Search

Objectives: Pregnant women represent a category at high risk of severe measles infection, that negatively affects the fetus as well. A systematic review of clinical outcomes of measles infection in gravid subjects and a meta-analysis of antibodies prevalence among pregnant women was conducted.Methods: MEDLINE and EMBASE databases were searched up to 18 June 2018. The screening focused on: (i) articles describing the outcome of measles in pregnancy, synthesized in a descriptive fashion; (ii) articles addressing the measles seroprevalence in cohorts of gravid women, analysed quantitatively.Results: Twenty-nine articles met inclusion criteria. A total of 420 cases of measles in gravid subjects were described, from 1941 to 2012. Among women, 18 deaths (4.3%) occurred, and the most frequent complication was pneumonia (75/420, 17.9%). Prematurity was the most important complication concerning fetal outcomes (55 out of 410 cases with available data, 13.4%). The random-effects pooled seroprevalence of measles in 20,546 gravid women worldwide was 89.3% (95% CI: 87.3-91.1%), that decreased, although not in a statistically significant way, over time (p = 0.54).Conclusions: Measles infection in pregnancy is dangerous both for the mother and the foetus. Antibody seroprevalence among gravid women on a global scale is lower than the herd immunity threshold. [ABSTRACT FROM AUTHOR]

Synopsis: A rare case of a massive hemorrhage from a ruptured splenic artery aneurysm (SAA) in pregnancy that resulted in an emergency laparotomy, splenectomy, and cesarean section with maternal survival, but fetal loss, is presented. The development of protocols or guidelines for the early identification or prevention of SAA rupture in pregnancy would be of greater importance than reactive measures to control acute SAA bleeds. [ABSTRACT FROM AUTHOR]

Background and Aim: Preeclampsia is one of the most important complications of pregnancy which complicates 5-8 percent of all pregnancies and is associated with increased maternal and fetal complications. This study aimed to determine the prevalence of preeclampsia and its fetal and maternal complications in pregnant women referring to the maternity ward of the Zabol-based Amiralmomenin Hospital. Materials and Methods: This is a retrospective, descriptive study conducted on the files of 2000 pregnant women referred to Amiralmomenin Hospital in Zabol. The data collection tools consisted of a two-part form that covered demographic and obstetric data as well as maternal and fetal complications of preeclampsia. Data were presented in descriptive statistics. Results: The prevalence of preeclampsia in Zabol was 6.5%. The frequency of the major maternal complications include liver dysfunction 13.1%, renal disorders 3.1%, transfusion 4.6%, thrombocytopenia 2.3%, visual impairment 2.3%, stillbirth 0.8% and HELLP syndrome 0.8%. Fetal complications involve prematurity 29.2%, amniotic fluid meconial 12.3%, and Apgar score below 7 at birth 7.7%. Conclusion: Given the prevalence of preeclampsia and its complications for the mother and the fetus, proper care during pregnancy should be provided in order for early detection and prevention of adverse effects.

Abstract Background The relation between grand multiparity (GMP) and the possible adverse pregnancy outcomes is not well identified. GMP (parity ≥5 births) frequently occurs in the Arab nations; therefore, this study aimed to identify the correlation between GMP and the different adverse maternal and neonatal outcomes in the Saudi population. Method This cohort study was conducted on a total of 3327 women from the labour ward in King Khaled University Hospital, Riyadh, Saudi Arabia. Primiparous, multiparous and grand multiparous females were included. Socio-demographic data and pregnancy complications like gestational diabetes or hypertension, preeclampsia and intrauterine growth restriction were retrieved from the participants’ files. In addition, the labour ward records were used to extract information about delivery events (e.g. spontaneous preterm delivery, caesarean section [CS]) and neonatal outcomes including anthropometric measurements, APGAR score and neonatal admission to the intensive care. Results Primiparas responses were more frequent in comparison to multiparas and GMP (56.8% and 33%, and 10.2% respectively). In general, history of miscarriage was elevated (27.2%), and was significantly higher in GMP (58.3%, p

Background: Pregnancy by itself, imposes great physical and psychological pressures on a person and consequently, coupled with other stressors such as violence, can have adverse effects on the fetus and mother. Objective: To assess the prevalence of domestic violence in pregnant women and maternal and infants’ outcomes. Methods: This is a descriptive study using a questionnaire. Data were collected from 725 women who delivered their babies at Shariati Hospital in Bandar Abbas in the summer and autumn of 2013. The questionnaire consisted of four parts: demographic characteristics, factors affecting violence, areas of violence (physical, emotional, sexual) and maternal and fetal outcomes. Data analysis was performed by SPSS 18 using descriptive statistics, ttest, Chi-square, and logistic regression. Results: The prevalence of physical, sexual and psychological violence were 6.5, 14.8 and 9.9 %, respectively. The variables of age, duration of marriage, previous marriage experience and the husband’s addiction, had a significant relationship with applying physical violence of the husband. There was significant correlation between physical violence and maternal outcomes (p

Background: Unfavorable Bioshop score, a score pre-labor of cervical ripening, is a marker for screening delayed labor. This study aimed to determine maternal and neonatal outcomes in full-term pregnancy with unfavorable Bishop score. Methods: In a cross-sectional study, 400 full-term pregnant women were selected and Bishop score was determined at labor induction. All mothers and neonates were followed until discharged from hospital and maternal and neonatal outcomes in those with low Bishop score were investigated. Findings: The mean Bishop score was 5.9 ± 2.1; 174 (39.9%) and 262 mothers (60.1%) had unfavorable and favorable Bishop score, respectively. The mean Bishop score was higher in normal delivery. In addition, Bishop score was different based on causes of cesarean, the results of oxytocin challenge test (OCT), and preeclampsia. The mean Bishop score was lower in mothers with post-partum hemorrhage. Conclusion: According to increase of maternal and neonatal complications, pregnant women with unfavorable Bishop score must be hospitalized; so, the risk of these complications, including neonatal asphyxia would be reduced.

Abstract Background Women in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman’s pregnancies. Inter-pregnancy intervals

Background In contrast to the general population, outcome‐derived thresholds for diagnosing ambulatory hypertension in pregnancy are not yet available. We aimed to identify and compare outcome‐derived ambulatory blood pressure (BP) monitoring thresholds for adverse perinatal outcomes by using approaches related and not related to clinic BP in a southern Chinese population. Methods and Results Ambulatory BP monitoring was performed in a cohort of 1768 high‐risk participants in late pregnancy who were not taking antihypertensive medications. Participants were followed for composite maternal (severe complications) and neonatal (pregnancy loss, advanced neonatal care, and small for gestational age) outcomes. Modeling of clinic BP–unrelated approaches revealed a nonlinear threshold effect of ambulatory diastolic BP on the composite outcome, with increased risk for daytime ≥79 mm Hg and 24‐hour measurement ≥76 mm Hg. For other ambulatory BP components showing linear associations with outcome, the following thresholds were identified: 131 mm Hg for daytime systolic, 121 mm Hg for nighttime systolic, 130 mm Hg for 24‐hour systolic, and 73 mm Hg for night‐time diastolic BP. These thresholds unrelated to clinic BP were lower than the equivalents yielding a similar probability of outcome to clinic BP of 140/90 mm Hg and were comparable with equivalents to clinic BP of 130/80 mm Hg. Conclusions Using an outcome‐derived approach unrelated to clinic BP, we identified rounded thresholds to define ambulatory hypertension in at‐risk women in late pregnancy in a southern Chinese population as follows: 130/80 mm Hg for daytime, 120/75 mm Hg for nighttime, and 130/75 mm Hg for 24‐hour measurement. For wider clinical applicability and to align both nonpregnancy and pregnancy ambulatory BP monitoring with an outcomes‐based approach, prospective, multiethnic, international studies from early pregnancy onward will be required.

Placenta accreta spectrum (PAS) disorder is one of the leading causes of peripartum maternal morbidity and mortality; its early identification during pregnancy is of utmost importance to ensure the optimal clinical outcome. The aim of the present study is to investigate the possible association of the presence and type/location of placenta previa on MRI with PAS and maternal peripartum outcome. One hundred eighty-nine pregnant women (mean age: 35 years; mean gestational age: 32 weeks) at high risk for PAS underwent a dedicated placental MRI. All women underwent a C-section within 6 weeks from the MRI. All MRIs were evaluated by two experienced genitourinary radiologists for presence, type (complete/partial vs. marginal/low lying), and location (anterior vs. anterior-posterior vs. posterior) of placenta previa. Statistical analysis was performed for possible association of type/location of previa with placental invasiveness and peripartum outcomes. Intraoperative information was used as a reference standard. Complete/partial previa was detected in 143/189 (75.6%) and marginal/low lying previa in 33/189 (17.5%) women; in 88/189 (46.6%) women, the placenta had anterior-posterior, in 54/189 (28.6%) anterior and in 41/189 (21.7%) posterior. Complete/partial previa had an at least 3-fold probability of invasiveness and was more frequently associated with unfavorable peripartum events, including massive intraoperative blood loss or hysterectomy, compared to low-lying/marginal placenta. Posterior placental location was significantly associated with lower rates of PAS and better clinical outcomes. In conclusion, the type and location of placenta previa shown with MRI seems to be associated with severity of complications during delivery and should be carefully studied.

Background: Neonatal outcomes and perinatal mortality are directly and significantly impacted by the use of appropriate antenatal care (ANC) during pregnancy. The objective of this study is to evaluate the association between the use of prenatal services and maternal and newborn outcomes in both public and private healthcare settings., Materials and Methods: This study was carried out in two tertiary healthcare setups in Mangaluru, Karnataka: Government Lady Goschen Hospital (LGH) and Kasturba Medical College Hospital (KMCH) Attavar. Data were collected from 150 women who were a part of the study. Microsoft Excel was used to compile the data, and SPSS version 25 was used to analyze it., Results: We found that 58 out of 90 women admitted to LGH went for ANC check-ups at least four times during their gestation period and the rest of them went eight times or more, compared to just 3 out of the 60 women admitted at KMCH who went at least four times, whereas the rest went eight or more. The number of checks the mother takes appears to affect the term of the gestation with fewer preterm seen in patients who have come for a minimum of eight ANC visits, a higher risk of abnormal weight gain during pregnancy, and a lower risk of giving birth to preterm babies., Conclusion: The study reveals that private healthcare setups offer more antenatal services, including hospital visits, routine testing, supplements, and doctor advice. The number of antenatal visits is a significant difference between public and private healthcare setups. The public setup requires a minimum of four antenatal care visits, while the updated 2016 version requires eight. The number of antenatal visits affects both mother's and neonatal outcomes. A higher number of visits leads to fewer preterm births and a higher risk of abnormal weight gain. Education also influences the frequency of antenatal visits. The study suggests increasing the frequency of prenatal care visits and improving public education on this matter., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Introduction: When acute kidney damage occurs during pregnancy, it poses a difficult clinical problem. One of the main causes of maternal and fetal morbidity and death is pregnancy-related acute kidney injury (AKI), a significant obstetric complication characterized by a fast deterioration in renal function and several subsequent clinical problems. The objective of the study is to analyze the etiological factors, clinical manifestations, and maternal and fetal outcomes of AKI during pregnancy., Materials and Methods: This prospective observational research involved patients hospitalized in the General Medicine and Obstetrics and Gynecology departments at Indira Gandhi Institute of Medical Sciences, Patna, for a year (October 2021 to September 2022) due to obstetric difficulties resulting in acute renal damage., Results: The study included 62 patients with a mean age of 25.08±4.25 years. The majority of patients in our study were aged 18-25 years (38, 61.3%), followed by 26-30 years (19, 30.6%) and >30 years (5, 8.1%). The majority of patients in our study were non-booked (52, 83.9%) and presented as emergency cases, whereas 10 (16.1%) patients had booked. In addition, 34 (54.8%) patients were primigravida, while 28 (45.1%) were multigravida. There were 25 patients in their third trimester (40.3%), 19 who were postpartum (30.6%), 10 who were post-abortion (16.1%), and eight in their second trimester (12.9%). Upon admission, the majority of the patients showed signs of oliguria, accounting for 45 cases (72.6%). This was followed by nine cases of abnormal kidney function (14.5%) and eight cases of anuria (12.9%). Among the other symptoms, fever was observed in 25 cases (40.32%), whereas breathlessness increased to 15 cases (24.19%), edema was present in 14 cases (22.58%), vomiting and altered sensorium were observed in four cases (6.45%), abdominal pain was observed in three cases (4.83%), and burning micturition was observed in two cases (3.22%). The most common causes of AKI in pregnancy in the present study were puerperal sepsis (18 cases, 29.0%), followed by preeclampsia/eclampsia (14 cases, 22.6%), hemorrhagic shock (10 cases, 16.1%), septic abortion (six cases, 9.7%), hyperemesis gravidarum (four cases, 6.5%), acute fatty liver of pregnancy (three cases, 4.8%), disseminated intravascular coagulation (three cases, 4.8%), drug-induced sepsis (two cases, 3.2%), and urosepsis (two cases, 3.2%). Modes of delivery in this study were normal vaginal delivery (32 cases, 51.6%), lower segment cesarean section (21 cases, 33.9%), dilation and evacuation (seven cases, 11.3%), and total hysterectomy (two cases, 3.2%). Hemodialysis was performed in 39 patients (62.9%), and 51 (82.3%) received blood transfusions. The mean systolic and diastolic BP (mmHg) were 111.37±22.60 and 71.40±18.88, respectively. Maternal outcome data revealed that 48 (77.4%) women had fully recovered, eight (12.9%) had not recovered, 43 (69.4%) were lost to follow-up, and two (3.2%) had died. Neonatal outcomes in the present study were as follows: live birth, 43 (69.4%); abortion, eight (12.9%); intrauterine death of the fetus, five (8.1%); and neonatal mortality, six (9.7%)., Conclusion: The diagnosis and treatment of AKI during pregnancy is a significant challenge for the treating physician because of the pathophysiological changes that occur during pregnancy, the variability of symptoms, and the fact that clinical and laboratory features may occasionally overlap., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Choudhary et al.)

Objective: To compare the labor duration and other maternal and neonatal outcomes between hospitalized women with uncomplicated pregnancies receiving amniotomy at 5 cm cervical dilatation and those not receiving amniotomy., Methods: This prospective, randomized controlled trial was conducted at a tertiary hospital between June 2020 and October 2021. The study included low-risk pregnant women with spontaneous onset of labor at term, carrying a single fetus in cephalic presentation and with intact amniotic membranes. When the cervical dilatation reached 5 cm, participants were randomly assigned to receive or not receive amniotomy. Maternal demographics, labor and delivery data, and neonatal outcomes were compared between the two groups., Results: The amniotomy group had a significantly shorter duration of labor compared with the control group (mean difference 49.4 min, 95% confidence interval [CI] 16.8-81.9, P = 0.003). The following outcomes were not significantly different between the two groups: (1) the need for oxytocin to augment labor; (2) cesarean section rates; (3) the incidence rates of suspected fetal distress and instrumental delivery; and (4) neonatal outcomes., Conclusions: Compared with expectant management, amniotomy during the active phase of labor (as newly defined by WHO) can shorten the labor duration without an increased risk of cesarean delivery or other negative consequences. THAI CLINICAL TRIALS REGISTRY (TCTR) (TCTR20200522001): https://www.thaiclinicaltrials.org/show/TCTR20200522001., (© 2024 International Federation of Gynecology and Obstetrics.)

Introduction: Pregnancy-associated gynecological cancer (PAGC) refers to cancers of the ovary, uterus, fallopian tube, cervix, vagina, and vulva diagnosed during pregnancy or within 12 months postpartum. We aimed to describe the incidence of, and perinatal outcomes associated with, invasive pregnancy-associated gynecological cancer., Material and Methods: We conducted a population-based historical cohort study using linked data from New South Wales, Australia. We included all women who gave birth between 1994 and 2013, with a follow-up period extending to September 30, 2018. Three groups were analyzed: a gestational PAGC group (women diagnosed during pregnancy), a postpartum PAGC group (women diagnosed within 1 year of giving birth), and a control group (women with control diagnosis during pregnancy or within 1 year of giving birth). We used generalized estimation equations to compare perinatal outcomes between study groups., Results: There were 1 786 137 deliveries during the study period; 70 women were diagnosed with gestational PAGC and 191 with postpartum PAGC. The incidence of PAGC was 14.6/100 000 deliveries and did not change during the study period. Women with gestational PAGC (adjusted odds ratio [aAOR] 6.81, 95% confidence interval [CI] 2.97-15.62) and with postpartum PAGC (aOR 2.65, 95% CI 1.25-5.61) had significantly increased odds of a severe maternal morbidity outcome compared with the control group. Babies born to women with gestational PAGC were more likely to be born preterm (aOR 3.11, 95% CI 1.47-6.59) and were at increased odds of severe neonatal complications (aOR 3.47, 95% CI 1.45-8.31) compared with babies born to women without PAC., Conclusions: The incidence of PAGC has not increased over time perhaps reflecting, in part, the effectiveness of cervical screening and early impacts of human papillomavirus vaccination programs in Australia. The higher rate of preterm birth among the gestational PAGC group is associated with adverse outcomes in babies born to these women., (© 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Introduction: Pregnant women with abnormal liver function tests (LFTs) require proper evaluation and timely management to reduce maternal and fetal morbidity and mortality., Objective: The present study was done with the objective of determining feto-maternal outcomes in antenatal women with abnormal LFTs and comparing them with antenatal women having normal liver function. The prevalence and possible causes of derangements in LFT were also identified., Method: Pregnant women referred to an antenatal clinic for several reasons pertaining to abnormal liver functions, and those admitted to the labor room for delivery with abnormal LFTs were included in the study. The pregnant women with abnormal LFT were studied prospectively, and they were compared with pregnant women having normal LFT. The fetal and maternal outcomes were also noted., Results:  The pregnant women attending the antenatal clinic with a history of pruritus, abdominal pain, jaundice, nausea/vomiting, hypertension ascites, etc. and delivered at our facility were evaluated. One hundred and eight women had abnormal LFT defined by criteria laid down in material and methods. Eighty-seven women with normal LFT were taken for comparison. In the abnormal LFT, the main cause was intrahepatic cholestasis of pregnancy (IHCP). There were 6 (5.5%) maternal deaths in this group and none in the normal LFTs. There were 6 (5.6%) fetal deaths and 4 (4.6%) in the other group (p-value=1). The prevalence of abnormal LFT was 9.11% throughout pregnancy. Increased bilirubin and alkaline phosphatase (ALP) were significantly correlated with maternal mortality, while gestational age at birth, presence of meconium, appearance, pulse, grimace, activity, and respiration (APGAR) score, maternal mortality, and raised alkaline phosphatase level were found to be significantly associated with fetal mortality., Conclusion: Patients with abnormal LFT were significantly associated with maternal morbidity and mortality. However, fetal outcomes in patients with abnormal and normal LFT were similar. Hyperbilirubinemia and raised alanine aminotransferase (ALT) were significant predictors of maternal mortality., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Pathak et al.)

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: This study was carried out to assess the effects of participating in CenteringPregnancy (CP) on maternal, birth, and neonatal outcomes among low-risk pregnant women in the Netherlands., Methods: A total of 2124 pregnant women in primary care were included in the study. Data were derived from the Dutch national database, Perined, complemented with data from questionnaires completed by pregnant women. A stepwise-wedge design was employed; multilevel intention-to-treat analyses and propensity score matching were the main analytic approaches. Propensity score matching resulted in sample sizes of 305 nulliparous women in both the individual care (IC) and the matched control group (control-IC) and 267 in the CP and control-CP groups. For multiparous women, 354 matches were found for IC and control-IC groups and 152 for CP and control-CP groups. Main outcome measures were maternal, birth, and neonatal outcomes., Results: Compared with the control-CP group receiving standard antenatal care, nulliparous women participating in CP had a lower risk of maternal hypertensive disorders (odds ratio [OR], 0.53; 95% CI, 0.30-0.93) and for the composite adverse maternal outcome (OR, 0.52; 95% CI, 0.33-0.82). Breastfeeding initiation rates were higher amongst nulliparous (OR, 2.23; 95% CI, 134-3.69) and multiparous women (OR, 1.62; 95% CI, 1.00-2.62) participating in CP compared with women in the control-CP group., Conclusion: Nulliparous women in CP were at lower risk of developing hypertensive disorders during pregnancy and, consequently, at lower risk of having adverse maternal outcomes. The results confirmed our hypothesis that both nulliparous and multiparous women who participated in CP would have higher breastfeeding rates compared with women receiving standard antenatal care., (© 2024 The Authors. Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

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., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Introduction: The trends of increasing use of cesarean section (CS) with a decrease in assisted vaginal birth (vacuum extraction or forceps) is a major concern in health care systems all over the world, particularly in low-resource settings. Studies show that a first birth by CS is associated with an increased risk of repeat CS in subsequent births. In addition, CS compared to assisted vaginal birth (AVB), attracts higher health service costs. Resource-constrained countries have low rates of AVB compared to high-income countries. The aim of this study was to compare mode of birth in the subsequent pregnancy among women who previously gave birth by vacuum extraction or second stage CS in their first pregnancy at Mulago National Referral Hospital, Uganda., Methods: This was a retrospective cohort study that involved interviews of 81 mothers who had a vacuum extraction or second stage CS in their first pregnancy at Mulago hospital between November 2014 to July 2015. Mode of birth in the subsequent pregnancy was compared using Chi-2 square test and a Fisher's exact test with a 0.05 level of statistical significance., Results: Higher rates of vaginal birth were achieved among women who had a vacuum extraction (78.4%) compared to those who had a second stage CS in their first pregnancy (38.6%), p < 0.001., Conclusions and Recommendations: Vacuum extraction increases a woman's chance of having a subsequent spontaneous vaginal birth compared to second stage CS. Health professionals need to continue to offer choice of vacuum extraction in the second stage of labor among laboring women that fulfill its indication. This will help curb the up-surging rates of CS., (© 2024. The Author(s).)

Objective: To assess the relationship between maternal, fetal, and neonatal outcomes and different forms of hypertensive disorders associating pregnancy in women needed intensive care units (ICUs) admission.Methods: A prospective case control study was conducted on 1238 women admitted to hypertensive ICU at three university hospitals. They were classified into four groups. Group I included 472 women with severe preeclampsia (PE), Group II included 243 women with eclampsia (E), Group III included 396 women diagnosed with E associated with HELLP syndrome, and Group IV included 127 women diagnosed as HELLP syndrome. All women received magnesium sulfate to prevent and/or control convulsions and nifedipine to control their blood pressure. Primary outcome parameter was maternal mortality. Other outcomes included maternal morbidities, fetal, and neonatal outcomes.Results: There was a significant difference among the study groups regarding the need for blood transfusion (58.1%, 70%, 84.3%, and 42.5% respectively, p < .001), number of transferred units (2.4 ± 1, 2.9 ± 0.9, 3.4 ± 1.1, and 3.5 ± 0.8 respectively, p < .001), placental abruption (23.3%, 16.5%, 30.3%, and 19.7% respectively, p < .001), pulmonary edema (14.8%, 22.6%, 19.9%, and 34.6% respectively, p < .001), multiple complications (12.5%, 12.3%, 19.9%, and 26% respectively, p < .001), and maternal mortality (1.9%, 4.1%, 6.1%, and 5.5% respectively, p < .001). Regarding fetal and neonatal outcomes, there was a significant difference among the four groups regarding Apgar score at 1 and 5 min, neonatal birth weight, neonatal intensive care unit (NICU) admission, NICU admission days, intrauterine growth restriction, perinatal death, respiratory distress syndrome, intraventricular hemorrhage, sepsis, and the need for mechanical ventilation (p < .001). Higher rate of vaginal delivery was reported in women with HELLP (40.9%) and severe PE (39.8%) and higher rates of performing cesarean section (CS) in women with eclampsia (77.8%). Maternal mortality is significantly related to delivery with CS, younger maternal age with lower parity, and the presence of placental abruption or pulmonary edema. For Groups III and IV, which included HELLP cases, there are significant differences between both groups as regards HELLP classes according to Mississippi classification, also significant differences were seen between both groups as regards, maternal mortality, abruptio placenta, pulmonary edema, multiple organ damage, NICU admission, perinatal deaths, and need for mechanical ventilation.Conclusion: Both maternal mortality and morbidity (placental abruption and need for blood transfusion) are significantly higher in women with HELLP syndrome worsens to become class 1 regardless of whether eclampsia is present or not.Synopsis: Maternal mortality and unfavorable outcome are significantly higher in women with HELLP syndrome whether it was associated with eclampsia or not. [ABSTRACT FROM AUTHOR]

Pregnancy by itself imposes great physical and psychological pressures on a woman and consequently, coupled with other stressors such as violence, can have adverse effects on the fetus and mother. Objectives: To identify the association of physical domestic violence with unfavorable feto maternal outcome. Study Design: Observational Cross Sectional Review. Setting: Department of Obstetrics and Gynaecology Unit 4 at Liaquat University Hospital Hyderabad. Period: Six months from June 2017 to December 2017. Material & Methods: All pregnant females admitted in department of OBS and Gynae for various obstetrical and gynaecological problems because of bodily domestic violence. Results: Overall 196 pregnant females were selected in review, mean age was 26.32±4.36 yrs. On assessment of maternal outcome females were presented as; preterm labor in 34.2% females, Antepartum hemorrhage in 25.5%. On fetal outcome Miscarriage in 31.1%, intrauterine mortality (IUD) in 15.3%, Stimulated miscarriage in 12.8%, intrauterine growth retardation (IUGR) in 12.8%, Neonatal mortality (NND) in 9.2% & Neonatal intensive care unit (NICU) admission was seen in 18.9% cases. It was found that the age, socio-economic status, maternal education, occupational status, education of husband, addiction of husband, parity, physical and psychological forms of violence, marriage duration, were significantly associated with maternal and fetal outcome (p value < 0.05) due to bodily domestic violent behavior. Conclusion: We concluded that domestic violence during the course of pregnancy has been identified as being a significant factor affecting health of mother and fetus. [ABSTRACT FROM AUTHOR]

Preeclampsia can cause increased neonatal mortality and serious neonatal morbidity. This study aimed to analyze the result of the preeclampsia screening program to the maternal and neonatal outcome at primary healthcare centers. A retrospective study through medical records and ultrasound records. Screening program, including anamnesis, physical examination, were Body Mass Index (BMI), Mean Arterial Pressure (MAP), Roll Over Test (ROT), and use of Doppler ultrasound. We conducted screening to 474/693 women with 308 (64.9%)/219 (36.7%) positive results with positive risk factor of 236 cases (49.8%)/378 (63.3%). In this study, 591 persons were primigravida with 200 obese pregnant women. We found 233 pregnant women with MAP >90 mmHg and as many as 140 pregnant women with ROT >15. For neonatal outcomes, we studied infants with congenital anomalies, Intra-Uterine Fetal Death (IUFD), Intra-Uterine Growth Restriction (IUGR), abortion, preterm birth, and APGAR score <7. IUFD, IUGR and premature events were respectively 1.1%, 0.19%, and 1.7% on normal Doppler Velocimetry Uterine Artery (DVUA) ultrasound compared with increased DVUA ultrasound. There were 19 pregnant women becoming preeclampsia, severe preeclampsia, and eclampsia from pregnant women screening positive preeclampsia with normal DVUA compared to 5 (0.95%) pregnant women becoming preeclampsia screening positive preeclampsia with DVUA. [ABSTRACT FROM AUTHOR]

Background: An ideal antenatal care includes identification of high risk pregnancies, her safe delivery, and postnatal follow up and care of her new born infant and maintenance of lactation. Maternal complication and poor perinatal outcome result from non-utilization of primary health care services in ground level. Materials and methods: A retrospective study was conducted over a period of 6 months in Department of Obstetrics and Gynecology, tertiary health care centre at King George Hospital, Visakhapatnam. Our study aimed at comparing the socio-demographic, obstetrical complications, maternal and perinatal outcome in booked and unbooked cases delivered in King George Hospital. Results: 66.3% of the high risk cases were unbooked. Most of the complications were seen in unbooked cases. It was observed that booked cases were better managed, maternal and perinatal outcome was better compared to un booked as they were brought in late stage, after complication have developed leaving less time for intervention. Conclusion: With improvement in antenatal services and care in primary level with the help of health workers, Regular antenatal visits by health workers, Counseling of the mother about advantages of regular antenatal check-ups, Early booking, Early detection, early referral to higher centres may lead to better treatment and management of complications and improving the maternal and fetal outcome. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer during pregnancy is extremely rare and data on optimal treatment and possible chemotherapeutic regimens are scarce. The aim of this study is to describe the obstetric and maternal outcome of women with gastric cancer during pregnancy and review the literature on antenatal chemotherapy for gastric cancer.Material and Methods: Treatment and outcome of patients registered in the International Network on Cancer, Infertility and Pregnancy database with gastric cancer diagnosed during pregnancy were analyzed.Results: In total, 13 women with gastric cancer during pregnancy were registered between 2002 and 2018. Median gestational age at diagnosis was 22 weeks (range 6-30 weeks). Twelve women were diagnosed with advanced disease and died within 2 years after pregnancy, most within 6 months. In total, eight out of 10 live births ended in a preterm delivery because of preeclampsia, maternal deterioration, or therapy planning. Two out of six women who initiated chemotherapy during pregnancy delivered at term. Two neonates prenatally exposed to chemotherapy were growth restricted and one of them developed a systemic infection with brain abscess after preterm delivery for preeclampsia 2 weeks after chemotherapy. No malformations were reported.Conclusions: The prognosis of gastric cancer during pregnancy is poor, mainly due to advanced disease at diagnosis, emphasizing the need for early diagnosis. Antenatal chemotherapy can be considered to reach fetal maturity, taking possible complications such as growth restriction, preterm delivery, and hematopoietic suppression at birth into account. [ABSTRACT FROM AUTHOR]

A retrospective study was been undertaken to determine the obstetrical and fetal outcome among unbooked mother's in a teritiary referral hospital. This study is to rule out the fetal and obstetrical outcome such as asphyxia, abruptio placenta; etc . A quantitative research approach is used. The data were been collected using electronic medical record of the unbooked population and analyzed by using descriptive statistics. Among 100 unbooked 74% are from Sharjah and 25% from Ajman. 82% are anemic. These few complications out of the vast leads on to life threatening situations. The Primary Health Center accessibility towards these vulnerable population have to be drastically improved that indirectly graphs up the maternal and fetal health. [ABSTRACT FROM AUTHOR]

Background: Maternal bearing down efforts plays a vital role in expulsive phase of labor. Various types of bearing down efforts has got its own advantages and disadvantages on mother and fetus. Various studies are done to evaluate the best bearing down techniques and have different results. The investigator personally felt there is a need to investigate the best bearing down technique with less complications to the mother and newborn Objective: 1. To assess the effect of vulsalva bearing down technique during second stage of labour on maternal and neonatal outcome among primigravida mothers admitted in selected hospitals of pune city. 2. To assess the effect of spontaneous bearing down technique during second stage of labour on maternal and neonatal outcome among primigravida mothers admitted in selected hospitals of pune city. 3. To compare the effectiveness of vulsalva bearing down techniques and spontaneous techniques and duration of second stage of labour on maternal and neonatal outcome among primigravida mothers admitted in selected hospitals of pune city Methodology: In the present study, Quantitative research approach is applied and approach is applied and pre experimental, Post test only control group design is used. The setting of the study was selected hospital of Pune. The sample size for study was 60, selected by using Non Probability Purposive Sampling Technique. The structured questionnaire and observation checklist was administered. In order to establish the reliability of the tool inter rater method was used. The scores were calculated and the reliability was established by Kappa method, which was 0.90. Results: On Comparison of the Spontaneous and vulsulva bearing down techniques on various maternal and neonatal outcome. Since the P values corresponding to the Maternal outcome, oxytocin given, Perineal laceration, Type of episiotomy, size of episiotomy, mode of delivery and fatigue and Neonatal outcome Crown heel length of newborn, Head circumference of newborn, Neonate Resuscitation, Admission to NICU, APGAR score are small (less than 0.005) suggests that vulsulva bearing down technique is significantly different that spontaneous bearing down technique in the above maternal and neonatal outcomes and good result for the health of mother and newborn Conclusion: The Spontaneous pushing method has a negative effect on various factors related to maternal and neonatal outcome factors according to the results in this study. Vulsalva pushing has various benefits towards the better health of Mother and Newborn so it should be accepted as best clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To assess the delivery outcome in nulliparous women at term and to compare the outcomes among induced versus spontaneous labor. Methods: A descriptive study was conducted at Obstetrics and Gynecology department of Patel Hospital, Karachi from April to October 2019. All women with age between 20-40 years, gestational age between 37-42 weeks, and singleton pregnancy were consecutively included. Mode of delivery and Apgar score at 5 minutes were noted. Results: Of 172 women, the mean age of the women was 29.9±4.64. Vaginal delivery was reported in 102 (59.3%) and cesarean section in 70 (40.7%) women. Cesarean delivery was found to be significantly higher among women with >29 years of age (p-value 0.006), >38 weeks of gestational age (p-value <0.001), obesity (p-value <0.001), and induction of labor (p-value 0.020). Mean APGAR score at 1 min was 7.45 ±0.69 and APGAR score at 5min was 8.84 ±0.41. Mean APGAR score at 5 minutes was significantly higher in women vaginal delivery than that of women with cesarean delivery (p-value 0.034). Conclusion: The frequency of vaginal delivery was found higher in nulliparous women presenting at term. Moreover, APGAR score at 5 minutes was found to be significantly different in both groups. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between anemia and cesarean delivery.Methods: A case-control study was conducted in Saad Abu-Alela Hospital in Khartoum, Sudan from March 1 to November 30, 2107. The cases were women who had cesarean delivery; women who delivered vaginally were the controls. Obstetrics history was gathered using a questionnaire.Results: There was no significant difference in age, parity, residence, job, education, and newborn gender between women who delivered by cesarean (n=130) and women who delivered vaginally (n=260). While mean (SD) of the body mass index (29.3 (5.4) kg/m2 vs 26.3 (5.6) kg/m2 , P<0.001) was significantly higher, hemoglobin level (103.0 (8.0) g/L vs 107.0 (8.0) g/L, P=0.001) was significantly lower in women who delivered by cesarean compared with women who delivered vaginally. In logistic regression analyses, age, gravidity, occupation, education, history of miscarriage, and newborn gender were not associated with cesarean delivery; overweight (adjusted odds ratio [AOR] 2.30, 95% confidence interval [CI] 1.24-4.26), obesity (AOR 7.17, 95% CI 3.64-14.13) and anemia (AOR 2.45, 95% CI 1.47-4. 11) were associated with cesarean delivery.Conclusion: The significant association between anemia and cesarean delivery has important implications for the prevention and treatment of anemia among these women. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility of a blood pressure self-monitoring intervention for managing pregnancy hypertension.Study Design: OPTIMUM-BP was an unmasked randomised controlled trial comparing a self-monitoring of blood pressure (SMBP) intervention versus usual care for the management of pregnancy hypertension. Women with chronic (CH) or gestational hypertension (GH) from 4 UK centres were randomised (2:1) intervention to control. Self-monitoring involved daily home blood pressure (BP) measurements, with recording via study diary or telemonitoring. Clinicians were invited to use the home readings in clinical and antihypertensive titration decisions.Main Outcomes: The primary outcomes were recruitment, retention, adherence and persistence with the intervention.Results: Women from four UK centres were randomised: 158/222 (71%) of those approached agreed, comprising: 86 women with chronic hypertension (55 SMBP, 31 control) and 72 with gestational hypertension (49 SMBP, 23 control) of whom outcome data were available from 154 (97%) and were included in the analysis. The median (IQR) number of days with home BP readings per week were 5.5 (3.1-6.5) for those with chronic hypertension and 6.1 (4.5-6.7) with gestational hypertension. Participants persisted with the intervention for 80% or more of their time from enrolment until delivery in 86% (43/50) and 76% (38/49) of those with chronic and gestational hypertension respectively. Recorded clinic and study BPs were similar for both groups.Conclusions: This is the first randomised investigation of BP self-monitoring for the management of pregnancy hypertension and indicates that a large RCT would be feasible. [ABSTRACT FROM AUTHOR]

The international CHIPS Trial (Control of Hypertension In Pregnancy Study) enrolled 987 women with chronic (75%) or gestational (25%) hypertension. Pre-eclampsia developed in 48%; women remained on their allocated BP control and delivered an average of two weeks later. 'Less tight' control (target diastolic BP 100 mmHg) achieved BP that was 6/5mmHg higher (p < 0.001) than 'tight' control (target diastolic 85 mmHg, BP achieved 133/85 mmHg). 'Less tight' (vs. 'tight') control resulted in similar adverse perinatal outcomes (31.5% vs. 30.7%; p = 0.84) that balanced birthweight < 10th percentile (16.1% vs. 19.8%; p = 0.14) against preterm birth (35.6% vs. 31.5%; p = 0.18). 12-month follow-up revealed no compelling evidence for developmental programming of child growth. However, 'less tight' (vs. 'tight') control resulted in more severe maternal hypertension (40.6% vs. 27.5%; p < 0.001), and more women with platelets < 100 × 109/L (4.3% vs. 1.6%; p = 0.02) or symptomatic elevated liver enzymes (4.3% vs. 1.8%; p = 0.03), with no difference in serious maternal complications (3.7% vs. 2.0%; p = 0.17). Labetalol was the drug of choice. Methyldopa did not result in inferior outcomes. Post-hoc, severe hypertension, independent of pre-eclampsia, was associated with heightened increased risk of adverse outcomes, and in 'less tight' control, of serious maternal complications. At no gestational age at initiation of BP control was 'less tight' superior to 'tight'. Women in both groups were equally satisfied with care. 'Less tight' control tended to be more expensive by CAD$6000 (p =0.07) based on neonatal care costs. Collectively, CHIPS publications have provided evidence that women with non-severe pregnancy hypertension should receive 'tight' BP control achieved by a simple algorithm. [ABSTRACT FROM AUTHOR]

Ornithine transcarbamylase deficiency (OTCD) is a rare X‐linked urea cycle disorder. Maternal OTCD can lead to life‐threatening hyperammonemia if untreated. We aimed to compare the outcomes of maternal OTCD when diagnosis is known prior to pregnancy to when diagnosis is made during pregnancy. We performed a systematic literature review on maternal OTCD using the databases Ovid MEDLINE and PubMed from 1982 through 2018. Studies were included if addressed maternal OTCD signs, symptoms, and detailed pregnancy outcomes. We calculated the median or the mean for continuous variables and percentages for categorical variables. Of 36 cases of maternal OTCD, 20 (55%) were diagnosed prior to pregnancy while 16 (45%) were not. In the 20 patients diagnosed prior to pregnancy, 7 (35%) had either a neurologic or psychiatric presentation during pregnancy or postpartum. Two hyperammonemic patients (11%) experienced ICU admission, dialysis, and coma with no maternal deaths. All had a favorable outcome. In the 16 patients not known to have maternal OTCD prior to pregnancy, 13 (81%) had neurologic or psychiatric presentation during pregnancy or postpartum. Four presented with hyperemesis gravidarum. Eleven (69%) hyperammonemic patients had ICU admission and coma and 7 (47%) of them had dialysis. There were 5 (31%) maternal deaths. Three patients (19%) had prolonged hospitalization course. Overall, three male neonatal deaths were reported. Three other male children had liver transplant. Maternal OTCD is associated with high maternal and neonatal morbidity and mortality when diagnosis is made during pregnancy compared to when diagnosis is known prior to pregnancy. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Obstetrics & Gynecology is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Complete uterine rupture, a rare peripartum complication, is often associated with a catastrophic outcome for both mother and child. However, few studies have investigated large datasets to evaluate maternal outcomes after complete ruptures, particularly in unscarred uteri. This paucity of studies is partly due to the rarity of both the event and the serious outcomes, such as peripartum hysterectomy and maternal death. The incidence of uterine rupture is expected to increase, due to increasing cesarean section rates worldwide. Thus, it is important to have more complete knowledge about the immediate maternal outcome following a complete uterine rupture. The objective was to identify maternal outcomes and their risk factors following complete uterine ruptures.Material and Methods: This was a population-based study using data from the Medical Birth Registry of Norway, the Patient Administration System and medical records. Maternities with complete uterine rupture after start of labor in Norway during 1967-2008 (n = 247 births), identified among 2 209 506 women. Uterine ruptures were identified from both registries and were further studied through a review of medical records. Only complete ruptures were included in analysis. The associations between maternal outcomes and demographic and labor risk factors were estimated. Odds ratios (ORs) were determined with crude logistic regressions for each risk factor. Separate multivariable logistic regressions were performed to calculate adjusted odds ratios and 95% confidence intervals (CIs).Results: We identified 88 (35.6%) healthy mothers, 107 (43.3%) severe postpartum hemorrhages without hysterectomy, 51 (20.6%) peripartum hysterectomies, and three (1.2%) maternal deaths. Peripartum hysterectomy decreased significantly in the last years of study. Unscarred uterine ruptures significantly increased the risk of peripartum hysterectomy compared with scarred uterine ruptures (AOR 2.6, 95% CI 1.3-5.3). Other factors that increased the risk of peripartum hysterectomy following rupture were: maternal age ≥35 years (AOR 2.3, 95% CI 1.1-5.0), parity ≥3 vs parity 1-2 (AOR 2.8, 95% CI 1.2-6.7), and rupture detection after vaginal delivery (AOR 2.2, 95% CI 1.1-4.8).Conclusions: Unscarred uteri, older maternal age, parity ≥3, and rupture detection after vaginal delivery showed the highest associations with the risk of peripartum hysterectomy after complete uterine rupture. [ABSTRACT FROM AUTHOR]

Background: Fetal head attitude has a substantial impact on labor progress and outcome. Fetal head deflexion is basically diagnosed by digital vaginal examination during labor.Objectives: To assess the effect of the fetal occiput-spine angle (OSA) measured through transabdominal ultrasound during the first stage of labor on the progress and outcome of labor.Material and Methods: A prospective cohort study conducted on 400 women with term uncomplicated singleton pregnancy with occipitoanterior position during active labor. The angle between two tangential lines to occipital bone and the vertebral body of the first cervical spine was measured during active labor. Follow up till delivery was done. The primary outcome parameter was the labor duration. Secondary outcomes included the mode of delivery, occurrence of maternal and fetal complications.Results: There was a significant longer duration of both first and second stage of labor among women with OSA <126° when compared to those with OSA ≥126° (6.8 ± 2.1 and1.89 ± 0.85 versus 4.16 ± 1.63 and 0.92 ± 0.43, respectively). Women with OSA <126° had higher incidence of CS (46.3 versus 5.7%), perineal tears (10.4 versus 5.1%), vaginal tears (22.4 versus 6.3%), need for oxytocin augmentation (47.8 versus 21.3%) when compared to those with OSA ≥126. OSA at cutoff value of 126° had a sensitivity, specificity, and accuracy of 8264.6 and 78.4% and 93.79 and 92% in prediction of mode of delivery and overall complications, respectively.Conclusions: There was a significantly longer duration of both first and second stages of labor with higher rates of CS and maternal and fetal complications in women with OSA <126. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether induction of labor (IOL), as compared with expectant management, in gestational diabetes mellitus (GDM) mothers at term (between 370/7 and 406/7), decreases caesarean section (CS) rate and the rate of adverse composite neonatal outcomes.Methods: A retrospective cohort study, of all women with GDM and a singleton gestation who delivered at term in a single, tertiary, university-affiliated medical center (2007-2014). We compared outcomes of women who underwent IOL at each week of gestation between 370/7 and 406/7 weeks with women who were managed expectantly. The primary outcome was CS rate.Results: Overall, 2472 GDM patients included in the study, of which 880 women had IOL. CS rate was not found to be significantly different between the groups at any gestational age. IOL at 37 weeks was associated with adverse composite neonatal outcome (aOR 2.2, 95% CI 1.4-3.6) and NICU admission (aOR 2.5, 95% CI 1.4-4.4). At 38 weeks, with NICU admission (aOR 2.0, 95% CI 1.4-2.9), and at 39 weeks with fracture of the clavicle. In a sub-analysis of nulliparous women, IOL at 37 weeks had higher odds of NICU admission and adverse composite neonatal outcomes, at 38 weeks with CS and at 39 weeks with fracture of the clavicle.Conclusions: IOL in GDM mothers at term does not reduce CS rate and may be associated with increased CS rate among nulliparous women at 38 weeks. It is also associated with increased risk for adverse composite neonatal outcome or NICU admission when done prior to 390/7 weeks. [ABSTRACT FROM AUTHOR]

Objective: To assess the maternal and fetal outcome in women with mild to moderate chronic hypertension on antihypertensive drug (methyldopa or nifedipine) therapy compared to no medication.Methods: This multicenter randomized clinical trial was conducted at Menoufia University hospital, Shibin El-kom Teaching hospital and 11 Central hospitals at Menoufia governorate, Egypt.490 pregnant women with mild to moderate chronic hypertension were randomized into three groups; methyldopa group (n = 166), nifedipine group (n = 160) and control or no medication group (n = 164) who were followed from the beginning of pregnancy till the end of puerperium to record maternal and fetal outcome.Results: Mothers in the control (no medication) group were more prone for the development of severe hypertension, preeclampsia, renal impairment, ECG changes, placental abruption and repeated hospital admissions (p < 0.001) when compared to mothers in both treatment groups (methyldopa and nifedipine). Neonates in the control (no medication) group were more prone for prematurity and admission to neonatal ICU (p < 0.001).Conclusion: Antihypertensive drug therapy is advisable in mild to moderate chronic hypertension during pregnancy to decrease maternal and fetal morbidity. When considering which agents to use for treatment, oral methyldopa and nifedipine are valid options. [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: Large observational studies have shown that obstetric and perinatal outcomes are negatively affected in obese women. In contrast, a recent Dutch randomized trial of infertile women and lifestyle weight intervention found no difference between the weight intervention group and the control group in obstetric or neonatal outcomes. We have recently published a large Nordic randomized trial where obese women scheduled for in vitro fertilization (IVF) treatment went through an intensive weight intervention treatment before IVF. No significant effect on live birth rate was found, despite large weight loss in the intervention group. The present study was conducted primarily to find out the effect of weight intervention in obese women scheduled for IVF on mean birthweight and mean deviation from expected birthweight, and secondarily the effect on other perinatal and maternal outcomes.Material and Methods: A secondary analysis of a prospective, randomized controlled trial performed between 2010 and 2016 in the Nordic countries was performed. In all, 317 women were randomized either to weight reduction and IVF treatment (n = 160) or IVF only (n = 157) and the primary end-point was live birth. From this study, all births were analyzed for perinatal and maternal outcomes. Nine infertility clinics participated, including women < 38 years of age planning for IVF, and having a body mass index ≥ 30 and < 35 kg/m2 . Data concerning perinatal and maternal outcomes were gathered from maternal health-care and delivery records for mother and child. All analyses were performed on singletons only.Results: There were 87 live births, 45 singletons in the intervention group and 41 singletons and one twin birth in the control group. The maternal characteristics for the women having a live birth were comparable in the two groups. The primary outcomes, mean birthweight, in the weight intervention and IVF group and the IVF only group were; 3486 g (standard deviation [SD] 523) vs 3584 g (SD 509) (P = 0.46), mean difference -98.6 g (95% confidence interval [CI] -320.3 to 123.2); deviation from expected birthweight 0.25% (SD 10.4) vs 0.87% (SD 12.9), mean difference 1.1% (95% CI -6.1 to 3.9). The estimates of the secondary perinatal and maternal outcomes in the 2 groups were: preterm birth < 37 weeks 2 (4.4%) vs 1 (2.4%) (odds ratio [OR] 1.95; 95% CI 0.17-22.36), small-for-gestational-age 0 (0%) vs 1 (2.4%), mean gestational age (days) 278 vs 280 (P = 0.95), preeclampsia 5 (11.1%) vs 4 (9.8%) (OR 1.19; 95% CI 0.30-4.76), cesarean section 13 (28.9%) vs 10 (24.4%) (OR 1.14; 95% CI 0.45-2.94).Conclusions: The outcomes in both groups were generally good. There are no indications that weight intervention in this setting, in infertile women with obesity WHO class 1 undergoing IVF, has a negative impact on mean birthweight and deviation from expected birthweight. However, the data are not sufficiently robust to draw firm conclusions concerning other outcomes. [ABSTRACT FROM AUTHOR]

Background: Adherent and invasive placenta, termed Placenta Creta Spectrum (PCS), is associated with increased maternal morbidity and mortality. Incidence and risk factors for Placenta Creta are on the rise and call to optimize the obstetric care for this condition.Objectives: We sought to compare maternal and neonatal outcomes between a ProActive Peripartum Multidisciplinary Approach (PAMA) as compared to the urgent management of the Placenta Creta Spectrum patients.Study Design: We conducted a single-center prospective observational study between 2005-2016. PCS patients registered with the implementation of a PAMA protocol 2014-2016 epoch(E2) were compared with the pre-PAMA 2005-2013 epoch(E1), managed by urgent team recruitment. The PAMA protocol is grounded on a continuum of care; A. Antenatal: PCS risk assessment based on clinical history and imaging, surgical, anesthesia, urological consults and designation of a dedicated team to be present at planned surgery; B. Delivery: planned at 34-35 weeks, massive transfusion protocol activation, insertion of ureteral catheters, vertical uterine incision, placement of vessel loops on the iliac vessels, avoidance of active placenta delivery, followed by the decision of hysterectomy or uterine repair; C. Post-operative care: intensive care admission. We evaluated maternal and neonatal outcomes.Results: During the study period 158,438 deliveries were registered in our institution; we identified a total of 72 PCS cases (0.05%): 50(69.4%) in E1 and 22 (30.6%) in E2. Patient characteristics were comparable among epochs. Significantly, patients in E2 vs. E1 had fewer events of massive blood transfusion 36.0% vs. 13.6%, p = 0.05; were transfused less RBC units: median 4 vs. 1.5, p = 0.012, had no transfusion-related respiratory complications and hemorrhage control re-laparotomies. Hysterectomy and hollow visceral injury rates were comparable (72% vs. 63.7%, 26% vs. 22%; respectively). The hysterectomy pathology assessment was available for the majority of the cases in both epochs; percreta diagnosis rate significantly increased in E2. The neonatal outcome was similar among the epochs.Conclusions: Institution of a PAMA protocol for PCS resulted in eliminating the urgent deliveries and in reducing the associated significant hemorrhagic related maternal morbidity, with no increase in the rate of hysterectomy or adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Objectives: Chronic hypertension in pregnancy is an important cause of maternal and neonatal morbidity and mortality. The aim of this study was to determine the effect of severity of chronic hypertension in pregnancy on maternal and perinatal outcome in an Indonesian population.Study Design: This study was performed in Dr Soetomo General Hospital, a tertiary center in East - Java, Indonesia over the period of 2013-2017. Chronic hypertension (CH) was divided using JNC VII criteria, as stage 1 (Blood pressure ≥140/90 mmHg) and Stage 2 (BP > 160/110 mmHg) hypertension.Main Outcome Measures: The primary outcomes were maternal and perinatal outcome. Data was statistically analyzed using Chi-square, Fischer exact test, and Mann-Whitney test (program: SPSS ®23).Results: Over these 5 years, 352 patients were diagnosed with CH. The stage 2 of CH was associated with worse maternal outcome: maternal death (5.6% vs 0.8%; p = 0.016), laboratory values of urinary protein +3 (67% vs 21,5%, p = 0.001) and +4 (12.3% vs 0.4%, p = 0.001), LDH > 600 IU/L (11.3% vs 5.3%, p = 0.04), ALT > 70 IU/L (11.3% vs 4.1%, p = 0.01), AST > 70 IU/L (12.3% vs 5.3%, p = 0.02), BUN > 25 mg/dL (27.4% vs 8.1%, p = 0.001), SK > 1.1 mg/dL (29.2% vs 6.5%, p = 0.001) and Albumin <3 g/dL (65.1% vs 10.2%, p = 0.001), need for ICU admission (76.4% vs 36.6%, p = 0.001), mechanical ventilation (48.1% vs 21.1%, p = 0.001), and occurrence of complications (72.6% vs 57.7%, p = 0.006). Stage 2 CH in pregnancy was associated with an increased risk of maternal death (OR: 7.22; 95% CI: 1.43-36.36; p = 0,016). Stage 2 CH was also associated with worse perinatal outcome, in terms of lower birth weight (1635 ± 863.27 vs 2063.74 ± 935.43, p = 0.001), lower Apgar score (p = 0.001), and number of intra uterine complications such as: IUGR, stillbirth, and placental abruption (27.4% vs 11.8%, p = 0.001).Conclusions: Stage 2 CH in pregnancy is associated with worse maternal and perinatal outcomes compared with stage 1. Intervention to prevent disease progression to stage 2 before pregnancy may improve maternal and perinatal outcomes during pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the relationship between serum beta-human chorionic gonadotropin (β-hCG) and preeclampsia (PE) and the effects of βhCG on maternal and perinatal outcomes.Methods: This case-control study included 125 pregnant women who were admitted to the labor ward of the Maternity Teaching Hospital, Erbil City, Kurdistan, Iraq between January and December 2016. Participants included 50 women with severe PE, 25 with mild PE, and 50 who were normotensive. Serum β-hCG concentrations during labor were compared between groups and maternal and perinatal outcomes were recorded.Results: There were no significant differences in maternal age or parity distribution between the three groups. Gestational age was less than 37 weeks in 34% of the women with severe PE and in 12% of women in the mild PE and normotensive groups (p = 0.012). Mean β-hCG concentration was 37,520.56 mIU/mL in women with severe PE, 16,487 mIU/mL in those with mild PE, and 11,699.82 mIU/mL in those who were normotensive (p < 0.001). There were no significant differences in perinatal outcomes between groups; however, those with β-hCG concentrations ≥ 40,000 mIU/mL had worse neonatal outcomes (lower Apgar scores, higher rate of NICU admission, and lower survival rate) and unfavorable maternal outcomes (seizures, abruption, post-partum hemorrhage, and deep vein thrombosis).Conclusions: There was a significant difference in β-hCG concentrations between women with PE and normotensive women. There were no significant differences in perinatal or maternal outcomes between groups, except in patients with β-hCG ≥ 40,000 mIU/mL. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether there is an association between predicted fetal macrosomia and adverse outcomes in macrosomic newborns (> 4000 g), based on a sonographic evaluation up to 2 weeks prior to delivery.Methods: A retrospective cohort study of 3098 mothers of macrosomic babies who were delivered at our institution (2000-2015). We compared the management and outcomes of women with predicted fetal macrosomia with that of women with unknown fetal macrosomia. The primary outcomes were cesarean section (CS) rate and postpartum hemorrhage. Secondary outcomes were composite maternal and neonatal outcomes and birth injuries.Results: In 601 (19.4%) women fetal macrosomia was predicted, and in 2497 (80.6%) women, fetal macrosomia was unknown. CS rate was more than 3.5 times higher in the group of predicted macrosomia (47.2% vs. 12.7%, P < 0.001) than those with unpredicted macrosomia; not only due to non-progressive labor, but for non-reassuring heart rate as well. However, predicted fetal macrosomia reduced the risk of postpartum hemorrhage (aOR 0.5, 95% CI 0.2-1.0), maternal (aOR 0.3, 95% CI 0.2-0.5) and neonatal composite adverse outcomes (aOR 0.7 95% CI 0.6-0.9). It was also associated with increased risk for induction of labor, episiotomy, 3rd- or 4th-degree tears and a longer maternal hospitalization. Birth injuries and shoulder dystocia were not different between the groups.Conclusions: Antepartum CS was found to be associated with predicted fetal macrosomia. Moreover, a planned CS due to macrosomia was associated with reduced risk for postpartum hemorrhage, maternal and neonatal outcome, even for babies with a mean birth weight < 4500 g. [ABSTRACT FROM AUTHOR]

Objectives: To determine the maternal and fetal outcomes in patients presented with major degree of placenta previa at tertiary care Hospital. Study Design: Descriptive cases series study. Setting: Department of Gynaecology and Obstetrics of Liaquat University Hospital Hyderabad. Period: One year from March 2015 to February 2016. Subject and Methods: All patients with major degrees of placenta previa were included in study. Following delivery the examination of neonate was carried out thoroughly including congenital abnormalities, weight of baby and Apgar score. Babies and mothers were examined within postoperative wards till stitches removal and systematically examined for any postoperative complication. All the data was entered in the proforma. Results: Total 50 patients with major degrees of placenta previa were selected. Majority of the women 40% belonged to the age group of 30-35 years. Most of the women 92.0%, were symptomatic and presented with painless vaginal bleeding. Elective cesarean section was performed among 20% patients while 80% patients underwent emergency cesarean section. 70% patients delivered preterm and 30% delivered at term. 3(6%) fetals were still births and 1(2.0%) presented macerated still birth. 16% fetuses developed respiratory distress syndrome, 6% had intrauterine growth restriction and only one had congenital abnormality (spina bifida). Neonatal weight less than 2500-grams was among 90%. Perinatal mortality was 6(12.0%), and according to maternal outcome, mortality rate was low i.e. just 1 subjects passed away. Conclusion: Major degree of placenta previa is a significant contributor of obstetric hemorrhage in 02nd and 03rd trimester of pregnancy as well as it adversely correlates with feto-maternal outcomes. Instant moving the case of obstetric hemorrhage to hospitals, precise diagnosis, sufficient transfusion provision, intervention without delay can reduce the fetomaternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Obstetric hemorrhage is one of the most dangerous and devasting group of disorders in Obstetrics of which placenta previa contributes 1/5th of the cases. The aim of this study was to analyze the maternal outcome of these cases. Materials and methods: This was a retrospective study conducted in the Department of Obstetrics and Gynecology of King George Hospital, Visakhapatnam from October 2017 to January 2018. Chart records of all women who had placenta previa were reviewed and relevant clinical findings were noted. Results: In the present study, 50 cases of placenta previa were studied regarding type of clinical presentation, clinical course, maternal outcome. Information obtained was arranged statistically. Placenta previa cases were highest in the age group 20-29 years (82%) and in multiparous group (74%). Most common risk factor was previous cesarean section (44%) followed by abortion in 24%. Major degree of placenta previa constitutes 74% i.e., majority of cases and minor degree constitutes 26% of cases. In the present study adherent placenta previa in 8% and a total of 14% required hysterectomy. Conclusions: Placenta previa poses danger to both the mother and the baby with high maternal morbidity and adverse perinatal outcome. [ABSTRACT FROM AUTHOR]

Objective: To compare the proportion of Twin pregnancies in different areas of Pakistan, also compare the obstetric outcomes in twins and singleton pregnancies. Study Design: Observational, Cross-Sectional Study. Place and Duration: This study was conducted at MCH Center, PIMS. Islamabad, from 1st March 2010 to 30th May, 2011. Methodology: This is a part of WHO Multi-Country survey 2011. In this study we randomly selected 7 Health facility centers from Punjab and Sindh (The big provinces of Pakistan) and 2 Health facility centers from Islamabad. Hospitals with minimum of 1,000 deliveries per year were selected to participate. All pregnant women, who met our inclusion criteria, were enrolled during the study period. One sample t-test was used to predict the incidence of twin pregnancies in different region. Chi square test was used to test the association between incidence of twin pregnancies and area. Results: The proportion of twin pregnancies was significantly high in Islamabad as compared to other areas with p value 0.000. There was significant association between twin pregnancies and severe maternal outcome with p value of 0.000. Highest maternal mortality was observed in Punjab (0.4%). Significant association was seen between maternal mortality and geographical area with p value of 0.04. Conclusion: Twin pregnancies are associated with more pregnancy complications and poorer neonatal outcome as compared to singleton. [ABSTRACT FROM AUTHOR]