Acute Fetal Distress Research Articles

Evaluation par régression logistique binaire de déterminants de la mortalité néonatale dans la province du Kongo Central

Neonatal mortality disturbs the whole of humanity. Its frequency remains very high throughout the world, but more so in developing countries. The DRC is ranked among the countries with the highest number of neonatal deaths in the world with the ratio of 47 per 1000 live births, (Kalonji DC et al 2018). Indeed, the province of Kongo Central has not remained indifferent to this health problem. With a view to improving newborn health during the neonatal period, the present study is conducted and envisages identifying the determinants of neonatal mortality in Kongo Central Province. For this study, the general population consisted of all newborns in the Province of Kongo Central from 2021 to 2022. A random sample of 117 cases met the inclusion criteria, of which we matched 1 case to 2 controls. After data analysis, we found the following results: the overall neonatal mortality rate was 333 per thousand live births. The logistic regression model identified the following determinants of neonatal mortality: age (OR= 1.16562 IC95 [1.035635 -1.3163]. p=0.0105), age less than 2 years (OR= 2.01966 IC95 [1.021601-4.058]. p=0.0449) and acute fetal distress (OR=2.62027IC95 [1.179464-5.878]. p=0.0181). In order to improve neonatal health, pregnant women should be made aware of the importance of prenatal consultations for early detection and appropriate management of high-risk pregnancies. They should be present at the onset of labor and give birth in the presence of qualified personnel.

Prenatal Manifestation of Transient Abnormal Myelopoiesis: Case Report and Review of the Literature.

Background: Congenital malignancies are unusual fetal conditions, and therefore, the data on their prenatal manifestation are limited. Transient abnormal myelopoiesis (TAM) is a hematologic disorder characteristic for babies with trisomy 21 and based on the transient appearance of blast cells in peripheral blood. Methods: This paper presents prenatal manifestation of congenital TAM in a newborn with normal karyotype and reviews the literature on prenatal manifestation of this disorder. Results: A pregnant woman in her third pregnancy referred herself to the hospital for reduced fetal movements at 30 weeks of gestation. Admission's ultrasound scan showed an increased middle cerebral artery peak systolic velocity together with hepatomegaly. The patient was admitted to the labor ward for cardiotocography monitoring which showed acute fetal distress with repeated unprovoked decelerations. An emergency cesarean section was conducted and a phenotypically normal female newborn with low Apgar score was delivered. Further examination of the peripheral blood revealed anemia and leukocytosis with high blast proportion. A bone marrow aspirate revealed 70.2% of blasts in a sample with an abnormal karyotype of 47 XX+21. Cytogenetic analysis of the blasts with later microarray comparative genomic hybridization confirmed the presence of GATA1 mutation. However, the buccal smear showed a normal karyotype in the infant. The disease was classified as TAM. Conclusions: Our study demonstrates a rare case of prenatal manifestation of TAM in a neonate with a normal karyotype. Obstetricians should pay attention to symptoms like high MCA PSV and hepatosplenomegaly as possible causes of fetal hematological disorders and differentiate it with infection or isoimmunization.

A Second Trimester Prediction Algorithm for Early-Onset Hypertensive Disorders of Pregnancy Occurrence and Severity Based on Soluble fms-like Tyrosine Kinase 1 (sFlt-1)/Placental Growth Factor (PlGF) Ratio and Uterine Doppler Ultrasound in Women at Risk.

Hypertensive disorders of pregnancy (HDPs) represent a significant source of severe maternal and fetal morbidity. Screening strategies relying on traditional medical history and clinical risk factors have traditionally shown relatively modest performance, mainly in the prediction of preeclampsia, displaying a sensitivity of 37% for the early-onset form and 29% for the late-onset form. The development of more accurate predictive and diagnostic models of preeclampsia in the early stages of pregnancy represents a matter of high priority. The aim of the present paper is to create an effective second trimester prediction algorithm of early-onset HDP occurrence and severity, by combining the following two biochemical markers: a soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio and uterine artery Doppler ultrasound parameters, namely the pulsatility index (PI) and the resistivity index (RI), in a population of high-risk pregnant women, initially assessed through traditional risk factors. A prospective single-center observational longitudinal study was conducted, in which 100 women with singleton pregnancy and traditional clinical and medical history risk factors for preeclampsia were enrolled at 24 weeks of gestation. Shortly after study enrollment, all women had their sFlt-1 and PlGF levels and mean uterine artery PI and RI determined. All pregnancies were followed up until delivery. Receiver operating characteristic (ROC) analysis established algorithms based on cutoffs for the prediction of the later development of preeclampsia: PI 1.25 (96.15% sensitivity, 86.49% specificity), RI 0.62 (84.6% sensitivity, 89.2% specificity) and sFlt-1/PlGF ratio 59.55 (100% sensitivity, 89.2% specificity). The sFlt-1/PlGF ratio was the best predictor for preeclampsia, as it displayed the highest area under the curve (AUC) of 0.973. The prediction algorithm for the severe form of preeclampsia, complicated by fetal growth restriction leading to preterm birth, antepartum fetal demise or acute fetal distress with a cerebro-placental ratio of <one consisted of the following cutoffs: PI 1.44 (93.75% sensitivity, 95.24% specificity), RI 0.69 (87.5% sensitivity, 100% specificity) and sFlt-1/PlGF ratio 102.74 (93.75% sensitivity, 95.2% specificity). These algorithms may significantly enhance the prediction accuracy of preeclampsia compared to traditional risk factors. The combination of the sFlt-1/PlGF ratio with mean uterine PI and RI in particular displayed an improved performance in the prediction of severe preeclampsia with the above-mentioned complications, compared to the biochemical markers or uterine Doppler parameters used alone. Therefore, HDP screening strategies should increasingly focus on implementing such algorithms for women who are initially regarded as high risk based on traditional risk factors, in order to properly diagnose HDP and properly limit or manage the later maternal and fetal complications.

Trend and Determinants of Neonatal Mortality at the Buea and Limbe Regional Hospitals, Southwest Region, Cameroon

Background: Over the years the rate of neonatal mortality in low-income settings has been on the increase and most cases of neonatal mortality can be associated with modifiable risk factors. However, the rate of neonatal mortality remains high in Cameroon with the Southwest Region having one of the highest rates of neonatal mortality. Objectives: We aimed to determine the trend and determinants of neonatal mortality in Buea and Limbe Regional Hospitals. Method and Materials: A hospital based retrospective study of files of neonates was conducted from the 1st of January 2017 to the 31st of December 2022. Socio-demographic, clinical and outcome data were obtained using a data extraction form and analyzed using Statistical Package for Social Science (SPSS) Version 27. Results: The trend of neonatal mortality was apparently constant (16.1% and 17.8%) between 2017 to 2022. Birth asphyxia 150(53.4%) was found to be the most common cause of neonatal mortality. Identified determinants were: acute fetal distress (AOR:2.6 [1.333-5.346]), no ANC visit (AOR:13.1 [3.849-44.284]), birth weight less than 2500g (AOR:2.050 [0.039-4.216]), birth weight greater than 4000 g (AOR:2 [1.002-3.43]), Apgar Score ˂ 3 (AOR:99.9 [87.036-100.000]) and Apgar score ˂ 6 (AOR=5.164 [1.768-15.082]). Conclusion: Neonatal mortality in our context is still below the expectations of SDG3 with perinatal asphyxia and its related modifiable factors influencing neonatal mortality the most. Therefore, more impactful community education and information sessions to build a positive mind set on pregnant women and their families to reduce neonatal mortality is required from all health sectors.

The effect of acetylsalicylic acid intake on fetal adaptation in placental dysfunction

Placental dysfunction (PD) is one of the actual topics of research in the modern scientific world. Fetal growth retardation (FGR) is the leading clinical manifestation of chronic PD. Assessment of fetal growth is one of the key tasks in prenatal care. FGR is associated with an increased risk of perinatal morbidity and mortality, with long-term adverse outcomes for the child.Prenatal diagnosis of FGR is an important task for stillbirth prevention, up to 30% of cases of which are associated with this pathology or with a small-for-gestational-age fetus at the end of the III trimester.The objective: to study the influence of acetylsalicylic acid on the development of compensatory abilities of the fetus by PD.Materials and methods. 118 pregnancies with FGR and/or PD were analyzed. The women were divided into two groups: I group (67 persons) – patients with FGR and/or PD who used acetylsalicylic acid during pregnancy; II group (51 women) – pregnant women with FGR and/or PD who did not use acetylsalicylic acid during pregnancy. In all cases, the method of delivery was cesarean section due to fetal distress.Fetal distress was diagnosed using ultrasound examinations based on the following criteria: abnormal blood flow according to Doppler data (Volusun S10 ultrasound device), fetal biophysical profile indicators (Volusun S10 ultrasound device, Sonicaid Team fetal monitor) and cardiotocographic assessment of short-term variability (STV) fetal heart rate; STV &gt; 4.5 according to the Sonicaid Team fetal monitor. Exclusion criteria: multiple pregnancy, antenatally confirmed fetal malformations.Results. The use of acetylsalicylic acid through placental regulation allows to achieve a longer gestation period before the development of fetal distress. The average gestational age before the appearance of this pathology in 50.75% of patients of the I group (34 persons) was larger – 33–36 weeks. On the other hand, 54.9% of women (28 individuals) in the II group had fetal distress earlier – at 28–32 weeks of gestation (p&lt;0.05).Pathological blood flow in the umbilical artery or fetal biophysical profile &lt;4 points was determined in 83.6% of cases in the I group (56 pregnant women) and in 23.5% in the II group (12 women). In women who used acetylsalicylic acid (I group) acute fetal distress diagnosed by STV was detected in 11 (16.4%) cases. In women who did not use acetylsalicylic acid (II group), distress manifested itself sharply – due to acidosis – in 39 (76.5%) cases (p&lt;0.05).Conclusions. 1. In women who did not use acetylsalicylic acid, fetal distress manifested itself sharply – due to acidosis (STV&lt;4.5 was recorded in 39 (76.5%) patients of the II group, while in women who used acetylsalicylic acid – in 11 pregnant women of the I group (16.4%; p&lt;0.05). 2. Prophylactic use of acetylsalicylic acid allows to slow down the growth of placental dysfunction, which lets to the development of compensatory mechanisms and adaptation. 3. By use of acetylsalicylic acid the gestational period delivery closer to full term pregnancy. In women who used acetylsalicylic acid, most cases of fetal distress occurred at 33–36 weeks – 50.75%, while in the group that did not use acetylsalicylic acid most cases of fetal distress occurred at 28–32 weeks – in 54.9% (p&lt;0.05).

ПРЕЖДЕВРЕМЕННЫЙ РАЗРЫВ ПЛОДНЫХ ОБОЛОЧЕК ПРИ ДОНОШЕННОЙ БЕРЕМЕННОСТИ КАК ФАКТОР РИСКА РАЗРЫВА ШЕЙКИ МАТКИ В РОДАХ

Abstract. Introduction. Premature rupture of membranes continues to be one of the urgent problems in modern obstetrics, since it is exactly the pathology a high frequency of unfavorable pregnancy outcomes is associated with. At the same time, an equally important task in obstetrics and gynecology remains the problem of maternal birth injuries, including cervical ruptures, the frequency of which ranges 6 to 15 %. Aim. To study how premature ruptures of membranes in full-term pregnancies affect the frequency of cervical ruptures in childbirth and to identify the risk factors of cervical injuries in at-term labor complicated by premature rupture of membranes. Materials and Methods. A retrospective analysis of birth histories for the years 2019-2020 was carried out according to the data of the perinatal center at Saratov City Clinical Hospital No. 8. The study group included 894 histories of single at-term vaginal deliveries complicated by premature rupture of membranes, while the control group included 6,735 birth histories of women whose vaginal deliveries were performed with timely ruptures of membranes. Later, we identified subgroups within the study group: Subgroup 1 (n=101) included patients with premature rupture of membranes at full-term gestation, whose at-term labors were complicated by uterine cervix ruptures, while Subgroup 2 (n=336) included women with premature ruptures of membranes during at-term labors without any maternal birth traumas. When analyzing medical records, special attention was paid to the anamnesis details and to the special aspects of birth courses and outcomes. Statistical data processing was performed using the MS Excel and Statistica 7.0 software programs. Differences in indications were considered statistically significant at p&lt;0.05. Results and Discussion. Probability of premature ruptures of membranes during full-term pregnancy increases in patients expecting their first childbirth by 1.6 times (χ2 = 173.49; p &lt;0.001), those with a burdened obstetric/gynecological history, such as abortions, miscarriages, and genital pathology, and those with concomitant extragenital diseases (85.9%). In the study group, we identified an increase in the incidence of labor anomalies (by 3 times) and acute fetal distress (by 1.9 times), which increased the proportion of using surgical aids in childbirth (by 2.7 times) and the risk of obstetric injuries to the mother (by up to 63.4%), including uterine cervix ruptures by up to 11.3%. Conclusions. Premature rupture of membranes at full-term gestation increases the risk of uterine cervix ruptures in childbirth by 10.3 times. In this obstetric context, the uterine cervix rupture risk factors should include the first birth (57.4%; p= 0.003) in the absence of biological readiness of the birth canal (“unripe” or “insufficiently ripe” uterine cervix, 76.2%), development of ineffective uterine contractions (12.9%), and the use of surgical aids in delivery (vacuum-assisted deliveries and episiotomies, 32.7%).

INTERRELATIONSHIP BETWEEN INDICATORS OF LOCAL AND SYSTEMIC INFLAMMATORY REACTION IN NEWBORNS WITH NEONATAL ENCEPHALOPATHY

Introduction. Neonatal encephalopathy is one of the most common diseases in newborns. Several factors influence the development of neonatal encephalopathy including adverse obstetric history, fetal distress, meconium-containing amniotic fluid and cesarean section. In moderate and severe neonatal encephalopathy, damage to internal organs, local and systemic inflammation may occur. Cytokines, which are activated in the central nervous system and released in response to its damage, play an important role in brain inflammation caused by neonatal encephalopathy. C-reactive protein is also a possible biomarker of neonatal encephalopathy severity, being considered a protein of the innate immune system with anti-inflammatory properties. The state of the inflammatory response can be influenced by a local inflammatory reaction, as a result of which children with neonatal encephalopathy have been shown to have increased levels of fecal calprotectin in the first weeks of life. Also, one of the results of the transferred inflammatory reaction is a change in the composition of the neonatal intestinal microbiome. Objective. To study risk factors for neonatal encephalopathy in newborns, the features of the relationship between local and systemic inflammatory response parameters in asphyxia of varying degrees, and the features of severity and control of inflammatory response parameters. Materials and methods. The study was conducted in 119 full-term newborns, of which 87 children had neonatal encephalopathy and 32 healthy children. To determine the features of severity and control of inflammatory response parameters, group A was identified, which included 60 newborns, 46 of them with moderate neonatal encephalopathy, 14 with severe neonatal encephalopathy. The study was conducted using a culture method to determine the composition of the intestinal microbiome in feces. Using a semi-automated Thermo Scientific Multiskan FC enzyme immunoassay analyzer, the level of fecal calprotectin in feces and C-reactive protein and interleukins 1β and 10 in the blood serum were estimated by the enzyme immunoassay. The results were analyzed using SPSS version 28.0. The correlation between the parameters was analyzed using the Pearson correlation coefficient. The odds ratio was used to quantitatively describe the closeness of the relationship between the features in the statistical population. Binary logistic regression was used to determine the dependencies of the severity of the inflammatory reaction and create a model for calculating its severity. Results. Risk factors for neonatal encephalopathy included mother’s acute respiratory infections and fetal distress. Bifidobacterium levels were positively correlated throughout the study, and there was also a relationship with lactobacilli in the control and non-probiotic treated neonatal encephalopathy groups. E. coli values were positively associated with opportunistic pathogens in the control and probiotic treated groups. Fecal calprotectin was negatively correlated with birth weight and height, Apgar scores, and gestational age. Fecal calprotectin levels were positively correlated with E. coli and opportunistic pathogens in healthy neonates. In children with neonatal encephalopathy interleukin 1β and 10 values were positively associated with fecal calprotectin, interleukin 1β were positively correlated with interleukin 10 and C-reactive protein. Conclusions. The most significant risk factors for the development of neonatal encephalopathy are mother’s acute infectious diseases and fetal distress. The severity of hypoxia/asphyxia at birth correlated with the levels of interleukin 1β and 10 at 2 and 5 weeks of life, and Bifidobacterium at 2 weeks of life. The severity of the inflammatory response in the study population was characterized by a change in the level of interleukin 1β and Bifidobacterium at 2 weeks and a change in the level of interleukin 10 at 5 weeks

Double Balloon Combined with Oxytocin in Labor Induction: Analysis of Multivariate Factors Affecting the Efficacy of Cervical Ripening.

Labor induction during the late trimester of pregnancy is a common option of terminating pregnancy by inducing uterine contractions through medication or cervical mechanical dilation. However, there are few researches on the factors influencing the effectiveness of cervical ripening balloon combined with oxytocin in inducing labor. To explore factors affecting the efficacy of cervical ripening double balloon combined with oxytocin in labor induction. Using a convenient sampling method, this study retrospectively collected the clinical data of 230 pregnant women who underwent cervical ripening double balloon combined with oxytocin for labor induction in our hospital from September 2021 to August 2022. The included subjects were divided into a vaginal delivery group (n = 180) and a cesarean section group (n = 50) based on the delivery mode for comparing relevant indicators between the two groups. The presence of acute chorioamnionitis (OR = 1.456, 95% CI: 1.257-2.112), fetal distress (OR = 1.371, 95% CI: 1.331-2.633), and the placement of cervical ripening balloon catheter for >12h (OR = 1.563, 95% CI: 1.231-3.263) were risk factors for successful application of cervical ripening double balloon combined with oxytocin for labor induction in pregnant women; while multi-gravidity (OR = 0.736, 95% CI: 0.455-0.875) was a protective factor. In addition, evaluation of the predictive value revealed that acute chorioamnionitis, fetal distress, the placement of cervical ripening balloon catheter for >12h, and gravidity all had certain predictive value for the failure of cervical ripening double balloon combined with oxytocin for labor induction, with the highest predictive value found through joint predictive (AUC: 0.931, 95% CI: 0.714-0.811). Cervical ripening double balloon combined with oxytocin for labor induction may have a high success rate in multigravida. Acute chorioamnionitis, fetal distress, and prolonged placement of the balloon may have a negative impact on the success rate of cervical ripening double balloon combined with oxytocin for labor induction.

Examining Cesarean Section Rates in Ghana’s 10 Regions Over a Decade a Comprehensive National Investigation

This study examines cesarean section (C‐section) deliveries in Ghana from 2008 to 2017 in 10 regions, distinguishing between scheduled and emergency procedures. Scheduled C‐sections target specific maternal conditions, such as advanced age, multiparity, and medical history, while emergency C‐sections address acute fetal distress, preeclampsia, bleeding, and other urgent situations. The analysis reveals various regional patterns, with the Brong‐Ahafo Region showing a potential deceleration after 2017 and the Upper West Region indicating a possible acceleration. The high number of C‐sections in Greater Accra and Ashanti may be related to population density and health facilities. The study proposes empirical models, including linear, quadratic, and exponential components, emphasizing quasilinearity. The exponential model suggests transient and permanent phases of cesarean frequency, with the latter dominated by quasilinearity. Optimal parameter values are determined, which highlights the stability of the model. However, caution is advised when projecting too far into the future due to the inevitable slowing of observed trends. The findings offer insights for healthcare planning, resource allocation, and policymaking, emphasizing the need for region‐specific approaches and ongoing monitoring of cesarean dynamics to inform nuanced interventions.

Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....

A Hidden Burden On Public Health: Adolescent Pregnancy And Increased Adverse Perinatal Outcomes

ABSTRACT&#x0D; Objective: Adolescent pregnancy, associated with increased adverse pregnancy outcomes, is a major public health problem. This study aimed to assess adverse perinatal outcomes in adolescent pregnancies by comparing them with adult pregnancies. &#x0D; Methods: 1104 adolescent and 2463 adult pregnant women were included. Presence of fetal anomaly, gestational diabetes, preeclampsia-eclampsia, intrauterine growth restriction, intrahepatic cholestasis, polyhydramnios, placenta previa, in utero mort fetus, uterine rupture, placenta abruption, umbilical cord prolapse, acute fetal distress, preterm birth, cesarean section, labor arrest, birth weight, macrosomia, dystocia, birth trauma, APGAR scores, neonatal intensive care unit admission, postpartum hemorrhage, hysterectomy, blood transfusion, and postpartum infection were recorded. &#x0D; Results: Rates of acute fetal distress, preterm birth, low birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and blood transfusion were higher while birth weight, APGAR scores of fifth minutes, the rates of cesarean section, prolonged and arrested labor, gestational diabetes, and macrosomia were lower in adolescents. In regression analysis, being adolescent pregnant increase the risk of acute fetal distress by 1.4 times (aOR=1.439;95%CI=1.030-2.01, p=0.033), preterm birth by 1.7 times (aOR=1.692; 95%CI=1.104-2.596, p=0.016) and decrease the risk of gestational diabetes (aOR=0.182; 95%CI=0.116-0.286, p

Retrospective Analysis of Pregnancy Outcomes Following External Cephalic Version for Breech Presentation.

We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation. We retrospectively analyzed data from 158 singleton pregnant women with breech presentation at 36 weeks gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2018 to March 2022. 42 underwent ECV, categorized as the ECV group, while 116 without ECV comprised the control group. Systematic collection and evaluation of pregnancy outcomes were conducted for both groups. Within the control group, 16 cases experienced a spontaneous transition to head presentation, among which 14 cases resulted in successful vaginal deliveries. In 2 cases, cesarean deliveries were performed due to fetal macrosomia and persistent posterior occipital presentation. Furthermore, 2 cases of breech presentation in pregnant women were successfully delivered vaginally through breech traction, necessitating an emergency procedure due to the wide opening of the uterus. Within the ECV group, 28 cases were successfully inverted to the cephalic presentation. Among them, 1 case underwent an emergency cesarean delivery due to fetal distress during cephalic delivery, 3 cases required cesarean deliveries due to abnormal labor, and 24 cases were successfully delivered vaginally. The comparative analyses showed that the cesarean section rate (18/42 vs 100/116) and non-cephalic delivery rate (14/42 vs 100/116) in the ECV group were significantly lower than those in the control group (P < 0.001). There was no statistically significant differences between the two groups with respect to the rate of newborns with Apgar score < 7 (1/42 vs 3/116), premature rupture of membrane (3/42 vs 20/116), acute fetal distress (2/42 vs 2/116), and cord prolapse (0/42 vs 1/116) (P > 0.05). ECV can effectively reduce the rate of cesarean delivery and non-cephalic deliveries. However, it but requires strict adherence to indications and continuous monitoring.

Impact of maternal age on perinatal results

Background/Purpose: In our study, we aimed to evaluate maternal, fetal, and neonatal outcomes of pregnancies managed by our perinatologists, obstetricians, and pediatricians in 3 different centers over the past five years, by age group.&#x0D; &#x0D; Methods: In this retrospective study, we collected the maternal and neonatal data from the hospital electronic records of 403 adolescents (15-19 years of age), 491 women of advanced age (&gt;40 years of age), and 200 pregnant controls (20-39 years of age) who delivered in our obstetrics units between 2016 and 2021.&#x0D; &#x0D; Results: Obstetric and fetal outcomes affected from women bearing children early or late stages in life. According to our results, rates of one or more parity, cesarean section, gestational hypertension, and acute fetal distress in the women of advanced age were significantly higher than those in the controls (p34 gestational weeks in the adolescents were significantly lower than those in the controls (p

Lactate and pH values in newborns with a history of acute fetal distress.

Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD. We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2. Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity. Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.

The association between umbilical cord coiling index and adverse perinatal outcomes at term pregnancies

Objectives: The umbilical coiling index, calculated by dividing the total coil number to the cord length, is a representative parameter for umbilical cord coiling status. Recent studies have shown that abnormal umbilical coiling index is associated with adverse perinatal outcomes. Here, we aimed to determine this association at term gestation in our population. Methods: A total of 98 singleton, term pregnant women were included in this prospective study. Demographic, obstetric features and perinatal outcomes of the patients were recorded. Patients were grouped according to the umbilical coiling index as hypocoiled, normocoiled and hypercoiled. Recorded parameters were firstly compared between normocoiled (n = 60) and abnormal coiled (n = 38) groups. Then, they were compared between normocoiled, hypocoiled (n = 20) and hypercoiled (n = 18) groups. Significantly different adverse perinatal outcomes were compared between normocoiled and other groups. Results: Abnormal coiled group had an higher incidence of low fifth minutes Apgar scores, meconium-stained amniotic fluid, intrauterine growth restriction and acute fetal distress as compared to normocoiled group. No significant adverse perinatal outcome was detected between hypocoiled and normocoiled groups. Intrauterine growth restriction (p = 0.004), low Apgar scores (p = 0.046) and fetal distress (p = 0.038) and meconium-stained amniotic fluid were found to be more common in hypercoiled group than normocoiled ones. Conclusions: Abnormal umbilical coiling is associated with adverse perinatal outcomes. Hence antenatal measurement of umbilical coiling index could be a useful parameter to determine high-risk pregnancies and can provide close monitoring for fetal well-being.

Comparison of extra-peritoneal cesarean section with conventional trans-peritoneal cesarean section: An open label randomized controlled trial.

To ascertain whether extra-peritoneal approach is superior to conventional trans-peritoneal approach of cesarean section in terms of fetus delivery time, intra-operative and postoperative outcomes, including return of bowel activity and pain. An open-label randomized controlled trial conducted over one year and six months at a tertiary care center in India. As per sample size calculation, 68 women enrolled in the study; 34 underwent extra-peritoneal, and another 34 underwent trans-peritoneal cesarean section after randomization. Statistical analysis was done with independent sample 't' test, chi-squared test, and fisher's exact test. Baseline characteristics were comparable in both groups. Fetus delivery time was significantly higher in extra-peritoneal than trans-peritoneal cesarean section (14.26±1.26 vs. 9.38±1.83min; p=<0.001). Total operation time was also higher in extra-peritoneal than trans-peritoneal approach (63.24±12.74 vs. 57.41±8.62min; p=0.027). Whereas average blood loss was comparable in both groups (733.82±219.06 vs. 694.12±351.57ml; p=0.063). Postoperatively, return of bowel activity was significantly earlier in extra-peritoneal than trans-peritoneal approach (4.59±0.56 vs. 8.65±1.23h; p=<0.001). Mean time taken for passage of flatus was also significantly less in extra-peritoneal cesarean section (8.56±0.99 vs. 12.76±2.05h; p=<0.001). Pain score at 6, 12, and 18h was significantly lower in extra-peritoneal approach. No patient in extra-peritoneal approach had nausea, vomiting, and abdominal distension. Whereas 11.8 % of patients had nausea, 5.9 % had constipation, and 14.7 % had abdominal distension in trans-peritoneal cesarean section. Requirement of injectable antibiotics and analgesics, and hospital stay was less with extra-peritoneal approach. Extra-peritoneal cesarean section is associated with better postoperative outcomes with respect to return of bowel functions, pain, and requirement of injectable analgesics and antibiotics than the routine trans-peritoneal cesarean section. However, the significantly higher fetus delivery time questions its feasibility in patients with acute fetal distress. Additionally, it is technically difficult and has a longer learning curve.

Perinatal morbidity and mortality in neonates of mothers with sickle cell disease at the Teaching Hospital of Borgou /Alibori (Benin)-II

Introduction: Pregnancy in women with sickle cell disease exposes the neonate to an increased risk of perinatal mortality. Objective: To determine perinatal morbidity and mortality in neonates of mothers with sickle cell disease at the teaching hospital of Borgou/Alibori in northen Benin. Patients and methods: This was a descriptive and observational study conducted in maternity and neonatology departments at the teaching hospital of Borgou/Alibori from January 1, 2015 to August 31, 2019. It included neonates of at least 22 weeks or weighing more than 500g, alive or not at birth from mothers with sickle cell disease. The variables studied were sociodemographic, clinical and evolutionary. The protocol was submitted to the ethics committee of the University of Parakou and obtained its approval under the reference 0289/CLERB-UP/P /SP/R/SA. Results: During the period, 130 pregnant women with sickle cell disease were admitted out of a total of 10,087, representing a frequency of 1.3%. The main perinatal morbidities were: acute fetal distress (10,4%), prematurity and intrauterine growth restriction (49.5%), respiratory distress (40%), bacterial infections (30.5%) and perinatal asphyxia (21.1%). Perinatal deaths occurred in 28 neonates and the perinatal mortality rate was 243.5‰. Conclusion: Acute fetal distress and low birth weight are the main perinatal morbidities observed. Perinatal mortality in these neonates is higher than in the general population in our context. Hence the need for early multi-disciplinary care.

Anaesthetic Management of Caesarean Sections at the Markala Reference Health Centre

Our work is a prospective study of 73 caesarean section cases (from 10 October to 10 December 2022), i.e. a period of 2 months at the Csréf in Markala. Our caesarean section success rate was 65.17%. The 20 to 40 age group was the most represented, with 73.97%, ranging from 16 to 42. In 83.56% of cases, caesarean sections were performed urgently. The indications for caesarean section were dominated by scar uterus (28.77%) and acute foetal distress (19.18%). General anaesthesia was the anaesthetic technique used in 89.04% of cases. Ketamine was the only narcotic used for induction and maintenance. Vomiting (8.22% of parturients) was the most common post-operative complication in the immediate post-partum period. Post-operative pain was managed with a combination of Paracetamol and Nefopam.

Panniculectomy as a surgical option for the management of a deep surgical site infection after C-section in a morbidly obese woman: a case report

BackgroundObesity is an independent risk factor for the occurrence of surgical site infections (SSIs) following all types of surgeries, especially after Caesarean section (C-section). SSIs increase postoperative morbidity, health economic cost and their management is quiet complex with no universal therapeutic consensus. Herein, we report a challenging case of a deep SSI after C-section in a central morbidly obese woman managed successfully by panniculectomy.Case presentationA 30-year-old black African pregnant woman with marked abdominal panniculus extending to the pubic area, a waist circumference = 162 cm and BMI = 47.7 kg/m2 underwent an emergency CS indicated for acute fetal distress. By day five post-operation, she developed a deep parietal incisional infection unremitting to antibiotic therapy, wound dressings and beside wound debridement till the 26th postoperative day. A large abdomen panniculus and maceration of the wound enhanced by central obesity increased the risk of failure of spontaneous closure; thus, an abdominoplasty by panniculectomy was indicated. The patient underwent panniculectomy on the 26th day after the initial surgery and her post-operative course was uneventful. Wound esthetics was satisfactory three months later. Adjuvant dietary and psychological management were associated.ConclusionPost-Caesarean deep SSI is a frequent complication in obese patients. A panniculectomy may be a safe and promising therapeutic surgical option with good cosmetic results and little postoperative complications when used in a multidisciplinary anti-obesogenic approach.

TRIAL OF LABOR AT THE MATERNITY DEPARTMENT OF THE SOUROSANOU UNIVERSITY HOSPITAL (CHUSS): CLINICAL ASPECTS, THE MATERNAL AND PERINATAL PROGNOSTICS

Aims : We aimed at studying the clinical aspects and the maternal and perinatal prognostics during trial of labor at the Gynecology and Obstetrics Unit. Patients and Methods : This is a transversal and Descriptive study over a period of 06 months from 1 st May to 30 th October 2016 in the Gynecology and Obstetrics Unit of the SourôSanou University Hospital (CHUSS). The data were collected and analyzed by the software Epi info version 3.4.5. Results : During the period of study, 109 cases of trial of labor for a total of 2124 births were registered, with an overall frequency of 5.13%. The average age of the patients was 26.6 years. In 42.2% of cases, the patients were primiparious . Admission was direct in 85.5% of cases. The coverage rate for prenatal consultation was 100%. There was vaginal delivery for 108 patients, ie a success rate of 99.08% for trial of labor. An episiotomy was performed in 18.34% of those who delivered vaginally with a labor time less than 3 hours in 65.13% of cases. The indication of the cesarean section during the failure of the trial of labor was dominated by acute fetal distress in 0.91% of cases. Among the 14 patients who had complications during the postpartum period, 06 cases of postpartum hemorrhage of 22.85%, were noted, but did not occasion any maternal death. We registered 109 newborns including 106 alive (97.2%), 10 fresh stillborn, 02 perinatal deaths and 01 macerated stillborn. Among the 13 cases of perinatal morbidity, infections, neonatal suffering and hypotrophy were largely dominant with 5.5%, 38, and 5.34% of the cases. Conclusion : The results of our study (99.08% of success) argue in favor of vaginal delivery after uterine scar, with little risk related to this scar when the pregnancies are followed closely. Indeed, with a normal and careful obstetric monitoring, a scarred uterus after one segmental cesarean section must be considered as a normal uterus that can allow the woman to deliver simply without her being exposed to any particular risk of uterine rupture.