Serum resistin and lipid profile in primigravida females with and without preeclampsia: An analytical cross-sectional study.

OBJECTIVE: To measure and compare the serum levels of resistin and lipid profile parameters in primigravida females with and without preeclampsia. Methods: The analytical cross-sectional study was conducted at the Department of Physiology and Cell Biology, University of Health Sciences, Lahore, Pakistan, from 2018 to 2020, and comprised primigravida females having gestational age 30-36 weeks. Those with preeclampsia constituted group 1, while normotensive females constituted group 2. All the participants were subjected to detailed history and general physical examination. Serum resistin levels were measured by enzymelinked immunosorbent assay, and lipid profile parameters were measured using the colorimetric method. Data was analysed using SPSS 20. RESULTS: Of the 80 women, 40(50%) were in group 1 with mean age 23.07±2.10 years and mean gestation age 33.45±2.30 weeks. There were 40(50%) women in group 2 with mean age 23.02±2.11 years and mean gestational age 34.45±1.75 weeks. Mean serum resistin was significantly higher in group 1 compared to group 2 (p<0.02). Mean levels of lipid parameters were significantly different between the groups (p˂0.05). Conclusion: Preeclampsia was found to be associated with higher levels of resistin and lipid parameters compared to normal pregnancy.

The short-term impact of high energy nutritional supplements on energy balance in underweight primi-gravidae: A randomized controlled trial.

OBJECTIVE: To determine the impact of high-energy nutritional supplements on appetite, appetite regulators, energy intake and macronutrients level among underweight primigravidae. Methods: The single-blind randomised controlled trial was conducted from April 26, 2018, to August 10, 2019, in tertiary care hospitals of Khyber Pakhtunkhwa province of Pakistan, after approval from the ethics review committee of Khyber Medical University, Peshawar, and comprised underweight primigravidae who were randomly allocated to high energy nutritional supplement group A and placebo group B. Appetite questionnaires were filled and blood samples were obtained in fasting state, at 30, 60, 120, 210 and 270 minutes to measure blood glucose, insulin, peptide YY and cholecystokinin. Breakfast and lunch were served at 30 minutes and 210 minutes after supplementation, respectively. Data was analysed using SPSS 20. RESULTS: Of the 36 subjects, 19(52.8%) were in group A and 17(47.2%) were in group B. The overall mean age was 18.66 ± 2.5 years. Energy intake in group A was significantly higher than group B (p<0.001), and so were mean protein and fats (p<0.001). The subjective appetite perceptions for 'hunger' and 'desire to eat' were significantly lower (p<0.001) before lunch in group A. Plasma concentrations of appetite hormones corresponded to the appetite perceptions and were significantly higher in group A after breakfast and lunch for peptide YY, cholecystokinin and insulin compared to group B (p<0.001). CONCLUSIONS: High-energy nutritional supplement was found to have short-term suppressive effect on energy intake and appetite. Trial registration: ClinicalTrials.gov Identifier: ISRCTN 10088578. Registered on 27 March 2018. https://www.isrctn.com/ ISRCTN10088578.

Three-dimensional magnetic resonance imaging assessment of levator ani in women progressing from full-term pregnancy to 10 months postpartum.

AIM: To identify the anatomical morphology of levator ani (LA) in primigravidae at term pregnancy and its natural process of changing after delivery. METHODS: Forty-one primigravidae (vaginal delivery: 29 women, cesarean delivery in the first stage of labor: 12 women) underwent magnetic resonance imaging (MRI) at full-term pregnancy, 6 weeks and 10 months postpartum. Three-dimensional (3-D) model of LA created from MRI data using Mimics v.21.0 software and source images were assessed to determine the morphology. LA volume (LVOL) was calculated and used as indicator of muscle atrophy. RESULTS: Decrease of levator hiatus length (LH-L) was shown in both groups since 6 weeks postpartum. In the vaginal delivery group, the differences in LVOL between time points were significant (p < 0.05), showing a persistent decreasing tendency. Puborectalis attachment width (PAW) on the left was the smallest at 6 weeks postpartum (p < 0.05). LA avulsion and significant 2-D morphological change after delivery were only observed in this group (p < 0.05); In the cesarean section group, smaller LVOL was found at 6 weeks postpartum comparing with full-term pregnancy (p < 0.05); Larger levator-symphysis gap (LSG) and levator hiatus width (LH-W), smaller PAW were observed in vaginal delivery group comparing with cesarean section group at 6 weeks postpartum (p < 0.05), but none of the values exhibited between-group differences (p > 0.05) at 10 months postpartum. No other comparisons were considered significant (p >0.05). CONCLUSIONS: Vaginal delivery, or even active labor itself may both lead to LA atrophy. And the morphology of LA is basically similar in different delivery modes at 10 months postpartum once the onset of labor has occurred, even though it changes more complicatedly after vaginal delivery.

Rising trend of Caesarean section in primigravida at Lady Aitchison Hospital Lahore: Phenomenological analysis of indications.

Objectives: To highlight the rising trend of caesarean section and strategies to reduce the caesarean section rate in an urban setting. METHODS: The qualitative, phenomenological study was conducted at the Lady Aitchison Hospital, Lahore, Pakistan, from October 16 to November 30, 2020, and comprised obstetrics and gynaecology practitioners principally responsible for making decisions related to caesarean sections. Data was collected through face-to-face detailed interview with each subject. The interviews were transcribed manually and codes were formed that led to themes. RESULTS: Of the 10 subjects interviewed, 1(10%) was the department head, 2(20%) were associate professors, 2(20%) were assistant professors and 5(50%) were senior registrars. Main indications of caesarean section in primigravida were foetal distress, failed induction, failure to progress, social demand, malpresentation, eclampsia and antepartum haemorrhage. There were 5-7 themes that fell under each of these seven codes. CONCLUSIONS: With proper implementation of uniform decision-making strategies, the rate of caesarean section in primigravida can be lowered with proper antenatal assessment, cardiotocographic monitoring, obstetric skills teaching, specialists; involvement in decision making and counselling of patients.

A study on periconceptional folic acid supplement intake and serum folic acid levels in pregnant mothers.

Background: Survey-based studies have examined the timing of receiving periconceptional folic acid supplementation. To assess the impact of the periconceptional folic acid supplementation, a postulate that multigravida mothers are more likely to have received the supplementation and the level of serum folic acid in them assayed during the first trimester is likely to be higher than primigravida mothers was put forth. Serum folic acid levels were measured in primigravida and multigravida mothers during the first trimester. Methods: One hundred twenty primigravida and multigravida mothers registered at antenatal clinic of a tertiary care referral centre were included. Serum folic acid assay from samples collected during the first trimester was carried out by chemiluminescence immuneassay. The mothers were followed up during subsequent OPD visits, during admission for delivery and through mobile phones for assessing the delivery outcomes. World Health Organization cutoff values for serum folic acid were used to analyse the results. Results: None of the mothers received folic acid supplement before conception. Mean interval from last menstrual period to receiving the first dose of folic acid supplementation was 71.2 days in primigravida and 67.6 days in multigravida mothers. Overall, 21/120 (17.5%) of primigravida mothers and 34/120 (28.3%) of multigravida mothers had serum folic acid values less than 6 ng/ml (deficiency and possible deficiency). Conclusion: None of the mothers received folic acid supplements before conception. Significant proportion of mothers, particularly the multigravida having less than normal levels serum folic acid indicates correctable lacunae amenable for preventive intervention.

The mediating role of prenatal depression in adult attachment and maternal-fetal attachment in primigravida in the third trimester.

BACKGROUND: Prenatal depression and adult attachment are factors that affect the establishment of an intimate relationship between a mother and fetus. The study explored differences in prenatal depression and maternal-fetal attachment (MFA) scores between different types of adult attachment and the effects of maternal depression scores and attachment dimensions on maternal intimacy with the fetus. METHODS: The Edinburgh Postnatal Depression Scale (EPDS), Experience of Close Relationship (ECR) scale, Maternal Antenatal Attachment Scale (MAAS) and a general data scale were used to investigate 260 primigravida. An exploratory analysis was performed to analyze the effects of the depression score and adult attachment on MFA. RESULTS: The results showed that pregnant women with insecure attachment exhibited an increased prevalence of prenatal depression, lower total MFA scores, and lower MFA quality compared with those women with secure adult attachment. The explorative analysis showed that the depression scores mediated the relationship between adult attachment avoidance and MFA quality. CONCLUSIONS: Primigravida who had insecure adult attachment exhibited an increased prevalence of prenatal depression and lower MFA. Maternal depression and adult attachment may affect the emotional bond between a mother and fetus. This finding should be seriously considered, and timely intervention needs to take personality traits into consideration.

A randomized controlled study of the effect of hyoscine butylbromide on duration of labor in primigravida women with prolonged labor.

OBJECTIVE: To assess the safety and efficacy of hyoscine butyl bromide (HBB) in primipara with prolonged 1st stage of labor. MATERIALS AND METHODS: A double-blinded randomized controlled trial included 100 primiparas diagnosed with prolonged labor. They were randomly divided two equal groups. Group I received 40 mg HBB intravenously. Group II received 2 ml of normal saline. The primary outcome was the duration of the 1st stage of labor. Secondary outcomes included success of vaginal delivery, rate of cervical dilation, duration of 2nd and 3rd stages of labor, causes of CS, neonatal outcome and drug side effects. RESULTS: The duration of the 1st stage was 322.3 ± 89.8 min in women who received HBB compared with 451.3 ± 198.3 min in the control women (P < 0.001). The rate of cervical dilation was increased from 0.4 ± 0.2 to 1.5 ± 0.6 in women who received HBB compared with its increase from 0.4 ± 0.1 to 0.9 ± 0.2 in other women (P < 0.001). The rate of CS were significantly higher in control women when compared to those received HBB (34 vs. 20%, P < 0.001). The commonest indication for the operation was arrest of cervical dilatation (28 and 16%, respectively). CONCLUSION: HBB is associated with shortening of the 1st stage, lowered rate of CS without any side effects. GOV ID: NCT03430362 date of registration 6 February 2018. Synopsis Hyoscine butyl bromide is associated with shortening of the 1st stage, lowered rate of CS in primiparas with prolonged labor.

Serum and urine levels of activin A in primigravidae and multigravidae: a prospective cross-sectional study.

The aim of the present study was to investigate serum and urine levels of activin A in different moments of gestation, in primigravidae and in multigravidae, to understand whether these variables (biological sample and first gestation) affect activin A as a biomarker in pregnancy. We prospectively included 43 pairs of serum and urine samples from 25 women examined at different gestational ages (range 45 to 268 days). In the group of primigravidae (n = 16 samples from 9 participants), there was no significant change in serum activin A levels across gestation. Conversely, the group of multigravidae (n = 27 samples from 16 women) had higher serum activin A levels in the third trimester (2676 ± 840 pg/ml) compared to the first (583 ± 408 pg/ml) and second (1040 ± 384) trimesters (p = .025). Urine activin A concentrations did not differ between the two groups and did not change according to the gestation phase. There was no correlation between serum and urinary levels of activin A (r = 0.149, p = .359). These data suggest that activin A secretion may vary less during the first pregnancy, while urine activin A is unlikely to be a surrogate for the systemic levels of this hormone in pregnant women.

Maternal health services utilisation among primigravidas in Uganda: what did the MDGs deliver?

BACKGROUND: Achieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common. METHODS: Guided by Andersen's Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions. RESULTS: The analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women's household decision-making power, place of residence as important determinants of ANC visits and SBAs. CONCLUSIONS: Based on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.

Knowledge about birth preparedness and complication readiness and associated factors among primigravida women in Addis Ababa governmental health facilities, Addis Ababa, Ethiopia, 2015.

BACKGROUND: Globally, every minute, at least one woman dies from complications related to pregnancy or childbirth. The situation is more serious for women in Sub-Saharan Africa which also include Ethiopia. Birth preparedness is a strategy to promote the timely use of skilled maternal and neonatal care, especially during childbirth. Based on the theory, preparing for childbirth reduces delays in obtaining this care. In adequate preparation for rapid action in the event of obstetric complications are well documented factors contributing to delay in receiving skilled obstetric care. Hence, the aim of this study was to assess the knowledge of birth preparedness and complication readiness and its associated factors among primigravida in Addis Ababa Governmental Health Facilities. METHODS: A quantitative facility based cross-sectional study design and client exit interview questionnaire were used. Simple random and census sampling was used to select the health care facilities and study participants, accordingly. The data were entered using Epidata version3.1 and analysed by window statistical package for social science version 20 software. Logistic regression model was used to assess the knowledge by predictor's variables. RESULT: From 442 respondents the response rate was 422 (95.5%). Based on finding, the respondents were knowledgeable on danger signs in pregnancy, labour, postnatal and new born neonate 113(26.8%), 47(11.1%), 60(14.2%) and 46(10.9%), respectively. According to birth preparedness, 64 (15.2%) of primigravida women were knowledgeable. In this study, factors associated with knowledge of birth preparedness and complication readiness were found to be being married [AOR = 0.110, 95%CI (0.026, 0.461);], house hold monthly income of 1000-3000 [AOR = 3.362(1.203,9.393);], knowledgeable for key danger signs of labour with [AOR = 3.685, 95%CI (1.157, 11.737);] and knowledgeable for key danger signs of post-partum period with [AOR =5.117, 95%CI (1.388, 18.863);]. CONCLUSION: The knowledge of primigravida women for birth preparedness and its complication readiness was low. Information given about danger sign and birth preparedness during ANC follow up was not comprehensive. Therefore, family health care providers, health facility, other partners, program level managers and policy makers take their responsibility and work together to improve the health education service and increase knowledge on birth preparedness and complication readiness through easily accessible health education strategies.

Learning from experience: cellular and molecular bases for improved outcome in subsequent pregnancies.

The frequencies of preeclampsia, fetal growth restriction, fetal demise, and low birthweight are lower in subsequent pregnancies. Enhanced maternal cardiovascular adaptation, shorter first and second stages of labor, and more robust lactation also have been observed in subsequent as compared with first pregnancies. We sought to investigate the cellular and molecular bases for better outcomes in subsequent pregnancies. Based on the knowledge that specialized immune cells at the maternal-fetal interface, decidual natural killer cells, promote development of the placental bed and conversion of the spiral arteries by secreting a myriad of angiogenic and growth factors, we asked whether decidual natural killer cells differ in subsequent as compared with first pregnancies. This idea stemmed from recent studies suggesting that natural killer cells, although part of the innate immune system, possess some features of adaptive immunity, including a certain type of immune cell memory, termed trained immunity. We found that decidual natural killer cells from parous women "remember pregnancy" and differ from decidual natural killer cells of primigravidae. Compared with the decidual natural killer cells of first pregnancy, these cells, that we termed pregnancy-trained decidual natural killer cells, express greater levels of the natural killer receptors NKG2C and leukocyte immunoglobulin-like receptor B1, which interact with ligands expressed on invasive trophoblasts. Furthermore, they secrete greater levels of several growth factors, including vascular endothelial growth factor α as well as interferon-γ, augmenting remodeling of the placental bed. We propose that this pregnancy-trained memory dwells in the epigenome, where memory of stimuli is known to persist even when the stimulus is no longer present. This epigenetic memory apparently resides in endometrial natural killer cells between pregnancies. We suggest that this trained memory, which we coined pregnancy-trained decidual natural killer cells, may be the missing link in the immune basis for enhanced subsequent pregnancy. Epigenetic memory (chromatin modification) also may afford a global explanation for additional findings of enhanced maternal cardiovascular adaptation, shorter first and second stages of labor, and more robust lactation. Understanding the molecular and cellular bases of improved outcomes of subsequent pregnancy may lead to the development of treatment modalities designed for women at high risk for pregnancy disorders originating at the maternal-fetal interface.

Herniation of the amniotic sac through congenital uterine defect confirmed during operation: A case report.

Herniation of the amniotic sac into the peritoneal cavity or bladder is a rare but serious condition during pregnancy, which has not been reported in pored congenital uterine anomaly. Here, we report a rare case to draw obstetricians' attention to the atypical uterine rupture. A primigravida at 35 weeks of gestation was admitted for upper abdominal pain. A primary diagnosis of uterine rupture was made after finding the amniotic sac herniation through obstetric ultrasound. Exploration during emergent cesarean section revealed symmetrical pored defect on the uterine horn. The diagnosis of uterine anomaly was eventually made. The educational meaning of this rare case is that it is advisable to rule out uterine anomalies when signs of uterine rupture are suspected during pregnancy while contributory risk factors have not been identified. Besides, it is of vital importance to make a full assessment of both the mother and the fetus so to determine the appropriate time of termination.

Pregnancy outcomes of adolescent primigravida and risk of pregnancy-induced hypertension: a hospital-based study in Southern Thailand.

The objectives were to examine pregnancy outcomes in adolescent primigravida and to determine the effects of adolescent pregnancy on pregnancy-induced hypertension (PIH). A retrospective analysis of pregnancy outcomes was carried out in 2440 adolescent primigravida, compared with 14,259 primigravida aged 20-29 years. The adolescents had significantly higher rates of maternal death, maternal heart disease, PIH, puerperal infection, chorioamnionitis, urinary tract infection, foetal anomaly, preterm delivery, low birth weight, low Apgar scores and stillbirth. Multivariate logistic regression analysis showed that both older (16-19 years old) and younger (≤15 years old) adolescents were significantly at an increased risk of PIH (adjusted OR of 1.29; 95% CI, 1.03-1.62 and 1.90; 95% CI, 1.02-3.54, respectively). Adolescent primigravida had significantly lower rates of caesarean delivery, diabetes mellitus, chronic hypertension, placenta praevia and cephalopelvic disproportion (CPD). Inadequate antenatal care in adolescents increased rates of PIH and adverse foetal outcomes. Impact statement What is already known on this subject? Adolescent pregnancy is associated with adverse pregnancy outcomes in both mothers and foetuses. Conflicting evidence on some adverse maternal outcomes still exists. What the results of this study add? Our data suggest a significant increase risk of pregnancy-induced hypertension (PIH) in both younger and older adolescent primigravida. Inadequate antenatal care (<4 times) in adolescents increased rates of PIH and adverse foetal outcomes. Rate of maternal death was higher than previous study, with different causes of death. In our study, the major cause of death was heart disease, but previous study found hypertensive disorder to be the leading cause of death in adolescents. Rates of infection also increased during pregnancy and postpartum period. The adolescents had lower rates of caesarean delivery, diabetes mellitus, chronic hypertension, placenta praevia and cephalopelvic disproportion (CPD). What the implications are of these findings for clinical practice and/or further research? Early detection and prompt treatment for adverse maternal complications, especially PIH, infection and preterm labour are essential. Ultrasound screening at 18-20 weeks' gestation should be performed due to an increased risk of foetal anomaly. Further research in prevention of PIH in adolescent pregnancy is suggested.

Three-Dimensional Endoanal Ultrasound Features of the Anal Sphincter in Asian Primigravidae.

OBJECTIVES: The normal parameters of 3-dimensional endoanal ultrasound (3DEAUS) of the anal sphincter have not been reported for primigravidae or pregnant women at present. 3DEAUS parameters in Asian primigravidae were assessed in this study. METHODS: We analyzed 3DEAUS data of 101 consecutives Asian primigravidae, assessed in the early third trimester. The assessment was performed with a rigid ultrasonic probe (Olympus® RU 12M-R1 probe and EU-ME1 ultrasound system (Olympus Corp., Shinjuku, Japan). The Wilcoxon signed-rank test was used to detect the differences in pressure in different quadrants. RESULTS: The participants had a mean age of 24.7 (standard deviation [SD], 5.1) years. The Cleveland Clinic Incontinence Score was normal in all participants. The anal sphincter complex had 3 characteristic segments that were identifiable: upper, middle and lower. The puborectalis muscle was identified as a striated "V"-shaped sling, and its mean thickness was 7.44 (SD, 1.41) mm. The mean thickness of internal (IAS) and external (EAS) sphincters at the mid-sphincter level were 1.78 (SD, 0.59) and 5.49 (SD, 1.21) mm, respectively. The EAS measured 6.02 (SD, 1.07) mm at the lower sphincter level. The statistically significant differences seen in the in quadrants were: the IAS was thicker anteriorly (Z = -2.642; P = .008), the EAS at both midsphincter level (Z = -3.70; P < .001) and lower sphincter level (Z = -7.712; P < .001) was thicker posteriorly, and the IAS was thicker at the 9 o'clock position (Z = -2.081; P = .037). Good symmetry at all 3 levels was seen in the EAS (including the puborectalis muscle). CONCLUSIONS: Normal values of 3DEAUS for primigravidae have been identified and may serve as reference values for other laboratories.

Placenta Percreta-Induced Uterine Rupture at 7th Week of Pregnancy After In Vitro Fertilization in a Primigravida Woman: Case Report.

BACKGROUND: Placenta percreta is the most severe form of abnormal placental attachment. Spontaneous uterine rupture due to placenta percreta is extremely rare and difficult to diagnose in the first trimester. Most prior cases were associated with some risk factor for placenta percreta. We report a case of placenta percreta-induced spontaneous uterine rupture at the 7th week of pregnancy after in vitro fertilization in a primigravida woman who was not otherwise at risk of placenta percreta. CASE REPORT: A 34-year-old, primigravida woman at the 7th week of pregnancy presented with sudden severe abdominal pain. The patient was impregnated by frozen embryo transfer. The patient's antenatal course was unremarkable and she had no risk factor for placenta percreta. An emergency laparotomy was performed to diagnose the cause of hemoperitoneum and the operative findings included a hemoperitoneum of 2000 mL and a fundal uterine defect of 3 × 2 cm with placental tissue penetrating through the uterine serosa. Histopathologic examination confirmed the diagnosis of placenta percreta. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Placenta percreta is associated with serious morbidity and mortality during pregnancy, but it is quite rare and difficult to diagnosis in the first trimester. Emergency physicians should suspect uterine rupture due to placenta percreta in pregnant women with abdominal pain even in their first trimester of pregnancy and without risk factors of placenta percreta, especially in in vitro fertilization pregnancies.

Effect of vaginal delivery on anal sphincter function in Asian primigravida: a prospective study.

INTRODUCTION AND HYPOTHESIS: The true incidence of obstetric anal sphincter injuries (OASI) among Asian primigravida is not known. This study aimed to evaluate OASI in Sri Lankan primigravida. METHODS: One hundred and one consecutive primigravida in their last trimester were recruited from antenatal clinics at a tertiary care centre in Sri Lanka and followed up 6 weeks and 6 months after delivery. They were assessed using anorectal manometry (3D-ARM) and endoanal ultrasound (3D-EAUS) on both occasions. RESULTS: Seventy-three (75.3 %) had vaginal delivery without instrumentation, whereas 3 (3.1 %) each delivered using forceps or vacuum. Twelve (12.4 %) had emergency caesarean sections and 6 (6.2 %) had elective caesarean sections. None had clinically identified anal sphincter injuries. EAUS identified IAS defects in 3 (5.1 %) and EAS defects in 28 (47.5 %). Both resting (p = 0.3) and squeeze (p = 0.001) pressures had decreased following childbirth. Multivariate analysis identified antepartum RP and postpartum EAS defects to be associated with RP reduction (χ(2)(4)=17.825, p < 0.0005) and antepartum SP and postpartum EAS defects to be associated with SP reduction (χ(2)(5)=31.517, p < 0.0005). Episiotomy was protective, whereas delivering after 40 weeks' gestation and delivering a baby with a longer length increased the risk of SP reduction. EAS defects (χ(2) (6)=23.502, p = .001) were more common in mothers who had labour augmented by oxytocin and in those who delivered a baby with a larger head circumference. Labour induction and delivering a longer baby were protective for EAS defects. CONCLUSIONS: Several risk and protective factors for the structural and functional damage of sphincters were identified. These findings will help to formulate a policy to minimize future obstetric anal sphincter injuries.

Three-Dimensional Anorectal Manometry Findings in Primigravida.

BACKGROUND: Vaginal delivery is an identified risk factor for anal sphincter injury. Therefore, to identify postpartum injury, an antepartum value or a normal range is required. However, at present, the normal values of 3D manometry are not available for primigravida or pregnant mothers. AIMS: Our study aims at describing normal values of 3D manometry in primigravida. METHODS: We analyzed 3DARM data of 101 consecutive primigravid mothers in the third trimester. 3DARM was performed using the Given Imaging(®) ManoScan system. RESULTS: The mean age was 24.7 (SD 5.1) years. All patients had a normal Cleveland Clinic Incontinence Score. The mean resting pressure (RP) was 87.02 (SD 18.43) mmHg and the maximum squeeze pressure (SP) was 179.21 (SD 52.96) mmHg. The mean length of the high-pressure zone (HPZ) was 3.67 (SD 0.52) cm. Mean volumes for initial rectal sensation, urge, and discomfort were 50.36 (± 25.57), 76.70 (± 35.17), and 143.40 (± 66.26) ml, respectively. The pressure asymmetry was highest in the lower anal sphincter and lowest in the mid-sphincter. There was a statistically significant relationship between the HPZ and RP (Pearson ρ -0.23, p = 0.01), height (Pearson ρ 0.22, p = 0.028), and weight (Pearson ρ 0.25, p = 0.012). There were no statistically significant correlations between age, height, or weight with RP, SP, or balloon fill volumes. The characteristic appearance of the normal RP and SP was clearly visualized in all patients. CONCLUSIONS: Normal 3DARM values for Sri Lankan primigravid mothers have been established. These may be used as reference values by other investigators.

Mode of delivery and birthweight among teenage and adult primigravida Saudi women: A retrospective comparative study.

AIM: The aim of this study was to determine the mode of delivery and birthweight among teenagers in comparison to adult pregnant Saudi women. MATERIAL AND METHODS: This was a retrospective comparative study. We included all primigravid teenage girls aged 19 years or younger and adult women aged 20-29 years with singleton term normal pregnancies who delivered at Hail Maternity Hospital during 1 January-31 December 2013. RESULTS: Incidence of vaginal delivery among teenagers was higher than that in adults, at 105 (80.2%) and 588 (70.5%), respectively. There was a lower incidence of vacuum extraction and cesarean section among the teenage group compared to the adult group (1 [0.8%] vs 25 [3.0%], and 25 [19.1%] vs 221 [26.5%], respectively [P > 0.05]). Incidence of low birthweight among the teenage group was higher than that in adults (28 [21.4%] and 84 [10.1%], respectively [P < 0.05]). CONCLUSION: Our study concluded that teenage pregnancy is associated with a high risk of low birthweight (P < 0.05). Adult mothers experienced more cesarean section and vacuum extraction deliveries (P > 0.05). Adequate antenatal care, community education and raising awareness might decrease the number of teenage pregnancies, which was 13.6% in our study.

Defect in the uterine wall with prolapse of amniotic sac into it at 32 weeks' gestation in a primigravida woman without any previous uterine surgery.

We experienced a case of uterine wall defect with amniocele in a primigravida woman without any history of uterine surgery. On admission due to acute abdominal pain at 32 weeks' gestation, an ultrasound examination showed a 9 × 7-cm sized echogenic cystic area in the Morrison pouch. Color Doppler revealed a flow from the uterus into the cystic area through a myometrial defect. During the operation, a 1-cm defect in the uterine myometrium was found on the right fundus. An intact amniotic sac was prolapsed into the abdominal cavity through the myometrial defect. This was an extremely rare case of unexplained uterine wall defect.

A rare case of morbidly adherent placenta in a young Primigravida with RH negative pregnancy managed with peripartum subtotal hysterectomy.

INTRODUCTION AND IMPORTANCE: Postpartum hemorrhage (PPH) can be defined as excessive bleeding (>500 ml) from the genital tract after the delivery of baby upto 6 weeks. PPH accounts for major cause of maternal mortality rate. Prevention and early intervention can prevent this complication of delivery. However condition like placenta accreta leads to retention of placenta and makes PPH inevitable. CASE SUMMARY: We present the case of massive postpartum hemorrhage secondary to Placenta accreta in young primigravida with RH negative pregnancy. Clinical findings and investigations were not significant during her admission. She delivered the baby via vaginal route but placenta was not expelled till 30 min. Due to failed manual removal of placenta patient was shifted to OT.Manual vacuum aspiration was done in OT setting and chunks of placenta along with blood clots were obtained.Uterine balloon tamponade was inserted. Due to persistent PV bleeding subtotal hysterectomy was carried out in line for placenta accreta. DISCUSSION: Placenta accreta being one of the life threatening obstetric condition, it should be diagnosed as early as possible and need prompt management so as to prevent maternal mortality. Due to increasing number of cesarean delivery the cases of placenta accreta has been rising but rarely in some cases can it present in young primigravida with Rh negative pregnancy. CONCLUSION: In the cases of morbidly adherent placenta it is necessary for obstetrician to early identify such conditions and timely intervene to save the mother's life. Moreover Rh negative could be a hidden risk factor.