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Aim: According to delivery room guidelines, an optimal position is not specified for the stabilization of the baby. This study aimed to define the positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates. Materials and Methods: A total of 60 neonates delivered by cesarean section stabilized randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, heart rates (HR), arterial oxygen saturations via pulse oximetry, and perfusion indexes (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation (SpO2) of the patients was monitored by near-infrared spectroscopy. Results: In the prone position, the 1st minute Apgar score was significantly lower than other groups, but no difference was observed at the 5th minute Apgar scores (1st min Apgarprone, p=0.05). Although there was no statistically significant difference, the prone position had the lowest HR at the 2nd minute, while the supine posture had the greatest HR at the 5th and 10th minutes. While the groups’ SpO2 values were similar, the left-side group’s perfusion rates increased at the 5th and 10th minute marks (5th and 10th min PIleft-side, p=0.67, p=0.21, respectively). Regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction did not differ significantly between groups at the 5th and 10th minute time intervals. Although right and left rScO2 were found to be higher in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rScO2 values were found to be similar in all groups at the 10th minute. Conclusion: Adaptation parameters were not affected by position, except for lower 1st minute Apgar scores in the prone group and higher perfusion indices in the left lateral position. Cerebral perfusion was similar in all groups. The left-side position, which results in a higher PI, may be a good alternative. Studies with larger case series may provide further information.

Abstract Background Decision-to-delivery time (DDT), a crucial factor during the emergency caesarean section, may potentially impact neonatal outcomes. This study aims to assess the association between DDT and various neonatal outcomes. Methods A comprehensive search of PubMed, Scopus, Cochrane Library, and Google Scholar databases was conducted. A total of 32 eligible studies that reported on various neonatal outcomes, such as Apgar score, acidosis, neonatal intensive unit (NICU) admissions and mortality were included in the review. Studies were selected based on predefined eligibility criteria, and a random-effects inverse-variance model with DerSimonian-Laird estimate of tau² was used for meta-analysis. Heterogeneity and publication bias were assessed using I² statistics and Egger’s test, respectively. Results The meta-analysis revealed a significant association between DDT

Abstract Adverse neonatal outcomes are a prevailing risk factor for both short- and long-term mortality and morbidity in infants. Given the importance of these outcomes, refining their assessment is paramount for improving prevention and care. Here we aim to enhance the assessment of these often correlated and multifaceted neonatal outcomes. To achieve this, we employ factor analysis to identify common and unique effects and further confirm these effects using criterion-related validity testing. This validation leverages methylome-wide profiles from neonatal blood. Specifically, we investigate nine neonatal health risk variables, including gestational age, Apgar score, three indicators of body size, jaundice, birth diagnosis, maternal preeclampsia, and maternal age. The methylomic profiles used for this research capture data from nearly all 28 million methylation sites in human blood, derived from the blood spot collected from 333 neonates, within 72 h post-birth. Our factor analysis revealed two common factors, size factor, that captured the shared effects of weight, head size, height, and gestational age and disease factor capturing the orthogonal shared effects of gestational age, combined with jaundice and birth diagnosis. To minimize false positives in the validation studies, validation was limited to variables with significant cumulative association as estimated through an in-sample replication procedure. This screening resulted in that the two common factors and the unique effects for gestational age, jaundice and Apgar were further investigated with full-scale cell-type specific methylome-wide association analyses. Highly significant, cell-type specific, associations were detected for both common effect factors and for Apgar. Gene Ontology analyses revealed multiple significant biologically relevant terms for the five fully investigated neonatal health risk variables. Given the established links between adverse neonatal outcomes and both immediate and long-term health, the distinct factor effects (representing the common and unique effects of the risk variables) and their biological profiles confirmed in our work, suggest their potential role as clinical biomarkers for assessing health risks and enhancing personalized care.

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Background: Decision-to-delivery time (DDT), a crucial factor during the emergency caesarean section, may potentially impact neonatal outcomes. This study aims to assess the association between DDT and various neonatal outcomes. Methods: A comprehensive search of PubMed, Scopus, Cochrane Library, and Google Scholar databases was conducted. A total of 32 eligible studies that reported on various neonatal outcomes, such as Apgar score, acidosis, neonatal intensive unit (NICU) admissions and mortality were included in the review. Studies were selected based on predefined eligibility criteria, and a random-effects inverse-variance model with DerSimonian-Laird estimate of tau² was used for meta-analysis. Heterogeneity and publication bias were assessed using I² statistics and Egger's test, respectively. Results: The meta-analysis revealed a significant association between DDT < 30 min and increased risk of Apgar score < 7 (OR 1.803, 95% CI: 1.284–2.533) and umbilical cord pH < 7.1 (OR 4.322, 95% CI: 2.302–8.115), with substantial heterogeneity. No significant association was found between DDT and NICU admission (OR 0.982, 95% CI: 0.767–1.258) or neonatal mortality (OR 0.983, 95% CI: 0.565–1.708), with negligible heterogeneity. Publication bias was not detected for any outcomes. Conclusions: This study underscores the association between shorter DDT and increased odds of adverse neonatal outcomes such as low Apgar scores and acidosis, while no significant association was found in terms of NICU admissions or neonatal mortality. Our findings highlight the complexity of DDT's impact, suggesting the need for nuanced clinical decision-making in cases of emergency caesarean sections. [ABSTRACT FROM AUTHOR]

Aim: According to delivery room guidelines, an optimal position is not specified for the stabilization of the baby. This study aimed to define the positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates. Materials and Methods: A total of 60 neonates delivered by cesarean section stabilized randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, heart rates (HR), arterial oxygen saturations via pulse oximetry, and perfusion indexes (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation (SpO2) of the patients was monitored by near-infrared spectroscopy. Results: In the prone position, the 1st minute Apgar score was significantly lower than other groups, but no difference was observed at the 5th minute Apgar scores (1st min Apgarprone, p=0.05). Although there was no statistically significant difference, the prone position had the lowest HR at the 2nd minute, while the supine posture had the greatest HR at the 5th and 10th minutes. While the groups' SpO2 values were similar, the left-side group's perfusion rates increased at the 5th and 10th minute marks (5th and 10th min PIleft-side, p=0.67, p=0.21, respectively). Regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction did not differ significantly between groups at the 5th and 10th minute time intervals. Although right and left rScO2 were found to be higher in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rScO2 values were found to be similar in all groups at the 10th minute. Conclusion: Adaptation parameters were not affected by position, except for lower 1st minute Apgar scores in the prone group and higher perfusion indices in the left lateral position. Cerebral perfusion was similar in all groups. The left-side position, which results in a higher PI, may be a good alternative. Studies with larger case series may provide further information. [ABSTRACT FROM AUTHOR]

Adverse neonatal outcomes are a prevailing risk factor for both short- and long-term mortality and morbidity in infants. Given the importance of these outcomes, refining their assessment is paramount for improving prevention and care. Here we aim to enhance the assessment of these often correlated and multifaceted neonatal outcomes. To achieve this, we employ factor analysis to identify common and unique effects and further confirm these effects using criterion-related validity testing. This validation leverages methylome-wide profiles from neonatal blood. Specifically, we investigate nine neonatal health risk variables, including gestational age, Apgar score, three indicators of body size, jaundice, birth diagnosis, maternal preeclampsia, and maternal age. The methylomic profiles used for this research capture data from nearly all 28 million methylation sites in human blood, derived from the blood spot collected from 333 neonates, within 72 h post-birth. Our factor analysis revealed two common factors, size factor, that captured the shared effects of weight, head size, height, and gestational age and disease factor capturing the orthogonal shared effects of gestational age, combined with jaundice and birth diagnosis. To minimize false positives in the validation studies, validation was limited to variables with significant cumulative association as estimated through an in-sample replication procedure. This screening resulted in that the two common factors and the unique effects for gestational age, jaundice and Apgar were further investigated with full-scale cell-type specific methylome-wide association analyses. Highly significant, cell-type specific, associations were detected for both common effect factors and for Apgar. Gene Ontology analyses revealed multiple significant biologically relevant terms for the five fully investigated neonatal health risk variables. Given the established links between adverse neonatal outcomes and both immediate and long-term health, the distinct factor effects (representing the common and unique effects of the risk variables) and their biological profiles confirmed in our work, suggest their potential role as clinical biomarkers for assessing health risks and enhancing personalized care. [ABSTRACT FROM AUTHOR]

Abstract Gestational diabetes is characterized by hyperglycaemia diagnosed during pregnancy. Gestational and pregestational diabetes can have deleterious effects during pregnancy and perinatally. The baby's weight is frequently above average and might reach macrosomia (≥ 4 kg), which can reduce pregnancy time causing preterm births, and increase foetal-pelvic disproportion which often requires delivery by caesarean section. Foetal-pelvic disproportion due to the baby’s weight can also cause foetal distress resulting in lower Apgar scores. To analyse the association between pregestational and gestational diabetes with maternal and foetal risk. We conducted a retrospective cohort study in women pregnant between 2012 and 2018 in the region of Lleida. Regression coefficients and 95% confidence intervals (CI) were used. The multivariate analysis showed statistically significant associations between pregestational diabetes and: prematurity (OR 2.4); caesarean section (OR 1.4); moderate (OR 1.3), high (OR 3.3) and very high (OR 1.7) risk pregnancies; and birth weight ≥ 4000 g (macrosomia) (OR 1.7). In getational diabetes the multivariate analysis show significant association with: caesarean section (OR 1.5); moderate (OR 1.7), high (OR 1.7) and very high (OR 1.8) risk pregnancies and lower 1-minuto Apgar score (OR 1.5). Pregestational and gestational diabetes increase: pregnancy risk, caesarean sections, prematurity, low Apgar scores, and macrosomia.

Background and Aim: The Apgar score is a useful assessment of neonatal viability in dogs. The Apgar score in puppies born by cesarean section can be lower than vaginal delivery because all anesthetic drugs can cross the placenta. Therefore, anesthetic drugs with minimal cardiorespiratory effect and rapid elimination are recommended for cesarean section. The present study aimed to compare Apgar scores in puppies born after the induction of etomidate, alfaxalone or propofol, and those maintained with isoflurane inhalation during cesarean section. Materials and Methods: Thirty-six bitches were equally divided in the three anesthetic drug groups. Modified Apgar scores were assessed at 5, 15, and 60 min after delivery. Intraoperative vital signs and Apgar scores were compared using a linear mixed model and adjusted pairwise comparisons using Bonferroni analysis. Results: A total of 125 puppies were included in this study. Age, body weight, litter size, type of surgery, delivery time, anesthetic and surgical duration, and intraoperative vital signs did not significantly differ between the groups. Puppies in the alfaxalone and propofol groups had significantly higher Apgar scores than the etomidate group in both elective and emergency surgery. In elective surgery, Apgar scores at 5 min after delivery did not differ significantly between groups. At 15 and 60 min after delivery, Apgar scores in the etomidate group were significantly lower than those in the other groups. In emergency surgery, Apgar scores were significantly lower in the etomidate group than in the alfaxalone group at all time points. Conclusion: Induction with alfaxalone and propofol resulted in better outcomes with higher Apgar scores and neonatal viability than etomidate. Therefore, alfaxalone and propofol should be used as anesthetic induction drugs in both elective and emergency cesarean sections.

Gestational diabetes is characterized by hyperglycaemia diagnosed during pregnancy. Gestational and pregestational diabetes can have deleterious effects during pregnancy and perinatally. The baby's weight is frequently above average and might reach macrosomia (≥ 4 kg), which can reduce pregnancy time causing preterm births, and increase foetal-pelvic disproportion which often requires delivery by caesarean section. Foetal-pelvic disproportion due to the baby's weight can also cause foetal distress resulting in lower Apgar scores. To analyse the association between pregestational and gestational diabetes with maternal and foetal risk. We conducted a retrospective cohort study in women pregnant between 2012 and 2018 in the region of Lleida. Regression coefficients and 95% confidence intervals (CI) were used. The multivariate analysis showed statistically significant associations between pregestational diabetes and: prematurity (OR 2.4); caesarean section (OR 1.4); moderate (OR 1.3), high (OR 3.3) and very high (OR 1.7) risk pregnancies; and birth weight ≥ 4000 g (macrosomia) (OR 1.7). In getational diabetes the multivariate analysis show significant association with: caesarean section (OR 1.5); moderate (OR 1.7), high (OR 1.7) and very high (OR 1.8) risk pregnancies and lower 1-minuto Apgar score (OR 1.5). Pregestational and gestational diabetes increase: pregnancy risk, caesarean sections, prematurity, low Apgar scores, and macrosomia. [ABSTRACT FROM AUTHOR]

Background: Prenatal exercise improves birth outcomes, but research into exercise dose–response effects is limited. Methods: This study is a retrospective, secondary analysis of pooled data from three blinded, prospective, randomized controlled trials. Prenatal exercise frequency, intensity, type, time, and volume (FITT‐V) were assessed in supervised sessions throughout pregnancy. Gestational age (GA), neonatal resting heart rate (rHR), morphometrics (body circumferences, weight‐to‐length and ponderal index) Apgar and reflex scores, and placental measures were obtained at birth. Stepwise regressions and Pearson correlations determined associations between FITT‐V and birth outcomes. Results: Prenatal exercise frequency reduces ponderal index (R2 = 0.15, F = 2.76, p =.05) and increased total number of reflexes present at birth (R2 = 0.24, F = 7.89, p <.001), while exercise intensity was related to greater gestational age and birth length (R2 = 0.08, F = 3.14; R2 = 0.12, F = 3.86, respectively; both p =.04); exercise weekly volume was associated with shorter hospital stay (R2 = 0.24, F = 4.73, p =.01). Furthermore, exercise type was associated with placenta size (R2 = 0.47, F = 3.51, p =.01). Conclusions: Prenatal exercise is positively related to birth and placental outcomes in a dose‐dependent manner. [ABSTRACT FROM AUTHOR]

Background: In order to reduce the complications of perineal damage and the pain caused by it for the mother, this study was conducted to determine the effect of warm perineal compress on perineal trauma (1st-, 2nd-, 3rd-, and 4th-degree perineal tears), postpartum pain, intact perineum (primary outcomes), episiotomy, length of the second stage, and APGAR score at 1 and 5 min after childbirth (secondary outcome). Methods: PubMed, Scopus, Cochrane Central Register of Controlled Trials, Google Scholar, Web of Science, SID, Magiran, and ClinicalTrials.gov were searched to identify the relevant articles from inception to November 1, 2022, with language restriction (only English and Persian). A manual search was also performed. Risk of bias 2 (RoB2) and ROBIN-I were employed to evaluate the quality of the included papers. Meta-analysis was conducted using RevMan 5.3. Heterogeneity was assessed using I2. In cases with high heterogeneity, subgroup analysis was utilized based on the parity and ethnicity, and time of pain measurement after delivery also a random-effects model was used instead of a fixed-effects model. Trial sequential analysis (TSA) was performed for the primary outcomes. The certainty of evidence was assessed using the GRADE approach. Results: A total number of 228 articles were found in databases. Of these articles, eighty-six were screened by title, 27 by abstract, and 21 by full text. Finally, 14 articles were included, of which ten were RCT and four were non-RCT. Meta-analysis results revealed that warm perineal compress significantly reduced perineal pain (RR 0.23, 95% CI 0.08–0.66; P = 0.0006), average pain (SMD − 0.73, 95% CI 1.23 to − 0.23; P = 0.004), second-degree perineal tear (RR 0.65, 95% CI 0.54–0.79; P˂0.00001), third-degree perineal tear (RR 0.32, 95% CI 0.15–0.67; P = 0.003), fourth-degree perineal tear (RR 0.11, 95% CI 0.01–0.87; P = 0.04), episiotomy (RR 0.63, 95% CI 0.46–0.86; P = 0.004), and intact perineum significantly increased (RR 3.06, 95% CI 1.79–5.22; P < 0.0001) compared to the control group. However, there was no statistically significant difference in terms of first-degree tear (RR 1.04, 95% CI 0.86–1.25; P = 0.72), length of the second stage of labor (MD − 0.60, 95% CI − 2.43 to 1.22; P = 0.52), the first minute (MD − 0.03, 95% CI − 0.07 to 0.02; P = 0.24) and the fifth minute Apgar score (MD − 0.02, 95% CI − 0.07 to 0.03; P = 0.46) between the two groups. Conclusion: Warm perineal compress administered during the second stage of labor reduce postpartum pain, second and third-degree perineal tears, and episiotomy rate while it increases the incidence of intact perineum compared to the control group. [ABSTRACT FROM AUTHOR]

Background/Aims: Vaginal birth following a previous caesarean section is considered a safe option for subsequent births following personal planning and counselling. The aim of this study was to compare neonatal outcomes for both elective caesarean and vaginal birth after a previous caesarean section to aid decision making for women/pregnant people. Methods: This quantitative study used retrospective data from low-risk pregnant people/women at term with one previous caesarean section (n=392). Logistic regression was used to determine the impact of mode of birth on neonatal outcomes. Further descriptive analyses were carried out to explore the results and reasons for admission to neonatal unit. Results: Apgar scores were higher in the vaginal birth group compared to the elective repeat caesarean group. There were no differences in neonatal unit admissions by mode of birth. Conclusions: There is minimal difference in neonatal outcomes, regardless of intention for either vaginal birth following a previous caesarean section or elective repeat caesarean. To fully investigate the factors that impacted Apgar scores and neonatal unit admissions for these groups, a much larger sample is needed. [ABSTRACT FROM AUTHOR]

Background and Aim: The Apgar score is a useful assessment of neonatal viability in dogs. The Apgar score in puppies born by cesarean section can be lower than vaginal delivery because all anesthetic drugs can cross the placenta. Therefore, anesthetic drugs with minimal cardiorespiratory effect and rapid elimination are recommended for cesarean section. The present study aimed to compare Apgar scores in puppies born after the induction of etomidate, alfaxalone or propofol, and those maintained with isoflurane inhalation during cesarean section. Materials and Methods: Thirty-six bitches were equally divided in the three anesthetic drug groups. Modified Apgar scores were assessed at 5, 15, and 60 min after delivery. Intraoperative vital signs and Apgar scores were compared using a linear mixed model and adjusted pairwise comparisons using Bonferroni analysis. Results: A total of 125 puppies were included in this study. Age, body weight, litter size, type of surgery, delivery time, anesthetic and surgical duration, and intraoperative vital signs did not significantly differ between the groups. Puppies in the alfaxalone and propofol groups had significantly higher Apgar scores than the etomidate group in both elective and emergency surgery. In elective surgery, Apgar scores at 5 min after delivery did not differ significantly between groups. At 15 and 60 min after delivery, Apgar scores in the etomidate group were significantly lower than those in the other groups. In emergency surgery, Apgar scores were significantly lower in the etomidate group than in the alfaxalone group at all time points. Conclusion: Induction with alfaxalone and propofol resulted in better outcomes with higher Apgar scores and neonatal viability than etomidate. Therefore, alfaxalone and propofol should be used as anesthetic induction drugs in both elective and emergency cesarean sections. [ABSTRACT FROM AUTHOR]

Introduction: the indigenous population is vulnerable and there is limited understanding of their somatometric indicators and APGAR score at birth. Aim: the objective of the study was to explore the association of the condition of indigenous newborn (INB) on somatometric parameters and APGAR score at birth. Methods: this study employed an exploratory cross-sectional design, utilizing the registry of newborns (NB) from a private clinic. The APGAR score at one minute after birth, as well as nutritional indicators derived from measurements of weight, height, and perimeters, were taken into consideration. The statistical analysis involved the use of logistic regressions. Results: the analysis included 7413 NB (1.8 % INB), 52 % were male and 8.1 % were born preterm (gestational age < 37 weeks). In comparison to non-indigenous NB, the INB group showed a higher risk of malnutrition (8 % vs. 6.3 %; p < 0.001), a greater prevalence of excess weight (7.3 % vs. 1.8 %; p < 0.001), smaller head circumference (33.6 cm vs. 34.1 cm; p = 0.017), smaller abdominal circumference (30.9 cm vs. 31.5 cm; p = 0.011), and a higher occurrence of low APGAR scores (< 7) (8.7 % vs. 1.2 %; p < 0.001). Furthermore, the indigenous condition was independently associated with low birth weight (< 2.500 g) (OR, 0.4; 95 % CI, 0.2; 0.9), excess head circumference (OR, 2.7; 95 % CI, 1.5; 4.7), and APGAR score < 7 points (OR, 8.3; 95 % CI, 4.2; 16.5). Conclusions: the indigenous condition was associated with factors that have adverse effects on the health of NB, including reduced head circumference and suboptimal performance on the APGAR scale. These results emphasize the importance of improving access to and quality of prenatal healthcare services for indigenous communities. [ABSTRACT FROM AUTHOR]

Childbirth is a defining moment in anyone's life, and it occurs 140 million times per year. Largely a physiologic process, parturition does come with risks; one mother dies every two minutes. These deaths occur mostly among healthy women, and many are considered preventable. For each death, 20 to 30 mothers experience complications that compromise their short- and long-term health. The risk of birth extends to the newborn, and, in 2020, 2.4 million neonates died, 25% in the first day of life. Hence, intrapartum care is an important priority for society. The American Journal of Obstetrics & Gynecology has devoted two special Supplements in 2023 and 2024 to the clinical aspects of labor at term. This article describes the content of the Supplements and highlights new developments in the induction of labor (a comparison of methods, definition of failed induction, new pharmacologic agents), management of the second stage, the value of intrapartum sonography, new concepts on soft tissue dystocia, optimal care during the third stage, and common complications that account for maternal death, such as infection, hemorrhage, and uterine rupture. All articles are available to subscribers and non-subscribers and have supporting video content to enhance dissemination and improve intrapartum care. Our hope is that no mother suffers because of lack of information. [ABSTRACT FROM AUTHOR]

Background & Objective: Despite the high efficacy of the Apgar score in finding respiratory distress, a low Apgar score doesn't necessarily indicate fetal hypoxiaasphyxia. Umbilical Artery pH (UApH) is one of the best indicators of fetal hypoxia. Therefore, it's so beneficial to consider these criteria and their relationship with the Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively which reduces the unnecessary cesarean section (CS) rate. Materials & Methods: 162 full-term (=259 days) neonates delivered by CS with the diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother's age, gravidity, gestational age, birth weight, newborn sex, and causes of decreased FHR on Apgar scores and UApH were studied as well. Results: The most common cause of decreased FHR was fetal distress, boys had higher weight (P=0.033) and lower UApH (P=0.049) than girls. Other parameters were not different significantly between both sexes. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (P<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05 (CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%: 1-1.26). Conclusion: Mild acidemia (UApH<7.2) at least in a male fetus would be a good predictor for postnatal complications and need for NICU admission. Future studies with more samples are suggested. [ABSTRACT FROM AUTHOR]

Latar belakang. Enterokolitis nekrotikans merupakan penyakit yang dapat terjadi pada neonatus kurang bulan kecil masa kehamilan. Prevalensi neonatus kecil masa kehamilan di Indonesia tahun 2012 mencapai 18% dengan neonatus kurang bulan sejumlah 8800. Penelitian sebelumnya menyatakan insidensi enterokolitis nekrotikans pada neonatus kurang bulan kecil masa kehamilan sebesar 3,2%. Hipoksia kronis menyebabkan hipoksia perinatal sehingga didapatkan Skor Apgar yang rendah saat lahir. Skor Apgar rendah diduga dapat menyebabkan hipoperfusi splanknik yang memicu peningkatan derajat keparahan enterokolitis nekrotikans. Tujuan. Mengetahui korelasi antara Skor Apgar dengan derajat keparahan enterokolitis nekrotikans pada neonatus kurang bulan kecil masa kehamilan. Metode. Studi potong lintang ini melibatkan neonatus kurang bulan kecil masa kehamilan yang terdiagnosis enterokolitis nekrotikans dan tidak enterokolitis nekrotikans. Data berasal dari rekam medis pasien yang dirawat pada tahun 2018-2022 di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung. Hasil. Terdapat 55 neonatus kurang bulan kecil masa kehamilan yang terdiagnosis enterokolitis nekrotikans dan 55 neonatus kurang bulan kecil masa kehamilan tidak enterokolitis nekrotikans. Hasil riset didapatkan korelasi yang signifikan antara Skor Apgar menit ke-1 (p

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS. Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery. Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p<0.05). Blood Transfusion and Premature rupture of membrane were not associated with any of the two groups. (p>0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p<0.01). Mean stay of hospitalization was significantly higher in LSCS group (p<0.01). Conclusion: Better Bisho's score has significantly more chances of successful VBAC. VBAC has better APGAR score at 1 min and at 5 min compared to LSCS group. Birth weight is not affected by the type of delivery after first caesarian delivery. [ABSTRACT FROM AUTHOR]

Introduction: Epidural anesthesia along with an experienced anaesthetist, a dedicated obstetrician and a trained midwife has ability to convert the painful and extensively stressful labour labour event into a less stressful event. The purpose of this study was to compare feto-maternal outcome of labour with epidural analgesia to those without epidural analgesia. Methodology: The prospective, comparative and interventional study was conducted among primigravida with full term pregnancy admitted to maternity ward. Study group were given epidural analgesia which was compared with control group who did not give any labour analgesia. Maternal and foetal outcome were assessed. Results: Difference in mean duration of first stage and second stage of labour was statistically non-significant between two groups (p>0.05). Before the analgesia (basal) mean VAS was 8.45 and 8.32 in women who received epidural anesthesia and cases who didn't receive epidural anesthesia respectively. The mean VAS was significantly less in women who received epidural anesthesia (p<0.001). Conclusion: Use of epidural analgesia during the later stage of labour, when cervical dilatation was more than 4 cm, provides better analgesic effect with minimal side effect and almost equivalent duration of labour. Epidural analgesia doesn't unnecessarily increase operative delivery rate and had no adverse effect on APGAR score of newborns. [ABSTRACT FROM AUTHOR]

Simple Summary: Puppy mortality is a widespread problem in small animal medicine. Apgar scoring, adapted for puppies performed by trained veterinary staff, was previously shown to be useful in identifying newborn puppies with an increased risk of mortality. The majority of puppies, however, are born in a home or kennel environment. In most whelpings, early evaluations and interventions are performed by the breeder. Therefore, we wanted to evaluate if a modified Apgar protocol for neonatal monitoring would be usable by breeders in a home environment. Our aim was to evaluate potential associations between neonatal scores, delivery times, birth weights, growth rates, and puppy mortality. Twenty-one bitches gave birth to 113 puppies by vaginal delivery. Neonatal scores were related to puppy mortality. Puppies with low neonatal scores had a longer expulsion interval and lower viability. Mortality was higher in puppies with a low relative birthweight. Puppies with a negative growth rate the first two days after parturition did not have a significantly higher risk of mortality in this study. Our results indicate that a modified and simplified neonatal scoring, performed by breeders approximately 5 min after birth, could be useful to identify puppies at risk of mortality. Mortality of neonatal puppies is a widespread problem in small animal medicine. Neonatal monitoring, according to standardized protocols, can be useful for identifying puppies that are at risk of mortality. Prompt intervention on weak puppies could increase survival rates. Apgar scoring adapted for puppies has been demonstrated to be associated with mortality and is usually performed by trained veterinary staff. The majority of puppies, however, are born in a home or kennel environment and not at a veterinary clinic. Our aims were, therefore, to evaluate if a modified protocol for neonatal monitoring would be usable by breeders in a home environment. We wanted to evaluate potential associations between modified Apgar scores, birth weights, delivery times, growth rates, and puppy mortality. Modified Apgar scores were related to the viability of live-born puppies (p < 0.0013). The viability and expulsion time of each puppy were significantly related (p = 0.010 with all puppies included and p = 0.038 with only live-born puppies included). Viability was significantly related to relative birthweight (p < 0.01). Puppies with a negative growth rate the first two days after parturition did not have a significantly higher risk of mortality. In conclusion, a modified and simplified Apgar scoring performed by breeders approximately 5 min after birth was associated with puppy mortality. [ABSTRACT FROM AUTHOR]

Background: Given the demanding nature of labour, alterations in the cardiotocography (CTG) trace may be an indication of how the foetus is responding to continuous hypoxic or mechanical stressors, such as compression of the umbilical cord or a decrease in placental blood flow. Any foetus deemed to be at a "high risk" of experiencing intrapartum hypoxic damage requires constant foetal monitoring. Objective: The aim of our study was to evaluate CTG in high-risk pregnancy and its correlation with maternal and fetal outcomes. Methodology: Two hundred antenatal patients with ≥ 37 weeks period of gestation with high-risk pregnancies were included in the study. As per the RCOG guidelines, the CTG analysis of recruited patients was performed. Maternal and fetal outcomes were then correlated with the CTG. Results: The mean age of the patients was 27.84 ± 4.58 years. Patients with non-reactive CTG found to have significantly high risk of premature rupture of membranes. Prolonged labour was also encountered significantly high in patients with non-reactive CTG. No significant difference in the mode of delivery was observed between patients with reactive or non-reactive CTG. APGAR score was significantly low in patients with non-reactive CTG. NICU admissions was also significantly high in patients non-reactive CTG. Conclusion: A non-reactive CTG indicate a lack of fetal well-being, which may be due to various causes such as fetal distress, umbilical cord compression, or low fetal oxygenation. In present study, we found that patients with non-reactive CTG tends to have poor maternal and foetal outcomes compared to the patients with reactive CTG which indicate potential role of CTG in predicting outcomes in high-risk pregnancy. [ABSTRACT FROM AUTHOR]

This aim of this study was to investigate maternal hematological laboratory parameters of term infants before birth diagnosed with asphyxia compared to mothers of healthy term infants and predict asphyxia by these parameters. This study was conducted on 109 and 192 mothers of the fetus with asphyxia and healthy, respectively. Laboratory parameters of complete blood count, including PDW (platelet distribution width), PCT (procalcitonin) and NLR (neutrophil/lymphocyte ratio), were recorded before birth from pregnant women. PDW and basophil counts were significantly higher in the asphyxia group than healthy group (p:.000). The cut-off level of 19.425 accurately predicted the occurrence of asphyxia (AUC = 0.724 (95% confidence interval 0.65–0.78), p =.000). Basophil count could predict asphyxia, especially the cut-off level of> 0.15(10³/μL) (AUC = 0.67) (95% confidence interval 0.60–0.74, p =.000). To predict asphyxia before labor, a cheap and routine test of PDW can be used after more research in this area. What is already known on this subject? Asphyxia is still an unsolved problem in neonatal mortality and morbidity, and it is seen in babies of mothers who carry some risks during pregnancy (such as multiple pregnancy, baby of mother with preeclampsia, meconium aspiration, diabetes); however, it is known that it is a subject that is still not fully understood as it can also occur as a result of labor that does not have any risk factors and goes well. What do the results of this study add? In term fetuses without risk factors, it can be predicted to a certain extent whether the fetus will be diagnosed with asphyxia from the hemogram test that can work from the blood of the mother before birth. What are the implications of these findings for clinical practice and/or further research? In clinical practice, asphyxia can be estimated with a cheap and simple test, without any extra examination, by looking at the routine blood tests taken from the mother before going into labor. [ABSTRACT FROM AUTHOR]

Delivering piglets is one of the most energy-demanding activities sows undergo in their lifetime. Sows can have myometrial contractions from 2 to 12 h before the first piglet is expelled as well as a nest-building behavior. Thus, when the first piglet is delivered, the female has already used part of her energy supply. When the sow gets exhausted due to lack of energy, the farrowing process can be interrupted, causing damage to the viability and vitality of the piglets. In the present study, we evaluated the effects of feeding sows an energy supplement at the onset of farrowing on farrowing kinetics and piglet vitality. The energy supplement consisted of a blend of carbohydrates and glycerol which provides 439 kJ of metabolizable energy per kg of metabolic weight. A total of 180 sows were used. At the onset of farrowing, sows were assigned to one of the following treatments: sows that were not supplied energy at the onset of farrowing, serving as controls (CON, n = 85); sows fed the energy supplement at the onset of farrowing (ESP, n = 95). Farrowing kinetics, blood glucose concentration, and piglet vitality were recorded for each sow. Blood glucose concentration was assessed by puncturing the auricular vein and using a portable glucometer at four different time points: after the birth of the 1st piglet (T0), and at 20 (T20), 40 (T40), 80 (T80), and 180 (T180) min after the birth of the 1st piglet. The vitality of the 1st, 6th, 12th, 17th, and 20th piglet born was evaluated using the Apgar score. Piglet birth weight and average colostrum intake were measured. The farrowing duration was 20 min shorter (P 0.05). In conclusion, feeding a blend of carbohydrates and glycerol as an energy supplement for farrowing sows improved farrowing kinetics and piglet vitality score.

Abstract Introduction Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations. Purpose To determine the association between inadequate PNC (

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS. Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery. Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p

Introduction: Epidural anesthesia along with an experienced anaesthetist, a dedicated obstetrician and a trained midwife has ability to convert the painful and extensively stressful labour labour event into a less stressful event. The purpose of this study was to compare feto-maternal outcome of labour with epidural analgesia to those without epidural analgesia. Methodology: The prospective, comparative and interventional study was conducted among primigravida with full term pregnancy admitted to maternity ward. Study group were given epidural analgesia which was compared with control group who did not give any labour analgesia. Maternal and foetal outcome were assessed. Results: Difference in mean duration of first stage and second stage of labour was statistically non-significant between two groups (p>0.05). Before the analgesia (basal) mean VAS was 8.45 and 8.32 in women who received epidural anesthesia and cases who didn’t receive epidural anesthesia respectively. The mean VAS was significantly less in women who received epidural anesthesia (p

Background: Children roaming the streets estimated at 1 in 10 by a 2021 United Nation Children’s Funds (UNICEF) report is a growing problem, in cities of lower- and middle-income African countries. Studies of street children with no family ties abound, but there is a paucity of studies on children on the street who exist within families and return home daily. We explored the family dynamics of children on the streets of Ibadan, emphasising family structure, resources and relationships. Methods: Using an exploratory design based on a qualitative approach 53 participants were interviewed, including children on the streets, parental figures, child-welfare officers and street shop owners. Participants were selected from streets in the five urban local government areas of Ibadan, Nigeria. Recorded data were transcribed, and framework analysis was performed. Results: The family dynamics included family structural problems, poor family resources and poor parent-child relationships. The family structural problems included: broken homes, large families and ambivalence around polygamy as subthemes. Family resources comprised: poor economic resources, poor social resources, educational challenges, cultural ambivalence and spiritual backdrops. The family relationships patterns included: poor adaptability, economic-oriented partnership, poor growth support, poor emotional connection and poor family bonding. Conclusion: The dynamics driving a family’s choice for child streetism in Ibadan, mostly to hawk, are devaluation of family life, parenting irresponsibility, and poor filial relationship, underscored by economic constraints and socio-cultural decadence. The results of this research buttress the need for family-level interventions to forestall the escalating phenomenon of child streetism in Ibadan, Nigeria. Contribution: This research highlights the family dynamics of children on the streets, and buttresses family-level interventions are necessary to forestall escalating child-streetism in Ibadan, Nigeria.

This aim of this study was to investigate maternal hematological laboratory parameters of term infants before birth diagnosed with asphyxia compared to mothers of healthy term infants and predict asphyxia by these parameters. This study was conducted on 109 and 192 mothers of the fetus with asphyxia and healthy, respectively. Laboratory parameters of complete blood count, including PDW (platelet distribution width), PCT (procalcitonin) and NLR (neutrophil/lymphocyte ratio), were recorded before birth from pregnant women. PDW and basophil counts were significantly higher in the asphyxia group than healthy group (p: .000). The cut-off level of 19.425 accurately predicted the occurrence of asphyxia (AUC = 0.724 (95% confidence interval 0.65–0.78), p = .000). Basophil count could predict asphyxia, especially the cut-off level of> 0.15(10³/μL) (AUC = 0.67) (95% confidence interval 0.60–0.74, p = .000). To predict asphyxia before labor, a cheap and routine test of PDW can be used after more research in this area.IMPACT STATEMENT What is already known on this subject? Asphyxia is still an unsolved problem in neonatal mortality and morbidity, and it is seen in babies of mothers who carry some risks during pregnancy (such as multiple pregnancy, baby of mother with preeclampsia, meconium aspiration, diabetes); however, it is known that it is a subject that is still not fully understood as it can also occur as a result of labor that does not have any risk factors and goes well. What do the results of this study add? In term fetuses without risk factors, it can be predicted to a certain extent whether the fetus will be diagnosed with asphyxia from the hemogram test that can work from the blood of the mother before birth. What are the implications of these findings for clinical practice and/or further research? In clinical practice, asphyxia can be estimated with a cheap and simple test, without any extra examination, by looking at the routine blood tests taken from the mother before going into labor.

Background and purpose: Mizaj (temperament) is an important concept in Persian medicine that has many applications in the diagnosis, prevention, care, and treatment of many diseases. This study aimed to determine the relationship between placenta accreta and the state of the general and uterine temperament and Apgar score of newborns in mothers candidates for cesarean section. Materials and methods: A case-control study was performed in mothers who were candidates for caesarean section. The subjects included expectant mothers with placenta accreta (n= 33) and a control group (n= 66). Current general and uterine temperament were measured using Mojahedi and Tansas questionnaire. Demographic variables and Apgar score of newborns was measured using the Apgar International Standard Checklist Score. T-test and Chi-square were used to compare the data. Results: Demographic characteristics were similar between the two groups. In pregnant mothers with placenta accreta the mean scores for total warm-cold and wet-dry temperaments were 14.81±1.55 and 3.72±1.23, respectively. In the control group, these scores were 16.81±4.38 and 3.39±0.65, respectively (P

Background and Aim: Most studies showed that low cord blood pH was associated with short-term mortality as well as long-term neurological disorders, but few studies showed associations between high cord blood lactate and adverse short-term outcomes. This study aimed to determine the association between umbilical cord blood lactate during the first hour of birth in infants with 5th-minute Apgar scores

Introduction: Infants of teenage births are known to have increased risk of poor infant outcomes. Adequate prenatal care (PNC) is essential to the overall health of infants and their birthing persons. While teenage births continue to be of concern in rural areas, little is known about the association between inadequate PNC and poor infant outcomes in teenage populations. Purpose: To determine the association between inadequate PNC (< 10 visits) and poor infant outcomes neonatal intensive care unit (NICU) stay, low APGAR score, small for gestational age (SGA) and length of stay (LOS). Methods: The study used West Virginia (WV) Project WATCH population level data (May 2018-March 2022). Multiple logistic regressions and survival analysis were performed on infant outcomes; NICU stay, APGAR score, infant size, and infant length of stay (LOS) with PNC categories inadequate (< 10 PNC visits) vs adequate (10 or more) adjusting for covariates including maternal race, insurance status, parity, smoking status, substance use status, and diabetes status. Results: Of births to teenagers, 14% received inadequate PNC. Teens who received inadequate PNC had increased odds of infant admitted to NICU (aOR: 1.84, CI:(1.41, 2.42), p < 0.0001), low 5- minute APGAR score (aOR: 3.26, CI:(2.03,5.22), p < 0.0001), and increased LOS (Est. = -0.33, HR: 0.72, CI:(0.65,0.81), p < 0.0001). Conclusions: Results demonstrated that infants of teenagers who received inadequate PNC are at increased risk of requiring a NICU stay, having a low APGAR score and requiring an increased LOS. PNC is particularly important for these groups as they are at increased risk of poor birth outcomes. [ABSTRACT FROM AUTHOR]

Normal birth is a eustress reaction, a beneficial hedonic stress with extremely high catecholamines that protects us from intrauterine hypoxia and assists in the rapid shift to extrauterine life. Occasionally the cellular O 2 requirement becomes critical and an O 2 deficit in blood (hypoxemia) may evolve to a tissue deficit (hypoxia) and finally a risk of organ damage (asphyxia). An increase in H+ concentration is reflected in a decrease in pH, which together with increased base deficit is a proxy for the level of fetal O 2 deficit. Base deficit (or its negative value, base excess) was introduced to reflect the metabolic component of a low pH and to distinguish from the respiratory cause of a low pH, which is a high CO 2 concentration. Base deficit is a theoretical estimate and not a measured parameter, calculated by the blood gas analyzer from values of pH, the partial pressure of CO 2 , and hemoglobin. Different brands of analyzers use different calculation equations, and base deficit values can thus differ by multiples. This could influence the diagnosis of metabolic acidosis, which is commonly defined as a pH <7.00 combined with a base deficit ≥12.0 mmol/L in umbilical cord arterial blood. Base deficit can be calculated as base deficit in blood (or actual base deficit) or base deficit in extracellular fluid (or standard base deficit). The extracellular fluid compartment represents the blood volume diluted with the interstitial fluid. Base deficit in extracellular fluid is advocated for fetal blood because a high partial pressure of CO 2 (hypercapnia) is common in newborns without concomitant hypoxia, and hypercapnia has a strong influence on the pH value, then termed respiratory acidosis. An increase in partial pressure of CO 2 causes less increase in base deficit in extracellular fluid than in base deficit in blood, thus base deficit in extracellular fluid better represents the metabolic component of acidosis. The different types of base deficit for defining metabolic acidosis in cord blood have unfortunately not been noticed by many obstetrical experts and organizations. In addition to an increase in H+ concentration, the lactate production is accelerated during hypoxia and anaerobic metabolism. There is no global consensus on definitions of normal cord blood gases and lactate, and different cutoff values for abnormality are used. At a pH <7.20, 7% to 9% of newborns are deemed academic; at <7.10, 1% to 3%; and at <7.00, 0.26% to 1.3%. From numerous studies of different eras and sizes, it can firmly be concluded that in the cord artery, the statistically defined lower pH limit (mean -2 standard deviations) is 7.10. Given that the pH for optimal enzyme activity differs between different cell types and organs, it seems difficult to establish a general biologically critical pH limit. The blood gases and lactate in cord blood change with the progression of pregnancy toward a mixed metabolic and respiratory acidemia because of increased metabolism and CO 2 production in the growing fetus. Gestational age-adjusted normal reference values have accordingly been published for pH and lactate, and they associate with Apgar score slightly better than stationary cutoffs, but they are not widely used in clinical practice. On the basis of good-quality data, it is reasonable to set a cord artery lactate cutoff (mean +2 standard deviations) at 10 mmol/L at 39 to 40 weeks' gestation. For base deficit, it is not possible to establish statistically defined reference values because base deficit is calculated with different equations, and there is no consensus on which to use. Arterial cord blood represents the fetus better than venous blood, and samples from both vessels are needed to validate the arterial origin. A venoarterial pH gradient of <0.02 is commonly used to differentiate arterial from venous samples. Reference values for pH in cord venous blood have been determined, but venous blood comes from the placenta after clearance of a surplus of arterial CO 2 , and base deficit in venous blood then overestimates the metabolic component of fetal acidosis. The ambition to increase neonatal hemoglobin and iron depots by delaying cord clamping after birth results in falsely acidic blood gas and lactate values if the blood sampling is also delayed. Within seconds after birth, sour metabolites accumulated in peripheral tissues and organs will flood into the central circulation and further to the cord arteries when the newborn starts to breathe, move, and cry. This influence of "hidden acidosis" can be avoided by needle puncture of unclamped cord vessels and blood collection immediately after birth. Because of a continuing anaerobic glycolysis in the collected blood, it should be analyzed within 5 minutes to not result in a falsely high lactate value. If the syringe is placed in ice slurry, the time limit is 20 minutes. For pH, it is reasonable to wait no longer than 15 minutes if not in ice. Routine analyses of cord blood gases enable perinatal audits to gain the wisdom of hindsight, to maintain quality assurance at a maternity unit over years by following the rate of neonatal acidosis, to compare results between hospitals on regional or national bases, and to obtain an objective outcome measure in clinical research. Given that the intrapartum cardiotocogram is an uncertain proxy for fetal hypoxia, and there is no strong correlation between pathologic cardiotocograms and fetal acidosis, a cord artery pH may help rather than hurt a staff person subjected to a malpractice suit based on undesirable cardiotocogram patterns. Contrary to common beliefs and assumptions, up to 90% of cases of cerebral palsy do not originate from intrapartum events. Future research will elucidate whether cell injury markers with point-of-care analysis will become valuable in improving the dating of perinatal injuries and differentiating hypoxic from nonhypoxic injuries. [ABSTRACT FROM AUTHOR]

We conducted a systematic review and meta-analysis to quantitatively summarize the present data on the association of prenatally identified lateral placenta in singleton pregnancies with small for gestational age (SGA) neonates, preeclampsia and other perinatal outcomes. From inception to November 2021, we searched PubMed/Medline, Scopus and The Cochrane Library for papers comparing the risk of SGA and preeclampsia, as well as other perinatal outcomes in singleton pregnancies with a prenatally identified lateral placenta to those with non-lateral placentas. The revised Newcastle-Ottawa Scale was used to evaluate the quality of eligible papers. The I2 test was employed to evaluate the heterogeneity of outcomes among the studies. To investigate the possibility of publication bias, funnel plots were constructed. Prospero RN: CRD42021251590. The search yielded 5,420 articles, of which 16 were chosen, comprising of 15 cohort studies and one case control study with a total of 4,947 cases of lateral and 96,035 of non-lateral placenta (controls) reported. SGA neonates were more likely to be delivered in cases with a lateral placenta (OR: 1.74; 95% CI: 1.54–1.96; p<0.00001; I2=47%). Likewise, placental laterality was linked to a higher risk of fetal growth restriction (OR: 2.18; 95% CI: 1.54–3.06; p<0.00001; I2=0%), hypertensive disorders of pregnancy (OR: 2.39; 95% CI: 1.65–3.51; p=0.0001; I2=80%), preeclampsia (OR: 2.92; 95% CI: 1.92–4.44; p<0.0001; I2=82%) and preterm delivery (OR: 1.65; 95% CI: 1.46–1.87; p<0.00001; I2=0%). The prenatal diagnosis of a lateral placenta appears to be associated with a higher incidence of preeclampsia, fetal growth restriction, preterm delivery and SGA. This may prove useful in screening for these conditions at the second trimester anomaly scan. [ABSTRACT FROM AUTHOR]

• Significant decrease in perinatal mortality due to improvement of quality of care combined with centralization of care. • Declining trend is stronger in Amsterdam compared to the Netherlands. • Preterm birth remains the biggest risk factor for perinatal mortality. • Prevention on preterm birth remains a major challenge. • Increasing trend in asphyxia and postpartum hemorrhage is of concern. To assess differences in adverse maternal and neonatal outcomes before and after closure of a secondary obstetric care unit of a community hospital in an urban district. Retrospective cohort study using aggregated data from National Perinatal Registry of the Netherlands (PERINED) in the very urban region of Amsterdam, consisting of data of five secondary and two tertiary hospitals. We assessed maternal and neonatal outcomes in singleton hospital births between 24+0 weeks of gestational age (GA) up to 42+6 weeks. Data of 78.613 births were stratified in two groups: before closure (years 2012–2015) and after closure (2016–2019). Perinatal mortality decreased significantly from 0.84 % to 0.63 % (p = 0.0009). The adjusted odds ratio (aOR) of the closure on perinatal mortality was 0.73 (95 % CI 0.62–0.87). Both antepartum death (0.46 % vs 0.36 %, p = 0.02) and early neonatal death (0.38 % vs 0.28 %, p = 0.015) declined after closure of the hospital. The number of preterm births decreased significantly (8.7 % vs 8.1 %, p=<0.007) as well as number of neonates with congenital abnormalities (3.2 % vs2.2 %, p=<0.0001). APGAR < 7 after 5 min increased (2.3 % vs 2.5 %, p = 0.04). There was no significant difference in SGA or NICU admission. Postpartum hemorrhage increased significantly from 7.7 % to 8.2 % (p=<0.003). Perinatal mortality from 32 weeks onwards was not significantly different after closure 0.29 % to 0.27 %. After closure of an obstetric unit in a community hospital in Amsterdam, there was a significant decrease in perinatal, intrapartum and early neonatal mortality in neonates born from 24+0 onwards. The mortality decrease coincides with a reduction of preterm deliveries. The increasing trend in asphyxia and postpartum hemorrhage is of concern.. Centralization of care and increasing birth volume per hospital may lead to improvement of quality of care. A broad integrated, multidisciplinary maternity healthcare system linked with the social domain can achieve health gains in maternity care for all women. [ABSTRACT FROM AUTHOR]

Background: Fetal health diagnostic tests are tools to reduce the incidence of adverse outcomes and neonatal death. However, their diagnostic value is still debated in relation to various outcomes. The aim of this study was to evaluate the value of biophysical profile and sonographic cerebroplacental ratio in predicting childbirth mode and adverse neonatal outcomes. Methods: In this cross-sectional study, 70 pregnant women (37-41 weeks) who were candidates for termination of pregnancy who were referred to Ayatollah Mousavi Hospital in Zanjan from October 2020 to May 2021 were studied. After selecting the mothers based on inclusion criteria, biophysical profile test (BPP) and CPR sonographic index were performed. Then delivery method, infant weight, fifth minute Apgar score, need for resuscitation and hospitalization of infants in NICU were recorded in each case. T-test, Mann-Whitney test and ROC curve in SPSS 22 software were used for statistical analysis. (P≤0.05). Results: In this study, the mean (SD) gestational age of participants was 38.56±1.11 weeks. Based on the data, there was a statistically significant relationship between CPR and the infant's need for resuscitation and hospitalization in the NICU (P=0.021) and Apgar score (P=0.042). However, there was no statistically significant relationship between CPR and delivery method, gestational age and birth weight. BPP score was not significantly associated with any of the consequences. Based on the results of the ROC curve, CPR with a cut point of 1.59 with a sensitivity of 88.9% and a specificity of 75% is able to predict the need for resuscitation and hospitalization in the NICU, and with a sensitivity of 83% and a specificity of 54.5%, it is able to predict a low Apgar score. However, BPP score did not have a predictive role in any of the studied parameters. Conclusion: It seems that CPR examination around delivery can be useful in predicting the condition of the baby immediately after birth and preparing the treatment staff for immediate action.

Abstract Background Perinatal markers of prenatal development are associated with offspring psychiatric symptoms. However, there is little research investigating the specificity of perinatal markers for the development of specific disorders. This study aimed to explore if perinatal markers are specifically associated with adolescent substance use disorder (SUDs). Methods Adolescent participants from two study centers, one for SUD patients (n = 196) and one for general psychopathology (n = 307), were recruited for participation. Since the SUD participants presented with a number of comorbid disorders, we performed a 1-on-1 matching procedure, based on age, gender, and specific pattern of comorbid disorders. This procedure resulted in n = 51 participants from each group. From all participants and their mothers we recorded perinatal markers (mode of birth, weeks of completed pregnancy, birth weight, Apgar score after 5 min) as well as intelligence quotient (IQ). The SUD sample additionally filled out the Youth Safe Report (YSR) as well as the PQ-16 and the DUDIT. We aimed to distinguish the two groups (SUD sample vs. general psychiatric sample) based on the perinatal variables via a logistic regression analysis. Additionally, linear regressions were performed for the total group and the subgroups to assess the relationship between perinatal variables and IQ, YSR, DUDIT and PQ-16. Results The perinatal variables were not able to predict group membership (X 2 [4] = 4.77, p = .312, Cox & Snell R² = 0.053). Odds ratios indicated a small increase in probability to belonging to the general psychiatric sample instead of the SUD sample if birth was completed via C-section. After Bonferroni-correction, the linear regression models showed no relation between perinatal markers and IQ (p = .60, R² = 0.068), YSR (p = .09, R² = 0.121), DUDIT (p = .65, R² = 0.020), and PQ-16 (p = .73, R² =0.021). Conclusion Perinatal markers were not able to distinguish SUD patients from patients with diverse psychopathologies. This pattern contradicts previous findings, perhaps because our chosen markers reflect general processes instead of specific mechanistic explanations. Future studies should take care to investigate specific prenatal markers and associate them with psychopathology on the symptom level.

This study aimed to explore the association between family function and sleep disturbances in preschool children in rural areas of China. Caregivers of preschool children completed sociodemographic questionnaires, the Children's Sleep Habits Questionnaire (CSHQ), the Self-rating Anxiety Scale (SAS) and the Family APGAR scale. Using sleep disturbances in children as the dependent variable, family function and other related factors as independent variables, binary logistic regression analyses were performed to examine associations between family function and sleep disturbances in children. A total of 3,636 caregivers of preschool children were enrolled in our study, and the prevalence of sleep disturbances among their preschool children was 89.4%. In our study, lower family function was associated with higher risk of sleep disturbances among preschool children. After adjusting for age (years), education level of mother, discipline attitudes of father and mother, only child status and caregivers' anxiety, the associations were statistically significant both in families of which caregivers of children are their parents or other relatives. (AOR for parents = 1.487, 95% CI:1.152–1.919, P = 0.002; AOR for other relatives = 1.963, 95% CI:1.302–2.958, P = 0.001). Our study results indicated that family function was associated with sleep disturbances in preschool children, and future high-quality cohort studies are needed to explore this topic in more detail. [ABSTRACT FROM AUTHOR]

Background and purpose: Mizaj (temperament) is an important concept in Persian medicine that has many applications in the diagnosis, prevention, care, and treatment of many diseases. This study aimed to determine the relationship between placenta accreta and the state of the general and uterine temperament and Apgar score of newborns in mothers candidates for cesarean section. Materials and methods: A case-control study was performed in mothers who were candidates for caesarean section. The subjects included expectant mothers with placenta accreta (n= 33) and a control group (n= 66). Current general and uterine temperament were measured using Mojahedi and Tansas questionnaire. Demographic variables and Apgar score of newborns was measured using the Apgar International Standard Checklist Score. T-test and Chi-square were used to compare the data. Results: Demographic characteristics were similar between the two groups. In pregnant mothers with placenta accreta the mean scores for total warm-cold and wet-dry temperaments were 14.81±1.55 and 3.72±1.23, respectively. In the control group, these scores were 16.81±4.38 and 3.39±0.65, respectively (P<0.002). The chance of placenta accreta in cold-tempered mothers was 8.571 compared to warm-tempered mothers. The chance of placenta accreta in pregnant women with cold-tempered uterine was 15.385 times higher compared to pregnant women with warm-tempered uterine. Those with dry uterus were 10.35 times more likely to develop placenta accreta compared to mothers with wet temperament. The mean score for warm-cold tempered uterine in the placenta accreta group was 33.27±2.21 and for wet-dry tempered uterine was 11.45±1.58 and in the control group the scores were 39.60±5.20 and 13.71±2.16, respectively (P<0.001). Conclusion: The chances of developing placenta accreta is higher in mothers candidate for Caesarean section with general and cold uterine temperament than in other temperamental conditions. Also, the chance of contracting placenta accreta is higher in mothers with wet general temperament and dry uterine temperament. Applying necessary measures based on the principles of Persian medicine is suggested for pregnant mothers in the early stages of pregnancy. [ABSTRACT FROM AUTHOR]

Background: Premature rupture of membranes is the most challenging obstetric dilemma which occurs even in low-risk pregnancies and can convert a traditional pregnancy into a high-risk pregnancy. This study aims to determine feto-maternal outcome, especially in the context of developing countries to help in formulating intervention strategies. Methods: This study is a hosptial based prospective study conducted on pregnant woman at term pregnancy (37-42 wks) presenting with PROM admitted in labour room in SHKBMC of Jhalawar Medical College, Jhalawar. Results: 42.50% cases delivered by LSCS and 57.50% cases were delivered by normal vaginal delivery. 79 patients (49.38%) delivered babies whose birth weight was between 2-2.5 kg 54 patients (33.75%) and 27 patients (16.88%) delivered babies of >2.5 kg and <2.0 kg birth weights respectively. No maternal complications were seen in 129 cases (80.63%) of PROM. Chorioamnionitis (8.13%) was the most common maternal complication followed by puerperal pyrexia (5.63%) and abruption each contributing to 3.75%. babies born to 38 mothers had NICU admission. Almost 76.25% of the newborn had no complications. 13.13% suffered from respiratory distress syndrome, 6.25% had septicemia, 3.75% suffered from septicemia and 2.50% had intraventricular hemorrhage. Mean APGAR score at 1 min was 7.56±1.02 and at 5 mint. was 8.50±1.13. Neonatal mortality was 5.63%. Conclusion: In the present study we concluded that maternal morbidity and neonatal morbidity was associated with PROM. Prediction of these morbidities is an important step in the management of infection associated with PROM. Hence an appropriate and accurate diagnosis of PROM is essential for favorable outcome in pregnancy. ANC cases should be educated regarding regular and timely antenatal checkup. The obstetrician and neonatologist should work as a team to ensure optimal care for mother and neonate. [ABSTRACT FROM AUTHOR]

Mortality of neonatal puppies is a widespread problem in small animal medicine. Neonatal monitoring, according to standardized protocols, can be useful for identifying puppies that are at risk of mortality. Prompt intervention on weak puppies could increase survival rates. Apgar scoring adapted for puppies has been demonstrated to be associated with mortality and is usually performed by trained veterinary staff. The majority of puppies, however, are born in a home or kennel environment and not at a veterinary clinic. Our aims were, therefore, to evaluate if a modified protocol for neonatal monitoring would be usable by breeders in a home environment. We wanted to evaluate potential associations between modified Apgar scores, birth weights, delivery times, growth rates, and puppy mortality. Modified Apgar scores were related to the viability of live-born puppies (p < 0.0013). The viability and expulsion time of each puppy were significantly related (p = 0.010 with all puppies included and p = 0.038 with only live-born puppies included). Viability was significantly related to relative birthweight (p < 0.01). Puppies with a negative growth rate the first two days after parturition did not have a significantly higher risk of mortality. In conclusion, a modified and simplified Apgar scoring performed by breeders approximately 5 min after birth was associated with puppy mortality.

Objectives: The study aimed to find out factors contributing to oligohydramnios in the third trimester of pregnancy, complications associated and its impact on maternal and foetal outcomes. Method: This was a retrospective study of 90 primigravidas at Parul Sevashram Hospital during the year October 2019 to September 2020 in the third trimester of pregnancy with AFI

BackgroundMeconium aspiration syndrome is respiratory distress diagnosed in neonates delivered with meconium-stained amniotic fluid that is unexplained by other pathologies. It has severe neonatal respiratory complications and a significant impact on the prevalence of neonatal mortality.ObjectiveTo identify the incidence and determinants associated with meconium aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section in Wolkite University specialized hospitals in Ethiopia from September 1, 2021, to August 30, 2022.MethodAn institution-based cross-sectional study was done prospectively through meticulous chart review and interviews with 275 mothers with meconium-stained amniotic fluid who gave birth with an emergency cesarean section. Data were entered using EpiData 7 and analyzed with SPSS 26. The association between independent variables and the meconium-aspiration syndrome was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at a p-value of 0.05.ResultThe prevalence of the meconium-aspiration syndrome is 28.7%. The factors associated are: latent phase (AOR: 2.580; 95% CI: 1.126, 5.913), low 1st minute APGAR score (AOR: 2.43; 95% CI: 0.892, 6.625), and thick meconium (AOR: 31.018; 95% CI: 9.982, 96.390). The neonatal death rate associated with meconium aspiration syndrome is 1.8%, and thick meconium contributed to 65% of admissions to the neonatal intensive care unit and all deaths.ConclusionThe incidence of meconium aspiration syndrome is high, and thick meconium, meconium at early labor, and low APGAR scores all contributed to this. Thick meconium has a substantial effect on neonatal mortality and morbidity. Therefore, an improvement in the quality of obstetric and neonatal care through early intervention in the case of thick meconium and meconium in the early phase of labor is recommended.

Background: There is a high lamb mortality rate during the first three days of life, resulting in sheep flock economic losses and neonate welfare concerns. A significant number of neonatal deaths could be avoided by preventive management, early diagnosis, and consequently well-timed intervention. The aim of the study was to evaluate the use of umbilical artery Doppler to predict the vitality score (APGAR) of lambs at birth, and its use as a screening tool for detecting high-risk neonatal cases in the last week of gestation, describing changes in the resistivity and pulsatility index in singletons and twins. Materials, Methods & Results: A total of 27 White Dorper pregnant ewes were studied: 19 multiparous (ewes, 2 to 4-yearsold) and 8 primiparous (yearling, up to 1-year-old). From 130 days of pregnancy, gestational ultrasound was performed weekly until delivery, but only data from the last pre-partum scan for each ewe was included. The inclusion criteria for the analysis of the umbilical arteries Doppler were the positioning of the fetus and the quality of the images obtained. Identification of each of the twin fetuses after birth was performed by reference to ultrasound fetometry and its correlation with birth weight. The vitality score at birth (APGAR) was used to classify each group, regardless of the characteristic of eutocic or dystocic delivery, with Group 1 lambs having normal vitality (APGAR = 7) and Group 2 lambs having low vitality (APGAR < 7). A transabdominal Doppler ultrasound of 28 fetal umbilical arteries was performed in the last week before delivery (146 ± 2.4 days of gestation), and the results were compared with the vitality scores of lambs at birth. There were 53.6% of lambs (15/28) with normal vitality scores (Group 1), and 46.4% of lambs (13/28) had low vitality scores (Group 2). The umbilical artery Doppler ultrasound analyzes of the resistance index (RI), the pulsatility index (PI), and the RI and PI oscillations determined by the resistivity index gradient (RIgrad), the resistivity index variations (RIvar%), the pulsatility index gradient (PIgrad) and the pulsatility index variation (PIvar%) were established for each fetus. Pearson's correlation was performed for each umbilical artery Doppler ultrasound variable and vitality score of each lamb, and the T Student's test was performed between Groups 1 and 2. There were no statistically significant differences between groups. Furthermore, the RI values or oscillations did not correlate with the lambs' vitality score, and mildly increased PI values need to be interpreted with caution. Neonatal vitality in lambs was correlated with pulsatility index oscillations: PIgrad (r = 0.4005; P = 0.0346) and PIvar% (r = 007; P = 0.0299). Discussion: Measurement of umbilical artery RI and PI is possible in ewes with singleton and twin pregnancies in the last week of gestation. High PI of the umbilical artery did not correlate with a low lamb vitality score at birth, as previously described in human fetal medicine. The PI alone cannot be correlated with APGAR in lambs, but the PIgrad and PIvar% analyzes should be performed. In conclusion, the RI and PI values, if analyzed in isolation, show no correlation with the vitality scores of lambs at birth. However, making multiple measurements to derive associations between maximum and minimum values of PI such as PIgrad and PIvar% in the same fetus, could help to screen for high-risk neonates. [ABSTRACT FROM AUTHOR]

Background: Children roaming the streets estimated at 1 in 10 by a 2021 United Nation Children's Funds (UNICEF) report is a growing problem, in cities of lower- and middle-income African countries. Studies of street children with no family ties abound, but there is a paucity of studies on children on the street who exist within families and return home daily. We explored the family dynamics of children on the streets of Ibadan, emphasising family structure, resources and relationships. Methods: Using an exploratory design based on a qualitative approach 53 participants were interviewed, including children on the streets, parental figures, child-welfare officers and street shop owners. Participants were selected from streets in the five urban local government areas of Ibadan, Nigeria. Recorded data were transcribed, and framework analysis was performed. Results: The family dynamics included family structural problems, poor family resources and poor parent-child relationships. The family structural problems included: broken homes, large families and ambivalence around polygamy as subthemes. Family resources comprised: poor economic resources, poor social resources, educational challenges, cultural ambivalence and spiritual backdrops. The family relationships patterns included: poor adaptability, economic-oriented partnership, poor growth support, poor emotional connection and poor family bonding. Conclusion: The dynamics driving a family's choice for child streetism in Ibadan, mostly to hawk, are devaluation of family life, parenting irresponsibility, and poor filial relationship, underscored by economic constraints and socio-cultural decadence. The results of this research buttress the need for family-level interventions to forestall the escalating phenomenon of child streetism in Ibadan, Nigeria. Contribution: This research highlights the family dynamics of children on the streets, and buttresses family-level interventions are necessary to forestall escalating child-streetism in Ibadan, Nigeria. [ABSTRACT FROM AUTHOR]

Neonatal sepsis is the third most common cause of neonatal mortality and a serious public health problem, especially in developing countries. There have been researches on human sepsis, vaccine response, and immunity. Also, machine learning methodologies were used for predicting infant mortality based on certain features like age, birth weight, gestational weeks, and Appearance, Pulse, Grimace, Activity and Respiration (APGAR) score. Sepsis, which is considered the most determining condition towards infant mortality, has never been considered for mortality prediction. So, we have deployed a deep neural model which is the state of art and performed a comparative analysis of machine learning models to predict the mortality among infants based on the most important features including sepsis. Also, for assessing the prediction reliability of deep neural model which is a black box, Explainable AI models like Dalex and Lime have been deployed. This would help any non-technical personnel like doctors and practitioners to understand and accordingly make decisions. [ABSTRACT FROM AUTHOR]

Background: One of the most critical functions of the fetal membranes is to remain intact until the onset of labor to maintain the protective intrauterine fluid environment. In most pregnancies, spontaneous rupture usually occurs near the end of the first stage of labor. Preterm premature membrane rupture (PROM) occurs when the fetal membrane ruptures before 37 weeks of pregnancy, and it contributes to adverse maternal, fetal, and neonatal outcomes. Therefore, this study aimed to determine the association of determinant factors with adverse perinatal outcomes. Methods: A prospective cohort study was conducted on pregnant women with preterm premature membrane rupture (n = 160) attending the teaching hospitals at Addis Ababa University. Socio-demographic and obstetric risk factors with adverse perinatal outcomes include the 5th minute Apgar score, neonatal intensive care unit (NICU) admission, early-onset neonatal sepsis (EONS), respiratory distress syndrome (RDS), perinatal mortality, Chorioamnionitis, and placental abruption were assessed. SPSS version 24, t-test, χ2 test, and logistic regression analysis were used. P-values <0.25 in the bivariate and p < 0.05 in the multiple logistic regression were considered statistically significant. Results: The preterm (PROM) rate was 2.2% with perinatal mortality rate of 206/1,000. Gestational age (GA) at delivery was the determinate for low Apgar score at the 5th minute (AOR: 7.23; 95% CI, 1.10, 47.6; p = 0.04). Unable to use steroid (AOR: 8.23; 95% CI, 1.83, 37.0; p = 0.000), GA at membrane rupture (AOR: 4.61; 95% CI, 1.98, 31.8; p = 0.000) and delivery (AOR: 4.32; 95% CI, 1.99, 30.9; p = 0.000) were determinates for NICU admission. EONS was significantly affected by GA at membrane rupture (AOR: 5.9; 95% CI, 1.01, 37.0; p = 0.04). Placental abruption was significantly affected by GA at delivery (AOR: 7.52; 95% CI, 1.15, 48.96; p = 0.04). Conclusion: GA at membrane rupture and delivery was the most critical predictors of adverse perinatal outcomes. Local guidelines on the approach and preterm PROM outcome management need to be prepared. [ABSTRACT FROM AUTHOR]

Introduction: The Apgar score is a standardized method of assessing the primary adaptation and clinical status of a neonate after birth. Our objective was to systematically review and meta-analyze the survival and the survival without moderate-to-severe neurodevelopmental impairment (NDI) of neonates with a 10-min Apgar score of zero. Methods: Six electronic databases were searched for reports published until November 2021 of neonates with a 10-min Apgar score of zero. Risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and the Joanna Briggs Institute Critical Appraisal Checklist for case series/reports. Meta-analyses of the proportion of outcomes were conducted using a random-effects model for studies published after year 2000 and reporting >5 neonates. Meta-regression using the median year of the study period and subgroup analyses by treatment with therapeutic hypothermia and by gestational age were conducted. Results: Twenty-eight studies of 820 neonates with moderate risk of bias were included. Survival was 40% (95% confidence interval 30–50%, 16 studies, 646 neonates, I2 = 83%), and it increased by 2.3% per year (95% CI 1.3–3.2%, p < 0.001). Survival without moderate-to-severe NDI was 19% (95% confidence interval 11–27%, 13 studies, 211 neonates, I2 = 62%). Survival was higher for neonates who received therapeutic hypothermia and for those with a gestational age ≥32 weeks compared to <32 weeks. Conclusion: Approximately 2 in 5 neonates with a 10-min Apgar score of zero survived, and 1 in 5 survive without moderate-to-severe NDI survived. Survival has improved over the years, especially since the era of therapeutic hypothermia. [ABSTRACT FROM AUTHOR]

Background: Fetal health diagnostic tests are tools to reduce the incidence of adverse outcomes and neonatal death. However, their diagnostic value is still debated in relation to various outcomes. The aim of this study was to evaluate the value of biophysical profile and sonographic cerebroplacental ratio in predicting childbirth mode and adverse neonatal outcomes. Methods: In this cross-sectional study, 70 pregnant women (37-41 weeks) who were candidates for termination of pregnancy who were referred to Ayatollah Mousavi Hospital in Zanjan from October 2020 to May 2021 were studied. After selecting the mothers based on inclusion criteria, biophysical profile test (BPP) and CPR sonographic index were performed. Then delivery method, infant weight, fifth minute Apgar score, need for resuscitation and hospitalization of infants in NICU were recorded in each case. T-test, Mann-Whitney test and ROC curve in SPSS 22 software were used for statistical analysis. (P≤0.05). Results: In this study, the mean (SD) gestational age of participants was 38.56±1.11 weeks. Based on the data, there was a statistically significant relationship between CPR and the infant's need for resuscitation and hospitalization in the NICU (P=0.021) and Apgar score (P=0.042). However, there was no statistically significant relationship between CPR and delivery method, gestational age and birth weight. BPP score was not significantly associated with any of the consequences. Based on the results of the ROC curve, CPR with a cut point of 1.59 with a sensitivity of 88.9% and a specificity of 75% is able to predict the need for resuscitation and hospitalization in the NICU, and with a sensitivity of 83% and a specificity of 54.5%, it is able to predict a low Apgar score. However, BPP score did not have a predictive role in any of the studied parameters. Conclusion: It seems that CPR examination around delivery can be useful in predicting the condition of the baby immediately after birth and preparing the treatment staff for immediate action. [ABSTRACT FROM AUTHOR]