A study on feto-maternal outcome in patients with preterm premature rupture of membranes

Background: Preterm premature rupture of membranes (PPROM) is rupture of fetal membranes prior to labor in pregnancies between 28-37 weeks. PPROM is associated with significant maternal and neonatal morbidity or mortality. The present study was conducted to evaluate risk factor and etiology of PPROM and its fetomaternal effect in tertiary care hospital.Methods: A cross-sectional study was conducted in the department of obstetrics and gynaecology, SMS Hospital, Ahemdabad. From August 2023 to February 2024.The study included 50 pregnant women between 28-37 weeks gestation with PPROM were subjected to detailed history and examination. Each patient was followed till her delivery and fetomaternal outcome was recorded.Results: PPROM is a fair complication of pregnancy. 80% were belongs to 20-29 age, 70% were unbooked, 76% from low SE-class, 68% with gestational age of 34-36 weeks. Vaginal delivery was common 58%. The babies born to mothers with PPROM more in weight of 2-2.5 kg (48%). 34 had no risk factors to develop PPROM. Most common etiology for PPROM infection 16% and malpresentation 10%. Most of the mothers with PPROM had no complications. 17 (34%) babies required NICU admissions for complaints of premturity, respiratory distress, birth asphyxia, and sepsis. RDS was most common neonatal complication. 2 neonatal deaths in this study due to RDS and prematurity.Conclusions: Effective PPROM Mx involves evaluating the risks and advantage of conservative Mx strategies. Whenever possible, Rx should be focused towards prophylactic use of antibiotics and steroids during pregnancy can reduce fetal and mother morbidity and mortality. Termination of pregnancy should be considered at the 1st sign of chorioamnionitis.

Evaluation of the effects of epidural labour analgesia on mode of delivery

Background: Epidural analgesia is the most effective method of pain relief during labour and the only method that provides complete analgesia without maternal or foetal adverse effects. This study aimed to assess the mode of delivery outcomes of labour in women who had received effective epidural analgesia.Methods: After ethical approval, this quasi-experimental study was carried out in Dhaka Medical College Hospital for one year, from July 2021 to June 2022. A total of 100 admitted pregnant women (37 weeks to 41 weeks) in the labour ward were included in the study according to the inclusion and exclusion criteria. Among them, 50 women were in group A (with epidural analgesia), and the other 50 were in group B (without epidural analgesia). A detailed history and thorough clinical examination were carried out on each patient. Data were collected in separate case-record forms and analyzed using SPSS 24.Results: Mean age, gestational age, parity, and body mass index were statistically similar in both group A and B. Normal vaginal delivery rate (86% vs. 90%), instrumental delivery rate (10% vs. 6%), and caesarean section rate (4% vs. 4%) were not significantly different in both groups. Besides, both group A and B had statistically similar APGAR scores at 1st (8.66±0.87 and 8.80±0.83 respectively, p=0.414) and 5th min (9.66±0.68 and 9.74±0.59 respectively, p=0.537).Conclusions: Epidural labour analgesia can be safely recommended as a method of labour analgesia, provided the prerequisites are fulfilled. It has no significant adverse effect on the mode of delivery.

The effects of group B streptococcus colonization during late pregnancy on vaginal microbiota and neonatal outcomes / 中国新生儿科杂志

Objective:To study the effects of group B streptococcus (GBS) colonization during late pregnancy on vaginal microbiota and neonatal outcomes.Methods:From September 2020 to September 2021, pregnant women receiving prenatal care and delivered in our hospital were prospectively enrolled. They were assigned into GBS(+) group and GBS(-) group based on the results of GBS culture and/or PCR tests of vaginal secretions. The mothers were also assigned into early-onset infection(EO) group and non-early-onset infection(non-EO) group based on the presence or absence of early-onset infection of their neonates. The vaginal microbiota and neonatal outcomes were compared between these groups.Results:A total of 125 cases were enrolled, including 65(52.0%) in GBS(+) group and 60(48.0%) in GBS(-) group. 24 cases (19.2%) were in EO group and 101 cases (80.8%) in non-EO group. The incidences of premature rupture of membranes (PROM), amniotic fluid contamination, chorioamnionitis and early-onset neonatal infection in GBS(+) group were significantly higher than GBS(-) group(all P<0.05).The abundances of Streptococcus and Ureaplasma in vaginal flora of GBS(+) group were higher than GBS(-) group ( P<0.01), whereas Rhodococcus, Phyllobacterium and Bifidobacterium were lower than GBS(-) group ( P<0.05).The EO group had significantly higher abundance of enterococcus than the non-EO group ( P<0.05). Mothers with GBS colonization and neonates with early-onset infection had the highest abundance of Escherichia/Shigella ( P=0.04). Mothers with GBS colonization and neonates without early-onset infection showed the highest abundance of Gardnerella ( P=0.04). Conclusions:GBS colonization during late pregnancy increases the incidences of PROM, amniotic fluid contamination, chorioamnionitis and early-onset neonatal infection. GBS colonization causes abnormal vaginal flora in pregnant women. The increases of Ureaplasma, Streptococcus, Escherichia/Shigella and Enterococcus in vaginal microbiota maybe associated with early-onset neonatal infection.

A study to determine the effects of epidural analgesia in labour and to assess its maternal and neonatal outcome

Background: There is widespread acceptance of epidural analgesia among many physicians and patients, but disagreement remains regarding the effect of intrapartum epidural analgesia on the subsequent progress of labour and the mode of delivery. This study was designed to look and assess the effects of labour analgesia on maternal and fetal outcomes.Methods: This is an observational prospective cohort study where 60 parturient visiting the hospital in labour during the study period who fulfilled the eligibility criteria & gave written informed consent for the participation were included as cases. Another 60 parturient visiting the hospital during the same period who also fulfilled the eligibility criteria and consent for the same were included as controls. After test dose of 3 ml of 2% lignocaine with 1:2,00,000 adrenaline, an initial bolus of 10 ml of 0.1% Ropivacaine+1microgram/cc Fentanyl is given.Results: Epidural analgesia gave better pain relief when the VAS scores of the two groups were compared. No effect on increase of Caesarean or instrumental delivery rates was observed. Even though the first stage of labour was prolonged and the second stage shortened, the overall time of active stage of labour remained the same in both groups. No adverse neonatal outcome was seen with respect to epidural analgesia.Conclusions: Epidural analgesia provided excellent pain relief for most of the women delivering at our institute & is associated with high patient satisfaction.

Association between maternal obesity and gestational diabetes mellitus and their related outcomes

Background: Gestational diabetes mellitus (GDM) has a direct correlation with maternal body mass index (BMI). Pre-pregnancy BMI is ideal for studying the outcomes of obesity in pregnancy. Unlike the west, in countries like India, pregnant women approach health facilities during first trimester making it appropriate to consider first trimester BMI, as a parameter to study outcome variables. In this study we correlate BMI and GDM in pregnancy as GDM has significant impact on mother and baby. Aim of study was to study maternal and neonatal outcomes in obese women who have conceived among two groups, GDM and non-GDM.Methods: Observational study conducted at tertiary care teaching hospital over a one-year period (2021-2022). All pregnant women in first trimester with Body Mass Index (BMI) ?30, calculated in first visit, was included in this study for follow-up. According to the results of GDM screening at 24-28?weeks of gestation by DIPSI method, pregnancies were divided into the GDM and non-GDM group. They were observed for risk of GDM. The obstetric and neonatal outcomes were noted and compared between the two groups. Data was analysed using SPSS software.Results: Mean BMI (32.79�47) among GDM group is greater than Non GDM (31.15�22), with p-value 0.00005 is significant. In obstetric outcomes, GDM is associated with increased incidence of preterm deliveries (p-value=0.004), gestational hypertension (p-value=0.002). In case of perinatal outcomes, increase incidence of hyperbilirubinemia (p-value=0.002), hypoglycemia (p-value=0.048) and sepsis (p value=0.046) in neonates born to GDM is seen.Conclusions: BMI calculation in early pregnancy is good indicator to monitor for complications in pregnancy including GDM. Therefore, identification of patients with high BMI and GDM requires regular follow up during pregnancy so that early intervention minimises complications.

Neonatal outcome in early term and late term pregnancy

Background: Full-term neonates born between 37- and 41-weeks’ gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies has pointed toward increased NICU admissions and morbidity associated with births (37-38 weeks) compared with term neonates (39-41 weeks). The objective of this study was to compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service.Methods: Retrospective observational population-based 2 year birth cohort study at Department of Obstetrics and Gynecology GSVM Medical College, Kanpur. All full-term live births comprised the birth cohort; this information was obtained from the hospitals’ perinatal databases, and data pertaining to NICU, or neonatology service admissions were extracted from individual medical records. Gestational age of early term (37 0/7-38 6/7 weeks) verses term (39 0/7-4 10/7 weeks). Admission to the NICU or neonatology service.Results: There were 17,132 live births during the 2 year period, of which 13679 had a gestational age between 37 and 41 weeks. Of all live births, 6204 (45.3%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycaemia (29.9% verses 14.7%), NICU or neonatology service admission (20.9% vs12.05 %), need for respiratory support (36.8% verses 29.9%), treatment with intravenous antibiotics [39.4% verses 25. Delivery by caesarean section was common among early-term births (45.9%)].Conclusions: Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources.

Neonatal outcome in early term and late term pregnancy

Background: Full-term neonates born between 37- and 41-weeks’ gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies has pointed toward increased NICU admissions and morbidity associated with births (37-38 weeks) compared with term neonates (39-41 weeks). The objective of this study was to compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service.Methods: Retrospective observational population-based 2 year birth cohort study at Department of Obstetrics and Gynecology GSVM Medical College, Kanpur. All full-term live births comprised the birth cohort; this information was obtained from the hospitals’ perinatal databases, and data pertaining to NICU, or neonatology service admissions were extracted from individual medical records. Gestational age of early term (37 0/7-38 6/7 weeks) verses term (39 0/7-4 10/7 weeks). Admission to the NICU or neonatology service.Results: There were 17,132 live births during the 2 year period, of which 13679 had a gestational age between 37 and 41 weeks. Of all live births, 6204 (45.3%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycaemia (29.9% verses 14.7%), NICU or neonatology service admission (20.9% vs12.05 %), need for respiratory support (36.8% verses 29.9%), treatment with intravenous antibiotics [39.4% verses 25. Delivery by caesarean section was common among early-term births (45.9%)].Conclusions: Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources.

A study on comparison of cerviprime and IV oxytocin in labour induction and evaluation of changes in the bishop’s score with these two agents

Background: There are several strategies for the induction of labor (IOL), and pharmacologic agents, including oxytocin and prostaglandins, are most commonly used in clinical practice. Compared with oxytocin, the prostaglandin E2 agent, dinoprostone, has been regarded as moreeffective for the induction of labor of LTPs with a non-dilated cervix. Objective was to compare the PGE2 gel placed intracervically with that of oxytocin given intravenously for induction of labor in both primipara as well as multipara with the comparison of Bishop’s score at the starting of induction and its improvement with both of these inducing agents in those with indications for induction with gestational age greater than 36 weeks.Methods: Hospital based prospective observational study over a period of one year on patients attending the antenatal and high-riskpregnancy clinic and scheduled for induction of labor with Bishop score <4.Results: The number of successful induction was low in primiparae group with low Bishop’s score (1-2). There were greater number of successful inductions in both primi as well as multiparae with higher Bishop’s score.Conclusions: When a primigravida had a low cervical score or an unfavourable cervix, intracervical PGE2 gel was found to be more effective at ripening the cervix and inducing labour. Both medicines were equally effective at inducing labour in cases of multigavidae with any Bishop's score and primi with a higher Bishop's score.

Predictive value of admission and intrapartum cardiotocography in normal and high risk antenatal women

Background: Cardiotocography is the most common method for assessing fetal health and reveals brain oxygenation. This study is done for admission and intrapartum cardiotocography in high- and low-risk pregnancies and its correlation with neonatal outcome.Methods: All high-risk and normal antenatal women with more than 34 weeks of pregnancy and vertex presentation who came to the labor room were included in the study. 200 cases were taken, 100 were in the "high risk group," and the remaining 100 were in the "low risk group." On admission CTG and intrapartum CTG tracing were taken after written and informed consent, neonatal outcomes were observed, and adverse neonatal outcomes were noted.Results: Admission CTG results were unsatisfactory for 9% of women in the high-risk group and none in the low-risk group. Intrapartum NST was non reassuring in 51% of high-risk women and 6% of the low-risk group. Of the total number of neonates admitted to the NICU, 14 were from the low-risk group, while 50 were from the high-risk group.Conclusions: On admission NST in both low and high-risk women, the absence of category III NST predicted the absence of an adverse neonatal outcome most accurately. Even during labor in both high-risk and low-risk women, the absence of category III reassured the fetal well-being most precisely.

Clinical study on feto-maternal outcome in teenage pregnancy in a tertiary care institute

Background: Pregnancies that occur below the age of 20 years are called teenage pregnancies. Teenage pregnancy is a common public health problem worldwide which is detrimental to the health of both the mother and the new-born. This study aims to evaluate the obstetric and perinatal outcomes of teenage pregnancy in the Indian rural and semi urban population.Methods: A retrospective observational study was undertaken in the department of obstetrics and gynecology, Mysore Medical College and Research Institute, Mysore, for a period of one year from August 2021 to September 2022. All the teenage mothers during the study period were included in the study. Data was analysed included various maternal parameters, fetal parameters, and the outcome of pregnancy.Results: Study showed the incidence of teenage pregnancy is 12.6%. About 88.3% were primgravida, 74% were booked cases. 51.6% of the teenage mothers had varying grades of anaemia, 29.09% of teenage mothers had spectra of hypertensive disorders if pregnancy, 27.92% had PROM. Caesarean section rates were 25%, Fetal distress being the most common indication in 47.3% followed by fail induction in 29.8%. Preterm delivery rates were as high as 13.6%. Postpartum complications included postpartum hemorrhage in 2.5%, puerperal pyexia in 1.9%, postpartum eclampsia in 1.38%. Respiratory distress was seen in 17.6% neonates, prematurity in 15.49%, IUGR in 13.6%, 2.99% were stillborn send 3.36% succumbed due to pre-maturity, respiratory distress, and sepsis.Conclusions: From the present study we infer that the prevalence of teenage pregnancy is still high in rural and semi urban population and they suffered from a significant number of complications in pregnancy including anemia pre-eclampsia and preterm labour, neonatal respiratory distress and early onset sepsis. To surmount these problems a multidisciplinary team involving health and social workers, obstetrician and gynaecologist are required to improve adolescent reproductive health.

Perinatal Outcome According to Gestational Age- A study of 50 Cases

Background: Gestational age supports predicting a potential due date, informing obstetrical care and testing, and assessing the baby’s health at birth. It is vital to obtain a gestational age in all pregnancies to offer regular care and medical management for both mother and fetus. The ultimate suitable techniques for calculating gestational age are ultrasonography. The study aims to investigate the perinatal outcome according to gestational age. Material & Methods: A Prospective cross-sectional study was carried out in the Department of Obstetrics & Gynecology, Bangabandhu Sheikh Mujib Medical University, Hospital, from January 2008 to June 2008. A total of 50 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Results: Among the study population (N=50), one-fifth of the mothers’ (10,20.0%) age was under twenty. The majority of mothers were (34,68.0%) between 20-30 years old with a mean age of 25.4 ± 4.32 years. Twenty-three patients (23,46.0%) came at 40+ weeks of pregnancy, eighteen patients came at (18,36,0%) on 41 weeks of pregnancy and nine patients (9,18.0%) came at41+ weeks of pregnancy. There was no perineal tear and two patients (2,4.0%) had cervical tears which were repaired. In two patients (2,4.0%) there was postpartum haemorrhage, among them two patients (2,4.0%) needed a blood transfusion. Among the healthy babies, the majority of the babies (20,40.0%) were born at 40 completed weeks of gestation, eighteen babies (18,36.0%) at 41 completed weeks and two babies (2,4.0%) were born at 42 completed weeks of gestation. Conclusion: Many childhood and adult diseases are linked with size at birth and are mostly inclined by early postnatal growth is widely accepted. The evolving fetus formulates itself for post-partum life by reporting to metabolic signals in its uterine environment.

Clinical study of primary caesarean section among multigravida in a tertiary care hospital

Background: Primary caesarean section in multigravida refers to first time caesarean section in multiparous women who have had previous one or more vaginal delivery. The study focused on the frequency, indication, intra operative and postoperative complications, maternal and fetal outcome of primary caesarean section in multiparous women with previous vaginal deliveries.Methods: It was a prospective study of all the cases of primary caesarean section in multigravida admitted at LLRM Medical College Meerut, Uttar Pradesh over period of 1 year from January 2021 to December 2021.Results: Total number of deliveries during the study period of 1 year was 5670 and total no of caesarean section was 2432 with a caesarean rate of 42.89%. Out of 2432 caesarean section 488 (20.10%) were done in primigravida and 253 (10.40%) in multigravida. In present study most common indication for caesarean section was malpresentation 68 (26.86%) followed by severe oligohydramnios in 47 (18.57%). Most common maternal complication was pyrexia in 24 (9.48%). Most common morbidity were due to preterm 65 (22.13%) neonates followed by RDS in 22 (8.69%) neonates.Conclusions: Though responsible for least number of overall caesarean section, multiparous subjects undergoing primary caesarean section is high risk pregnancy with possibility of adverse obstetric outcome in significant number of subjects and hence multiparous women deserve the same attention during pregnancy and labour as primigravida and women with repeat caesarean section.

Pregnancy with COVID-19: feto-maternal outcome from a tertiary care hospital, Bangladesh

Background: The objective was to determine the maternal and fetal outcomes of pregnant women with COVID-19 infection in the southeast part of Bangladesh.Methods: A prospective observational study was conducted at Chittagong Medical College Hospital (CMCH), Bangladesh, for one year. Pregnant women were divided into suspected and confirmed groups based on the clinical features of COVID-19 and the results of RT-PCR (SARS-CoV2). Outcome measures were maternal death, ICU admission, mechanical ventilation, and stillbirth/neonatal death. The Mann-Whitney U test was applied for between-group comparisons. Binary logistic regression analysis was done for factors affecting feto-maternal outcomes. Results were presented as odds ratios (OR) and 95% confidence intervals (CI).Results: A total of 144 pregnant women (n=144) were included in the study, divided into confirmed (n=71) and suspected (n=73). Complications were more in the confirmed group (p=0.315). Caesarean section was 69% and 64.4% in the confirmed and suspected groups, respectively (p=0.556). Eight women (5.55%) needed ICU admission, five (3.5%) required mechanical ventilation, and five (3.5%) women expired. Fetal distress was seen in 15 (10.41%) pregnancies. Stillbirth or neonatal death and the need for NICU admission were higher for suspected than in confirmed cases. Pregnancies with suspected COVID-19 had 3.91 times (OR: 3.913, 95% CI: 1.398-10.954) higher poor feto-maternal outcome. Unbooked status, COVID-19 test negativity, and use of antivirals were associated with poor feto-maternal outcomes.Conclusions: Pregnancies with COVID-19 were prone to poor feto-maternal outcomes. The study pointed to an improvement in the ANC of pregnant women with COVID-19 in a public hospital like Bangladesh.

Effect of Spontaneous Blastocyst Collapse on Pregnancy and Neonatal Outcomes in Frozen-thawed Transfer Cycle / 华中科技大学学报(医学版)

Objective To observe the effect of spontaneous blastocyst collapse on pregnancy and neonatal outcomes in fro-zen-thawed transfer cycle.Methods The clinical data of 10120 single blastocyst frozen-thawed transfer cycles from January 2018 to December 2020 was retrospectively analyzed,of which 133 cycles were spontaneous collapsed blastocysts(collapse group),133 cycles of transplanted embryos were obtained as non-collapse blastocysts(non-collapse group)after balancing the co-variates between groups by 1∶1 propensity score matching(PSM),pregnancy and neonatal outcomes were compared between the two groups.Results The live birth rate in collapse group was significantly lower than that in non-collapse group(30.08％vs.45.86％,P＜0.01).The implantation rate and clinical pregnancy rate in collapse group were decreased,and the early abor-tion rate was increased,but the differences were not statistically significant(all P＞0.05).Logistic regression analysis showed that women's age,infertility type and spontaneous blastocyst collapse had significant effects on live birth(all P＜0.05).The odds ratio of live birth between collapse group and non-collapse group was 0.54(95％CI:0.32～0.91).There was no statistical-ly significant difference in the gestation days at birth,birth weight and the proportion of male newborns between the two groups(all P＞0.05).There were 2 premature births in live birth of each group,and 1 birth defect in singleton pregnancy in collapse group,which was the enlargement of infant adrenal gland.There was no birth defect in singleton pregnancy newborns in non-collapse group.Conclusion In frozen-thawed transfer cycle,the transplantation of spontaneous collapsed blastocysts can reduce the maternal live birth rate,spontaneous collapsed blastocysts for implantation may not increase incidence rates of poor perinatal outcomes and neonatal defects.Spontaneous collapsed blastocysts can be used as a means to improve embryo selection,so as to improve the live birth rate and improve the pregnancy outcome of assisted reproductive technology.

Desempeño predictivo de los criterios diagnósticos de restricción de crecimiento fetal para resultados adversos perinatales en un hospital de Popayán, Colombia / Predictive performance of fetal growth restriction criteria for adverse perinatal outcomes in a hospital in Popayán, Colombia

Objetivos: determinar el desempeño predictivo de la definición de retardo de crecimiento fetal (RCF) de ultrasonografía de la Sociedad de Medicina Materno Fetal (SMMF), consenso Delphi (CD) y Medicina Fetal de Barcelona (MFB) respecto a resultados adversos perinatales en cada una, e identificar si hay asociación entre diagnóstico de RCF y resultados adversos perinatales. Materiales y métodos: se realizó un estudio de cohorte retrospectiva. Se incluyeron gestantes con embarazo único de 24 a 36 semanas con 6 días, quienes fueron atendidas en la unidad de medicina materna fetal con evaluación ecográfica de crecimiento fetal y atención de parto en una institución hospitalaria pública de referencia ubicada en Popayán, Colombia. Se excluyeron embarazos con hallazgos ecográficos de anomalías congénitas. Muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas de las gestantes al ingreso, la edad gestacional, el diagnóstico de RCF y el resultado adverso perinatal compuesto. Se analizó la capacidad predictiva de tres criterios diagnósticos de restricción de crecimiento fetal para malos resultados perinatales y la asociación entre el diagnóstico de RCF y mal resultado periantal. Resultados: se incluyeron 228 gestantes, cuya edad media fue de 26,8 años, la prevalencia de RCF según los tres criterios fue de 3,95 %, 16,6 % y 21,9 % para CD, MFB y SMMF respectivamente. Ningún criterio aportó área bajo la curva aceptable para predicción de resultado neonatal adverso compuesto, el diagnóstico de RCF por CD y SMMF se asoció a resultados adversos perinatales con RR de 2,6 (IC 95 %: 1,5-4,3) y 1,57 (IC 95 %: 1,01-2,44), respectivamente. No se encontró asociación por MFB RR: 1,32 (IC 95 %: 0,8-2,1). Conclusiones: ante un resultado positivo para RCF, el método Delphi se asocia de manera más importante a los resultados perinatales adversos.Los tres métodos tienen una muy alta proporción de falsos negativos en la predicción de mal resultado perinatal. Se requieren estudios prospectivos que reduzcan los sesgos de medición y datos ausentes.

Objectives: To determine the predictive performance of fetal growth restriction by Maternal Fetal Medicine Society (MFMS) definition of ultrasound, the Delphi consensus (DC) and the Barcelona Fetal Medicine (BFM) criteria for adverse perinatal outcomes, and to identify whether there is an association between the diagnosis of fetal growth restriction (FGR) and adverse perinatal outcomes. Material and methods: A retrospective cohort study was conducted including women with singleton pregnancies between 24 and 36 weeks of gestation seen at the maternal fetal medicine unit for ultrasound assessment of fetal growth and delivery care in a public referral hospital in Popayán, Colombia. Pregnancies with ultrasound findings of congenital abnormalities were excluded. Convenience sampling was used. Sociodemographic and clinical variables were measured on admission; additional variables were gestational age, FGR diagnosis and adverse composite perinatal outcome. The predictive ability of three fetal growth restriction diagnostic criteria for poor perinatal outcomes was analyzed and asociation between FGR and adverse perinatlal outcomes. Results: Overall, 228 pregnant women with a mean age of 26.8 years were included; FGR prevalence according to the three criteria was 3.95 %, 16.6 % and 21.9 % for DC, BFM and MFMS, respectively. None of the criteria resulted in an acceptable area under the curve for the prediction of the composite adverse neonatal outcome; FGR diagnosis by DC and MFMS were associated with adverse perinatal outcomes with a RR of 2.6 (95 % CI: 1.5-4.3) and 1.57 (95 % CI: 1.01-2.44) respectively. No association was found for BFM RR: 1.32 (95 % CI: 0.8-2.1). Conclusions: Given a positive result for FGR, the Delphi method is significantly associated with adverse perinatal outcomes. The proportion of false negative results for a poor perinatal outcome is high for the three methods. Prospective studies that reduce measurement and attrition bias are required.

Clinical profile and course on follow-up of newborns of SARS-CoV-2 positive mothers

Objective@#This study aims to determine the clinical profile and course on follow-up of newborns delivered to a SARS-CoV-2 positive mother from two private tertiary hospitals. @*Methodology@#This is a retrospective, cross-sectional study. A chart review of all neonates delivered to SARS-CoV-2 positive mothers was conducted. Subsequent interview was done to determine their clinical course and neurologic status at 3-, 6-, 9-, 12-, and 15-month-old. Data collected was presented as frequencies, percentages, or proportions. @*Results@#Out of the 67 newborns born to SARS-CoV-2 positive mothers, three neonates tested positive for SARS-CoV-2. All three were delivered to mothers with mild symptoms, were full term, with good APGAR score and appropriate for gestational age. One was eventually intubated and managed as COVID-19 confirmed critical. Among the SARS-CoV-2 negative newborns, majority had an unremarkable neonatal outcome. Thirty-six neonates were available for follow-up: 1 expired due to aspiration pneumonia at 2 months of age, 4 were readmitted for pneumonia, UTI, acute gastroenteritis, and cow’s milk allergy. Twenty-one had infection at one point prior to this study follow-up but were all mild not requiring admission. Two had abnormal head size, while 2 had developmental delay, these 4 infants with neurological findings on follow-up were all RT-PCR negative at birth. @*Conclusion@#Maternal COVID-19 infection does not necessarily result to a neonatal infection. For those neonate swith mild symptoms, SARS-CoV-2 causality could not be established. On follow-up, there were a few who developed significant problems that have long-term implications in the overall growth and development of the child.

Maternal and neonatal outcomes of pregnant women with clinically confirmed COVID-19 admitted at the Philippine General Hospital

@#Objectives. The effect of COVID-19 infection in pregnant women and her neonate is not well-understood, with no clear evidence for vertical transmission. This study aims to determine the maternal and neonatal clinical characteristics and the dyad’s outcomes among those infected with COVID-19 infection. Methods. An ambispective cross-sectional study involving pregnant women with confirmed COVID-19 infection was conducted at the Philippine General Hospital from April to August 2020. Two hundred nine obstetric patients were included, 14 of whom consented to specimen collection to determine vertical transmission. Results. The majority of pregnant women with COVID-19 infection and their neonates had good outcomes. Labor, delivery, and the immediate postpartum course were generally uneventful. The all-cause maternal morbidity rate was high at 75.6 per 100 cases during the five-month study period. COVID-19 related morbidities included the development of Guillain-Barré Syndrome. The in-hospital all-cause maternal mortality rate was 1.91 per 100 cases. The causes of maternal death were acute respiratory failure, septic shock, and congenital heart disease (atrial septal defect with Eisenmengerization). The in-hospital, all-cause neonatal mortality rate was 1.04 per 100 neonates of cases. The lone mother and infant deaths were in a postmortem rt-PCR swab negative mother with an rt-PCR swab positive live neonate who eventually succumbed after nine days of life. All 14 dyads with collected specimens that included amniotic fluid, placental tissue, umbilical cord, and neonate nasopharyngeal swab tested negative for SARS-CoV-2 rt-PCR. Conclusion. The prognosis for COVID-19 infected pregnant patients was generally good, with most of the patients discharged improved. Almost all of the neonates born to COVID-19-infected mothers were stable-term infants. There was no evidence for vertical transmission, as shown by negative rt-PCR results for all the additional specimens obtained. In general, the prognosis for COVID-19 infected dyads was good. The majority of the mothers were discharged well with their term infants. All possible maternal sources of COVID-19 infection to the neonate tested negative. This study provided no evidence for vertical transmission.

Research Progress of the Effects of Vitamin D Supplementation on Glycemic Control and Adverse Maternal-neonatal Outcomes in Gestational Diabetes Mellitus Patients / 中国医学科学院学报

Gestational diabetes mellitus(GDM)can cause blood glucose disorders in pregnant women and result in adverse maternal-neonatal outcomes.Vitamin D(VD)can improve glucose tolerance and insulin sensitivity,and thus theoretically,VD supplementation during pregnancy could improve glycemic control as well as maternal-neonatal outcomes in GDM patients.Although studies have shown that VD deficiency is associated with poor maternal-neonatal outcomes in GDM patients,no solid conclusion has been drawn with regard to the effects of VD supplementation on these patients.Therefore,here we summarized the research progress of the effects of VD supplementation on glycemic control and adverse maternal-neonatal outcomes in GDM patients,in an effort to guide the clinical VD supplementation during pregnancy.

Challenges Faced by an Obstetrician while Dealing with Obstetric Emergency in Cases of Placenta Previa.

Placenta previa itself is a challenge for obstetrician as it may be a fatal condition. Placenta previa is a life-threatening condition and bleeds frequently after second trimester with complaints of bleeding per vagina, mildly or severely. Incidence is 35% of antepartum haemorrhage. We wanted to determine the maternal and foetal outcome at any cost by strengthening the casualty team for emergency management of unpredictable APH and PPH by giving training for the same.METHODSIt is a descriptive observational study was conducted among 35 patients of placenta previa who were diagnosed clinically as well as on ultrasonography, from June 2017 to August 2018 in Gujarat Adani Institute of Medical Sciences. A detailed history was taken as per fixed proforma for all pregnant women.RESULTSPlacenta previa was common in the age group of 21-30 (71.8%) and amongst them multiparous group of more than 5 parity (29%). 3 cases (9.09%) were bilateral uterine artery ligation and 1 case of B-Lynch suture. A single case of internal iliac artery ligation and obstetric hysterectomy was observed. In this study 3 cases of placenta accreta, 1 case of placenta increta, 15 cases of preterm baby, 5 cases (14.2%) of IUFD and 7 cases (20%) of NICU admission were studied.CONCLUSIONSPlacenta previa is a challenging job. A proper multidisciplinary approach based management including expert obstetricians, anaesthetists, neonatologists, radiologists, surgeons as well as trained nursing staff is required for saving mother’s as well as baby’s life.

A study to correlate admission non stress test and immediate post-partum umbilical cord arterial pH with neonatal outcome

Background: Continuous electronic fetal monitoring in labour has become a standard practice in developed countries; this may not be possible in low middle-income countries. So, this study was conducted to correlate admission non stress test (NST) and immediate post-partum umbilical cord arterial (UCA) pH with neonatal outcome.Methods: This prospective observational study was conducted at tertiary care centre in North India. After informed and written consent, 100 pregnant women with singleton live pregnancy of gestational age ≥32 weeks admitted in labour, were subjected to admission NST and immediately after delivery sample for UCA pH was taken. Clinically relevant neonatal outcome was correlated with admission NST and UCA pH. Appropriate statistical tests were used and p-value <0.05 taken as significant.Results: Admission NST was normal, suspicious, pathological in 67%, 27%, 6% subjects, respectively. Study found statistically significant correlation between admission NST and UCA pH with neonatal outcomes (i.e. fetal distress, need of advanced resuscitation, delayed oral feeding). Fetal distress was seen in 9 newborns, in these 8 delivered by CS and 1 required ventous application. Admission NST had high sensitivity (88.89%) and NPV (98.5%) for detection of fetal distress. The optimal cut off for pH and lactate was 7.25 and 2.55 mmol/L, respectively to predict fetal distress.Conclusions: Admission NST can be considered as a screening modality to detect fetus in distress and it showed good correlation with umbilical cord arterial pH for predicting short term neonatal outcome.