Search

Background: Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation. Methods: We compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models. Results: We analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable. Conclusions: Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery. Trial registration: This systematic review was registered at PROSPERO (CRD42023397259). [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the differences in characteristics and outcomes of early-onset and late-onset Preeclampsia. Methods: A retrospective cross-sectional study was conducted on female patients giving birth with preeclampsia admitted into the Department of Obstetrics and Gynecology of Dr. Hasan Sadikin Hospital Bandung from January 2020 to December 2022 who met the study criteria. A total of 435 subjects met the inclusion criteria were divided into two groups: early-onset preeclampsia and late-onset preeclampsia. Differences in outcomes were analyzed using the Chi-square or Fisher test for categorical data and the T-independent or Mann–Whitney test for numerical data. Results: There were differences in the incidence of HELLP syndrome (9.0 vs. 2.7%; p = 0.009), prematurity (77.7 vs. 21.4%; p = 0.000), early neonatal death (10.4 vs. 2.7%; p = 0.002), asphyxia (22.7 vs. 8.0%; p = 0.000), SGA (41.7 vs 21.9%; p = 0.000), and LBW (78.7 vs 40.2%; p = 0.000) in early-onset preeclampsia with late-onset. Length of stay was longer in early-onset preeclampsia cases (4.0 vs 3.0 days; p = 0.000). Increased ureum and liver enzymes results were significantly higher in early-onset preeclampsia. Conclusion: There is a difference in the outcome of pregnant women with early-onset and late-onset preeclampsia. Women with early-onset preeclampsia tend to have more adverse maternal and neonatal outcomes. In terms of maternal outcome, they tend to have higher liver enzymes level and HELLP syndrome, while in terms of neonatal outcome they tend to have prematurity, early neonatal death, asphyxia, SGA, and LBW. [ABSTRACT FROM AUTHOR]

Background: In India, about 3-4% of people are carriers of beta thalassemia. Sickle cell occurs in about 1 in 100 Indians. As per WHO at least 5.2% of the world population with 7% prevalence in pregnant women carries a variant of hemoglobin disorder. HbE is the most common hemoglobinopathy in north eastern states of India, with carrier frequency of around 50% in a hospital based study27. Objective: To follow up the maternal and fetal outcome of pregnancy with hemoglobinopathies. Methodology: A prospective observational study to evaluate the maternal and fetal outcome in pregnancy with hemoglobinopathies. Results: 78% of the patients had moderate anaemia. HbE disease comprising of 44.8 % was the most common hemoglobinopathy. 53 % of the patients underwent LSCS. The most common indication being fetal distress in first stage of labour (19.56%). 43 % of the patients had associated obstetrics complications with 23 % preterm delivery, 7 % FGR pregnancy, 4.59% hyperbilirubinemia, 9.1% PROM. 26 (29.8%) of babies were born with low birth weight. 22.9% of the babies were admitted in NICU. Among the pregnant women, 19.5 % had severe anaemia which needed blood transfusion. There was one maternal death due to postpartum haemorrhage. Conclusion: HbE disease comprising of 46 % was the most common among the hemoglobinopathies. Since the incidence of hemoglobinopathy is high in our region, routine Hb typing has to be done for Hb of < 8 g/dl. [ABSTRACT FROM AUTHOR]

Background/Aim: Our study compares repeat cesarian section with and without labor in progress and evaluates adverse maternal outcomes that could discourage pregnant women in planning labor at term or at least after 39 weeks of gestation as recommended due to benefits in neonatal outcome. Patients and Methods: In this retrospective study, we analyzed 191 patients undergoing third C-section and compared two groups of women of undergoing C-section either before or after the onset of labor. The primary outcome measure was the incidence of maternal morbidity. Values of p≤0.05 were regarded as significant. Results: Comparing the two subgroups, we did not find any significant differences in the occurrence of maternal complications or severe acute morbidity except for incomplete uterine rupture (p=0.04). Conclusion: Undergoing a third C-section after the start of labor has no relevant or adverse impact on maternal outcome. Therefore, elective repeat C-section can be planned in late weeks of gestation aiming at reducing neonatal morbidity. The higher rate of uterine dehiscence was not associated with other issues of severe acute maternal morbidity. [ABSTRACT FROM AUTHOR]

Background: The impact of COVID-19 on pregnancy remains a critical area of research, with growing evidence suggesting that maternal infection, particularly in the third trimester, may lead to significant complications Aims: The primary aim was to investigate the maternal and neonatal outcome of pregnant Jordanian women with COVID-19. The secondary aim included exploring demographics, obstetrics characteristics, and comorbidities among these women. Methods: A retrospective comprehensive review of the records of 300 cases of pregnant women with COVID-19, who were treated between November 2020 and April 2021 at Queen Alia Military Hospital (a main referral center for patients with COVID-19) in Jordan. All cases were confirmed by the rapid antigen test (RAT) + long polymerase chain reaction (PCR) test used to detect SARS-CoV-2 by amplifying viral RNA from patient samples. Women infected with COVID-19 were categorized into four groups according to the RCOG guidelines for COVID-19 infection in pregnancy: asymptomatic, mild, moderate, and severe cases. All cases were managed following the Royal College of Obstetricians and Gynecologists protocol for COVID-19 in pregnancy. Data extracted from patient's records included demographic information, COVID-19 clinical manifestations, obstetric history, diagnostic findings, treatment plans, comorbidities, gestational age at diagnosis, treatment protocols, and maternal and neonatal outcomes. Results: The mean age was 29.7 years; 98.3% were nonsmokers; 8% had previous miscarriages, and 67.3% had the infection in the third trimester. Iron deficiency anemia affected 30.3%, while 18.3% had comorbidities, mainly hypothyroidism. Most women were asymptomatic 61.7%, but 33% had respiratory symptoms, 4.7% needed intensive care unit (ICU) admission, and 2.7% resulted in maternal deaths. First-trimester and second-trimester miscarriages were recorded in 2.67% and 3.67% of cases, respectively, while preterm labor occurred in 3.0% of pregnancies. Additionally, age and hospitalization duration had a positive correlation with the neonatal outcomes (r = 0.349, p < 0.01), (r = 0.376, p < 0.01), respectively. Furthermore, COVID-19 presentation and treatment options demonstrated a strong positive correlation (p-value <0.01). On the other hand, maternal death had a strong negative correlation with poor neonatal outcomes (r = −0.776, p < 0.01). Conclusion: The study showed that COVID-19 in pregnant women, particularly in the third trimester, is associated with significant neonatal complications, with age, hospitalization duration, and COVID-19 severity strongly impacting outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Thyroid dysfunction is the most common endocrinological disorder in pregnancy, only second to diabetes. If not treated, they can have adverse effects on maternal and neonatal outcomes. Maternal complications include miscarriage, anaemia, preeclampsia, gestational hypertension, placental abruption, preterm delivery, increased rate of caesarean section, and postpartum haemorrhage. Fetal outcomes include preterm birth, low birth weight (LBW), perinatal morbidity and mortality, increased NICU admission; and neuropsychological and cognitive impairment. Thus it is important to adopt appropriate strategies to identify women at risk of these adverse outcomes for early detection and initiation of effective treatment, hence the study was undertaken. Methodology: A cross - sectional study was conducted in 400 pregnant women attending antenatal outpatient department in a tertiary care after obtaining ethical committee approval. This study was conducted from march 2020 to September 2023, after obtaining written informed consent from patients. Demographic data included maternal age, parity, years of marital life, infertility, family history of thyroid disorder, menstrual history. Maternal comorbidities pertaining to thyroid dysfunction include history of miscarriage, anaemia, preeclampsia, gestational hypertension, oligohydramnios, preterm delivery and increased rate of caesarean section. Fetal outcomes include LBW, Low Apgar score, and increased NICU admission. Routine hematological parameters and estimation of T3, T4 and TSH was conducted. The categorical variables were assessed using Pearson chi-square test and continuous variable using t test. The test was considered significant when the p value is less than 0.05. Results: The prevalence of thyroid disorders in this study was 16% (64/400 patients), with subclinical hypothyroidism (10.75%) being the commonest, followed by overt hypothyroidism (3.25%) and subclinical hyperthyroidism (2%). Thyroid disorders seen in more proportion of patients with gravida 1(68.75%) compared to gravida 2 (31.25%) which was significant. More proportion of patients with thyroid disorders have anaemia, preeclampsia, gestational diabetes mellitus and significant family history when compared with euthyroid patients and this was significant statistically. Preterm labour, assisted labour and cesarean section was seen in more patients with thyroid disorders compared to euthyroid patients. Fetal complications like low birth weight, low APGAR score and need for NICU admission was seen in more babies with mothers having thyroid disorders which was significant statistically. Conclusion: Our study shows high complication rates associated with thyroid disorders in pregnancy, thus insisting on screening for thyroid disorders for better foetal and maternal outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Vasopressors are effective in managing perioperative hypotension in high-risk parturients undergoing Caesarean section (CS). Nevertheless, the optimal vasopressor for addressing hypotension induced by neuraxial anesthesia remains a subject of investigation. Methods We compared hypotension episodes among high-risk parturients who received ephedrine, noradrenaline, or phenylephrine by searching four electronic databases and reviewing the relevant references. Inclusion criteria encompassed randomized controlled trials directly comparing two or more vasopressors in the context of managing hypotension in high-risk parturients undergoing neuraxial anesthesia for CS. A network meta-analysis was performed using fixed-effects and Bayesian random-effects models. Results We analyzed 13 trials involving 1,262 patients. While our direct and indirect comparisons revealed no reveal statistically significant differences in the number of hypotensive episodes among patients treated with different vasopressors, vasopressors were hierarchically ranked. Phenylephrine (Rank of the best choice = 0.81) exhibited the highest effectiveness in preventing hypotension, followed by ephedrine (Rank of the best choice = 0.10) and noradrenaline (Rank of the best choice = 0.09). Bradycardia occurrence was higher in patients administered phenylephrine compared to those given noradrenaline (risk ratio [RR]: 0.23; 95% confidence interval [CI]: 0.03 to 0.85) or ephedrine (RR: 0.01; 95% CI: 0.00 to 0.12). Notably, patients treated with phenylephrine or noradrenaline experienced reduced occurrences of nausea or vomiting compared to those who received ephedrine (RR: 0.37; 95% CI: 0.19 to 0.59 for phenylephrine and RR: 0.28; 95% CI: 0.10 to 0.75 for noradrenaline). Regarding fetal outcomes, no significant differences were noted between noradrenaline and phenylephrine. Overall norepinephrine in maternal outcomes may be more favorable. Conclusions Our findings suggest the potential advantages of phenylephrine for reducing hypotensive episodes in high-risk parturients undergoing CS. Noradrenalin may emerge as an alternative, particularly for women at high risk of caesarean delivery. Trial registration This systematic review was registered at PROSPERO (CRD42023397259).

• Different Level of care did not impact the Decision-to-delivery interval. • Rates of appropriate indications were higher in the level-2 than level-1 hospitals. • Code red CD indications and level-2 were associated with worse perinatal outcome. Code red cesarean delivery (CD) is performed in the presence of an impending danger to maternal or fetal life. The indications, times, and procedures in this setting remain ambiguous. The aim of this study was to evaluate in a cohort of code red CD the impact of the level of care of Obstetric Units, indications, and decision to delivery interval CD on maternal and perinatal outcomes. This was a multicenter retrospective study conducted at four maternal units (two level-2 University Hospitals and two level-1 Community Hospitals) on a cohort of women who underwent code red CD between 2018 and 2021. An independent team of experts performed retrospective audits to assess the appropriateness of indications. A cohort of 168 code red CDs were included. The most frequent indications were severely abnormal fetal heart rate patterns (41.7 %) and sentinel events (38.1 %). Decision to delivery interval (DDI) was similar between different level of care (20.7 vs 21.4 min, p = 0.66) and didn't affect adverse perinatal outcome. Rates of appropriate indications were higher in the level-2 than level-1 hospitals (80.2 % vs 65 %, p = 0.036), with worse adverse perinatal outcome in the former than the latter (43.4 % vs 21.1 %, p = 0.002). At multivariate analysis, worse perinatal outcomes were independently associated with indications for code red CD (P = 0.01) and level-2 units (P = 0.005). Level-1 hospitals guarantee a promptness of response comparable to that of level-2 centers in dealing with emergency in CD, however with lower rates of appropriate indications. Indications for code red CD but not DDI are associated with worse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Birth preparedness and complications readiness (BPCR) is a strategy to prevent three late causes of maternal death. Previous study results focused on BPCR intermediate outcomes, such as utilizing healthcare facilities during pregnancy and delivery, rather than maternal outcomes like maternal near miss, morbidity, and mortality.Objectives: This study examined the correlation between BPCR practices and maternal outcomes among postpartum mothersMethods: This cross-sectional research was conducted on postpartum mothers in the working area of the Sumberbaru Primary Health Service, Jember Regency, which was carried out from April to June 2023. A total of 78 postpartum mothers were selected using simple random sampling. The interview instrument was adopted from the BPCR JHPIEGO questionnaire, and maternal outcome observations were made using the MCH book. Data were analyzed using the chi-square test to examine the relationship between BPCR and maternal outcome. The level of statistical significance was set to p-value < 0.05Results: The results of this study indicated that 69.2% of postpartum mothers had less prepared BPCR practices, and for most postpartum women, 55.1% recovered. There was a relationship between BPCR practices and maternal outcomes among postpartum mothers (p-valueConclusions: The practice of BPCR in postpartum mothers is in the poor category; most mothers' maternal outcomes are in the fully recovered category. BPCR is an essential factor influencing maternal outcomes, so increasing counseling for mothers and families regarding BPCR is necessary to ensure more optimal maternal outcomes.

Objective: To compare frequency of caesarean section in singleton primary-para women induced at 39 week and its comparison with conventional management. The other objective was comparison of perinatal and neonatal outcomes. Method: Open random allocation study was conducted at Gynae/Obst Department JPMC during period from 1st June 2022 to 30th September 2023. Primiparous women with singleton pregnancy without risk factors with gestational age 38 weeks 0 days to 38 weeks six days attending the anti-natal clinic offered to participate after consent. Non-probability convenience sampling method was used for induction. Randomization was done using random number table into one of the two groups, Group-A in which induction was done at 39 weeks while in Group-B induction was done conventionally. Mean age ±SD, gestational age and delivery time was calculated and compared by Student’s t test. Frequency of CS, perinatal and neonatal outcomes was compared by χ² test. Results: Eighty-two women were inducted in Group-A and eighty-five in Group-B. The mean delivery time in Group-A was significantly more at 8.12±2.77 hours while in Group-B was 7.0±2.62 hours (p = .005). Frequency of CS between two groups was not statistically significant, it was 5 (6.1%) in Group-A and 2 (2.4%) in Group-B (p = 0.412). No significant difference in frequency of NICU admission was seen, in Group-A 8.54% babies were admitted to NICU while in Group-B 16.47% were admitted to NICU (p = 0.122). Conclusion: No significant difference was observed in frequencies of CS, Foetal, Neonatal, and Maternal outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The goal of this study was to identify the risk factors associated with puerperal genital hematoma (PGHA) and analyze the management strategies employed and the resulting maternal outcomes. Methods: This retrospective cohort study examined the pregnant women delivering vaginally with PGHA in Peking University Third Hospital during January 2002 to December 2021. Exploratory data analysis was performed to assess mean, standard deviation (SD), frequency, percentage and percentiles. Independent‐samples t‐test was performed for continuous variables. Chi‐squared test was performed to compare categorical data. Results: A total of 47 women with PGHA were included, and 94 matched controls were enrolled during the same study period. Compared with the control group, labor induction (34.0% vs. 9.6%, P = 0.000) and episiotomy (66.0% vs. 31.9%, P = 0.000) were more frequently performed in PGHA cases. There was a significantly higher incidence of postpartum hemorrhage (PPH) (53.2% vs. 6.4%, P = 0.000) in PGHA patients than in controls. Compared with the patients with <5 cm hematoma, the proportion of prenatal anemia (25.8% vs. 0.0%, P = 0.027) and the incidence of PPH (67.7% vs. 25.0%, P = 0.005) were significantly higher in patients with ≥5 cm hematoma. In comparison, the active period was significantly shorter (3.1 ± 1.9 vs. 5.1 ± 3.0, P = 0.031) in patients with ≥5 cm hematoma. There were significant differences in perineal pain and swelling (31.3% vs. 67.7%, P = 0.017), vulva hematoma (93.8% vs. 48.4%, P = 0.002) and surgical treatment (62.5% vs. 96.8%, P = 0.002). Nearly half of the patients in the ≥5 cm group underwent secondary suture (41.9% vs. 6.3%, P = 0.011). In patients with PGHA detected after more than 2 h, the body mass index was substantially higher (24.5 ± 4.3 vs. 21.4 ± 2.7, P = 0.011), and the weight gain during pregnancy (14.1 ± 4.3 vs. 11.4 ± 3.5, P = 0.021) was significantly lower. Compared with the patients in PGHA without PPH, age (31.7 ± 4.4 vs. 29.4 ± 2.6, P = 0.033) and newborn birth weight (3367 ± 390 g vs. 3110 ± 419 g, P = 0.045) were considerably higher in PGHA cases with PPH, and the platelet count ([182 ± 44] × 109/L vs. [219 ± 51] × 109/L, P = 0.015) was significantly lower. Conclusions: Pregnant women who underwent labor induction and episiotomy had a higher incidence of PGHA. The PGHA‐related PPH rate is significantly increased. Active surgical treatment is recommended for patients with ≥5 cm hematoma. Synopsis: Induced labor and episiotomy are risk factors of perinatal genital hematoma, along with higher incidence of postpartum hemorrhage. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH). Methods: A multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight. Results: The histologically‐based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34–8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38–24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08–10.31, P = 0.036), urgent/emergency C‐section (OR: 24.15, 95% CI: 2.60–223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48–16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05–12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32–11.02, P = 0.013). Conclusion: In patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes. Synopsis: In patients undergoing postpartum hysterectomy due to postpartum hemorrhage, adenomyosis shows a histologically‐based prevalence of almost 40% and is associated to several adverse obstetric, maternal, and neonatal outcomes. [ABSTRACT FROM AUTHOR]

• Successful VBB lowers blood loss but worsens UApH compared to elective CS. • Lower BMI and multiparity boost VBB success. • Failed VBB indicates worse UApH, but no difference in Apgar score or NICU transfer rates. • VBB: It's worth a try taking into account predictors and strict birth management. The debate about the safest birth mode for breech presentation at term remains unresolved. The comparison of a vaginal breech birth (VBB) with an elective caesarean section (CS) regarding fetal outcomes favors the CS. However, the question of whether attempting a VBB is associated with poorer fetal outcomes is examined in this study. Additionally, the study evaluates factors contributing to a successful VBB and illustrates possible errors in VBB management. Study design: We performed a retrospective analysis of term breech births over 15 years in a Perinatal Center Level I regarding fetal, maternal, and obstetric outcomes by comparing successful with unsuccessful VBB attempt and all attempted VBB vs. CS including a multivariate analysis of predictors for a successful VBB. A root cause analysis of severe adverse events (SAE) was conducted to evaluate factors leading to poorer fetal outcomes in VBB. Of 863 breech cases, in 78 % a CS was performed and in 22 % a VBB was attempted, with 57 % succeeding. Comparing successful with unsuccessful VBB attempts, successful VBB showed significantly lower maternal blood loss (p < 0.001) but poorer umbilical arterial pH (UApH) (p < 0.001), while other fetal outcome parameters showed no significant differences. Predictive factors for a successful VBB attempt were a body mass index (BMI) below 30.0 kg/m2 (p = 0.010) and multiparity (p = 0.003). Comparing all attempted VBB to CS, maternal blood loss was significantly higher in CS (p < 0.001), while fetal outcomes were significantly worse in VBB attempts, included poorer Apgar scores (p < 0.001), poorer UApH values (p < 0.001), higher transfer rate to the Neonatal Intensive Care Unit (NICU) (p < 0.001) and higher rate of respiratory support in the first 24 h (p = 0.003). The failed attempt of VBB indicates significantly worse UApH without lower Apgar scores or higher transfer rate to the NICU. The likelihood of a successful VBB is 9% lower with obesity and 2.5 times higher in multiparous women. Attempting a VBB should include detailed pre-labor counseling, regarding predictive success factors, an experienced team, and consistent management during birth. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal and fetal outcomes between early (<2 h) and delayed (>2 h) vacuum extraction (VE) deliveries. Methods: We performed a retrospective cohort study in a single, university‐affiliated medical center (2014–2021). We included term singleton pregnancies delivered by VE, allocated into one of two groups according to second stage duration: <2 h or >2 h. Primary outcome was maternal composite adverse outcome (included chorioamnionitis, 3–4 degree lacerations, and postpartum hemorrhage [PPH]). Results: We included 2521 deliveries: 2261 (89.6%) with early VE and 260 (10.4%) with delayed VE. Study groups' characteristics were not different, except of parity. Maternal composite outcome almost reached a significance (P = 0.054) comparing between the groups. Comparing second stage length up to 2 h versus more, there was similar rate of advance maternal lacerations. However, extending the second stage to more than 3 h was associated with third degree lacerations compared to 2–3 h (9.8% vs 3%, P = 0.011). There were significantly more PPH events in the later VE group (P = 0.004), but the need for blood transfusions was similar. The rates of 5 min Apgar score ≤7 (P = 0.001) and umbilical artery pH <7.0 were significantly higher in group 2 compared with group 1. The effect was much more pronounced when second stage was >3 h. After conducting multiregression analysis, the results became insignificant. Conclusion: Our study suggests that VE performed in the late second stage of labor, up to 3 h, is safe as VE performed in the early stages regarding maternal and neonatal outcomes. Extra caution is needed with extended second stage to more than 3 h. Synopsis: Vacuum extraction delivery performed in the late second stage of labor, up to 3 h, is probably safe as VE performed in the early stages. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine the differences in characteristics and outcomes of early-onset and late-onset Preeclampsia.Methods A retrospective cross-sectional study was conducted on female patients giving birth with preeclampsia admitted into the Department of Obstetrics and Gynecology of Dr. Hasan Sadikin Hospital Bandung from January 2020 to December 2022 who met the study criteria. A total of 435 subjects met the inclusion criteria were divided into two groups: early-onset preeclampsia and late-onset preeclampsia. Differences in outcomes were analyzed using the Chi-square or Fisher test for categorical data and the T-independent or Mann–Whitney test for numerical data.Results There were differences in the incidence of HELLP syndrome (9.0 vs. 2.7%; p = 0.009), prematurity (77.7 vs. 21.4%; p = 0.000), early neonatal death (10.4 vs. 2.7%; p = 0.002), asphyxia (22.7 vs. 8.0%; p = 0.000), SGA (41.7 vs 21.9%; p = 0.000), and LBW (78.7 vs 40.2%; p = 0.000) in early-onset preeclampsia with late-onset. Length of stay was longer in early-onset preeclampsia cases (4.0 vs 3.0 days; p = 0.000). Increased ureum and liver enzymes results were significantly higher in early-onset preeclampsia.Conclusion There is a difference in the outcome of pregnant women with early-onset and late-onset preeclampsia. Women with early-onset preeclampsia tend to have more adverse maternal and neonatal outcomes. In terms of maternal outcome, they tend to have higher liver enzymes level and HELLP syndrome, while in terms of neonatal outcome they tend to have prematurity, early neonatal death, asphyxia, SGA, and LBW.

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

Introduction: Teenage pregnancy is a global public health challenge, and it is a major contributor to the high maternal and neonatal morbidity and mortality rates reported in sub‐Saharan Africa and Uganda. However, there is a paucity of data regarding pregnancy outcomes and their associated factors among teenagers in Uganda. The purpose of this study was to determine the prevalence and factors associated with pregnancy outcomes among teenagers who delivered at a National Referral Hospital in Kampala, Uganda. Materials and Methods: This cross‐sectional study was conducted among teenage mothers who delivered at a National Referral Hospital in Kampala, Uganda. Consecutive participant recruitment was done for those who fulfilled the eligibility criteria. The outcomes of interest included adverse maternal outcome with obstructed labor being used as a proxy and adverse fetal outcomes with birth asphyxia used as a proxy. Logistic regression analysis was used to determine the association between independent and dependent variables with a 5% level of statistical significance (α = 0.05). Results: Teenage pregnancy was associated with adverse maternal outcomes which included obstructed labor (18%) and preterm labor (5.5%). There were no maternal deaths during the study period. Adverse fetal outcomes observed in this study population included low birth weight (83%), birth asphyxia (18%), and stillbirth (4%). The only factor associated with adverse maternal outcome was gestational age where teenage mothers had 4 times likelihood of delivering before 37 weeks. Relatedly, teenage mothers had an 81% chance of having a preterm birth. Conclusion: Teenage pregnancy was generally not associated with adverse maternal or fetal outcomes except for preterm birth. The reasons for adverse pregnancy outcomes may reflect a combination of gynecological and biological immaturity, as well as adverse socioeconomic pressures. [ABSTRACT FROM AUTHOR]

Introduction Obesity is increasing worldwide, and bariatric surgery (BS) is increasingly employed for weight management in women of reproductive age. An interplay between pregnancy and BS is very likely. A review of the challenges faced and solutions needed is warranted. Materials and Methods A narrative, nonsystematic review of the international literature from a single online database (PubMed) was performed on July 23, 2023. All articles were included. The retrieved relevant literature is narrated in a concise thematic account. Results BS carries major metabolic, mechanical, and vascular benefits, possibly accompanied by nutritional, vitamins, minerals, and micronutrient deficiencies, which might be clinical or subclinical. A few of the frequently reported postbariatric nutritional jeopardies could be augmented by the physiological changes of pregnancy, which need a different approach to management. Nutritional deficiencies during pregnancy could carry both maternal and fetal short- and long-term risks. Fetal risks may range from miscarriage to low birth weight, neural tube defects, congenital anomalies, cognitive impairment, and internal organ dysplasia. Postbariatric status is, by default, a high-risk pregnancy category, given the altered biochemical, vasomotor, and mechanical indices of any lady treated with BS. Postgastric bypass hypoglycemia (PGBH) is a relatively common phenomenon during pregnancy, and it usually calls for multidisciplinary action to control. A dedicated monitoring protocol before, during, and after pregnancy has been suggested in several guidelines to guard against the potentially devastating consequences to both mother and fetus. Conclusions Weight reduction after BS enhances fertility. The optimum timing for ladies treated with BS to get pregnant is not very well established yet. However, various societies have provided multidisciplinary management guidance of management prior to and during pregnancy. Many nutritional supplements that are not routinely prescribed during pregnancy will be essential for those treated with BS. Further studies are still warranted to ensure the safe interim between BS and conception as well as the safety of various doses of medications used for postbariatric individuals, for instance, medications used for PGBH. [ABSTRACT FROM AUTHOR]

Background: COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods: Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results: The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53–43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52–38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34–4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions: Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia. [ABSTRACT FROM AUTHOR]

Women with preexisting diabetes and gestational diabetes mellitus (GDM) are at higher risk for adverse maternal and neonatal outcomes. However, there is no consensus on a uniform approach regarding mode of birth (MOB) for all forms of diabetes. The aim of the study is to compare MOB in women with preexisting diabetes and GDM and possible factors influencing it. A retrospective cohort study of women with GDM and preexisting diabetes between 2015 and 2021 at a tertiary referral center was conducted. One thousand three hundred eighty-five singleton pregnancies were included. One thousand twenty-two (74.4%) women had a vaginal birth (VB) and 351 (25.6%) a caesarean section. Preexisting diabetes was significantly associated with caesarean section compared to GDM (OR 2.43). Five hundred fifty-one (40.1%) women underwent induction of labor, and 122 (22.1%) women had a secondary caesarean after IOL. Women induced due to spontaneous rupture of membrane (SROM) achieved the highest rate of VB at 93%. The lowest rates of VB occurred if indication for induction was for preeclampsia or hypertension. IOL was significantly less successful in preexisting diabetes with a VB achieved in 56.4% for type 1 diabetes and 52.6% of type 2 diabetes compared to GDM (78.2% in GDM; 81.2% in IGDM; OR 3.25, 95% CI 1.70–6.19, p < 0.001). The rate of VB was higher who were induced preterm compared to women with term IOL (n = 240 (81.9%) vs. n = 199 (73.2%); p < 0.05). Parity, previous VB and SROM favored VB after IOL, whereas preexisting diabetes, hypertension, and IOL after 40 + 0 weeks are independent risk factors for caesarean delivery. [ABSTRACT FROM AUTHOR]

Introduction: As maternal age during pregnancy is rising all over the world, there is a growing need for prognostic factors that determine maternal and perinatal outcomes in older women. Material and methods: This study is a retrospective cohort study of women aged 40 years or older at the time of delivery in four Santeon hospitals across the Netherlands between January 2016 and December 2019. Outcomes were compared between women of 40–44 years (advanced maternal age) and 45 years and older (very advanced maternal age). Primary outcome was unplanned cesarean section, secondary outcomes included postpartum hemorrhage and neonatal outcomes. Multivariate regression analysis was performed to analyze predictive factors for unplanned cesarean sections in women who attempted vaginal delivery. Subsequently, a predictive model and risk scores were constructed to predict unplanned cesarean section. Results: A cohort of 1660 women was analyzed; mean maternal age was 41.4 years, 4.8% of the women were 45 years and older. In both groups, more than half of the women had not delivered vaginally before. Unplanned cesarean sections were performed in 21.1% of the deliveries in advanced maternal age and in 29.1% in very advanced maternal age. Four predictive factors were significantly correlated with unplanned cesarean sections: higher body mass index (BMI), no previous vaginal delivery, spontaneous start of delivery and number of days needed for cervical priming. A predictive model was constructed from these factors with an area under the curve of 0.75 (95% confidence interval 0.72–0.78). A sensitivity analysis in nulliparous women proved that BMI, days of cervical priming, age, and gestational age were risk factors, whereas spontaneous start of delivery and induction were protective factors. There was one occurrence of neonatal death. Conclusions: Women of advanced maternal age and those of very advanced maternal age have a higher chance of having an unplanned cesarean section compared to the general obstetric population in the Netherlands. Unplanned cesarean sections can be predicted through use of our predictive model. Risk increases with higher BMI, no previous vaginal delivery, and increasing number of days needed for cervical priming, whereas spontaneous start of labor lowers the risk. In nulliparous women, age and gestational age also increase risk, but induction lowers the risk of having an unplanned cesarean section. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia 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.)

This document provides data on the maternal and neonatal outcomes of preterm premature rupture of membranes (PPROM) in a tertiary care hospital in India. The majority of participants were young, urban, and had lower socioeconomic status. Comorbidities such as gestational diabetes and thyroid disorders were common, as were genital infections. Vaginal delivery was the most common method, with favorable neonatal outcomes and no significant differences based on the delivery interval following PPROM. The study suggests further research on antibiotic treatment and neuroprotection. [Extracted from the article]

Background: Dengue is a vector borne disease with various grades of severity. Pregnancy is a high-risk group and is prone for complications of dengue haemorrhagic fever. Dengue fever has rapidly emerged as the most common arboviral infection globally. Objectives: The primary objective of the study was to assess maternal and fetal outcomes of pregnancies affected with dengue fever. Materials and methods: It was an institutional based prospective observational study. It was conducted in Department of Gynaecology and Obstetrics, College of Medicine & Sagar Dutta Hospital, Kamarhati, Kolkata, West Bengal, India. After receiving the clearance from the ethical committee study was conducted from June 2022 to December 2022. All pregnant patients reporting to the hospital with fever and serologically confirmed dengue infection (40 confirmed cases) were included in the study. Clinical and laboratory data of patients were collected. The cases were followed up till their delivery to monitor the effect of dengue. The data were entered in MS Excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Result: In the present study platelet count of 9 (22%) patients were <25000 lac and platelet count of 13 (33%) patients were 15000 to 50000 lac. In the present study 3 (7.50%) patients need ICU care followed by 9 (22.50%) need platelet transfusion, 7 (17.50%) need C PAP, 8 (20%) need PPH, 7 (17.50%) need abortion and 2 (5%) patients need abruption. In the present study 5 (12.5%) fetals suffered from fetal distress followed by 2 (5%) suffered from Oligohydramnios. In the present study 4 (35%) neonatal were normal. 8 (20%) neonatal need SNCU admission, 2 (5%) neonatal need NICU admission. Conclusion: Pregnancy-related dengue illness progressed quickly and caused serious consequences. For both the mother and the fetus to have a positive outcome, close materno-fetal monitoring and prompt obstetric care are necessary. [ABSTRACT FROM AUTHOR]

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. Synopsis: Amniotomy during the active phase of labor (as newly defined by WHO) can shorten the labor duration without any significant negative consequences. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare pregnancy outcomes in pregnant women in the third trimester with and without anemia.Methods: A case-control study was conducted, involving 144 pregnant women with anemia (case group) and 144 pregnant women without anemia (control group) receiving prenatal care in the third trimester between April 2021 and March 2022. Various maternal and neonatal clinical outcomes, such as response to iron intake, incidence of preeclampsia during delivery, rates of cesarean section, postpartum infections, small for gestational age (SGA) infants, Apgar scores at 1 and 5 minutes, and birth weight, were recorded and compared between the two groups.Results: Mean hemoglobin and hematocrit levels were significantly lower in women with anemia compared to those in the control group (p

Abstract 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

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.

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.

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

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. [ABSTRACT FROM AUTHOR]

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

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

Background: The patients who are of age 35 or more at the time of delivery are termed as elderly gravida patients. The topic is related to concern as in previous 2-3 decades there is a shift towards advanced maternal age due to multiple reasons and it can result in adverse maternal as well as perinatal outcomes. Also reduced fertility with increasing maternal age is evidenced by decline in ovarian reserve and quality. Materials & Methods: An observational retrospective study participated by 500 pregnant women. These 500 patients are divided into a group of cases consisting of 250 elderly gravida patients who are compared with 250 patients of control group of non-elderly gravida group. Results: A significant difference can be noticed in associated morbidities and mortalities in maternal as well as perinatal context with increasing maternal age. Along with elderly gravida patients are at higher risk of undergoing operative delivery as well. Conclusions: The elderly gravida patients should be considered in high risk group due to possibility of antecedent complications and should be counseled and managed accordingly. For this purpose preconceptional counseling, prenatal diagnosis along with management of labor can play a vital role. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancy is a serious issue in both developed and underdeveloped nations. Causative factors being early puberty, early marriage, sociocultural factors, illiteracy, early sexual activity, lack of knowledge and access to contraception, ignorance, and poverty. Teenage pregnancy has been associated with several adverse consequences, including anaemia, preeclampsia, premature delivery, infants being small for gestational age, low birth weight, and increased neonatal morbidity and mortality. Materials and Methods: A comparative study regarding maternal and perinatal outcome was conducted between 100 cases of primigravidae aged 14- 19-year-old and 100 cases of primigravidae of 20-29-year-old attending Government Maternity Hospital, Tirupati and willing to give written informed consent. All high risk pregnancies were excluded from the study. Results: The mean age in teen age primigravidae found to be 18.1yrs where as it is 24.6yrs in adult primigravidae. There is no significant difference in distribution of unbooked cases in teenage and adult pregnancies. 19% of teenage pregnant women were illiterate compared to only 4% in adult group. 69% of teenage group and 52% of adult group belongs to low socioeconomic status. Majority of study participants are of term gestational age. Teenage pregnancy is an important risk factor for development of anaemia and hypertension incidence being 68% & 27% compared to that of adult group where incidence being 32% & 8% respectively. Preterm and IUGR is a common neonatal outcome observed in teenage pregnancies compared to that of adult pregnancies. 2 IUDs observed in teenage group and no IUDs in adult group. Incidence of failed induction and cephalopelvic disproportion were significantly more associated with teenage primigravidae. Majority of the adult primigravidae adopted for one or other method of contraception. Conclusion: Teenage mothers had numerous complications in pregnancy, anemia, pre-eclampsia, and preterm labor, oligo hydamnios, Thyroid disorders. Higher operational intervention and a higher LSCS rate are also contributing factors in the rise in maternal morbidity. Neonatal morbidity is also more in teenage mothers due to prematurity, low birth weight, and perinatal asphyxia. Stringent rules should be implemented to avoid early marriages and teenage pregnancies. [ABSTRACT FROM AUTHOR]

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

Introduction: Hypertensive disorders are the most common medical disorders encountered in pregnancy approximately 7% to 10% of all pregnancies. Hypertensive disorders are associated with foetal growth restriction, perinatal asphyxia, Iatrogenic prematurity, still births, preterm delivery, perinatal death, neonatal mortality and affects vital maternal organ system such as hepatic, renal, cardiorespiratory, cerebral and haematologic leading to maternal morbidity and mortality. The aim of the study was to assess the prevalence of severe pre-eclampsia, eclampsia and HELLP syndrome in our Hospital and its maternal and foetal outcome. Materials and Methods: This is retrospective study done in Department of Obstetrics and Gynaecology, Government General Hospital, Guntur over a period of six months (July 2023 to December 2023). All women presenting with severe pre-eclampsia, pre-eclampsia with imminent features, eclampsia and HELLP syndrome attending Labour room, Government General hospital Guntur were included in this study. Women with gestational HTN, nonsevere pre-eclampsia, chronic HTN were excluded. Ethical approval was obtained from institutional ethical committee. Out of all the total deliveries, 130 were studied. All detailed data such as demographic data, maternal age, parity, mode of delivery, obstetrical history, obstetric outcome, maternal complications, and foetal outcome were recorded. Results: 130 cases were recorded out of 3007deliveries. Among these, 66 cases were severe pre-eclampsia (50.76%),33 cases were imminent eclampsia(25.38%), 27 cases were Eclampsia(20.76%), four cases were HELLP syndrome(3%). The total prevalence was4.32% in our study. Majority of them were primigravida(61.53%) and belong to an age group of 20 to 25 (60%). Majority of them were delivered by caesarean section (67.69%). Most complications were seen in the eclampsia group. Prematurity was seen in 60.75% and LBW seen in 40.57%. 10 cases were IUD and 15 were neonatal deaths. Conclusion: It is one of the important causes of maternal and perinatal morbidity and mortality probably resulting from inadequate and suboptimal antenatal care and lack of education and awareness amongst people belonging to low socio-economic status. The high prevalence of hypertensive disorders complicates the maternal and foetal outcome. Antenatal surveillance, early detection, prompt treatment and early intervention and timely termination of pregnancy could reduce the maternal morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Amniotic fluid has many important functions and is regulated by multiple factors. It is integral to fetal development, including fetal pulmonary, gastrointestinal, and musculoskeletal maturation. It also acts to cushion the fetus from trauma. It is also believed to be sterile and possesses bacteriostatic properties. Amniotic fluid is regulated by fetal swallowing, fetal urine production, lung secretions, and intramembranous absorption. Amniotic fluid abnormalities (either increased or decreased fluid) are due to dysregulation of these processes from maternal or fetal disease. Normal amniotic fluid volume has been extensively studied using direct measurement, dye dilution methods, and ultrasound estimation. Materials and methods: The present study was conducted in the Department of Obstetrics and Gynecology, Arundathi Hospital over a period of 1 year. This study subjects consisted of registered antenatal patients at term gestation with single live fetus in cephalic presentation. The study group subjects constituted registered 90 antenatal cases presented at gestational age above 37 weeks. The mothers during their first visit were included for detailed history, clinical examination and blood investigations as follows. Detailed case history including age / parity / menstrual history / obstetric history/past and family history were taken. Detailed general and systemic examination of the patient was done. Result: The study was done on 90 antenatal patients with oligohydramnios. The mean age group of the study participants was 28.39±6.49 years. Majority (50%) of them were primigravida and most of them (44%) belonged to the age group of 26 to 30 years. 41(82%) patients required an emergency LSCS and 35 (38.9%) of the new-born required an extra care and were admitted in NICU. Gestational age, birth weight and abnormal doppler study were found to have an association with the perinatal outcome. The present study revealed that children with increased birth weight and gestational age had a favourable perinatal outcome. Those with an abnormal doppler study had an unfavourable perinatal outcome. Other factors like age of the mother, parity, mode of delivery and AFI did not have any association with perinatal outcome. Perinatal mortality in the present study was 8.9%. Conclusion: In conclusion, due to such adverse outcomes mentioned in patients with borderline AFI and because there is no sufficient evidence and specific decision about delivery based on a borderline AFI, there should be a close observation and antepartum surveillance for them. Also, further studies with prospective design are needed. [ABSTRACT FROM AUTHOR]

Background/Aim: Due to still controversial discussion regarding appropriate termination of low-risk singleton pregnancies beyond term, this retrospective study aimed to evaluate maternal and perinatal outcomes depending on gestational age and obstetric management. Patients and Methods: This is a retrospective cohort analysis including 3.242 low-risk singleton deliveries at the Department of Obstetrics of the University Hospital of Cologne between 2017 and 2022. According to current national guidelines, the cohort was subdivided into three gestational groups, group 1: 40+0- 40+6 weeks, group 2: 40+7-40+10 weeks and group 3>40+10 weeks. Results: In our cohort, advanced gestational age was associated with higher rates of secondary caesarean sections, lower rates of spontaneous vaginal deliveries, higher rates of meconium-stained amniotic fluid and depressed neonates with APGAR < 7 after 5 min. Analyzing obstetric management, induction of labor significantly increased the rate of secondary sections and reduced the rate of spontaneous deliveries, while the percentage of assistant vaginal deliveries was independent from obstetric management and gestational age. Induction of labor also significantly enhanced the need for tocolytic subpartu and epidural anesthesia and caused higher rates of abnormalities in cardiotocography (CTG), which also resulted in more frequent fetal scalp blood testing; however, the rate of fetal acidosis was independent of both obstetric management and gestational age. Conclusion: Our study supports expectant management of low-risk pregnancies beyond term, as induction of labor increased the rate of secondary sections and did not improve perinatal outcome. [ABSTRACT FROM AUTHOR]

Aim: To explore the impact of the Omicron variant on maternal and neonatal outcomes. Design: Cross‐sectional cohort study of women giving live birth in a single hospital in Shanghai in December 2022. Methods: Demographic characteristics, maternal and neonatal outcomes and laboratory testing results were retrieved from medical records. Propensity score matching was used to match COVID‐19‐positive and ‐negative women. Differential analysis was used to assess associations between COVID‐19 and in‐hospital maternal and neonatal outcomes. Results: A total of 1508 women were included, comprising 729 natural births, 741 caesarean sections and 38 forceps deliveries. After 1:1 matching, 310 clients were included for analysis with each 155 in COVID‐19‐positive and ‐negative groups. Higher maternal fever was found in all modes of delivery, and higher preterm birth and lower pH value of blood gas of the umbilical artery in the vaginal delivery subgroup (p < 0.05). Other maternal and neonatal outcomes showed no significant difference between COVID‐19‐positive and ‐negative clients. [ABSTRACT FROM AUTHOR]

Background COVID-19 is an infectious pathology that shows vascular changes during pregnancy, as well as in the placentas. The main objectives of this study were to estimate the prevalence and the risk factors for preeclampsia in hospitalized pregnant women with COVID-19. As well as comparing maternal and perinatal outcomes in hospitalized pregnant women with COVID-19 and preeclampsia with those without preeclampsia. Methods Prospective cohort study of 100 hospitalized pregnant women from two tertiary hospitals, diagnosed with COVID-19, and divided into two groups: PE+ group (pregnant women with COVID-19 and preeclampsia) and PE- group (pregnant women with COVID-19 without preeclampsia). These pregnant women had prevalence, risk factors, maternal and perinatal data analyzed. Results The prevalence of preeclampsia was 11%. Severe COVID-19 was the main risk factor for preeclampsia (OR = 8.18 [CI 1.53–43.52]), as well as fetal growth restriction was the main perinatal outcome (OR = 8.90 [CI 1.52–38.4]). Comorbidities were more frequent in the PE+ group (63.6% vs 31.5%, p = 0.03), as well as prematurity (81.8% vs 41.6%, p = 0.02), low birth weight (63.6% vs 24.7%, p = 0.01), and the need for neonatal intensive care admission of the newborn (63.6% vs 27.0%, p = 0.03). Pregnant women with PE had twice as long a length of stay in the intensive care unit (RR = 2.35 [CI 1.34–4.14]). Although maternal mortality was more frequent among pregnant women with PE, it was not statistically significant. Conclusions Prevalence of preeclampsia in hospitalized pregnant women with COVID-19 was 11%. Severe COVID-19 was the main risk factor for preeclampsia and associated comorbidities increased the risk for developing preeclampsia. Long length of stay in the intensive care unit was the main maternal outcome and fetal growth restriction was the main perinatal outcome of preeclampsia.

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

Objective: To evaluate the maternal and perinatal outcomes following antenatal screening for ICP using a retrospective approach. Materials and methods: A retrospective study was conducted at the second affiliated hospital of Chongqing Medical University, Chongqing, China, from 2012 to 2017. Pregnant women registered for antenatal in our hospital were screened for ICP. The pregnant women with detailed delivery record and presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. Method: The pregnant women with detailed delivery records presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. 1410 pregnant women were enrolled in this study. We selected 940 pregnant women without the diagnosis of ICP as our control and 470 pregnant women diagnosed with ICP as our case study. Data collection and sampling in the control group was done using microsoft excel (version 16.61) random number generator. Results: The mean age of the pregnant women and the gestational age at the time of diagnosis of ICP were 29.01 ± 4.3 years and 31.90 ± 8.83 weeks, respectively. It was found that a significant number of patients with ICP had a preterm birth and low birth weight (LBW), n = 151 (32.5%) P

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic has subjected us all to difficult times in managing patients, particularly pregnant women. Numerous studies have been conducted during each wave, but limited data is available on maternal and neonatal outcomes. Given that people must coexist with COVID-19, it is crucial to enhance the understanding of antenatal patient management. Aim: To compare the clinical presentation, co-morbidities, and maternal and neonatal outcomes among pregnant women with COVID-19 during the first, second, and third waves of the pandemic. Materials and Methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynaecology (OBG) at JSS Hospital, Mysore, Karnataka, India, from January 2020 to February 2022. A total of 33 expectant mothers with COVID-19 presented during the first wave (from January 30, 2020, to the end of February 2021), 50 expectant mothers with COVID-19 during the second wave (from March 2021 to the end of September 2021), and 19 expectant women with COVID-19 during the third wave (from January 2022 to the end of February 2022). Data were collected for each wave, and a comparison of different variables in all three waves was performed. Microsoft Excel was used for data entry, and analysis was conducted using Statistical Package for Social Sciences (SPSS) version 22.0. Chi-square test was employed to compare the different variables as a test of significance. Results: The mean age of the expecting mothers in the first wave was 27.12±4.35 years, in the second wave was 25.86±3.98 years, and in the third wave it was 24.61±3.98 years, with a p-value=0.103. Symptoms like cough, cold, running nose were highest in the second wave (22 cases, 44.0%), followed by breathlessness in 6 (12.0%) cases, and fever, chills, myalgia, generalised weakness, vomiting in 45 (90.0%) cases. Hypertensive disease of pregnancy was highest in the first wave (8 cases, 24.2%). In the first, second, and third waves, a total of 23 (69.7%), 30 (60.0%), and 12 (63.1%) individuals, respectively, did not have any co-morbidities. The majority of women in the first wave 18 (54.6%) cases and second wave 27 (54.0%) cases were multigravida, while in the third wave, they were primigravida 14 (73.7%) cases. Pre-term deliveries 22 (44.0%) cases and intrauterine deaths 8 (16.0%) cases were highest in the second wave. There was a higher frequency of Preterm Premature Rupture of Membranes (PPROM) and Premature Rupture of Membranes (PROM) in the first wave 6 (18.2%) cases. Neonatal Intensive Care Unit ( NICU) admission of babies was found to be highest in the third wave 8 (42.1%) cases, compared to the first two waves. There was no statistically significant association between these parameters and the waves of the pandemic. The mean Haemoglobin (Hb) levels of the study subjects were least in the first wave, compared to those in the rest of the waves (p-value=0.499). Mean Erythrocyte Sedimentation Rate (ESR) levels were significantly lower in the first wave (p-value=0.041), and C-reactive Protein (CRP) was highest in women in the second wave (p-value=0.036). Conclusion: It is important that always study the features of the disease over a period of time so that the management protocols can be modified.

Introduction: Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease of the esophagus. It has a peak incidence in the 2nd and 3rd decades of life. Despite this, little is known about pregnancy outcomes in patients with EoE. Methods: Using a validated histopathologic and nationwide population-based cohort for the diagnosis of EoE, we examined maternal and fetal outcomes, with preterm birth as the primary outcome, in females with EoE compared to matched controls. Odds ratios (ORs) were calculated using logistic regression. Results: Between 1992 and 2016, we identified 19 females with EoE who gave birth to 23 children (reference births: n = 115). There was 1 (4.3%) preterm birth in the EoE cohort versus 8 (7.0%) in the reference cohort (OR = 0.60; 95% CI = 0.07–5.14). Secondary fetal outcomes included stillbirth, neonatal death, small for gestational age, low birth weight (LBW), and low Apgar score. Of these, LBW (

The article focuses on real-world effectiveness of an ethnic diet plan for managing gestational diabetes in high-risk ethnic groups. It aims to demonstrate how tailoring dietary interventions based on Mediterranean diet principles can impact maternal and fetal outcomes, as well as insulin therapy requirements, in females with gestational diabetes mellitus (GDM) from diverse ethnic backgrounds attending an Interdisciplinary Diabetes and Pregnancy Center.

Introduction: Eclampsia, a hypertensive disorder, is one of the leading causes of maternal mortality in developing countries like Nigeria. We evaluated the relationship between the pattern of liver enzymes and maternal mortality in eclamptic women. Method: A retrospective study of 55 eclamptic women admitted to the Intensive Care Unit (ICU), University College Hospital, Nigeria, was conducted. Data were obtained on their demographic, obstetric, and clinical characteristics, liver enzyme patterns, and maternal outcome. Analysis was by descriptive statistics, univariate analysis, and non-parametric tests with level of significance set at p