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Complications that may occur while performing myomectomy in pregnancy can be prevented in a well-optimised surgery. Counselling and comprehensive peri-operative preparations are mandatory to minimise litigations and untoward events. Myomectomy in pregnancy remains a contentious issue. Degeneration of fibroid during pregnancy is common. However, conservative management suffices in majority of cases. In nonresponsive conservative treatment, myomectomy may be an option. this article discusses our experience in treating a 38-year-old woman in her fourth pregnancy at 15 weeks gestation with symptomatic uterine fibroid. she had persistent abdominal pain since nine weeks gestation. she developed fever and acute abdomenat at 15 weeks and the uterus was larger than dates.Ultrasound scan confirmed single pregnancy with a large intramural fibroid showing degenerative changes. A myomectomy was performed as a preventive measure to prevent massive haemorrhage. Although performing myomectomy during pregnancy is considered controversial, complications can be minimised with properly-planned surgery.

Background: COVID-19 is an emerging global pandemic with potential adverse effects during pregnancy. This study aimed to determine the adverse maternal and foetal outcomes due to COVID-19 infection. We also compared maternal and neonatal outcomes with regard to the timing of diagnosis (first and second trimester vs. third and fourth trimester); early COVID-19 (stage I and II) vs. severe-stage COVID-19 (III, IV, and V); and lastly, women who were partially vaccinated vs. unvaccinated., Methods: This was a retrospective study conducted in HCTM from January 2021 to January 2022. All pregnant women admitted for COVID-19 infections were recruited. The patients' records were traced. Adverse maternal and neonatal outcomes were documented and analysed., Results: There were 172 pregnant women recruited into this study. We excluded twenty-four patients with incomplete data and nine women who delivered elsewhere. The final 139 patients were available for data analysis. The majority of women were in their third trimester of pregnancy (87.8%); however, only 5.0% and 7.2% were in the first and second trimesters, respectively. The study population had a median BMI of 29.1 kg/m 2 and almost half of them had never received a COVID-19 vaccination. A sub-analysis of data concerning adverse maternal and foetal outcomes comparing early vs. severe stages of COVID-19 infection showed that severe-stage disease increased the risk of preterm birth (54.5% vs. 15.4%, p < 0.001) and preterm birth before 34 weeks (31.9% vs. 2.6%, p < 0.001) significantly. The severe-stage disease also increased NICU admission (40.9% vs. 15.4%, p = 0.017) with lower birth weight (2995 g vs. 2770 g, p = 0.017). The unvaccinated mothers had an increased risk of preterm birth before 34 weeks and this was statistically significant (11.6% vs. 2.9%, p = 0.048)., Conclusions: Adverse pregnancy outcomes such as ICU admission or patient death could occur; however, the clinical course of COVID-19 in most women was not severe and the infection did not significantly influence the pregnancy. The risk of preterm birth before 34 weeks was higher in a more severe-stage disease and unvaccinated mother. The findings from this study can guide and enhance antenatal counselling of women with COVID-19 infection, although they should be interpreted with caution in view of the very small number of included cases of patients in the first and second trimesters.

Pelvic floor disorders are common and of concern, as the majority of maternity healthcare providers seldom discuss this issue with patients compared to other antenatal issues. The aim of this study is to determine the prevalence and to assess the knowledge and awareness of pelvic floor disorder (PFD) among pregnant women in a tertiary centre in Malaysia. We also aim to assess the association between women’s risk factors regarding their knowledge and awareness of pelvic floor disorder so that primary prevention strategies can be planned, initiated and implemented in the future. This is a cross-sectional study with a total of four hundred twenty-four pregnant women that were recruited over a 6-month duration from May to November 2017 in a tertiary centre in Malaysia. The Pelvic Floor Distress Inventory (PFDI-20) was used to evaluate pelvic floor distress symptoms during pregnancy, namely urinary incontinence, pelvic organ prolapse and faecal incontinence. A validated Prolapse and Incontinence Knowledge Questionnaire (PIKQ), which consists of 24 items, was used to assess respondents’ knowledge about urinary incontinence (UI) and pelvic organ prolapse (POP). A total of 450 participants were approached, but 424 participants agreed to participate, showing a response rate of 94.3%. The median age was 31.5 years old, and 33.3% were primiparity. Overall, 46.1% of pregnant women had at least one symptom of pelvic floor disorder during pregnancy. Of these, 62.3% experienced urinary incontinence, 41.1% experienced symptoms of pelvic organ prolapse, and 37.8% experienced symptoms of faecal incontinence. The overall median score of PIKQ was 12.0 (8.0, 17.0). The median score for PIKQ—UI was 7.0 (5.0, 9.0) and the median score for PIKQ—POP was 6.0 (4.0, 8.0). There were 341 (80.4%) pregnant women that had a low level of knowledge in UI, and 191 (45.0%) had a low level of knowledge in POP. Having a tertiary level of education and receiving antenatal specialist care were both associated with better proficiency in both the PIKQ—UI (p < 0.001) and PIKQ—POP (p < 0.001) subscales. Pelvic floor disorder during pregnancy was common. A knowledge of pelvic floor disorder was lacking among pregnant women in this study. Having a tertiary education and receiving antenatal specialist care were both associated with better knowledge proficiency. This study hopefully serves as a basic platform for future educational programs to bridge the knowledge gaps in PFD among pregnant women.

Objective: The aim of this study was to assess the prevalence of foetal anomaly diagnosed during a detailed ultrasonography amongst patients of advanced maternal age (AMA) and to identify the related anomalies in these age groups., Method: A retrospective observational study amongst AMA mothers was done in Universiti Kebangsaan Malaysia Medical Centre, a Malaysian teaching hospital. The data over a period of three years (January 2013 - December 2016) obtained from the Maternal Foetal Medicine clinic registry was analysed. AMA mothers with singleton pregnancy presenting for foetal structural anomaly scan was included. They were later subdivided into 2 groups (35-39 years and ≥ 40 years). The logistic regression analysis was used to analyse the association of the chromosomal anomalies and the age groups., Results: In all 486 patients were recruited and 84 patients were identified with foetal anomaly (17.3%). There was no significant difference in the prevalence of foetal anomalies or significant association with a specific structural foetal anomaly identified (p>0.05). However, the number of followups for these patients are significantly higher (p<0.001)., Conclusion: The prevalence of structural foetal anomalies identified in detailed ultrasonography was low in AMA mothers. Hence, referral criteria for detailed anomaly ultrasonography need to be re-looked.

Primary umbilical endometriosis (PUE) is a rare gynaecological disorder. A majority of the reported cases were treated with surgical excision as medical treatment had been found to be less successful. We reported a case of PUE successfully treated with dienogest without any profound side effects from the drug.

Reduced fetal movement is a worrisome common complaint, not only for mothers but also for the attending medical personnel. The aim of this study was to analyse the pregnancy outcomes of women who presented primarily with reduced fetal movements (RFM). A retrospective study was performed based on patients' perception alone. Obstetric, past medical history, current presentation and outcomes of pregnancy were analysed. A total of 230 case notes were reviewed, with the majority being primigravidae. Less than half (48.7%) of the women had spontaneous labour, 45.7% had induction and 5.6% had elective caesarean section. There were no maternal complications in 97.4% (n = 224) of them. About 0.9% (n = 2) and 1.7% (n = 4) had primary postpartum haemorrhage and extended perineal tear, respectively. Although there was no major neonatal mortality and morbidity, until a randomised trial with a significant sample is conducted in the management of RFM, careful selections for elective delivery or conservative management would prevent untoward complications.

Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF) contribute in the development of preeclampsia and are suggested as prediction markers in healthy pregnant women but limited data is available in women with major preeclampsia risk factors. This study aimed to determine the role of sFlt-1 and PlGF in predicting preeclampsia among high risk pregnant women. This was a prospective study and samples were collected for a period of ten months. Blood samples were obtained from 84 pregnant women who had at least one risk factor for preeclampsia at 25 to 28 weeks and at 29 to 36 weeks of gestation. SFlt-1 and PlGF concentrations were determined by immunoassay method. There were significantly higher median sFlt-1 and sFlt-1:PlGF ratio at gestational interval 25 to 28 weeks and sFlt-1:PlGF ratio at 29 to 36 weeks in high risk women who developed preeclampsia. Significant lower median serum PlGF levels at 25 to 28 weeks and 29 to 36 weeks were observed in this group of women. In conclusion, the concentrations of these markers were altered in high risk preeclamptic women, a similar pattern seen in low risk preeclamptic women. However the predictive value of these markers could not be established clearly.

Gestational trophoblastic disease (GTD) is a common problem among Asian ethnics. A total of 102 women with molar pregnancies between 1 January 2005 and 31 December 2010, were analysed. The aim of the study was to determine the outcome of all molar pregnancies in our institution. The local incidence of molar pregnancy was 2.6 per 1,000 deliveries. A total of 48 women (47.1%) had complete hydatidiform mole and another 54 (52.9%) had partial mole. The mean age of the women with molar pregnancies was 32.0 ± 7.9 years. The mean gestational age at initial diagnosis was 11 weeks ± 3 days. The majority (97 women, 95.1%) had symptoms of vaginal bleeding and 18 (17.6%) women had a uterus larger than dates. A total of 48 (47.1%) women had ultrasound scan findings of 'snow-storm' appearance. None of the women with uncomplicated molar pregnancy had evidence of relapse following one undetectable serum β-hCG level. Four out of the 102 women (3.9%) developed persistent trophoblastic disease before attaining one undetectable serum β-hCG level. All four women required single agent methotrexate and they remained in remission. The prognosis for uncomplicated molar pregnancy is good. Establishment of a National Trophoblastic Centre is recommended to maintain optimal outcome.

Aim: To evaluate the safety and tolerability of once or twice daily neutral protamine hagedorn (NPH) insulin in fasting pregnant diabetics during Ramadan., Methods: This was a prospective cohort study conducted during Ramadan 2006 and 2007. Twenty four pregnant diabetic women were given NPH insulin once at 5 pm or twice daily at 5 pm and 5 am. Demographic data, blood glucose control, insulin requirement, days of fasting and hypoglycemic episodes were analyzed., Results: Most women were parity 1 (37.5%) in their second trimester (54.2%) and worked during the daytime (87.5%). Fourteen women (58.3%) had gestational diabetes mellitus, nine women (37.5%) had type 2 and one (4.2%) had type 1 diabetes mellitus. There were significant reductions in mean fasting blood glucose (6.16 mmol/L versus 5.34 mmol/L, P = 0.001), glycosylated hemoglobin (HbA1c) (6.70% ± 0.91 versus 6.64% ± 0.96, P = 0.001) and serum fructosamine (232.4 mmol/L ± 24.0 versus 217.0 mmol/L ± 24.3, P = 0.001) after Ramadan compared to before Ramadan. Throughout the four weeks of Ramadan, home blood glucose monitoring showed a reducing trend and was within the acceptable limits. Insulin requirement was increased from the first to the fourth week with a reduction in insulin dose noted after (38.5 U/day) compared to before the start of Ramadan (40 U/day). Most women (79.2%) were able to fast for more than 15 days without any hypoglycemia or fetal demise., Conclusion: Once or twice daily NPH insulin is a safe and tolerable option for pregnant diabetics who wish to fast during Ramadan., (© 2010 The Authors. Journal of Obstetrics and Gynaecology Research © 2010 Japan Society of Obstetrics and Gynecology.)

This study was undertaken to determine the presence of thyroid autoantibodies and associated pregnancy complications from 49 pregnant women with thyroid disease. There were 31 (63%) women with Graves' disease (GD) and 18 (37%) with primary hypothyroidism (PHT). A total of 26 (53.1%) women, 19 (61%) with GD and seven (39%) with PHT, had positive antibodies. Six had thyroid peroxidase antibodies (TPO), one with thyroglobulin antibody (TG) and eight had TSH receptor antibodies (TR). Two had a mixture of antibodies involving TG/TPO (one GD vs one PHT), four with TG/TPO/TR (all had GD) and five with TPO/TR (four with GD vs one with PHT). There were associations in women with positive thyroid antibodies and pre-eclampsia (15.4%), abruptio placenta (4%), caesarean deliveries (31%), postpartum thyroiditis (19.2%) and abnormal neonatal thyroid function (15.4%). Women with positive thyroid antibodies in pregnancy need close care during and after pregnancy, as they can develop complications affecting both mother and fetus.

Dysmenorrhoea is painful menstruation that occurs in 45-72% of all women. This was a prospective randomised study of the efficacy of etoricoxib (Arcoxia) compared with mefenamic acid (Ponstan) in treating primary dysmenorrhoea. All single, sexually inactive women with primary dysmenorrhoea were randomised into two groups (mefenamic acid and etoricoxib) of pain relief and underwent a cross-over study. The success of treatment as evidenced by pain relief, the side-effects and complications were observed and analysed. Some 80% (20 women) had significantly better pain relief with etoricoxib, compared with only 20 per cent in the mefenamic acid group (p = 0.007). Etoricoxib has significantly fewer side-effects compared with mefenamic acid (p = 0.005) with significantly reduced menstrual blood loss (p = 0.025). In conclusion, etoricoxib is a better treatment for primary dysmenorrhoea with better pain relief, less menstrual blood loss and fewer side-effects compared with mefenamic acid.

Objectives: The objective of this study was to evaluate the knowledge of urinary incontinence (UI) and pelvic organ prolapse (POP) among women postpartum. Materials and Methods: The author of the “prolapse and incontinence knowledge questionnaire (PIKQ)” was approached and permission was taken for use and translation of the questionnaire used in this study. An ethical clearance was obtained from ethical committee of Ramaiah Medical College. All participants were screened and those meeting the inclusion criteria were enrolled in the study. The participants were then administered the PIKQ questionnaire and demographic questionnaire that consisted of details of age, educational qualifications and socio-economic status. Results: Sixty-six women were administered the PIKQ. Data analysis of the scores obtained suggested that 6% of the women postpartum had more than adequate knowledge on UI and 42% of women postpartum had more than adequate knowledge on POP. Further analysis demonstrated a good correlation between the PIKQ score and age of the women postpartum who were aged between 30 and 34 years. Conclusion: In the current study, 6% of women postpartum had higher than usual knowledge on UI and 42% had higher than usual knowledge on POP. Women postpartum had limited knowledge about POP and UI. This study emphasizes that a greater understanding of pelvic floor disorders may prove to be beneficial. [ABSTRACT FROM AUTHOR]

Gemeprost (Cervagem) has been used widely compared with Misoprostol (Cytotec) alone in second trimester pregnancy termination. This prospective randomised trial was to evaluate the efficacy of intravaginal Misoprostol (alone) and Gemeprost in second trimester termination of pregnancy. A total of 54 women with 27 on each arm were involved. A total of 25 patients (92.6%) in the Misoprostol group and 22 patients (81.5%) in the Gemeprost group delivered within 48 h. The Misoprostol group delivered earlier, although average number of tablets required were similar. The side-effects were not significant between the two groups in fact, but there was more pyrexia in the Gemeprost group (p = 0.004). Misoprostol in second trimester termination of pregnancy is clinically as effective and less costly than the standard regimen of Gemeprost.

Objectives: To study the effect of ritodrine tocolysis on the success of external cephalic version (ECV) and to assess the role of ECV in breech presentation at our centre., Material and Methods: A prospective randomized double-blind-controlled trial comparing ritodrine and placebo in ECV of singleton term breech pregnancy at a tertiary hospital., Results: Among the 60 patients who were recruited, there was a success rate of 36.7%. Ritodrine tocolysis significantly improved the success rate of ECV (50% vs. 23%; P=0.032). There was a marked effect of ritodrine tocolysis on the ECV success in nulliparae (36.4% vs. 13.0%) and multiparae (87.5% vs. 57.1%). External cephalic version has shown to reduce the rate of cesarean section for breech presentation by 33.5% in our unit., Conclusion: External cephalic version significantly reduced the rate of cesarean section in breech presentation, and ritodrine tocolysis improved the success of ECV and should be offered to both nulliparous and parous women in the case of term breech presentation.

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

Plain language summary: Over one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby's head may result – this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance. [ABSTRACT FROM AUTHOR]

Background: Pregnant women with diabetes are strongly advised against Ramadan fasting and have religious exemption, but a large proportion still choose to fast. Unfortunately, there is little information about glycemic control in these patients. This study aims to determine the fasting and postprandial blood glucose levels and to predict the risk factors for hypoglycemia in pregnant women with type 2 diabetes mellitus (DM) and gestational DM (GDM) who fast during Ramadan.Methods: A prospective cohort research was conducted at a single tertiary hospital between 2021 and 2023 on 70 pregnant women with GDM (n = 53) and type 2 DM (n = 17) in their second and third trimester. Their fasting and postprandial blood glucose levels during Ramadan were compared to those of the previous month, and hypoglycemia was defined as blood glucose levels less than 60 mg/dl. Binary regression was used to predict the risk variables for hypoglycemia.Results: The GDM and type 2 DM groups were similar in terms of age, parity, number of fasting days, and number of daily fasting hours. Only 26.9% of the women who were permitted to fast were given special instructions for Ramadan fasting. Dietary intervention was more common in the GDM group, whereas insulin and metformin treatment were more common in the type 2 DM group. The fasting glucose level decreased significantly after Ramadan fasting in both groups, from 92.5 (17.4) mg/dl to 90 (17.13) mg/dl (p = 0.033). However, there were a significantly higher number of hypoglycemia events in the type 2 DM group. Further, type 2 DM was identified as a risk factor for hypoglycemia (OR = 6.23; 95% CI = 1.04– 37.54; P = 0.046.Conclusion: The present findings indicate that Ramadan fasting may improve fasting glucose control. In addition, type 2 DM was identified as a risk factor for hypoglycemia. [ABSTRACT FROM AUTHOR]

Introduction and Hypothesis: Pelvic floor disorders (PFDs), significantly impacting women's quality of life, are often underdiscussed owing to misconceptions and limited understanding of treatment options. This study is aimed at validating an Arabic version of the Prolapse and Incontinence Knowledge Questionnaire (PIKQ) to assess knowledge of pelvic organ prolapse (POP) and urinary incontinence (UI) among Arabic-speaking women, addressing knowledge gaps in these areas., Methods: The study obtained ethical approval and followed a two-stage process, including a pilot study for preliminary validation and a larger study involving 300 participants. The PIKQ, a self-administered tool with two scales focusing on UI and POP, was translated into Arabic with cultural and linguistic adaptations. The study evaluated the reliability and validity of the Arabic PIKQ, employing Cronbach's alpha, intraclass correlation coefficient (ICC), and Spearman's rho for reliability assessments, as well as factor analysis for construct validity., Results: The Arabic PIKQ demonstrated high internal consistency (Cronbach's alpha > 0.8) and test-retest reliability (ICC > 0.79) for both the UI and the POP scales. The questionnaire also showed significant construct validity. Among the 300 participants, knowledge gaps were evident, influenced by educational and professional backgrounds. Notably, 22% reported UI and 14.7% reported pelvic organ prolapse, with less than half seeking treatment., Conclusions: The Arabic PIKQ has been validated as a reliable tool for improving knowledge and addressing misconceptions regarding PFDs among Arabic-speaking women. The study underscores the importance of culturally sensitive educational tools in enhancing awareness and facilitating access to medical care for pelvic floor disorders., (© 2024. The Author(s).)

Background: A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority. Objectives: To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth. Search strategy: Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021. Selection criteria: Randomised and non‐randomised comparative or non‐comparative studies reporting a stillbirth care intervention. Data collection and analysis: Interventions, outcomes reported, definitions and outcome measurement tools were extracted. Main results: Forty randomised and 200 non‐randomised studies were included. Fifty‐eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0–22 tools per outcome. Conclusions: Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research. [ABSTRACT FROM AUTHOR]

Objective: To compare maternal and perinatal outcome of Ramadan fasting during pregnancy in women with/ without gestational diabetes. Methods: This prospective case-control study was conducted at Department of Obstetrics & Gynecology Unit 1 Ruth PKM Civil Hospital & Dow Medical College and Holy Family Hospital, Karachi during 1st April to 31st July, 2022. In this study normoglycemic pregnant women and those identified as gestational diabetes(n=52) on oral glucose tolerance test, who fasted during Ramadan were included. Women, on diet control or diet plus metformin were included in the study. Study questionnaire included demographic details, days of fasting, self-reported hypoglycemic episodes. Maternal outcomes included preterm birth, pregnancy induced hypertension. Perinatal outcome included hyperbilirubinemia, hypoglycemia, weight of placenta, and apgar score. Result: Eighty two women were included in the study, gestational diabetes (n=57) and normoglycemic (n=25). Average days of fasting were 16 ± 9.0 days (range 5-30). Women with GDM were older (28.6 vs. 26.0 years, p-value=0.034), had raised levels of HbA1c (5.5 vs. 5.1, p-value=0.004), mean FBS (102.8 vs. 84.6 mg/dl, p-value <0.001), mean RBS (135.3 vs. 106.4 mg/dl, p-value <0.001) and had higher BMI at delivery (31.0 vs. 26.6 kg/m², p-value=0.004). HbA1c (p-value=0.016) and head circumference of baby (p-value=0.038) were found lower in the group who fasted for more than 20 days among normoglycemic pregnant women. No other maternal and neonatal outcomes were found to be significantly affected by Ramadan fasting among pregnant women with/without GDM. Conclusion: Gestational diabetes do not affect maternal and perinatal outcome among pregnant women. [ABSTRACT FROM AUTHOR]

Background: The present study aimed to report Australian dietetic practice regarding management of gestational diabetes mellitus (GDM) and to make comparisons with the findings from a 2009 survey of dietitians and with the Academy of Nutrition and Dietetics Evidence‐Based Nutrition Practice Guidelines (NPG). Methods: Cross‐sectional surveys were conducted in 2019 and 2009 of dietitians providing medical nutrition therapy (MNT) to women with GDM in Australia. The present study compares responses on demographics, dietetic assessment and interventions, and guideline use in 2019 vs. 2009. Results: In total, 149 dietitians (2019) and 220 (2009) met survey inclusion criteria. In both surveys >60% of respondents reported dietary interventions aiming for >45% energy from carbohydrate, 15%–25% energy from protein and 15%–30% energy from fat. Many variations in MNT found in 2009 continued to be evident in 2019, including the percentage of energy from carbohydrate aimed for (30%–65% in 2019 vs. 20%–75% in 2009) and the wide range in the recommended minimum daily carbohydrate intake (40–220 and 60–300 g). Few dietitians reported aiming for the NPG minimum of 175 g of carbohydrate daily in both surveys (32% in 2019 vs. 26% in 2009). There were, however, some significant increases in MNT consistent with NPG recommendations in 2019 vs. 2009, including the minimum frequency of visits provided (49%, n = 61 vs. 33%, n = 69; p < 0.001) and provision of gestational weight gain advice (59%, n = 95 vs. 40%, n = 195; p < 0.05). Conclusions: Although many dietitians continue to provide MNT consistent with existing NPG, there is a need to support greater uptake, especially for recommendations regarding carbohydrate intake. Key points: Consistencies continue a decade later in broad education topics covered for gestational diabetes mellitus.Variations in dietetic practice remain, especially regarding carbohydrate recommendations and frequency of review visits.Adherence to some Nutrition Practice Guidelines (NPG) (2016) recommendations remain low, especially regarding minimum carbohydrate intake.Adherence to NPG recommendations increased for the minimum frequency of visits provided and provision of gestational weight gain advice.There is a need to further increase medical nutrition therapy consistent with existing NPG, especially for recommendations regarding carbohydrate intake. [ABSTRACT FROM AUTHOR]

Myomectomy in pregnancy, until this day, remains very controversial. We present two cases of successful antepartum myomectomies performed in the second trimester of gestation. In both cases, the initial suspected origin of these tumours was the ovaries. However, as it was shortly after confirmed, since both women underwent laparotomy, the diagnosis of these masses was uterine fibroids. Both cases resulted on the live birth of two healthy infants via caesarean section. Secondarily, we conducted a thorough review of current data of myomectomies performed during pregnancy, including the characteristics and diagnosis of the myomas of pregnant women, the surgical details and complications, along with the outcomes of these gestations. Overall, the analysis of cases published in international literature, suggests that the surgical removal of myomas during pregnancy can be considered safe, given certain indications and considerations. Our review comprises of 71 women undergoing excision of fibroids during pregnancy. Only three cases ended in a miscarriage while the remaining 68 resulted in a second or third trimester delivery. However, the data concerning the safety of the procedure are scarce and originate mostly from case reports. Thus, conclusions on the exact maternal and obstetrical complication rates cannot be drawn. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal 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.)

aimy,1 Shadin Alkatari,1 Mohamed AlMaatouq,1 Daad Alotaibi,1 Sarah Aljasser,1 Amal Aseeri,1 Anwar Jammah,1 Muhammad Mujammami,1– 3 Mona Fouda,1 Assim A Alfadda,1,2,4 Riad Sulaimani11Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia; 2Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia; 3University Diabetes Center, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia; 4Obesity Research Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi ArabiaCorrespondence: Aishah Ekhzaimy, Division of Endocrinology, Department of Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia, Email [email protected] Purpose: Impact of ramadan fasting on healthy and women with diabetes is already known. However, there is a scarcity of data on impact of fasting on pregnant women with diabetes. Moreover, religious and medical recommendations advise pregnant women against fasting as it is unsafe. Despite being exempted, many pregnant Muslim women with diabetes still choose to fast during ramadan. This study investigated different glycemic marker as an indicator for diabetes control in fasting pregnant women. Patients and Methods: This is a prospective observational study. A total of 89 pregnant diabetes women were recruited. Blood glucose was self-monitored in all the pregnant women using glucose monitoring device at home. We measure the fructosamine, HbA1c levels before, during and after ramadan. Results: Pregnant women with type 1 diabetes were 14 (25%), type 2 diabetes were 21 (37.5%), and gestational diabetes were 21 (37.5%). The mean fructosamine level decreased during and after ramadan in gestation diabetes pregnant women compared to type 2 diabetes and type 1 diabetes pregnant women subjects (p = 0.009). Conclusion: The present study indicates that pregnant women with diabetes were able to fast during ramadan and there fructosamine level reduced during fasting. Utilization of fructosamine for short-term monitoring of glycemic control in addition to home glucose monitoring in pregnant women with diabetes will provide a good index of glycemic control. Recommendation: Religious and medical recommendations advise pregnant women against fasting as it is unsafe, and they are under high risk. However, if they insist to do fast, they must do under strict medical supervision and fructosamine can be used as a glycemic control marker. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adverse pregnancy outcomes (APO) continue to trouble physicians worldwide, and uric acid has become a marker of interest in its prediction. Despite this, the correlation of uric acid in the third trimester is rarely studied, and the reference value for normal uric acid levels in pregnancy has yet to be established. This study was conducted to evaluate the association of uric acid levels in the third trimester of pregnancy and the development of APO, specifically gestational hypertension (GH), pre-eclampsia (PE), gestational diabetes mellitus (GDM), small for gestational age (SGA) and to determine the cut-off value of serum uric acid levels for screening of APO. MATERIALS AND METHODS: A retrospective observational study was conducted among 374 women who delivered at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) and developed APO of interest and had serum uric acid levels taken during the third trimester of pregnancy. A cut-off value of 309µmol/L was used to assess the sensitivity and specificity in predicting APO. RESULTS: Associations were observed between 309 µmol/L and the development of GH (p<0.0005), PE (p<0.0005), GDM (p<0.0005), SGA (p=0.0264). Plotted ROC curves with a cut-off point of 309µmol/L demonstrated moderate predictive value of serum uric acid and the development of GH (AUC 0.639), PE (AUC 0.713), SGA (AUC 0.649), and low predictive value for GDM (AUC 0.4). CONCLUSION: Serum uric acid level of 309µmol/L in the third trimester of pregnancy is a moderate predictor of GH, PE, SGA and a poor predictor of GDM. [ABSTRACT FROM AUTHOR]

Over one-quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby's head may result - this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance., (© 2023 Royal College of Obstetricians and Gynaecologists.)

Background: For women with gestational diabetes mellitus (GDM) poor dietary choices can have deleterious consequences for both themselves and their baby. Diet is a well-recognised primary strategy for the management of GDM. Women who develop GDM may receive dietary recommendations from a range of sources that may be inconsistent and are often faced with needing to make several dietary adaptations in a short period of time to achieve glycaemic control. The aim of this study was to explore how women diagnosed with GDM perceive dietary recommendations and how this information influences their dietary decisions during pregnancy and beyond.Methods: Women diagnosed with GDM before 30 weeks' gestation were purposively recruited from two GDM clinics in Auckland, New Zealand. Data were generated using semi-structured interviews and thematic analysed to identify themes describing women's perceptions and experiences of dietary recommendations for the management of GDM.Results: Eighteen women from a diverse range of sociodemographic backgrounds participated in the study. Three interconnected themes described women's perceptions of dietary recommendations and experiences in managing their GDM through diet: managing GDM is a balancing act; using the numbers as evidence, and the GDM timeframe. The primary objective of dietary advice was perceived to be to control blood glucose levels and this was central to each theme. Women faced a number of challenges in adhering to dietary recommendations. Their relationships with healthcare professionals played a significant role in their perception of advice and motivation to adhere to recommendations. Many women perceived the need to follow dietary recommendations to be temporary, with few planning to continue dietary adaptations long-term.Conclusions: The value of empathetic, individually tailored advice was highlighted in this study. A greater emphasis on establishing healthy dietary habits not just during pregnancy but for the long-term health of both mother and baby is needed. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the impact of women's body mass index (BMI) on the probability of a successful external cephalic version (ECV).Material and Methods: A retrospective population-based observational study including all women that underwent an ECV in the southeast region of Sweden from January 2014 to December 2019. Data were collected from electronic medical records, Obstetrix, Cerner. The women were divided into BMI categories according to the World Health Organization classification. Women with a BMI below 25 kg/m2 formed the reference group. Crude and adjusted odds ratios for unsuccessful ECV in each BMI group were calculated using binary logistic regression. Furthermore, the association between maternal characteristics and clinical and ultrasound variables at the time of the ECV and unsuccessful ECV was evaluated.Results: A total of 2331 women were included. The overall success rate of ECV was 53.4%. Women with a BMI below 25 kg/m2 had a success rate of 51.3% whereas obese women had a success rate of 58.6%. The risk of an unsuccessful ECV among obese women (BMI ≥30 kg/m2 ) had an OR of 0.74 (95% CI 0.59-0.94) compared with women with a BMI below 25 kg/m2 . After adjusting for suitable confounding factors, the association was no longer significant. Higher maternal age, multiparity, higher gestational age, posterior placenta position, polyhydramnios and higher estimated weight of the fetus at the ECV significantly decreased the risk of an unsuccessful ECV.Conclusions: Maternal obesity does not seem to negatively influence the success rate of ECV. This is a finding that may encourage both caregivers and obese pregnant women to consider an ECV and so avoid a planned cesarean section for breech presentation in this group. [ABSTRACT FROM AUTHOR]

Background: Pregestational diabetes mellitus (PGDM) is associated with adverse pregnancy outcomes. Studies assessing interventions to improve maternal and infant outcomes have increased exponentially over recent years. Several outcomes in this field of maternal diabetes are rare, making it difficult to synthesise evidence. Objectives: To collect outcomes reported in studies assessing treatment interventions in pregnant women with PGDM. Search strategy: CENTRAL, Web of Science, Medline, CINAHL, Embase and ClinicalTrials.gov from their inception until 27 January 2020. Selection criteria: Any randomised controlled trial assessing treatment interventions in pregnant women with PGDM reported in English. Data collection and analysis: Two independent reviewers assessed the suitability of articles and retrieved the data. Outcomes extracted from the literature were broadly categorised into maternal, fetal/infant or other outcomes by the study advisory group. Main results: Sixty‐seven of the 1475 studies identified fulfilled the inclusion criteria. The median number of outcomes reported per study was 15 (range 1–46). The majority of studies were from North America and Europe. Insulin and metformin were the most commonly investigated pharmacological interventions. Glucose monitoring was the most assessed technological intervention. In all, 131 unique outcomes were extracted: maternal (n = 69), fetal/infant (n = 61) and other (n = 1). Conclusions: Outcome reporting in treatment interventions trials of pregnant women with PGDM is varied, making it difficult to synthesise evidence, especially for rare outcomes. Systems are needed to standardise outcome reporting in future clinical trials and so facilitate evidence synthesis in this area of maternal diabetes. Registration: The systematic review was registered prospectively with the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020173549). Outcome reporting is heterogeneous in intervention trials of pregnant women with diabetes existing before pregnancy. Outcome reporting is heterogeneous in intervention trials of pregnant women with diabetes existing before pregnancy. [ABSTRACT FROM AUTHOR]

Background: The objective was to compare the effectiveness and tolerability of mefenamic acid and celecoxib in women with primary dysmenorrhea (PD) and to compare the quality of life of study participants pre- and post-treatment. Materials and methods: This was a randomized crossover clinical trial conducted among sexually inactive female adults aged 18–25 years with PD. Participants were asked to rate their pain score and answer a validated quality of life questionnaire (EQ-5D-3L) before and after consumption of each medication in two menstrual cycles. The effectiveness of celecoxib and mefenamic acid in treating PD was compared with regard to reduction in pain score and the need for medical leave and rescue therapy. Drug tolerability was determined by comparing the occurrence of side effects of both drugs. Quality of life scores pre- and post-intervention were measured and compared. Results: Mefenamic acid had a comparable effect to celecoxib in relieving symptoms of PD. Both drugs were equally tolerable and showed similar impacts on quality of life. Conclusions: This study demonstrated that mefenamic acid and celecoxib had similar effectiveness in improving pain score and quality of life in women with PD. [ABSTRACT FROM AUTHOR]

Background: A core outcome set could address inconsistent outcome reporting and improve evidence for stillbirth care research, which have been identified as an important research priority., Objectives: To identify outcomes and outcome measurement instruments reported by studies evaluating interventions after the diagnosis of a stillbirth., Search Strategy: Amed, BNI, CINAHL, ClinicalTrials.gov, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase, MEDLINE, PsycINFO, and WHO ICTRP from 1998 to August 2021., Selection Criteria: Randomised and non-randomised comparative or non-comparative studies reporting a stillbirth care intervention., Data Collection and Analysis: Interventions, outcomes reported, definitions and outcome measurement tools were extracted., Main Results: Forty randomised and 200 non-randomised studies were included. Fifty-eight different interventions were reported, labour and birth care (52 studies), hospital bereavement care (28 studies), clinical investigations (116 studies), care in a multiple pregnancy (2 studies), psychosocial support (28 studies) and care in a subsequent pregnancy (14 studies). A total of 391 unique outcomes were reported and organised into 14 outcome domains: labour and birth; postpartum; delivery of care; investigations; multiple pregnancy; mental health; emotional functioning; grief and bereavement; social functioning; relationship; whole person; subsequent pregnancy; subsequent children and siblings and economic. A total of 242 outcome measurement instruments were used, with 0-22 tools per outcome., Conclusions: Heterogeneity in outcome reporting, outcome definition and measurement tools in care after stillbirth exists. Considerable research gaps on specific intervention types in stillbirth care were identified. A core outcome set is needed to standardise outcome collection and reporting for stillbirth care research., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Introduction: There is inconclusive evidence to support any specific criteria for starting pharmacologic therapy after diet in women with gestational diabetes mellitus (GDM). We aimed to analyze the most used criteria for starting pharmacologic treatment for patients with GDM. Material and methods: Electronic databases were searched from their inception to September 2017. We included all the randomized controlled trials (RCTs) of GDM managed initially by diet and exercise reporting criteria for starting pharmacologic therapy. RCTs in women with pregestational diabetes were excluded. Data regarding glucose values used for starting pharmacologic therapy were extracted and carefully reviewed. Results: We included 15 RCTs (4307 women) in the meta-analysis. For fasting glucose target, 8/14 (57%) used a value lower or equal to 90 mg/dL and the remainder used values <99 mg/dL. Of the 10 RCTs targeting 2-h postprandial values, the majority (9/10, 90%) used 120 mg/dL. The majority of RCTs (13/15, 87%) recommended pharmacologic therapy if either 1 or 2 values per 1- or 2-week period were higher than the target values: 7/13 (54%) used 1 value and 6/13 (46%) used 2 values higher than target values. One RCT (7%) used >50% of the values higher than the target values and another one (7%) used >30%. Conclusion: The majority of RCTs (87%) used very tight criteria of either 1 or 2 values over the target values in the 1 or 2-week period for starting pharmacologic treatment for patients with GDM; more than 50% used 2 values. Key Message Pharmacologic therapy should be considered in women with gestational diabetes when, despite an adequate diet and exercise, 1 or 2 blood glucose values are over the target values of 90mg/dL fasting or 120mg/dL 2-hour postprandial over 1 or 2 weeks. [ABSTRACT FROM AUTHOR]

Objective: To compare cases of previous caesarean cases with non- caesarean for complications in Misoprostol Induced Mid Trimester abortions Study Design: A prospective cohort study design. Place and Duration of Study: This study was conducted at Combined Military Hospital (CMH) Nowshera, from Jan 2014 to Jun 2015. Patient and Methods: This is a comparative study of two cohorts. One of the cohorts, labeled as 'A' included cases (n=30) of at least one previous caesarean delivery and other cohort labeled as 'B' were normal cases (n=76) with no uterine scars either from previous caesarean delivery or any other surgery. Both these cohorts were admitted to CMH Nowshera for Misoprostol Induced Mid Trimester (MI-MT) abortions. Indications for abortion varied from case to case. Comparison between the two cohorts was made for complications including (1) Heavy blood loss (2) Severe pain (3) Failure of Induction. A cut off value was set for heavy blood loss (>1000 ml), while severity of pain was a subjective perception, categorizing into mild to moderate and severe. Failure of induction was considered after 72 hours. Chi square and Fisher's exact tests were performed to test the null hypothesis of no significant difference between the two cohorts for each of the three complications. Effect of two confounding variables (i) Maternal age and (ii) Parity was also investigated. ANOVA was performed to find out a significant difference between categories of maternal age and parity within each cohort. Results: Chi square and Fisher's exact tests showed a significant difference (p-value<0.05) between the two cohorts for all the three complications of MI-MT abortions. Incidence of heavy blood loss, severe pain and failure of induction were significantly higher in cohort 'A' that comprised of previous caesarean cases. Conclusion: This study emphasized the need for more sensitive and careful management of cases admitted for termination of pregnancies with history of previous caesarean sections. [ABSTRACT FROM AUTHOR]

Introduction: Women’s awareness of fetal movements is important as perception of decreased fetal movements can be a sign of a compromised fetus. We aimed to study rate of labor induction in relation to number of times women seek care due to decreased or altered fetal movements during their pregnancy compared to women not seeking such care. Further, we investigated the indication of induction. Material and methods: A prospective population-based cohort study including all obstetric clinics in Stockholm, Sweden. Questionnaires were distributed to women who sought care due to decreased or altered fetal movements ≥ 28 week’s gestation in 2014, women for whom an examination did not indicate a compromised fetus that required induction of labor or cesarean section when they sought care. Women who gave birth at ≥ 28 weeks’ gestation in 2014 in Stockholm comprises the reference group. Results: Labor was induced more often among the 2683 women who had sought care due to decreased or altered fetal movements (RR 1.4, 95% CI 1.3–1.5). In women who presented with decreased or altered fetal movements induction of labor occurred more frequently for fetal indication than those with induction of labor and no prior fetal movement presentation (RR 1.6, 95% CI 1.4–1.8). The rate of induction increased with number of times a woman sought care, RR 1.3 for single presentation to 3.2 for five or more. Conclusions: We studied women seeking care for decreased or altered fetal movements and for whom pregnancy was not terminated with induction or caesarean section. Subsequent (median 20 days), induction of labor and induction for fetal indications were more frequent in this group compared to the group of women with no fetal movement presentations. Among women seeking care for altered or decreased fetal movements, the likelihood of induction of labor increased with frequency of presentation. [ABSTRACT FROM AUTHOR]

Objective To report perception of fetal movements in women who experienced a stillbirth compared with controls at a similar gestation with a live birth. Design Case.control study. Setting 41 maternity units in the UK. Participants Cases were women who had a late stillbirth .28 weeks gestation (n=291) and controls were women with an ongoing pregnancy at the time of the interview (n=733). Controls were frequency matched to cases by obstetric unit and gestational age. Methods Data were collected using an intervieweradministered questionnaire which included questions on maternal perception of fetal movement (frequency, strength, increased and decreased movements and hiccups) in the 2 weeks before the interview/stillbirth. Five fetal movement patterns were identified incorporating the changes in strength and frequency in the last 2 weeks by combining groups of similar pattern and risk. Multivariable analysis adjusted for known confounders. Primary outcome measure Association of maternally perceived fetal movements in relation to late stillbirth. Results In multivariable analyses, women who reported increased strength of movements in the last 2 weeks had decreased risk of late stillbirth compared with those whose movements were unchanged (adjusted OR (aOR) 0.18, 95% CI 0.13 to 0.26). Women with decreased frequency (without increase in strength) of fetal movements were at increased risk (aOR 4.51, 95% CI 2.38 to 8.55). Daily perception of fetal hiccups was protective (aOR 0.31, 95% CI 0.17 to 0.56). Conclusions Increased strength of fetal movements and fetal hiccups is associated with decreased risk of stillbirth. Alterations in frequency of fetal movements are important in identifying pregnancies at increased risk of stillbirth, with the greatest risk in women noting a reduction in fetal activity. Clinical guidance should be updated to reflect that increase in strength and frequency of fetal movements is associated with the lowest risk of stillbirth, and that decreased fetal movements are associated with stillbirth. [ABSTRACT FROM AUTHOR]

Introduction: There is inconclusive evidence from randomized controlled trials (RCTs) to support any specific criteria for pharmacologic therapy dose adjustment in diabetes in pregnancy. Our objective was to analyze the criteria for dose adjustment of pharmacologic treatment for diabetes mellitus (DM) in pregnancy.Material and Methods: Data sources: MEDLINE, OVID and Cochrane Library were searched from their inception to September 2017. Selection criteria included all trials of DM in pregnancy managed by oral hypoglycemic agents or insulin reporting criteria for pharmacologic therapy dose adjustment. RCTs in women with pregestational DM and gestational DM (GDM) were included. For each trial, data regarding glucose values used for pharmacologic therapy dose adjustment were extracted and carefully reviewed.Results: Of 51 RCTs on therapy for GDM or pregestational DM, 17 (4230 women) were included as they reported criteria for pharmacologic therapy dose adjustment. Most of them (88%, 15/17) included women with GDM only. For RCTs including women with GDM, 12/16 (75%) used the two-step approach, three (19%) the one-step approach and one (6%) either the one- or two-step approach. Regarding the type of initial therapy, 13 (77%) RCTs used different types and doses of insulin; nine (53%) used metformin; five (30%) used glyburide; and one (6%) used placebo. In most RCTs, glucose monitoring was assessed four times daily, i.e. fasting (all RCTs) and two hours (15 RCTs, 88%) after each of the three main meals - breakfast, lunch, and dinner. For fasting glucose target, all used a value <105 mg/dL; nine (53%) used 95 mg/dL as target. Of the 15 RCTs using a two-hour postprandial value as target, 11 (73%) had 120 mg/dL as cutoff. Regarding the criteria for pharmacologic therapy dose adjustment, we found six different criteria. The majority of RCTs (9/17, 53%) used either one or two values per week higher than the target values, of which two-thirds used only one value (35% of total), and one-third (18% of total) two values. Five RCTs (29%) used >50%, one (6%) >30%, and one (6%) >20% of the values higher than the target value; one (6%) used the appearance of glycosuria.Conclusions: When evaluating RCTs which included criteria for pharmacologic GDM therapy dose adjustment, the most common criterion for diagnosis was the two-step test, and the most common used therapies were insulin and metformin. Regarding glucose monitoring, the most common frequency was four times per day, fasting and two hours after each main meal, using as target glucose values 95 and 120 mg/dL, respectively. Importantly, we found six different criteria for pharmacologic GDM therapy dose adjustment, with the majority using very tight criteria of either one or two values per week higher than the target values, of which two-thirds used only one value, and one-third used two values. [ABSTRACT FROM AUTHOR]

Fifty women with singleton pregnancies between 26+0/7and 33+6/7 weeks of gestation and arrested preterm labour (PTL) after acute tocolysis were randomised by a computer generated randomisation table into an intervention group (n = 25) who received maintenance tocolysis with tablet nifedipine for 12 days or up to 34 weeks of gestation, whichever was later and a control group (n = 25). The primary outcome was achievement of term gestation and the secondary outcomes were the number of days gained till delivery and neonatal mortality and morbidity. The mean gestation at admission, cervical dilatation and effacement were similar in the two groups (30 + weeks, 2.5 cm, 60%). In the intervention group, 7/25 (28%) and in the control group, 2/25 (8%) delivered at term (p = .066) and pregnancy prolongation of 20 days (IQR 2.5–51) and 14 days (IQR 1–27.5) were achieved, respectively (p = .269). Maintenance tocolysis was given for a median of 14 days (range 3–25.5). Kaplan–Meier analysis showed no statistically significant difference in prolongation of pregnancy between the control and the intervention groups (p = .077). The median number of days of neonatal hospital stay were reduced with maintenance tocolysis, but the difference was not significant (4.0 vs 5.5;p = .608). The mean birth weight was significantly higher in the intervention group (2266 vs 1880 g,p = .044). Among women at a high risk for preterm birth (PTB) due to established PTL as evidenced by a mean cervical dilatation of 2.5 cm and a PTB rate of 92% in the control group, maintenance tocolysis did not prolong the pregnancy or reduce the neonatal hospital stay significantly.Impact statementWhat is already known on this subject: In women with preterm labour (PTL) the role of maintenance tocolysis following acute tocolysis to reduce recurrent PTL is uncertain. Of the six studies using nifedipine, one reported pregnancy prolongation (26.65 vs 16.14 days, p = .007), but similar perinatal outcome (Sayin et al. 2004). Others did not find pregnancy prolongation (Carr et al. 1999; Lyell et al. 2008; Uma et al. 2012; Roos et al. 2013; Parry et al. 2014). The PTB rate in the control groups ranged from 38 to 67%. A Cochrane review reported pregnancy prolongation by 5.35 days but similar neonatal outcome (RR 0.75) (Naik et al. 2013). A meta-analysis including five studies using progesterone and five using nifedipine concluded that progesterone, but not nifedipine, prolonged pregnancy (Ding et al. 2016). Thus, data on maintenance tocolysis is limited and inconclusive.What the results of this study add: In the present randomised study in 50 women with arrested PTL, 25 received maintenance tocolysis. The mean gestation at admission, cervical dilatation and effacement were similar in the two groups (30+ weeks, 2.5cm, 60%). In the intervention group, 7/25 (28%) and controls, 2/25 (8%) delivered at term (p = .066) and pregnancy prolongation of 20 days (IQR 2.5–51) and 14 days (IQR 1–27.5) were achieved, respectively (p = .269). Kaplan–Meier analysis showed no statistically significant difference in prolongation of pregnancy between the control and the intervention groups (p = .077). The median number of days of neonatal hospital stay were reduced with maintenance tocolysis but the difference was not significant (4.0 vs 5.5; p = .608).What are the implications of these findings for clinical practice and/or future research: The mean birth weight was higher in the intervention group (2266 vs 1880g, p = .044). Future studies should take cervical dilatation and the PTB rate in the control group into consideration while assessing the impact of maintenance tocolysis. [ABSTRACT FROM PUBLISHER]

Background: Maternal perception of decreased fetal movements and low awareness of fetal movements are associated with a negative birth outcome. Mindfetalness is a method developed for women to facilitate systematic observations of the intensity, character and frequency of fetal movements in late pregnancy. We sought to explore women's attitudes, experiences and compliance in using Mindfetalness.Methods: We enrolled 104 pregnant women treated at three maternity clinics in Stockholm, Sweden, from February to July of 2016. We educated 104 women in gestational week 28-32 by providing information about fetal movements and how to practice Mindfetalness. Each was instructed to perform the assessment daily for 15 min. At each subsequent follow-up, the midwife collected information regarding their perceptions of Mindfetalness, and their compliance. Content analyses, descriptive and analytic statistics were used in the analysis of data.Results: Of the women, 93 (89%) were positive towards Mindfetalness and compliance was high 78 (75%). Subjective responses could be binned into one of five categories: Decreased worry, relaxing, creating a relationship, more knowledge about the unborn baby and awareness of the unborn baby. Eleven (11%) women had negative perceptions of Mindfetalness, citing time, and the lack of need for a method to observe fetal movements as the most common reasons.Conclusion: Women in late pregnancy are generally positive about Mindfetalness and their compliance with daily use is high. The technique helped them to be more aware of, and create a relationship with, their unborn baby. Mindfetalness can be a useful tool in antenatal care. However, further study is necessary in order to determine whether the technique is able to reduce the incidence of negative birth outcome. [ABSTRACT FROM AUTHOR]

Although the incidence of diabetes is rising in Southeast Asia, there is limited information regarding the incidence and manifestation of insulin-associated hypoglycemia. The aim of the present review was to discuss what is currently known regarding insulin-associated hypoglycemia in Southeast Asia, including its known incidence and impact in the region, and how the Southeast Asian population with diabetes differs from other populations. We found a paucity of data regarding the incidence of hypoglycemia in Southeast Asia, which has contributed to the adoption of Western guidelines. This might not be appropriate, as Southeast Asians have a range of etiological, educational and cultural differences from Western populations with diabetes that might place them at greater risk of hypoglycemia if not managed optimally. For example, Southeast Asians with type 2 diabetes tend to be younger, with lower body mass indexes than their Western counterparts, and the management of type 2 diabetes with premixed insulin preparations is more common in Southeast Asia. Both of these factors might result in higher rates of hypoglycemia. In addition, Southeast Asians are often poorly educated about hypoglycemia and its management, including during Ramadan fasting. We conclude there is a need for more information about Southeast Asian populations with diabetes to assist with the construction of more appropriate national and regional guidelines for the management of hypoglycemia, more closely aligned to patient demographics, behaviors and treatment practices. Such bespoke guidelines might result in a greater degree of implementation and adherence within clinical practice in Southeast Asian nations. [ABSTRACT FROM AUTHOR]

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Objective: The aim of the study is to determine the prevalence of gestational diabetes mellitus (GDM), its associated risk factors, foeto-maternal outcomes and prevalence of postnatal diabetes mellitus (DM). Methods: This is a cross-sectional study using retrospective data from existing antenatal records of new antenatal women who registered at 72 public health clinics in Selangor in January 2014. Results: A total of 745 antenatal records were reviewed. The prevalence of GDM women was 27.9% (n = 184). GDM risks were higher in women aged 35 years old and above and in those with maternal obesity. GDM women had a higher risk of having a non-spontaneous vaginal delivery compared to non-GDM women. The prevalence of postnatal DM among GDM mother was 12.1%. Working GDM mothers were at higher risk of developing postnatal DM. Conclusion: The prevalence of GDM among newly registered women attending antenatal public health care in Selangor was higher than previous studies. Health care personnel need to be vigilant in screening women with risk factors. [ABSTRACT FROM AUTHOR]

Background: Pregestational diabetes mellitus (PGDM) is associated with adverse pregnancy outcomes. Studies assessing interventions to improve maternal and infant outcomes have increased exponentially over recent years. Several outcomes in this field of maternal diabetes are rare, making it difficult to synthesise evidence., Objectives: To collect outcomes reported in studies assessing treatment interventions in pregnant women with PGDM., Search Strategy: CENTRAL, Web of Science, Medline, CINAHL, Embase and ClinicalTrials.gov from their inception until 27 January 2020., Selection Criteria: Any randomised controlled trial assessing treatment interventions in pregnant women with PGDM reported in English., Data Collection and Analysis: Two independent reviewers assessed the suitability of articles and retrieved the data. Outcomes extracted from the literature were broadly categorised into maternal, fetal/infant or other outcomes by the study advisory group., Main Results: Sixty-seven of the 1475 studies identified fulfilled the inclusion criteria. The median number of outcomes reported per study was 15 (range 1-46). The majority of studies were from North America and Europe. Insulin and metformin were the most commonly investigated pharmacological interventions. Glucose monitoring was the most assessed technological intervention. In all, 131 unique outcomes were extracted: maternal (n = 69), fetal/infant (n = 61) and other (n = 1)., Conclusions: Outcome reporting in treatment interventions trials of pregnant women with PGDM is varied, making it difficult to synthesise evidence, especially for rare outcomes. Systems are needed to standardise outcome reporting in future clinical trials and so facilitate evidence synthesis in this area of maternal diabetes., Registration: The systematic review was registered prospectively with the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration number CRD42020173549)., Tweetable Abstract: Outcome reporting is heterogeneous in intervention trials of pregnant women with diabetes existing before pregnancy., (© 2021 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Aim: The aim of this study was to evaluate dietetic practice in the management of gestational diabetes in New Zealand, compare this with evidence ‐ based guidelines and determine the need for New Zealand ‐ specific evidence ‐ based nutrition practice guidelines for gestational diabetes. Methods: A 64 ‐ item cross ‐ sectional online survey of New Zealand ‐ registered dietitians providing care to women with gestational diabetes was undertaken. Participants were recruited through Dietitians New Zealand, District Health Boards and private practices across New Zealand. The survey examined dietetic service provision, management recommendations, guideline use, service evaluation, compliance with national and international guidelines and the perceived need for New Zealand ‐ specific evidence ‐ based guidelines for the nutritional management of gestational diabetes. Results: Thirty ‐ three (62%) eligible dietitians participated in the survey. There was significant variation in dietetic services and management recommendations. Nine (28%) dietitians felt the service within which they worked did not offer adequate dietetic services for women with gestational diabetes. Compliance with national and international evidence ‐ based guidelines ranged from 28 to 100% depending on the recommendation. Twenty ‐ five (76%) respondents felt there was a need for New Zealand ‐ specific evidence ‐ based nutrition practice guidelines for gestational diabetes. Conclusions: These results highlight differences in dietetic services and practice in New Zealand and variations in compliance with local and international evidence ‐ based guidelines. The development of New Zealand ‐ specific evidence ‐ based nutrition practice guidelines for gestational diabetes is supported. [ABSTRACT FROM AUTHOR]