (pre-hyperplastic stage) on piglet's vitality, blood parameters, number, diameter and perimeter of muscle fibres in semitendinosus muscle and developmental characteristics of piglets at birth to weaning. Forty-one hybrid sows were divided into three dietary treatments: (1) control diet without Rac (control), (2) addition of 10 mg/kg of Rac (Rac10) and (3) addition of 20 mg/kg of Rac (Rac20). Higher numbers of low-vitality piglets (P

Background and Objective: Phenylephrine bolus or infusion is used to maintain arterial blood pressure during the subarachnoid block (SAB) for cesarean section. The objective was to assess the clinical efficacy of prophylactic phenylephrine infusion or bolus doses for maternal hemodynamics maintenance and its effect on fetal outcomes. Materials and Methods: Sixty parturients were randomized to receive either a continuous prophylactic IV infusion of phenylephrine (n = 30, group A) at a dose of 0.50 μg.kg−1.min−1 or phenylephrine (n = 30, Group B) 50 μg bolus dose after the systolic blood pressure (SBP) fell by 20% from the baseline. The changes in hemodynamics, ill effects, neonatal APGAR scores, and fetal acidosis were recorded at different time intervals. Results: SBP was significantly higher over time in group A. Group A showed a significant fall in heart rate from baseline after giving SAB and remained significantly low throughout the intraoperative period (P < 0.05). In group A, 12 patients showed a fall in blood pressure of >20% from the baseline; however, hypotension was observed in 21 patients in group B (P < 0.03). The number of hypotensive episodes was higher in the group B. Incidence of hypotension in Group A was 40% (12 out of 30 patients) and 70% (21 out of 30 patients) in Group B (P < 0.037). Episodes of reactive hypertension, defined as a rise in SBP >20% of baseline value, were noted in 3 out of 30 patients in the Group A. There was also a statistically nonsignificant trend toward a less frequent incidence of nausea and vomiting in the group A (P < 0.29). There was no significant difference between the two groups in APGAR scores at 1 and 5 min after delivery (P < 0.56, 0.13). The incidence of neonatal acidosis was similar in the two groups. Conclusion: Prophylactic phenylephrine infusion is superior to therapeutic phenylephrine bolus dose for control of hemodynamics.

Early amniotomy is one of the main interventions to enhance the labor progress and prevent dystocia in pregnant women. However, the efficacy of amniotomy has not been approved via labor-related indices and outcomes and has remained a subject for debate and future research. The present study was conducted to evaluate the effect of early amniotomy on labor indices and outcomes in nulliparous women. This randomized clinical trial was performed on 151 singleton pregnant women who were referred to Besat Hospital in Sanandaj, Iran, from March 2016 to March 2018. Participants were randomly divided into an early amniotomy (EA) group and a control group. Duration of the first and second phases of labor, corioamionit, dystocia rate, Apgar score at the first and fifth minutes, prolonged labor and post-partum haemorrhage were evaluated and compared between the two groups. Data were recorded in a checklist and analysed using SPSS Version 23. The p value

Aim The aim of this study was to evaluate the effect of surgical site infiltration prior to giving incision, with ketamine, fentanyl, and ropivacaine, on perioperative hemodynamic parameters, pain, and any adverse outcomes. Methods The study was carried out on 68 patients divided into four groups of 17 each. After intubation, the study drug was infiltrated subcutaneously at the surgical site, seven min before incision, by the surgeon who was unaware of the injectate. Hemodynamic variables were monitored and recorded during the intraoperative period and postoperative period at one, two, four, six, eight, 12, and 24 hours. The level of sedation was assessed using the Ramsay sedation score (RSS). The fetal outcome was assessed by the APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) score at one, five, and 10 minutes. Results The mean visual analog scale (VAS) scores were significantly (p < 0.05) lower in group A as compared to other groups for most of the postoperative period. Hemodynamic stability was also significantly better with group A as compared to other groups during the perioperative period. The fetal outcome was comparable between the study groups with the APGAR scores similar between the groups at 10 min. However, significantly lower APGAR values were seen in group C as compared to the other study groups, at one and five minutes. Conclusion Ketamine infiltration resulted in a better hemodynamic profile, a significantly longer duration of the postoperative pain-free interval, and more sedation in the postoperative anesthesia care unit (PACU). It did not affect the fetal wellbeing, as discernable from the APGAR scores.

Background: The Apgar score of newborn babies is a determining factor involved with mortality of newborns after birth. Regarding the disagreement on advantages and possible disadvantages of propofol and thiopental in the available references, the study was triggered with the aim of analyzing effects of two mentioned drugs on babies’ Apgar score. Methods: In this double-blind clinical trial, a total of 100 healthy women who volunteered to undertake cesarean operation were selected and then divided randomly into two equal groups using statistical blocking. One group was treated by propofol while other one was treated by thiopental. The prescribed drugs for both groups were identical. Babies’ Apgar score 1 and 5 minutes after birth and recovery period and some of the critical maternal parameters after operation were recorded. The obtained data were analyzed by SPSS 19 software. Results: Apgar score I minute 1 (p=0.317) and Apgar score in minute 5 (p=1.00) for propofol group were not different meaningfully. The groups had significant differences in the indices such as first systolic (P=0.00) and diastolic (P=0.00) pressure in recovery, last diastolic pressure in recovery (P=0.001) and duration of postoperative recovery (P=0.001). Statistical analysis of nausea and vomit in both groups showed that they are lower in propofol group rather than the thiopental group (p=0.000). Conclusion: Propofol and thiopental did not differ significantly in Apgar score, but it seems that propofol can be a better option to induce anesthesia for an elective cesarean operation.

Background Adolescent pregnancy is a high-risk condition that can potentially lead to adverse perinatal and obstetric outcomes. It is a growing concern in developing countries including Sri Lanka. The main objective of this study was to evaluate obstetric and perinatal outcomes amongst adolescent pregnancies and compare them with outcomes of pregnancies of average maternal age (AMA) women. Method This was a prospective, cross-sectional study conducted at a tertiary care hospital in the Eastern province of Sri Lanka. A total of 795 primigravidae who had singleton pregnancies and delivered their live babies over a period of three months from February to April 2019 were selected for the study. The data were retrieved from Bed Head Tickets (BHTs) of those patients upon discharge from the postnatal ward. Results The majority of primigravida was AMA women and accounted for 83.4% (n=663) of the study population while primiparous adolescents comprised 16.6% (n=132). Among the 132 adolescent pregnancies, 81.1% (n=107) were associated with complications and the remaining 18.9% (n=25) were uncomplicated. The most common risk associated with adolescent pregnancy was the low birth weight (LBW; n=24, 18.2%), followed by preterm labour (n=10, 7.6%). An adolescent mother had a 1.3 times higher possibility of delivering an LBW baby than an AMA mother and the risk was statistically significant (p=0.04). The likelihood of delivering an intrauterine growth restriction (IUGR) baby was higher in adolescent mothers (6%) than in AMA mothers (5%). Adolescent mothers had a 1.2 times higher chance of delivering newborns with IUGR compared to AMA mothers; however, the difference of IUGR was not statistically significant (p>0.05). The incidence of foetal distress was less among adolescent mothers compared to AMA mothers. The majority of the babies (n=126, 95.5%) of adolescent pregnancies were healthy. Only 4.5% (n=6) babies needed neonatal intensive care unit (NICU) admissions; of those, four babies had very LBW and prematurity and the other two babies depressed at birth and developed respiratory distress. Conclusion Adolescent pregnancy carries a significant risk of obstetric complications including LBW and prematurity that should draw public and healthcare providers’ attention. The effectiveness of a comprehensive antenatal and community-based program to prevent adolescent pregnancy and related adverse outcomes should further be evaluated.

(1) Background: Women with personality disorder are at risk of social and emotional problems which impact deleteriously on everyday functioning. Moreover, a personality disorder diagnosis has been established to have an adverse impact upon pregnancy outcomes and child health. Understanding this impact is critical to improving both maternal and child outcomes. This systematic review and meta-analysis will evaluate the contemporary evidence regarding these relationships. (2) Methods: Prospero and Cochrane were searched for any systematic reviews already completed on this topic. Academic Search Premier, CINAHL Complete, MEDLINE, PsycARTICLES, PsycINFO via the EBSCO host, and the Web of Science Core Collection were searched to include research articles published between 1980 and 2019. A total of 158 records were identified; 105 records were screened by reviewing the abstract; 99 records were excluded; 6 full text articles were assessed for eligibility; 5 records were included in the review. (3) Results: All the included studies reported on preterm birth. The meta-analysis indicates significant risk of preterm birth in women with personality disorder (overall odds ratio (OR) 2.62; CI 2.24–3.06; p < 0.01). Three studies reported on low birth weight, with the meta-analysis indicating a raised risk of low birth weight of the babies born to women with personality disorder (overall OR 2.00 CI 1.12–3.57 (p = 0.02)). Three studies reported on appearance, pulse, grimace, activity, and respiration (APGAR) score, with the meta-analysis of OR’s indicating a risk of low APGAR score in women with personality disorder (overall OR 2.31; CI 1.17–4.55; p = 0.02). (4) Conclusions: The infants of women with personality disorder are at elevated risk of preterm birth, low birth weight and low APGAR score.

Background: Family instability and partner conflicts are reportedly common in serodiscordant relationships. To date, the family adaptability, partnership, growth, affection and resolve (Family APGAR), a standardised tool for assessing family function, has not been used in any published literature involving this peculiar group. Aim: The aim of this study was to determine the predictors of family functionality and its association with human immunodeficiency virus (HIV) serodiscordance. Setting: The study was undertaken at the Kwame Nkrumah University of Science and Technology Hospital and Komfo Anokye Teaching Hospital in Kumasi, Ghana. Method: This was a cross-sectional study. A systematic sampling method was used to select HIV-positive clients whose partners were seropositive (concordant) or seronegative (discordant). A standardised format was used to extract relevant data. All data were analysed using STATA ® (version 14). Results were reported as odds ratios with 95% confidence intervals for study and outcome variables. Results: The study recruited 374 respondents, of which 52% (195) were in HIV-discordant relationships. Approximately 68% (254) of the respondents rated their families as functional, 15% (57) rated as moderately dysfunctional and 17% (63) rated as severely dysfunctional. A statistically significant relationship was found between family functionality and gender, as well as between family functionality and HIV status disclosure to the partner. No association was found between the Family APGAR and HIV serodiscordance. Conclusion: Amongst HIV couples, the strongest predictors of family functionality are gender and status disclosure. Healthcare providers should invest efforts into addressing gender-based challenges, utilise the Family APGAR and support disclosure of HIV status, especially amongst discordant couples.

Background The novel coronavirus disease (COVID-19) is the most challenging health crisis that we are facing today. Against the backdrop of this pandemic, it becomes imperative to study the effects of this infection on pregnancy and its outcome. Hence, the present study was undertaken to evaluate the effects of COVID-19 infection on the maternal morbidity and mortality, the course of labour as well as the neonatal outcome. Materials and Methods A total of 977 pregnant women were included in the study, from 1st April to 15th May 2020 at a tertiary care hospital. There were 141 women who tested COVID positive and remaining 836 patients were included in the COVID negative group. Findings were compared in both the groups. Results The incidence of COVID positive pregnant women was found to be 14.43%. More patients delivered by LSCS in the COVID positive and the COVID negative group (50%) as compared to COVID negative group (47%), (p > 0.05). Low APGAR score (0-3) was observed in 2(1.52%) neonates of COVID positive mothers and in 15 (1.91%) neonates of COVID negative mothers. Overall most of the babies were healthy. Out of all babies tested, 3 were detected positive initially which were retested on day 5 and were found to be negative. Conclusion There is no significant effect of COVID infection on maternal and foetal outcome in pregnancy and there is no evidence of vertical transmission of the COVID-19 infection but long-term follow-up of these babies is recommended.

Background and objectives: Surgical patients frequently require admission in high-dependency units or intensive care units. Resources are scarce and there are no universally accepted admission criteria, so patients’ allocation must be optimized. The purpose of this study was to investigate the relationship between postoperative destination of patients submitted to colorectal surgery and the scores ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) and Surgical Apgar Score (SAS) and, secondarily find cut-offs to aid this allocation. Methods: A cross-sectional prospective observational study, including all adult patients undergoing colorectal surgery during a 2 years period. Data collected from the electronic clinical process and anesthesia records. Results: A total of 358 patients were included. Median score for SAS was 8 and CR-POSSUM had a median mortality probability of 4.5%. Immediate admission on high-dependency units/intensive care units occurred in 51 patients and late admission in 18. Scores from ward and high-dependency units/intensive care units patients were statistically different (SAS: 8 vs. 7, p

Background and aim: Entonox was one of the important methods for pain management in the delivery process. In previous years some studies have assessed the effect of this method in Iran. In this regard, the aim of this study was to systematically review studies addressing the effect of Entonox for pain management in labor. Methods: This systematic review and meta-analysis study was conducted in 2016. The required data was collected using keywords such as ”Entonox”, “nitrous oxide”, ”vaginal delivery”, ”pain relief”, “obstetric”, “labor pain”, and “labor analgesia”, from databases including Google scholar, PubMed, Science Direct, Magiran, SID, and Scopus, and hand-searching of related and valid journals and references of articles. Articles published from 2000 to 2016 were searched. To conduct meta-analysis, CMA:2 (Comprehensive Meta-analysis) was used. Results: Finally, 14 articles were included in the study. Pain relief standard difference in mean between-groups was -1.01 (95% CI: -1.59 to -0.43, Q=148.5, df=8, p=0.02, I2=76) this difference was significant (p

Purpose: To identify obstetric risk factors of delivering a neonate with poor neonatal adaptation at birth.Material and methods: Nested case-control study. Poor neonatal adaptation was defined for presence of at least: umbilical cord artery pH

Background: Accurate assessment of fetal growth is one of crucial components of antenatal care. A generic reference for fetal-weight and birthweight percentiles that can be easily adapted to local populations have been developed by Mikolajczyk and colleagues. This study aimed to validate our own local percentile standard by evaluating the odds ratio (OR) of low 1st and 5th minute Apgar score for small-for-gestational age (SGA) versus those not SGA.Methods: We used the generic reference tools for fetal-weight and birthweight percentiles developed by Mikolajczyk and colleagues to create our own local standard and then defined the SGA neonates. For validation, we used the database of singleton live deliveries (2,139 birth) during January 1st to December 31st 2013 in Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We compared our reference with that of Hadlock and colleagues. For every reference, the OR of Apgar score

Introduction: About 10 million women develop pre-eclampsia per year. Intra-Uterine Growth Restriction (IUGR) is a common complication of Hypertensive disorders of pregnancy, due to failure of normal placental invasion and development. Identification of the pregnancies at risk for preventable perinatal morbidity and mortality is a primary goal of obstetric care. Doppler flow studies are an important adjunct to fetal biometry in identifying the fetus at risk of adverse outcome. Cerebro-Placental Ratio (CPR) incorporates data of both Umbilical artery and Middle cerebral artery and is a better index than using either of them alone for predicting adverse perinatal outcome. Aim: To determine the role of CPR in women with Hypertensive disorders of pregnancy, so as to assess the fetus at greater risk of adverse perinatal outcome. Materials and Methods: This cohort study was done in JSS Hospital, Mysore on subjects satisfying inclusion and exclusion criteria. The study period was from November 2016 to November 2018. A total of 128 antenatal women of >32 weeks of gestation were selected for the study; preliminary data were recorded and subjected to ultrasound scan. Association between CPR and other categorical variables were analysed using chi-square test. Pearson’s Correlation coefficient was used to show correlation between CPR and other quantitative variables. Results: Among pregnancy-related hypertension, preeclampsia was the most common cause (71.1%), followed by eclampsia (20.3%). The five minute APGAR score was ≤7 in 21.8% while the rest had a score of >7 (78.2%). There was significant association between CPR and the Ultrasonographic gestational age, birth weight and fetal outcome. Lower APGAR score at 5th minute was associated with abnormal CPR values, especially the babies with APGAR score of ≤7 at 5 minutes. Conclusion: Abnormal CPR is valuable in predicting the outcome of hypertensive disorders in pregnancy. Perinatal outcomes namely, preterm delivery, caesarean section and fetal compromise like low birth weight, lower APGAR at 5 minutes, requirement of NICU care can be predicted with lower CPR.

Excessive body weight and some concomitant diseases, such as psoriasis, accompany women treated due to infertility by intracytoplasmic sperm injection (ICSI). This study is aimed to assess effect of obesity and psoriasis on quality of egg cells, embryos, course of pregnancy, and state of a newborn after treatment with ICSI. A total of 140 women were included into the study (110 healthy women and 30 with psoriasis). Among healthy women, BMI negatively correlated with total recovery rate, total oocyte score, blastocyst formation rate (BFR) and amount and quality of blastocysts (r &lt, 0, p &lt, 0.001). The relationships were similar in psoriasis, however apart from average blastocyst quality (p = 0.17) and BFR (p = 0.352). In healthy patients, BMI negatively correlated with gestational age at delivery (r = &minus, 0.444, p = 0.010) and APGAR (r = &minus, 0.481, p = 0.005). An excess of adipose tissue exerts an unfavourable effect on female reproductive functions, especially with a simultaneous burden of psoriasis. Excessive body weight is conducive to development of gestational diabetes and shortens the duration of pregnancy. The burden of psoriasis in combination with excessive body weight has an impact on the risk of occurrence of intrauterine growth restriction of foetus. Overweight and obesity negatively affect the state of a newborn, measured using APGAR scale.

Background: Oligohydramnios is one of the major causes of maternal and perinatal morbidity and mortality. Our study was aimed to study the maternal and perinatal outcome in oligohydramnios and measures needed to reduce the incidence. Aims: To find out the incidence of oligohydramnios by ultrasonographic evaluation of AFI, obstetric risk factors associated with oligohydramnios and maternal outcome in the form of mode of delivery. The purpose of this study is also to assess congenital anomalies in fetus along with their apgar score at birth, NICU admission rates and still birth rates. Materials and Methods: After taking consent from the women, risk factors at the time of admission were recorded. Detailed clinical history including obstetric, menstrual, past and personal history were taken.AFI to be measured using Phelan’s four quadrant ultrasound technique. All the information was entered in the proforma and analyzed and observations were made and accordingly discussion and recommendations were made. Results: The incidence of oligohydramnios was 3%. In the present study 78.5% cases had associated obstetrical complications; acting singly or in combination for causing oligohydramnios. The incidence of congenital anomalies is 9%. The LSCS was done in 47% in present study.17.5% babies had low Apgar score (less than 7 at 5 min).In our study 36% of neonates were admitted in nursery. The perinatal mortality was 15% in present study. Conclusion: Hence it can be concluded that maternal evaluation of risk factors, AFI, regular antenatal and intranatal monitoring of fetus should be done to improve maternal and neonatal outcome in oligohydramnios. Key words: Maternal, Fetal, Oligohydramnios, AFI, Apgar

Objective: Administration of warm intravenous (IV) fluid infusion and use of forced air warmers is the most easy and physiologically viable method for maintaining normothermia during surgery and postsurgical periods This study was conducted to assess the effect of combination of active warming (AW) methods namely warm IV fluid infusion and forced air warming versus forced air warming only (WA) on maternal temperature during elective C-delivery under spinal anesthesia. Materials and Methods: A total of 100 patients scheduled for elective c-section were grouped into those who received both warmed IV fluid infusion and forced air warmer (Combination of active warming WI= 50) and those who received only forced air warmer (WA = 50). Core body temperature and shivering incidence were recorded using a tympanic thermometer from prespinal till the end of surgery every 10 min and in postanesthesia care unit (PACU) at 0, 15, and 30 min. Results: Core temperature showed statistically significant difference in 15, 35, 45, and 55 min between air warmer and warm infusion groups and in PACU at 0, 15, and 30 min, it was statistically significant (P = 0.000) among WI group (mean temperature = 36.79°C) when compared to WA group (mean temperature = 35.96°C). There was a lower incidence of shivering in WI compared to WA group, which is statistically significant. Conclusion: Combination of warm Intravenous fluid infusion and Forced air warming is better than forced air warming alone. In maintaining near normal maternal core body temperature during elective cesarean section following spinal anesthesia. Combined warming method also reduces shivering incidence.

Background: Predicting perinatal outcomes based on patterns of fetal heart rate (FHR) remains a challenge. The aim of this study was to evaluate intrapartum FHR variability as predictor for neonatal acidemia and APGAR score. Methods: This was a retrospective observational study of 552 childbirths. Multivariable linear regression models were used to assess the association between FHR variability and each of the following outcomes: arterial cord blood pH and base deficit, Apgar 1, and 5 scores. Variables used for adjustment were maternal age, comorbidities (gestational diabetes, preeclampsia, maternal fever, and hypertension), parity, gravidity, uterine contractions, and newborn gestational age, and weight at birth. Results: The following factors were associated with an increased risk of metabolic acidosis and low Apgar scores at birth: increased mean and coefficient of variation (CV) of the FHR, type of delivery and decreased parity. Each 10-beat/min increase in the FHR was associated with an increase of 0.43 mEq/L in the base deficit, and a decrease of 0.01 in the pH, 0.2 in the Apgar 1, and 0.14 in the Apgar 5 scores. Each 10% increase in the CV of the FHR was associated with an increase of 4.05 mEq/L in the base deficit and a decrease of 0.13 in the pH, 1.31 in the Apgar 1, and 0.86 in the Apgar 5 scores. Conclusion: These data suggest the intrapartum FHR variability is physiologically relevant and can be used for predicting the acidemia and Apgar scores at birth of the newborn infants without severe cases of morbidity and from uncomplicated pregnancies.

Background: Umbilical cord blood analysis is assumed to give a picture of acid base balance of the infant at the moment of birth when umbilical circulation is arrested by clamping of the cord. Meconium stained deliveries often cause anxiety in the minds of clinicians attending such newborn. Aims and Objectives: To study the correlation of umbilical cord pH with apgar and outcome and predict a model to help us to detect cases of meconium that need active monitoring and intervention. Materials and Methods: This was a prospective observational study.86 newborn born to mothers with meconium at artificial rupture of membranes was enrolled for the study All newborn had arterial blood gas analysis from umbilical cord. Results : The pH of umbilical blood showed positive correlation with apgar scores at 1minute (r=0.46) and negative correlation with thick meconium(r=-0.35) and outcome (r=0.36). Conclusion: The correlation though not strong are suggestive of the fact that meconium deliveries with poor apgar and thick meconium should be monitored before discharge. Asian Journal of Medical Sciences Vol.7(4) 2016 113-115

Made available in DSpace on 2018-12-11T17:24:28Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-01-01 Made available in DSpace on 2014-12-03T13:08:41Z (GMT). No. of bitstreams: 0 Previous issue date: 2014-06-01Bitstream added on 2014-12-03T13:24:41Z : No. of bitstreams: 1 S0103-84782014000600025.pdf: 135978 bytes, checksum: b8668a6c4489ae5ca6a3ec71952cf8a9 (MD5) Item merged in doublecheck by Luana Priscila Costa (luana@reitoria.unesp.br) on 2019-04-26T18:53:50Z Item was identical to item(s): 179488, 110581 at handle(s): http://hdl.handle.net/11449/177208, http://hdl.handle.net/11449/111481 O objetivo deste trabalho foi avaliar a influência do glicocorticoide sobre parâmetros vitais de cordeiros nascidos a termo e prematuros, do nascimento às 48 horas de vida. Foram constituídos quatros grupos: PN (cordeiros nascidos de parto normal, n=15, média de 146 dias); PNDEX (cordeiros nascidos de parto normal, cujas mães receberam 16mg de dexametasona aos 141 dias de gestação, n=8, média de 143 dias); PRE (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, n=10); e PREDEX (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, cujas mães receberam 16mg de dexametasona dois dias antes, n=9). As frequências cardíaca e respiratória variaram ao longo do período, com os maiores valores nos grupos de partos normais. A temperatura retal diminuiu em todos os grupos nos primeiros 60 minutos de vida, sendo os menores valores observados nos cordeiros prematuros, e o escore Apgar foi mais alto nos animais nascidos em tempo gestacional normal. Os cordeiros prematuros apresentaram menor vitalidade e menor taxa de sobrevivência, entretanto, menor taxa de mortalidade foi observada nos prematuros sob influência da dexametasona. The aim of the study was to evaluate the influence of glucocorticoids on vital parameters of full-term and preterm lambs from birth to 48 hours of life. Four experimental groups were formed: NDG (normal delivery group - lambs vaginally delivered, n=15, average of 146-day gestation); NDEXG (normal delivery with dexamethasone group - lambs vaginally delivered whose mothers received 16mg of dexamethasone at 141 days of gestation, n=8, average of 143-day gestation); PRE (premature lambs born by cesarean section at 138 days of gestation, n=10) and PREDEX (premature lambs born by cesarean section at 138 days gestation, whose mothers received 16mg of dexamethasone two days before, n=9). Heart and respiratory rates had variations during the observation period, with the highest mean values in the groups of normal deliveries (NDG and NDEXG). Rectal temperature decreased in all groups in the first 60 minutes of life, with the lowest mean values in premature lambs (PRE and PREDEX) and the Apgar score was higher in animals delivered at normal gestational time. Preterm lambs had lower vitality and chance of survival, however, lower mortality rate was observed in offspring of ewes that received dexamethasone two days before surgery. Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Rua Clóvis Pestana, 793, 16050-680, Araçatuba, SP Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, MS Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Araçatuba, SP Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Rua Clóvis Pestana, 793, 16050-680, Araçatuba, SP Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Araçatuba, SP

Background: Microalbuminuria and serum creatinine are markers of acute kidney injury. Birth asphyxia is responsible for 50% of all newborn deaths and acute non-oliguric kidney injury is one of such complications. This study was undertaken to determine the efficacy of serum creatinine and microalbuminuria for the detection of early renal lesion in severely asphyxiated babies in Calabar, Nigeria. Materials and Method: This prospective cross-sectional investigational study was undertaken among severely asphyxiated babies admitted into the newborn units of the University of Calabar Teaching Hospital (UCTH), Calabar, Nigeria. Standard method for blood collection and determination of urea, electrolytes were used. Micral-test strips were used on samples negative only for albumin after using urine dipstick. Color comparison was done with the standardized color scale on test strip container after 5 minutes. Results: Fifty term newborn babies were enrolled, their serum electrolytes, creatinine and creatinine clearance were essentially normal. Six (12%) babies had positive microalbuminuria, while 44(88%) had negative microalbuminuria with specificity and negative predictive values of 100% and 88% respectively. Conclusion: Microalbuminuria was not useful for early detection of acute renal failure in babies with severe birth asphyxia, but further studies are recommended., {"references":["Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421-6. http://dx.doi.org/10.1001/jama.286.4.421","Nash K, Hafeez A, Hou S. Hospital-acquired renal insufficiency. Am J Kidney Dis 2002; 39: 930-6. http://dx.doi.org/10.1053/ajkd.2002.32766","Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007; 35: 1837-43. http://dx.doi.org/10.1097/01.CCM.0000277041.13090.0A"]}

This study evaluated the interrater reliability and perceived importance of components of a developed neonatal adaption score, Neonatal Resuscitation Adaptation Score (NRAS), for evaluation of resuscitation need in the delivery room for extremely premature to term infants. Similar to the Apgar, the NRAS highest score was 10, but greater weight was given to respiratory and cardiovascular parameters. Evaluation of provider (N = 17) perception and scoring pattern was recorded for 5 clinical scenarios of gestational ages 23 to 40 weeks at 1 and 5 minutes and documenting NRAS and Apgar score. Providers assessed the tool twice within a 1-month interval. NRAS showed superior interrater reliability ( P < .001) and respiratory component reliability ( P < .001) for all gestational ages compared to the Apgar score. These findings identify an objective tool in resuscitation assessment of infants, especially those of smaller gestation age, allowing for greater discrimination of postbirth transition in the delivery room.

(1) Background: Epidural analgesia (EA), at the present time, is one of the most effective methods to reduce labor pain. In recent years its use has increased, being used between 20&ndash, 70% of all deliveries, (2) Methods: Historical cohort on a total of 2947 deliveries during the years 2012&ndash, 2016 at the &ldquo, Mancha-Centro Hospital&rdquo, of Alc&aacute, zar de San Juan. The main outcome variables were four neonatal morbidity (NM) criteria: umbilical artery pH of &lt, 7.10, Apgar score at 5 min &lt, 7, need for advanced resuscitation and composite morbidity. We used the multivariate analysis to control confounding bias. (3) Results: No statistical relationship between EA and the second stage of labor duration with none of the four criteria of NM used (p &gt, 0.005). However, the type of delivery was associated with three criteria (pH, resuscitation, and composite morbidity). The instrumental delivery presented an OR of pH &lt, 7.10 of 2.68 95% CI [1.15, 6.27], an OR of advanced resuscitation of 2.44 95% CI [1.17, 5.08] and OR of composite morbidity of 2.86 95% CI [1.59, 5.12], (4) Conclusions: The EA and the second stage of labor duration are not related to the NM. While the instrumental delivery doubles the risk of NM compared to the normal vaginal delivery.

Background: The present study was planned to study the role of Mg in preeclampsia and its correlation with dietary intake of proteins and calories by analyzing serum Mg at 20 weeks, delivery, and cord blood Mg levels. Methods: The study was conducted in 102 pregnant women aged 17–36 years attending the outpatient department (OPD) before 20 weeks of gestation. The study samples were drawn twice: once before 20 weeks during visit in the OPD and second within 1 h of childbirth. Serum was analyzed for Mg levels using spectrophotometric method. Furthermore, thyroid-stimulating hormone and glucose challenge test were done as per the standard methods. Results: In normal pregnant women, the mean serum Mg level at

We are reporting this patient who was presented with severe upper air way obstruction soon after delivery. She was a girl born with multiple firm nodules, variable in size, widespread all over the body with affection of the oropharynx, long bones, ribs, muscles, subcutaneous tissues, also lungs and intestine. Infantile myofibromatosis was proved on histopathological examination of the masses excised from the oropharynx at the age of 27 days to relieve the upper airway obstruction. The girl had passed the critical stage in NICU and was discharged home with tracheostomy tube. An autosomal recessive mode of inheritance was supported in our case as there was two other male sibs affected with a similar condition and the parents were healthy.

Premature rupture of membranes (PROM) is a condition of rupture of membranes before the birth takes place. The incidence of PROM varies from 3% to 10% of all births and complicates more than 3% of pregnancies with PROM. The purpose of this study was to determine the relationship between the length of the PROM period toward the APGAR score of the infant and maternal leukocyte serum. The research design was analytic observational with retrospective cohort approach. From the result we found a correlation between PROM period with outcome of infant’s APGAR score, there were a total of 89 samples fulfilling the inclusion criteria, with 57 samples of PROM 12 hours (16 with good APGAR score, and 16 with bad APGAR score). From the result of the correlation of leukocyte level with the length of PROM period was found total of 84 samples fulfilling the inclusion criteria, with 54 samples of PROM 12 hours (28 with normal leukocyte score, and 2 with leukocytosis score). From the analysis results we obtained a strong relationship between the length of PROM period with the infant’s APGAR (P = 0.0001, OR 8.5), whereas in the relationship between the length of PROM period with maternal blood leukocyte level there is no significant relationship (p= 0,599). Keywords: Premature Rupture of Membranes, APGAR, Leukocyte Serum

Background Increasing rates of overweight have been reported. In Germany, women of childbearing age are especially affected. Those women are at increased risks of several peri- and postnatal complications. The purpose of this study was to carry out Germany’s first study in terms of secular trends of overweight and weight gain during pregnancy related to foetal clinical outcomes (birth weight, Apgar score and umbilical blood pH). Methods A database maintained by a large regional university hospital in Cologne, Germany was used to evaluate clinical routine data from 1996 to 2012. 11771 women (23.5 ± 5.4 years; 18–48 years), who gave birth to a live singleton child (>2000 gram) were included. Recommended weight gain during pregnancy was based on IOM guidelines: Total weight gain range for underweight (initial BMI

TNF-related apoptosis inducing ligand (TRAIL) plasma levels was measured in plasma samples obtained 1 h (time 1) and 2–3 days (time 2) after delivery in a group of healthy women ( n = 17) who underwent cesarean delivery, and showed a significantly increase from time 1 (39.3 pg/ml median; 41.2 ± 15.9 mean ± SD) to time 2 (71.6 pg/ml median; 73.8 ± 27.8 mean ± SD). Similarly, circulating TRAIL levels were extremely low in the plasma of newborns ( n = 41) within the first 24 h after partum (time 1; 27.5 pg/ml, median; 31.5 ± 15.8 means ± SD), showing a significant increase 2–3 days after partum (time 2; 68.4 pg/ml, median; 75.1 ± 36.7 mean ± SD). It is also noteworthy that the highest levels of plasma TRAIL were observed in newborns with the following characteristics: (i) born at later gestational age, (ii) Apgar score >9, (iii) higher birth weight, (iv) born through vaginal partum. In conclusion, we have demonstrated for the first time that the levels of circulating TRAIL are markedly low in both mothers and children after delivery, rapidly rising thereafter. Moreover, the highest levels of TRAIL are observed in newborns with the best clinical parameters.

In order to provide adequate medical assistance to neonates, the extent of vitality impairment has to be investigated through complementary exams, as well as clinical assessment. This investigation aimed to identify the physiological changes that occur during neonatal adaptation and to develop a clinical approach that can be performed during the first hour of life in neonatal lambs born through vaginal eutocic labor. The neonatal vitality of 14 Santa Ines lambs was verified using the Apgar system and rectal temperature at birth and after 5 and 60 min after birth. From the total number of neonates, 7 lambs were randomly selected for blood gas analysis and glucose immediately at birth and 1 h after birth. The lambs had hypoglycemia immediately after birth, as well as acidosis due to metabolic and respiratory causes. Given their hypoxemia at birth, lambs immediately exhibit tachycardia and tachypnea. However, neonatal lambs reached Apgar score superior than 7 after 5 min of birth. Ovine neonates are relatively mature at birth, with adequate thermoregulation and active mechanisms to compensate for physiological acid–base imbalances. In conclusion, a systematic clinical examination of newborn sheep should include the implementation of the Apgar score coupled with the confirmation of any acid–base imbalances. Further research should evaluate neonatal adaptation to this critical period over a longer period of time.

Introducción: la preeclampsia se presenta en 6% de los embarazos en Colombia y se asocia con una elevada tasa de morbimortalidad maternofetal. Con frecuencia los casos severos se acompañan de restricción del crecimiento intrauterino; en estos casos el doppler fetoplacentario es útil para determinar el pronóstico fetal, pero su valor en preeclampsia leve o hipertensión gestacional no está bien definido. Objetivos: determinar en estas dos circunstancias la frecuencia de alteraciones en el doppler de las arterias umbilical y cerebral media. Materiales y métodos: búsqueda de casos en la base datos de la unidad de medicina maternofetal del Hospital de San José, entre agosto de 2006 y febrero de 2008. Se definió como casos las pacientes con gestaciones > a 28 semanas con HTG o PL y fetos con perfil de crecimiento normal. Se consideraron y analizaron variables demográficas, resultados del doppler fetoplacentario y las complicaciones. Resultados: se identificaron 85 pacientes. El 17% presentó alteración del doppler de la AU y 7% de la ACM; en gestaciones < 32 semanas los hallazgos anormales son bajos (75% AU y 85% ACM normales). Conclusiones: la frecuencia de alteraciones en el Doppler de AU y ACM fue similar en el grupo de mujeres que presentaron complicaciones y aquellas con un desenlace normal. Abreviaturas: RCIU, restricción del crecimiento intrauterino; PL, preclampsia leve; HTG, hipertensión gestacional; AU, arteria umbilical; ACM, arteria cerebral media.

La asfixia neonatal es una causa importante de mortalidad y secuelas neurológicas. El objetivo de nuestro estudio es identificar los factores de riesgo maternos, perinatales y neonatales asociado a un Puntaje de Apgar (PA) bajo. Pacientes y Método: Se analizan los datos de 57 241 recién nacidos (RN), entre los años 1997 y 2004; los antecedentes fueron ingresados en forma prospectiva a una base de datos computacional. Se realizó un análisis multivariado con un modelo de regresión logística para identificar los factores de riesgo. Resultados: 1 167 presentaron un PA £ 3 al minuto (2,1%) y 291 presentaron además un puntaje £ 5 a los 5 minutos (0,5%). Los factores de riesgo de PA bajo estadísticamente significativos fueron: RN de muy bajo peso, malformaciones congénitas mayores, RN pequeño para la edad gestacional, RN pretérmino, embarazo de 42 semanas, expulsivo prolongado, fórceps, desprendimiento placentario y líquido amniótico con meconio. Conclusiones: En este trabajo se identifican los factores de riesgo de PA bajo en nuestra población, los cuales deben ser considerados para una adecuado manejo perinatal Background: Neonatal asphyxia is an important cause of mortality and neurological sequelaes. Objective: Identify maternal, perinatal and neonatal risk factors associated with low Apgar Score (AS). Method: A multivariate analysis using logistic regression model was performed to identify risk factors in a population of 57.241 infants, born between 1997 - 2004, whose information was recollect prospectively in a computer data base. Results: 1.167 newborns had a 1-minute AS £ 3 (2,06%) and 291 presented a 5-minute AS £ 5 (0,51%). The low AS predictors, according to multivariate analysis, were: very low birth weight, prematurity, congenital malformations, low gestational age, placental abruption, 42 - weeks pregnancy, meconium stained amniotic fluid and forceps. Conclusions: Risk factors of low AS are identified in our population, essential for an adequate perinatal care

Exercise during pregnancy is interested for pregnant women, but there is worry about fetal outcomes. The purpose of this study was to assess the effect of a planned aerobic exercise program on neonatal outcomes. This was a case-control study. By using a continued method, performed on pregnant women with singleton gestation were assigned to either a training or a control group. The supervised training included three days a week, with duration of 30-45 minutes, from 20-26th weeks until delivery. Neonatal outcomes include neonatal weight and first and fifth minute's apgar was recorded for two groups. According finding of this study, there were not meaningful statistical evidences for exercise training and first and fifth minute's apgar or neonatal weight in two groups. Therefore, such programs should be considered as part of routine pregnancy care for pregnant women.

Made available in DSpace on 2018-12-11T17:24:22Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-06-01. Added 1 bitstream(s) on 2019-10-09T18:32:06Z : No. of bitstreams: 1 S0100-736X2018000601172.pdf: 790171 bytes, checksum: a4ea1b918f5c5f7c99b41c03f7015e40 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) This study aimed to demonstrate and to correlate possible methods for neonatal assessment in dogs born by elective cesarean surgery using inhalation anesthesia, enhancing its advantages and disadvantages as well as proposing lactate measurement as an adjunctive method of evaluation. After elective cesarean surgery of four bitches subjected to morphine premedication followed by propofol induction and sevoflurane anesthesia, 30 neonates were evaluated through blood sampling from the umbilical cord for lactate measurement and blood gas analyses, as well as neurological and cardiorespiratory assessment at birth and at 10 minutes of age. The neonates presented respiratory acidosis and acidemia at birth related to blood lactate values (4.98±1.39mmol/L). Neurological and cardiorespiratory depressions were present at birth with recovery at 10 minutes and no complications were observed during the first 30 days of life. The methods for neonatal assessment used in this study are safe when appropriately interpreted and the effects of general anesthesia on neonates were transient. Blood lactate obtained from the umbilical cord can be an option for the evaluation of these patients. Objetivou-se demonstrar e correlacionar os possíveis métodos de avaliação neonatal de filhotes de cães nascidos de cesarianas eletivas com a utilização de anestesia inalatória, apontando suas vantagens e desvantagens e propor a dosagem de lactato sanguíneo como prática auxiliar. Após a cesariana eletiva em quatro cadelas submetidas ao protocolo anestésico composto de morfina, propofol e sevofluorano, foram avaliados 30 neonatos com exames de sangue do cordão umbilical para dosagem de lactato e gases sanguíneos, avaliação neurológica e cardiorrespiratória realizadas no nascimento e aos 10 minutos de vida. Os animais apresentaram acidose respiratória com acidemia ao nascimento, associados a altos valores de lactato sanguíneo (4,89±1,39mmol/L). Ocorreu depressão neurológica e cardiorrespiratória no nascimento, com recuperação após 10 minutos, sem complicações nos primeiros 30 dias. Pode-se concluir que os métodos de avaliação neonatal utilizados são seguros quando interpretados adequadamente e os efeitos da anestesia nos neonatos foram transitórios. O lactato do sangue umbilical pode ser opção na avaliação desses pacientes. Faculdade de Medicina Veterinária de Araçatuba (FMVA) Universidade Estadual Paulista (Unesp), Rua Clovis Pestana 793 Faculdade de Medicina Veterinária de Jaguariúna Rodovia Dr. Adhemar Pereira de Barros Research Worker Fundect/CNPq Fellow level C Universidade Federal do Mato Grosso do Sul (UFMS), Av. Senador Felinto Muller 2443 Centro Universitário de Rio Preto, Av. Clóvis Oger 900 Autonomous Veterinarian, Rua São Luiz 244 Faculdades Integradas de Ourinhos Centro Universitário Católico, BR-153 Km 339 Faculdade Católica Salesiano Auxilium, Rodovia Teotônio Vilela 3821 Faculdade de Medicina Veterinária de Araçatuba (FMVA) Universidade Estadual Paulista (Unesp), Rua Clovis Pestana 793