5-minute Apgar Score Research Articles

Impact of continuous labor companion- who is the best: A systematic review and meta-analysis of randomized controlled trials.

Continuous labor support is widely acknowledged for potentially enhancing maternal and neonatal outcomes, the physiological labor process, and maternal satisfaction with the labor experience. However, the existing literature lacks a comprehensive analysis of the optimal characteristics of labor companions, particularly in comparing the effects of trained versus untrained and familiar versus unfamiliar labor companions across diverse geographical regions, both pre-and post-millennial. This meta-analysis addresses these research gaps by providing insights into the most influential aspects of continuous labor support. A thorough search of PubMed, Google Scholar, Science Direct, International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Research4Life, and Cochrane Library was conducted from 25/06/2023 to 04/07/2023. Study selection utilized the semi-automated tool Rayyan. The original version of the Cochrane Risk of Bias tool was used to assess the quality of Randomized Controlled Trials (RCTs) while funnel plots gauged the publication bias. Statistical analysis employed RevMan 5.4, using Mantel-Haenszel statistics and random effects models to calculate risk ratios with 95% confidence intervals. Subgroup analyses were performed for different characteristics, including familiarity, training, temporal associations, and geographical locations. The study was registered in INPLASY (Registration number: INPLASY202410003). Thirty-five RCTs were identified from 5,346 studies. The meta-analysis highlighted significant positive effects of continuous labor support across various outcomes. The highest overall effect without subgroup divisions was the improvement reported in the 5-minute Apgar score < 7, with an effect size of 1.52 (95% Confidence Interval (CI) 1.05, 2.20). Familiar labor companions were better at reducing tocophobia, with an effect size of 1.73 (95% CI 1.49, 2.42), compared to unfamiliar companions, with an effect size of 1.34 (95% CI 1.14, 1.58). Untrained labor companions were the better choice in reducing tocophobia and the cesarean section rate compared to trained companions. For the analysis of tocophobia, the pooled effect sizes were 1.34 (95% CI 1.14, 1.57) and 1.84(95% CI 1.60, 2.12) in trained versus untrained subgroup comparisons. For the cesarean rate, they were represented as 1.22 (95% CI 1.05, 1.42) and 2.16 (95% CI 1.37, 3.40), respectively. The pooled effect size for the duration of labor was 0.16 (95% CI 0.06, 0.26) for the subgroup of RCTs conducted before 2000 and 0.53 (95% CI 0.30, 0.77) for the subgroup of RCTs conducted after 2000. A significant subgroup difference (<0.1) was found in relation to the duration of labor, cesarean section rate, oxytocin for labor induction, analgesic usage, and tocophobia in the subgroup analysis of geographical regions. The beneficial effects of a labor companion are well-established in the literature. However, studies systematically assessing the characteristics of labor companions for optimal beneficial effects are lacking. The current study provides insights into the familiarity, training, temporal association, and geographical settings of labor companions, highlighting the differing impact of these characteristics on measured outcomes by evaluating the current randomized controlled trials on the topic. There is insufficient evidence to define the 'best labor companion' owing to the heterogeneity of labor companions and outcome assessment across different studies. We encourage well-designed further research to fill the research gap.

The role of ultrasound and mitofusin-2 levels to predict pregnancy outcomes in patients with severe preeclampsia: a case-control study.

The aim of this study was to evaluate mitofusin-2 levels and fetal Doppler ultrasonography effects in patients with severe preeclampsia. This single-center case-control study was conducted in the gynecology service of the university hospital in Van. A total of 90 pregnant women aged 18-40 years were included in the study. Of these, 30 are normal, 30 have mild preeclampsia, and 30 are pregnant with severe preeclampsia. In this study, especially in severe preeclampsia patients, serum mitofusin-2 levels and important fetal Doppler flows such as uterine arterial pressure, umbilical arterial pressure, and 1st and 5th minute Apgar scores, birth weight, and the relationship between postnatal outcomes such as week of birth and the number of patients in the neonatal intensive care unit were investigated. There was a significant difference between the three groups in terms of mitofusin-2 levels, which was the highest in the group (p<0.05). Maternal serum mitofusin-2 levels were positively correlated with uterine arterial pressure (r=0.543, p=0.007), umbilical arterial pressure (r=0.238, p=0.008), diastolic blood pressure, and systolic blood pressure (p<0.001). Receiver operating characteristic curve of mitofusin-2 in predicting preeclampsia is as follows: optimal cutoff 1.6 ng/mL; area under the curve: 0.861; 95%CI: 0.786-0.917; sensitivity: 83.9%; and specificity: 70.0%, (p≤0.001). A one-unit increase in mitofusin-2 resulted in a statistically significant 4.21-fold increase in preeclampsia risk. This study recommends the use of mitofusin-2 together with fetal Doppler ultrasound findings as a reliable indicator of preeclampsia severity.

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st Dec 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score &lt;7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score&lt;7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

Effect of Remifentanil on Active Phase Duration of Labor in Nulliparous Pregnant Women: A Cross-sectional Study

Objectives: Due to the increase in elective cesarean section and its high complications, epidural analgesia is the gold standard for reducing the pain of vaginal delivery. In contraindication cases, other effective and safe analgesic methods such as remifentanil are suggested. The present study aimed to compare the duration of active phase of labor at stages I and II, as well as neonatal Apgar score following the use of remifentanil analgesia. Materials and Methods: In this study, 120 healthy primiparous women who were candidates for vaginal delivery were selected. After matching for age and body mass index (BMI), the participants were assigned into two equal groups (n=60 each) of intervention (receiving remifentanil) and control. We compared the duration of active phase of labor at stages I and II, neonatal Apgar scores, and the cesarean section rate between the groups. Statistical analysis was performed using SPSS software (version 23). Results: There was no statistically significant difference between the two groups in terms of the duration of active phase in the first and second stages of labor (P=0.84 and P=0.78, respectively), 1-minute Apgar score (P=0.95), 5-min Apgar score (P=0.92), and the rate of cesarean section (P=0.067). Moreover, we observed no maternal complications with remifentanil. Conclusions: According to our results, remifentanil did not increase the duration of labor, rate of cesarean section, and maternal complications. Hence, it can be a good alternative in cases where epidural analgesia is contraindicated.

Evaluation of Pregnancy Outcomes of Women with Borderline Amniotic Fluid Index Measured in the Second Trimester

Objective: The aim of this study is to evaluate the pregnancy outcomes of pregnant women who were found to have borderline amniotic fluid index (AFI) in second trimester. Materials and Methods: 71 patients who underwent second trimester ultrasound scan (18-24 weeks) between 1 February and 1 August 2021 at our clinic were investigated retrospectively. Patients with borderline AFI (5-8 cm) and who gave birth in the same center were selected. Pregnancy outcomes such as mode of delivery, gestational age at birth, 1st minute APGAR score and birth weights were examined. All data were obtained from the hospital database. Results: In the study sample, the mean age was 28.2±6.7, the mean gravida was 2±1.4 and the mean week of gestation in which AFI was measured was 22±2.5. 38.1% of the pregnancies (27 patients) resulted in cesarean section. 18.3% of births (13 patients) occurred at preterm. 16.9% of pregnancies (12 patients) resulted in low birth weight. APGAR score at 1-minute was 8 and above in all term newborns. Conclusions: Borderline AFI detected in the second trimester is a challenging issue for the obstetricians in terms of clinical management. There is insufficient evidence in the literature regarding the effect of borderline AFI on pregnancy outcomes, and previous studies have reported controversial results. Compared to the findings of previous studies, our results support the studies reporting adverse effects of borderline AFI on pregnancy outcomes.

Association of high pre-pregnancy body mass index with adverse maternal and perinatal outcomes.

Obesity is an epidemic of the 21st century with its rates doubling in both developed and developing countries. It raises concerns for both maternal and fetal well-being and needs altered care throughout pregnancy and in postnatal period. Raised BMI prior to conception is associated with adverse feto-maternal outcomes. Limited data is available about its association with adverse maternofetal outcome in this region of the world. Our objective was to find out association of high pre-pregnancy BMI with adverse maternal and perinatal outcomes. This cohort study of 390 patients was conducted in Gynae department of Lady Reading Hospital Peshawar. Study duration was from June 2021 to March 2022. Patients enrolled in third trimester of gestation (≥ 37 weeks) were divided into two groups based on BMI i.e., Group-A with BMI <25 and Group-B with BMI ≥ 25. Both groups were followed until their delivery and discharge. The mean age of 390 women was 28.2 ± 4.8 years. There was statistically significant association between raised pre pregnancy BMI and maternal risks like postpartum hemorrhage (p-0.0001), genital tract (p-0.0002) and perineal trauma (p-0.04). Neonatal risks significantly associated with high pre-pregnancy BMI were macrosomia (p-0.0001), and one minute APGAR score of < 8/10(p- 0.01). Both groups had no statistically significant difference for different modes of delivery i.e normal vaginal/ instrumental delivery and cesarean section (P-value 0.9). Maternal pre-conception BMI of ≥ 25 leads to poor maternal and perinatal outcomes.

Prevalence and Outcome of Repeat Caesarean Delivery: A Retrospective Review in Rasheed Shekoni Federal University Teaching Hospital Dutse, North-west Nigeria

Background: Caesarean section is the most common Obstetric surgical procedure. Repeat CS has been a significant contributor to the overall increase in CS rate and accounts for about one- third of all caesarean deliveries worldwide. Objective: This study aimed to determine the prevalence and outcome of repeat Caesarean section. Materials and methods: The study was a 3-year retrospective review of Caesarean sections, carried out between 1st July 2020 and 31st June 2023 in the department of Obstetrics and Gynecology of Rasheed Shekoni Federal University Teaching hospital. The case files of the participants were retrieved from the record department. Data analysis was carried out using IBM statistical package for social sciences (SPSS) version 26. Measured variables were expressed in frequencies and percentage. Test for association was done using chi-square non-parametric test, setting P-value at &lt;0.05. Results: A total of 144 were repeat caesarean deliveries were performed out of 344 Caesarean sections done during the review period, giving an incidence rate of 41.9%. The mean age of the patients was 30.42 ± 50 years and the mean parity was 4.47±2.62. Most (51.39%) of the repeat CS were elective. Majority (93.06) of the patients had EBL ≤1000ml and most (82.6%) of the babies delivered had 5th minute Apgar score of ≥7. Conclusion: The repeat Caesarean section rate in this study is high. Similarly, the emergency Caesarean section rate at first and second order repeat Caesarean deliveries is high. Additionally maternal and fetal complications are higher among women lower order Caesarean deliveries.

Low Fifth-Minute Apgar Score Analysed According to Robson Ten Group Classification At a Tertiary Hospital in Nigeria

OBJECTIVE: Robson classification can be used to analyze and audit other indices of delivery outcome besides cesarean section (CS). The objective is to analyze low fifth-minute APGAR scores according to Robson’s classification and present deducible conclusions. STUDY DESIGN: A cross-sectional dataset of 584 neonates of parturients at the Federal Medical Centre Yenagoa (FMCY), Bayelsa State, Nigeria between July 2020 and April 2021 was analyzed. Neonates were classified by the corresponding Robson group with subgroup modification of their mothers. Data was analyzed using IBM SPSS Statistics version 25. Descriptive statistics and association between low fifth-minute APGAR Score and the Robson group are presented. The statistical significance is a p value &lt;0.05. RESULTS: The largest contribution (29.6%) to the low fifth-minute APGAR score was from Robson group 3. Group rate was high in groups 10b (66.7%), 7a (61.1%), 10a (53.6%), 9a (50.0%), 6a (50.0%), 5.2a (33.3%) and 10c (30.3%) relative to others. Neonates of parturients in Robson groups 6a (OR - 11.00; 95% CI-1.27-95.18; p Value-0.029), 7a (OR-17.29; 95% CI-3.06-97.52; p value-0.001), 9a (OR-11.00; 95% CI-1.48-81.61; p Value-0.019), 10a (OR-12.69; 95% CI-2.49 - 64.58; p value-0.002) and 10b (OR-22.00; 95% CI-1.33 -362.92; p value-0.031) had significantly higher odds of low fifth minute APGAR score relative to 8c with the lowest group rate. CONCLUSION: Meaningful deduction is possible with use of the Robson’s classification for audit of low APGAR Score. By this study, parturients in Robson groups 3, 5.2a, 6a, 7a, 9a, 10a, 10b, and 10c are identified for focused interventions towards improving APGAR score outcomes at FMCY.

Fetal and maternal outcomes of segmental uterine resection in emergency and planned placenta percreta deliveries.

This study evaluated maternal and fetal outcomes of emergency uterine resection versus planned segmental uterine resection in patients with placenta percreta (PPC) and placenta previa (PP). Patients with PP and PPC who underwent planned or emergency segmental uterine resection were included in this study. Demographic data, hemorrhagic morbidities, intra- and postoperative complications, length of hospital stay, surgical duration, and peri- and neonatal morbidities were compared. A total of 141 PPC and PP cases were included in this study. Twenty-five patients (17.73%) underwent emergency uterine resection, while 116 (82.27%) underwent planned segmental uterine resections. The postoperative hemoglobin changes, operation times, total blood transfusion, bladder injury, and length of hospital stay did not differ significantly between groups (P=0.7, P=0.6, P=0.9, P=0.9, and P=0.2, respectively). Fetal weights, 5-minute Apgar scores, and neonatal intensive care unit admission rates did not differ significantly between groups. The gestational age at delivery of patients presenting with bleeding was lower than that of patients who were admitted in active labor and underwent elective surgery (32 weeks [95% confidence interval [CI], 26-37] vs. 35 weeks [95% CI, 34-35]; P=0.037). Using a multidisciplinary approach, this study performed at a tertiary center showed that maternal and fetal morbidity and mortality did not differ significantly between emergency versus planned segmental uterine resection.

Risk factors for brain injury in premature infants with twin-to-twin transfusion syndrome: a retrospective cohort study.

Brain injury (BI) is prevalent in premature infants with twin-to-twin transfusion syndrome (TTTS), while risk factors of BI in these patients remains unknown. Our study aims to discern potential risk factors that contribute to BI in premature infants with TTTS. We conducted a retrospective cohort and analyzed clinical data of premature infants diagnosed with TTTS at the Northwest Women's and Children's Hospital between January 1, 2015 and January 1, 2020. Data included the infants' perinatal information, key postnatal examinations, laboratory tests, and treatments. Of the 84 patients enrolled in the study, 22 (26.2%) were categorized in the BI group and 62 (73.8%) in the non-BI group, based on cranial imaging. No significant differences were found at baseline between the groups in relation to the proportion of males (40.9% vs. 35.5%, P=0.845), median gestational age (weeks) [31.9 (31.5, 33.4) vs. 34.2 (31.6, 35.4), P=0.061], average weight (g) (1,676.4±567.5 vs. 1,845.2±511.7, P=0.200), maternal age (years) [29.5 (26.0, 31.0) vs. 28.5 (27.8, 31.0), P=0.656], the proportion of in-vitro fertilization (9.1% vs. 16.1%, P=0.648), cesarean sections (86.4% vs. 93.5%, P=0.549) or TTTS donor infants (50.0% vs. 51.6%, P=0.897). Multivariate logistic regression analysis indicated that invasive mechanical ventilation [invasive mechanical ventilation (IMV); odds ratio (OR) =4.365; 95% confidence interval (CI): 1.066-17.870; P=0.040], [necrotizing enterocolitis (NEC); OR =8.632; 95% CI: 1.542-48.318; P=0.014], [single intrauterine fetal demise (sIUFD); OR =14.067; 95% CI: 1.298-224.421; P=0.031], and a 5-minute Apgar score <9 (OR =4.663; 95% CI: 1.015-21.419; P=0.048) were strongly associated with BI in TTTS premature infants. Our study identifies IMV, NEC, sIUFD, and a 5-minute Apgar score <9 as independent risk factors for BI in premature infants with TTTS.

Factors associated with the response to postnatal dexamethasone use in very low birthweight infants: a nationwide cohort study

BackgroundDexamethasone is widely used as a systemic corticosteroid to treat and prevent bronchopulmonary dysplasia (BPD) in preterm infants. We evaluated the current epidemiology of dexamethasone use to prevent BPD and...

A novel clinical risk scoring system for neurodevelopmental outcomes among survivors of neonatal hypoxic-ischemic encephalopathy (HIE)

ObjectiveWe aimed to develop a risk scoring system as a predictor of 24-month neurodevelopmental outcomes (cognitive, language, and motor) for neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE). MethodsThis was a chart review of infants with HIE treated with therapeutic hypothermia who were admitted to the Neonatal Intensive Care Unit (NICU) at the University of Michigan between 2009 and 2019 and followed in the neonatal developmental clinic until 24 months of age. We examined bivariate associations between the neonatal characteristics and Bayley-III scores. We then performed stepwise logistic regression. To create the risk scores, a participant was given one point for each of the factors included in the final model. ResultsFifty-five infants were included. The final model for Bayley cognitive abnormality included abnormal neonatal neurologic exam (p < 0.0001), white matter/watershed MRI abnormality (p = 0.01), 5-min Apgar score (p = 0.02), and EEG-confirmed seizures (p = 0.04). The model for language abnormality included abnormal neurologic exam (p = 0.0002), seizures (p = 0.007), clinical severity of HIE (p = 0.06), and basal ganglia/thalamus MRI abnormality (p = 0.17). The model for motor abnormality included seizures (p = 0.03), abnormal neurologic exam (p = 0.06) and basal ganglia/thalamus MRI abnormality (p = 0.02). The positive predictive values for the risk scores were 60 %, 85 % and 71 %, respectively, for the Bayley-III cognitive, language and motor domains. ConclusionOur study identifies early clinical features that differentially predict domains of neurodevelopmental outcome and associated risk scores that may be of value to both clinicians and families. This novel scoring system should next be validated in a larger, prospective study.

Clinical and Laboratory Characteristics and Associated Factors to Mortality in Neonates with Birth Asphyxia: A Prospective Observational Study

Aims: To describe the clinical and laboratory characteristics and to investigate associated factors with mortality of birth asphyxia. Methods: This was a prospective observational study conducted on a total of 120 asphyxiated neonates admitted to the Neonatal Intensive Care Unit (NICU). Results: Severe asphyxia was observed in 33.3%, and moderate asphyxia in 66.7% of the cases. The mortality rate was 19.2%. The common clinical features: apnea/gasping (45.8%), hypothermia (37.5%), lethargy (33.0%). The serious clinical signs: abnormal heart rate (15.8%), gastrointestinal bleeding (13.3%), oliguria and anuria (17.5%). The laboratory findings showed hypoglycemia (30.8%), elevated SGOT (45.0%), serum creatinine &gt; 133 µmol/l (31.7%), hyponatremia (35.0%), hypocalcemia (65.8%), elevated lactate &gt; 5mmol/l (53.6%). The factors that increased the risk of mortality in neonatal asphyxia were Apgar score at 5 min ≤ 5, seizure/coma, need for mechanical ventilation, serum creatinine &gt; 133 µmol/l, liver injury, and lactate ≥ 5 mmol/l. Conclusion: The mortality rate is still high, and elevated serum creatinine, elevated liver enzymes, elevated lactate, and low 5-minute Apgar scores increase the risk of death in asphyxiated neonates. Key words: birth asphyxia, mortality, risk factors, neonates.

Pre-delivery fibrinogen level is a predictor for severity of placental abruption

ObjectiveTo determine pre-delivery fibrinogen levels in predicting adverse maternal or neonatal outcomes in patients with placental abruption. Materials and methodWe conducted a retrospective study of all women admitted for placental abruption between January 2012 and May 2018. Postpartum hemorrhage (PPH), disseminated intravascular coagulation (DIC), massive blood transfusion and hospitalization in intensive care unit parameters were evaluated for maternal outcomes. For the neonatal outcomes, the 5th minute APGAR score, umbilical artery pH and stillbirth were evaluated. ResultsThe mean predelivery fibrinogen levels were 221.3 ± 111.6 mg/dL. In multivariate logistic regression analysis, fibrinogen level was determined as an independent indicator for PPH, red cell concentrate (RCC) and fresh frozen plasma (FFP) transfusion. When fibrinogen levels decreased below 130 mg/dL, the risk of PPH increased and when fibrinogen levels decreased below 100 mg/dL, the risk of overt DİC and also the risk of red cell concentrate and fresh frozen plasma transfusion increased. In terms of the fetal results, there may be adverse neonatal outcomes when fibrinogen levels are below 250 mg/dL. ConclusionPredelivery fibrinogen levels are good indicators for predicting adverse maternal outcomes in placental abruption cases. In addition, fibrinogen levels might be a guide for management of placental abruption cases.

The impact on pregnancy outcomes of late-onset gestational diabetes mellitus diagnosed during the third trimester: A systematic review and meta-analysis.

Evidence is inconsistent regarding the impact of late gestational diabetes mellitus (GDM) on perinatal outcomes. To evaluate associations of GDM diagnosed in the third trimester (late GDM) with adverse obstetric and neonatal outcomes. We searched Embase, Medline, and Web of Science from January 1, 1990 to June 16, 2022, for observational studies. Late GDM was defined as a de novo diagnosis, i.e. after a negative screening for diabetes in the second trimester, and at later than 28 weeks of pregnancy. Each abstract and full-text article was independently reviewed by the same two authors. Quality was assessed with the use of the Newcastle-Ottawa Scale. Summary odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effects model. Twelve studies were identified as meeting the inclusion criteria, including 3103 patients (571 with late GDM and 3103 controls). Incidences of shoulder dystocia (OR 1.57, 95% CI 1.02-2.42, P = 0.040), 5-minute Apgar score <7 (OR 1.80, 95% CI 1.14-2.86, P = 0.024), cesarean delivery (OR 1.98, 95% CI 1.51-2.60, P < 0.001), and emergent cesarean delivery (OR 1.57, 95% CI 1.02-2.40, P = 0.040) were significantly higher among women with late GDM than among the controls. The groups showed similarity in the rates of fetal macrosomia, large-for-gestational-age fetuses, neonatal hypoglycemia, and hypertensive disorders of pregnancy. This meta-analysis showed associations of late GDM with increased adverse perinatal outcomes. Prospective studies should evaluate the impact on perinatal outcomes of repeated third-trimester screening for late GDM.

Higher risk of preterm twin delivery among shorter nulliparous women

ObjectiveTo determine if maternal height in nulliparous women influences pregnancy results in twin pregnancies. Material and methodsRetrospective cohort analysis evaluating twin pregnancies followed at Centro Hospitalar Universitário Lisboa Central, between 1995 and 2020. Of the 2900 pregnancies followed in that period, 886 nulliparous women with dichorionic twin pregnancies were selected. Two groups were considered: A - maternal height <163 cm (<Q2) (n = 436) and B - maternal height ≥167 cm (≥Q3) (n = 234), The following results were compared: Age, body mass index (BMI), premature contractions, premature rupture of membranes (PROM), hypertensive disorders, gestational diabetes, gestational age at birth, delivery <28, <32, <34, < 36, ≥37 weeks (wks), average weight of newborns, very low birth weight, low birth weight, cesarean section rate, stillbirths, five minute Apgar score, neonatal death and perinatal death. Result(s)PTB rates decreased along increasing maternal height. The comparison between group A and group B revealed no statistically significant differences in maternal characteristics (age, mode of conception - spontaneous or ART pregnancies, or BMI). Statistically significant differences were found in mean gestational age at birth (35.1 ± 1.8 vs. 36.0 ± 2.6 wks), PTB rates < 32, 34 and 36 wks, OR: 3.2, 2.3 and 2.4 respectively, p < 0.01. Shorter women had a 1.7× and 2.6× increased risk for significantly low (<2500 g) and very low (<1500 g) newborn birth weight (BW), respectively, and a 40 % increased risk of Cesarian delivery. No significant differences were shown with respect to stillbirths, neonatal and perinatal deaths, which had a low incidence in this study. In ART pregnancies we found the same results regarding PTB rates and newborn birthweight in shorter women. In Logistic Regression analysis, maternal height <Q2 is an independent risk factor for PTB under 32, 34 and 36 wks, adjusted OR: 2.0. 2.2 and 2.4, respectively, 95 % CI 1.1–3.7, p = 0.021. ConclusionIncreased pregnancy risk in nulliparous shorter women should be taken into consideration in double embryo transfers.

Preterm infants with positive conjunctival swab culture: risk factors and association with late-onset sepsis-a retrospective cohort study.

Purulent conjunctival discharge in hospitalized preterm infants may indicate conjunctivitis and warrant treatment. The purpose of this study was to examine the relationship between positive conjunctival swab (CS) culture and late-onset sepsis (LOS) in preterm infants. A retrospective cohort study was conducted to determine the relationship between positive CS culture growth results (CSP) obtained in preterm infants ≤34 weeks' gestation and the development of LOS within 120 h of obtaining CS compared with those who had negative CS culture results (CSN). Electronic medical records were reviewed from January 2015 until December 2019 for preterm infants presenting with purulent conjunctival discharge and underwent CS culture testing due to suspected conjunctivitis. Of the 234 CS cultures obtained during the study period, 145 (61.9%) were CSP compared to 89 (38.1%) CSN cultures. Gram-negative organisms accounted for 70% of all CSP cultures, with the remaining 30% being Gram-positive. Patients with CSP were smaller, younger, had lower 1-minute APGAR scores, and required respiratory support more frequently than those with CSN. Infants with CSP received antibiotics for longer periods, both topically and systemically. Infants who developed LOS were more likely to require invasive ventilation (adjusted odds ratio, 33.5; 95% CI, 2.52-446.5, p = 0.008). The incidence of LOS between the two groups was similar, with 6.2% observed in the CSP group compared to 3.4% in the CSN group (p = 0.543). Similarly, the rates of bacteremia were similar in both groups. Of the CSP patients who were presented with bacteremia, four out of seven (57%) exhibited bacteremia caused by the same organism found in their CS cultures. Similarly, within the entire cohort, respiratory cultures were performed on nine intubated patients within two weeks of obtaining CS cultures. Of these, in the CSP group, five out of six (83%) showed an organism identical to that found in the CS cultures. The study found a significant proportion of positive CS cultures in preterm infants, with distinct patient characteristics and treatment compared to negative cultures. While the incidence of LOS was not significantly different between the two groups, some CSP patients demonstrated bacteremia with the same CS organism, suggesting a possible connection between conjunctival or respiratory colonization and bacteremia.

Risk and Protective Factors for COVID-19 Infection Among Pregnant Women with Sickle Cell Trait

BACKGROUND: Pregnant women and individuals with sickle cell trait (SCT) and underlying comorbidities are more vulnerable to severe illness from the coronavirus disease of 2019 (COVID-19) compared to nonpregnant women and those without SCT (PMID: 35916859, 34129519). However, the impact of the pandemic and factors affecting susceptibility to COVID-19 among pregnant women with SCT is unknown. This study aims to examine various factors that can alter the likelihood of COVID-19 among pregnant women with SCT, including vaccination against COVID-19 and influenza and the presence of underlying comorbidities such as cardiac disease, diabetes, obesity, renal disease, and stroke. In addition, the study aims to provide insights into the fetal outcomes among pregnant women with SCT who have contracted COVID-19. METHODS: A total of 295 individuals with the diagnosis of SCT who had encounters at three large hospitals in Michigan from January 1, 2022, to December 31, 2022, were screened in this retrospective study. 151 women with SCT met the inclusion criteria and are within the reproductive age group between 15-49 years old. Demographics, underlying comorbidities, fetal outcomes, and other clinical information were collected by electronic medical records review. COVID-19 and influenza vaccination were verified from the immunization records registry in Michigan. Multivariable regression analysis was used to analyze the protective or risk factors associated with COVID-19 infection. Statistical analyses were performed using the SPSS version 29 statistical software, and a p-value of &amp;lt;0.05 was considered statistically significant. RESULTS: Data was collected from 151 women with SCT, with 34% being pregnant and 66% being non-pregnant. Approximately 85% of the participants were Black, and their mean age was 32 years. 35% contracted COVID-19 among pregnant women, while 31% among non-pregnant women (p&amp;gt;0.05). In a multivariable regression analysis, the study found that pregnant women with SCT who received COVID-19 vaccine were 90% less likely to have a COVID-19 infection (OR=0.102 with 95%CI: 0.011-0.950) and 9 times more likely to have a COVID-19 infection if they had a history of pulmonary conditions such as asthma, chronic obstructive pulmonary disease, or obstructive sleep apnea (OR=9.375 with 95% CI: 1.090-80.627). There were no other protective or risk factors that showed a significant statistical association with COVID-19 infection among pregnant women, including influenza vaccination, obesity, underlying cardiac history, diabetes mellitus, renal disorder, stroke, or transient ischemic attack (p&amp;gt;0.05). Most pregnant women with SCT who contracted COVID-19 in the study had mild-moderate disease, except for one patient who developed severe disease in the third trimester, warranting premature delivery of an infant via emergency cesarean section. 72% did not have fetal complications, except for 3 newborns who were delivered preterm (&amp;lt;37 weeks) and 2 with low birth weight (&amp;lt;2500 grams). While 2 newborns initially had a low Apgar score (APGAR&amp;lt;7) at 1 minute, their condition eventually improved after 5 minutes. Overall, all newborns delivered to COVID-19-infected women with SCT had a good 5-minute Apgar score. CONCLUSION: The study further emphasizes the importance of encouraging COVID-19 vaccination among individuals with SCT, particularly pregnant, reproductive age group women and those with underlying comorbidities. Pregnant women with SCT and underlying comorbidities should be carefully monitored to prevent severe disease, as they may be more vulnerable to COVID-19 infection. Further studies with larger sample sizes are recommended to investigate factors associated with severe COVID-19 infection among these populations.

Comparison of Umbilical Cord Arterial Blood Gas and Neonatal Outcomes in Women with and without Meconium-Stained Amniotic Fluid During Labor

Introduction: Meconium-stained amniotic fluid (MSAF) may increase maternal and neonatal complications. The favorable mode of delivery is controversial in women with MSAF. This study aimed to compare umbilical cord arterial blood gas (ABG) and neonatal outcomes in deliveries complicated by meconium and clear amniotic fluid during the active phase of labor. Materials and Methods: This observational study was performed on 144 term pregnant women (72 with MSAF and 72 with clear amniotic fluid) during the active phase of labor with ruptured membranes admitted to Al-Zahra and Taleghani hospitals in Tabriz, Iran, from June 2019 to June 2020. A checklist was used to record the ABG and neonatal outcomes. Results: The frequency of cesarean delivery in the MSAF group (25%) was significantly higher than in the women with clear amniotic fluid (20%) (P = 0.006). There was no statistically significant difference between the groups regarding pH, base excess, PCO2, 1- and 5- minute Apgar scores, and neonatal intensive care unit (NICU) admission of the newborn due to MSAF (P&gt; 0.05). There was no incidence of hypoxic-ischemic encephalopathy, sepsis, and seizure. Conclusion: Given the non-significant difference between two groups of women with and without MSAF during labor in terms of neonatal outcomes and umbilical cord ABG, it seems that MSAF alone is not an indication for cesarean delivery. Thus, vaginal delivery is recommended in pregnant women with MSAF.

Incidence and predictors of respiratory distress syndrome among low birth weight neonates in the first seven days in Northwest Ethiopia Comprehensive Specialized Hospitals, 2023: A retrospective follow-up study

IntroductionRespiratory distress syndrome is a catastrophic respiratory problem among low birth weight neonates. It increases the suffering of neonates and the economic expenditure of the countries. Notably, it is a...