Antenatal Complications Research Articles

Neurological Sequelae in Children Born After Assisted Conception Techniques in a Tertiary University Hospital in Riyadh, Saudi Arabia: A Retrospective Cohort Study.

Background Assisted conception (AC) methods, including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), have transformed reproductive medicine by offering solutions to infertility. However, their long-term health implications, particularly on neurological outcomes in children, require further investigations, especially in the Middle East. Objective This study aimed to evaluate the neurological complications among children conceived through assisted reproductive techniques at King Khalid University Hospital, a tertiary hospital in Riyadh, Saudi Arabia. Methods A descriptive retrospective review was conducted on the records of pediatric patients born via assisted conception between January 2017 and December 2022. Eligible children aged 18 months and older were included. Data on demographic characteristics, antenatal and postnatal complications, and neurological assessments were collected and analyzed using the Statistical Package for Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY). Results Out of 303 patients, 283 children met the inclusion criteria, with a mean age of 4.1 ± 1.7 years. Most deliveries were via cesarean section (CS) (194, 68.6%). Premature births accounted for 129 (45.6%), with antenatal complications reported in 58 (45.0%). The primary neurological sequela identified was speech disorder, affecting 18 children (6.4%), with a smaller proportion experiencing behavioral issues (eight, 2.8%) and motor delays (five, 1.8%). Significant associations were found between neurological complications and factors such as very preterm status, low birth weight (LBW), neonatal intensive care unit (NICU) admission, and associated complications during NICU stays. Conclusion Although the majority of children conceived through assisted reproductive techniques exhibitno significant complications, those born prematurely appear to have a higher risk of neurological issues. These findings underscore the importance of ongoing monitoring for children born through assisted conception, particularly those with identified risk factors. Future prospective studies are necessary to further elucidate these associations and improve clinical outcomes for this population.

Maternal and Perinatal Outcomes in Teenage Versus Adult Pregnancies – A Prospective Comparative Study

Objectives To assess maternal and neonatal outcomes in teenage versus adult pregnant women and also to compare the sociodemographic characteristics of these women.Methods It was a cross-sectional study conducted at Bangalore Medical College and Research Institute in which 1368 teenage pregnant women and 15605 adult pregnant women were studied for a period of 12 months. Maternal parameters such as sociodemographic details education status parity antenatal complications postpartum complications and mode of delivery were compared. Neonatal parameters compared included gestational age at birth birth weight need for resuscitation neonatal intensive care unit NICU admission and perinatal death.Results The percentage of teenage pregnancies was 8.05. Majority of women in the teenage group were from rural background 68.56 had only primary education 76.68 were primiparous 95 had lesser antenatal visits 52.26 with late initiation of first antenatal visit in second trimester 6505. The occurrence of anaemia 6 hypertensive disorders 17.25 low birth weight 30.26 NICU admissions 24 and perinatal deaths 2.5 was greater in teenage group P value-lt0.0001. Significant differences were noted between the two studied groups regarding sociodemographic characteristics pattern of antenatal care antenatal complications hypertensive disorders of pregnancy and anaemia and neonatal outcomes.Conclusion Teenage pregnancy was found linked to high incidence of maternal and neonatal complications. Maternal and perinatal morbidity and mortality can be minimized in teenage pregnancies by providing education improving their nutritional status socioeconomic status educating them about contraception safe sex practices to avoid unintended pregnancies and by providing them good antenatal care.

A cross-sectional study of paramedic management of out-of-hospital obstetric emergencies

Background/Aims Most birth-related ambulance calls occur without difficulty, but in some cases, complications can arise. Paramedics’ involvement in birth is infrequent; therefore, the knowledge and skills required to manage complications can atrophy over time, particularly without educational interventions. This may impact outcomes. The study's aims were to measure the knowledge, attitude, and practice of paramedics in managing obstetric cases. Methods This cross-sectional questionnaire-based study was carried out with 264 paramedics. Spearman's measure of correlation was used to observe linear correlations between ranks of the observations. Results The majority of participants were advanced care paramedics (81.1%). Participants reported infrequently attending births in the community, with under half feeling confident in managing these (44%). Antenatal complications and trauma in pregnancy were self-reported areas of weakness; this was consistent with assessed knowledge. Conclusions Paramedics self-reported infrequently responding to obstetric calls and the majority lacked confidence in managing these. Few indicated an excellent level of obstetric knowledge, reporting a desire to receive more education in this area. Implications for practice When paramedics lack confidence in managing obstetric emergencies, it can lead to delayed decision making, inadequate assessment, increased error rates and adverse maternal and neonatal outcomes.

Gestational Diabetes Management and Outcomes in South Jordan: Metformin Alone vs. Metformin-Insulin Therapy, A Retrospective Cohort Study

Background: Gestational diabetes mellitus (GDM) in Jordan displays a considerable variable prevalence, with reported rates ranging from 1.2% to 13.5%. To address this, our institution established a dedicated GDM clinic. The primary goal was to develop an efficient management system that reduces hospital admissions and improves outpatient care for pregnant women with diabetes. The current study aims to assess the cost-benefit ratio of the clinic, determine the incidence of GDM at our hospital, identify its associated risk factors, assess pregnancy outcomes, and analyze the treatment regimens applied. Methods: From March to August 2023, data from newly diagnosed women with GDM attending outpatient clinics and the GDM clinic at Al Karak Governmental Hospital were retrospectively analyzed. Extraction of information on hospital admissions, baseline maternal characteristics, and perinatal outcomes from medical records was performed. The hospital’s accounting department provided daily cost details for the patient’s stay. We then used these details to calculate the average costs over a four-day period. Descriptive analysis was performed for the maternal sociodemographics, obstetric characteristics, and perinatal outcomes. The association between categorical variables was analyzed using Fisher’s exact test. We conducted a Mantel-Haenszel (MH) analysis to evaluate the associations between selected perinatal outcomes (large for gestational age (LGA), polyhydramnios, pregnancy-induced hypertension (PIH), and neonatal intensive care unit (NICU) admission rate) and two treatment regimens (metformin vs. metformin and insulin), while controlling for the gestational age at diagnosis. SPSS version 25 was used to complete the statistical analysis. Results: During the six-month study period, 75 women were diagnosed with GDM, yielding an incidence rate of 4.97%. Hospitalization for blood sugar management decreased from 81 admissions in the previous year to 16 during the study period. A mean age of 32.6 years (±5.47) was observed among the participants, and 46% were considered obese. Two-thirds of multiparous women had a first-degree relative with diabetes, and 45% reported prior GDM. At diagnosis, 60% were less than 24 weeks pregnant. Treatment modalities included metformin alone (25.3%) and combined metformin-insulin therapy (65.3%). LGA was the most prevalent antenatal complication (30.6%). After controlling for gestational age at diagnosis, no statistically significant differences were found between treatment groups for LGA, polyhydramnios, and pregnancy-induced hypertension (MH p values: 0.505, 0.971, and 0.737, respectively). However, the combined therapy group showed a tendency towards increased odds of polyhydramnios (odd ratio (OR) 1.431, 95% confidence interval (CI) 0.285–7.173) and PIH (OR 2.818, 95% CI 0.255–31.097), but decreased odds of LGA (OR 0.476, 95% CI 0.111–2.050). Compared to the metformin-only group, the combined therapy group had significantly higher rates of NICU admissions (87% vs. 13%, p value = 0.001). 66.7% of these admissions were for hypoglycemia screening. Conclusions: This study evaluated a clinic dedicated to managing GDM in a region with a high prevalence of diabetes. The clinic improved care and created a valuable research database. Our findings revealed no significant outcome differences between insulin-treated patients and those on metformin, though the former group had higher NICU admission rates due to logistical factors. As a result of this centralized approach, we may be able to develop population-specific protocols, enhance maternal and neonatal care, and advance the management of GDM in our community and the development of new research.

OA08 Ocrelizumab in pregnancy in a patient with juvenile onset systemic lupus erythematosus

Abstract Introduction Juvenile-onset systemic lupus erythematosus (jSLE) is a multisystem autoimmune disease that results in increased disease activity compared to adult-onset SLE. jSLE in pregnancy results in a greater incidence of disease flares as well as adverse pregnancy outcomes. Management of SLE in pregnancy is particularly difficult due to lack of safety data for immunosuppressant medications and is therefore limited. Ocrelizumab is a humanised monoclonal antibody that selectively targets CD20 B cells and is approved for the treatment of multiple sclerosis. Despite never being trialled in a patient with active SLE in pregnancy, this case demonstrates its use with a successful outcome. Case description An 18-year-old female was diagnosed at age 14 with juvenile onset systemic lupus erythematosus with the presence of a photosensitive malar rash, arthralgia, alopecia, aphthous ulcers and headache. At the time of diagnosis her investigations revealed ANA 1:5120 with homogenous pattern, high dsDNA, low C3 and C4, thrombocytopenia, antibodies to Smith, Ro, RNP, anti-Rib-P, strongly positive lupus anticoagulant antibodies and low titre anti-cardiolipin IgG and IgM. Previous treatment included methotrexate, mycophenolate mofetil and cyclosporin which were discontinued either due to patient choice, inefficacy or adverse reaction. Azathioprine was contraindicated due to low TMPT. Rituximab was trialled and although effective had to be stopped due to adverse reaction. Unfortunately, she experienced a primigravida pregnancy loss at 15-20 weeks secondary to active SLE and pre-eclampsia. Shortly after this, she developed a rare case of anti-fascin antibody neuropathy and was treated with ocrelizumab. Six months later during her second pregnancy, she was treated with hydroxychloroquine 400 mg, aspirin 150 mg, folic acid 5 mg and low molecular weight heparin prophylaxis which were continued throughout the pregnancy. Due to concerns of active lupus at 13 weeks due to facial rash and fatigue, prednisolone was commenced at 10 mg daily and continued. After careful consideration, Ocrelizumab was given in the second trimester at 17 and 19 weeks’ gestation. Following this, symptoms remained under control and disease activity was low with normal C3/C4 and dsDNA levels without significant proteinuria. A newborn baby was delivered at 38 weeks by caesarean section without complication or foetal abnormalities. Both the mother and baby remain under close follow- up but have not demonstrated adverse outcomes at 3 months postpartum. Discussion This case demonstrates the use of Ocrelizumab in the second trimester of a high-risk pregnancy complicated by active jSLE. At present, there is no license for use of Ocrelizumab in SLE and no safety data on its use in pregnancy. However, there was a good outcome for this patient which resulted in no antenatal or postpartum complications and the successful birth of a healthy newborn without foetal abnormalities. Ocrelizumab is used for the treatment of early relapsing-remitting multiple sclerosis (RRMS) and is increasingly used by neurologists in women of childbearing age despite being unlicensed for use in pregnancy. Concerns of its use in pregnancy surround B cell depletion in the neonate which while tends to be transient, causes significant concern regarding long term immunological development and response to vaccination. B cell depleting therapies are widely used in the context of active and refractory SLE and therefore use of Ocrelizumab has been evaluated in cases of SLE in two phase III clinical trials. The first study examined the efficacy of Ocrelizumab in SLE without renal involvement (BEGIN) and the second recruited patients with lupus nephritis (BELONG). The BEGIN study was terminated early due to lack of response and the BELONG study was terminated due to a significant increase in serious infections (in the Ocrelizumab plus mycophenolate treatment group). However, results on disease activity were positive with complete renal response being achieved non-statistically more frequently in the Ocrelizumab treated patients versus placebo. Real world evidence shows the importance of achieving disease control in SLE around pregnancy to prevent adverse outcomes. The decision for the use of Ocrelizumab therefore needs to be balanced carefully against potential harm to the baby either from direct foetal exposure to the drug, or from gestation in an immunocompromised mother. Key learning points • Pre-pregnancy counselling is of paramount importance in severe cases of active SLE and when possible, pregnancy should be postponed in these instances until disease activity is stabilised with contraception counselling offered to those on teratogenic immunosuppressive agents. • A multidisciplinary approach to the management of complex SLE in pregnancy in essential with obstetrician, midwife, maternal medicine physician and rheumatologist input. • The benefit of potentially life-saving immunosuppressive treatment should be carefully balanced against the poor outcomes of active SLE in pregnancy and decisions should be made on a case-by-case basis.

Feasibility, safety, and outcome of fetoscopic endoluminal tracheal occlusion for severe congenital diaphragmatic hernia at a low case-load center: one center's experience.

Antenatal fetoscopic endoluminal tracheal occlusion (FETO) has been introduced as an effective intervention to improve the outcome of severe congenital diaphragmatic hernia (CDH). We report our early experience with FETO. A retrospective chart review of case series. Tertiary health care center. 18-45 years old, with single fetuses diagnosed with left severe CDH (lung-head ratio <1 measured between 27-29 weeks of gestational age (GA) and liver up or observed/expected lung-to-head ratio <25%, normal echocardiogram and karyotype were included. FETO was performed between 28-30 weeks of gestation and removed after 4-6 weeks or at birth during an ex utero intrapartum treatment (EXIT) procedure. FETO represents a viable option for severe type of CDH fetuses with reasonable outcomes. FETO performance in low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies. 5. 14 pregnant women were referred for assessment and only 7 met the inclusion criteria. Two were excluded initially (late referral and spouse refusal) and a 3rd excluded later due to failure of FETO due to faulty balloons. The median age of the mothers was 28 years and the gestational age was 29 weeks. Median observed/expected lung-to-head ratio was 23%. Among patients who had successful FETO, one had the balloon removed fetoscopically 4 weeks after insertion and one was removed 8 weeks after insertion during an elective EXIT procedure and both have survived. The other two had premature labor after 1 and 5 weeks after FETO and balloon removed during an emergency EXIT procedures, and both died within 24 hours of birth. FETO represents a viable option for severe type of CDH fetuses with reasonable outcome. FETO performance in a low volume centers may be feasible with reasonable outcomes. Good outcome of postnatal care with no potential antenatal complications may affect FETO adoption in some societies. Retrospective nature of the study may imply inaccuracy, but we believe data from electronic medical records is highly accurate.

Risk Factors for Major Pregnancy Complications in Female Cardiothoracic Surgeons.

To describe the incidence of and risk factors for pregnancy complications in female cardiothoracic surgeons compared with women of similar sociodemographic profiles. Female cardiothoracic surgeons often postpone childbearing, but little is known about their pregnancy outcomes. In 2023, a self-administered survey was distributed to US cardiothoracic surgeons/trainees. Surgeons with ≥1 live birth were queried on maternal work hours during pregnancy and major antenatal pregnancy complications. Male surgeons answered on behalf of non-surgeon childbearing partners (female non-surgeons). The study included 255 surgeons (63.53% male; 36.47% female). Compared with female surgeons, male surgeons more often had partners who were not employed outside the home (25.64% vs 13.33%, P <0.001). Female surgeons were older than female non-surgeons at first live birth (34.49±4.41 vs 31.45±4.16, P <0.001), more often worked >60h/wk during pregnancy (70.33% vs 14.08%, P <0.001), and more often had pregnancy complications (45.16% vs 27.16%, P =0.003; operating room (OR): 1.78, 95% CI: 1.01-3.13). Among female surgeons, 18.28% reduced work hours during pregnancy. During their third trimester, 54.84% worked >6 overnight calls/mo, and 72.04% operated >12h/wk. Age ≥35 years (OR: 3.28, 95% CI: 1.27-8.45) and operating >12h/wk during the third trimester (OR: 3.72, 95% CI: 1.04-13.30) were associated with pregnancy complications. Female cardiothoracic surgeons are more likely to experience major pregnancy complications than non-surgeon partners of their male peers. Long operative hours during pregnancy and older maternal age are significant risk factors for pregnancy complications. To advance gender equity, policies to protect maternal-fetal health and facilitate childbearing during training and early career are needed.

Obstetric outcome following bariatric surgery in kingdom of Bahrain

Obesity has complications in relation to health as well as pregnancy. Bariatric surgeries gain interest among obese women to reduce the adverse obstetric outcomes. However, pregnancy post bariatric surgeries have benefits as well as risks. The study analyzed the effects of bariatric surgery on pregnancy, delivery, and postpartum period.This is a retrospective study conducted in Bahrain Defense Force Hospital from September 2019 till August 2020. The study included women in the reproductive age who had bariatric surgery before planning pregnancy and a control group of women who did not undergo the bariatric surgeries. Comparison of obstetric outcome was done between both groups. Data included demographic characteristics, method conceived, antenatal pathway, delivery process and postpartum period. Results were presented as odds-ratios (OR) with 95% confidence interval (CI) and P-values. P values of less than 0.05 were considered statistically significant.This analysis includes 2972 patients. 47 patients of them had undergone previous bariatric procedure. Patients with previous bariatric surgery were older 32.8vs 29.9 and interestingly heavier with BMI 34.5 vs 31.1. Patients with previous bariatric surgery had more antenatal complications 36% vs 18.5% (p=0.002). The most evident complication is gestational diabetes with 21.3% of patients who had bariatric surgery developed Gestational Diabetes Mellitus(GDM) during pregnancy compared to 8.9% of patients without the surgery (P=0.004). Both groups had similar start of labor, 1 stage of labor, 2 stage of labor, 3 stage of labor and prolonged 2 stage of labor. Caesarean section rate was similar at 42.6% vs 35.4% (p=0.31). After adjusting confounding factors, previous bariatric surgery increased length of stay in hospital more than 3 days with OR 2.3 95%CI (1.2-4.4) P=0.01.Our study concluded the antenatal complications, Gestational diabetes as well as postpartum length of stay are significantly increased in post bariatric pregnant women. However, labor process and fetal outcome did not show significant difference.

Predictors and a scoring model for maternal near-miss and maternal death in Southern Thailand: a case-control study.

To identify predictors and develop a scoring model to predict maternal near-miss (MNM) and maternal mortality. A case-control study of 1,420 women delivered between 2014 and 2020 was conducted. Cases were women with MNM or maternal death, controls were women who had uneventful deliveries directly after women in the cases group. Antenatal characteristics and complications were reviewed. Multivariate logistic regression and Akaike information criterion were used to identify predictors and develop a risk score for MNM and maternal mortality. Predictors for MNM and maternal mortality (aOR and score for predictive model) were advanced age (aOR 1.73, 95% CI 1.25-2.39, 1), obesity (aOR 2.03, 95% CI 1.22-3.39, 1), parity ≥ 3 (aOR 1.75, 95% CI 1.27-2.41, 1), history of uterine curettage (aOR 5.13, 95% CI 2.47-10.66, 3), history of postpartum hemorrhage (PPH) (aOR 13.55, 95% CI 1.40-130.99, 5), anemia (aOR 5.53, 95% CI 3.65-8.38, 3), pregestational diabetes (aOR 5.29, 95% CI 1.27-21.99, 3), heart disease (aOR 13.40, 95%CI 4.42-40.61, 5), multiple pregnancy (aOR 5.57, 95% CI 2.00-15.50, 3), placenta previa and/or placenta-accreta spectrum (aOR 48.19, 95% CI 22.75-102.09, 8), gestational hypertension/preeclampsia without severe features (aOR 5.95, 95% CI 2.64-13.45, 4), and with severe features (aOR 16.64, 95% CI 9.17-30.19, 6), preterm delivery <37weeks (aOR 1.65, 95%CI 1.06-2.58, 1) and < 34weeks (aOR 2.71, 95% CI 1.59-4.62, 2). A cut-off score of ≥4 gave the highest chance of correctly classified women into high risk group with 74.4% sensitivity and 90.4% specificity. We identified predictors and proposed a scoring model to predict MNM and maternal mortality with acceptable predictive performance.

Prevalence and feto-maternal outcomes of subclinical hypothyroidism in pregnancy among mothers attending a tertiary care hospital of Darjeeling District, West Bengal, India

Background: Pregnancy is a stressful test for the mother’s thyroid function. The frequency of hypothyroidism in pregnant women is high. However, there are no adequate studies to evaluate the adverse effects of subclinical hypothyroidism (SCH) during pregnancy. Aims and Objectives: This study was carried out to evaluate the prevalence of SCH in pregnancy and its adverse feto-maternal outcomes among mothers attending a tertiary care teaching hospital in Darjeeling district, West Bengal, India. Materials and Methods: The present study was an institution-based observational descriptive study with a prospective longitudinal design conducted for 1 year among pregnant women attending the antenatal clinic of the study institution in the first trimester of their pregnancy. The sample size for the present study was calculated to be 200. A consecutive sampling technique was utilized. The enrolled women were evaluated for thyroid status by assessing serum thyroid stimulating hormone and free T4 level. All the enrolled mothers were kept under close follow-up and they were evaluated for the development of any antenatal, intranatal, and postnatal complications. Results: The mean age was found to be 23.1±4.2 years, most of the women were nulliparous (60%). Of the women, 74% were euthyroid, while the prevalence of SCH was found to be 16%. On follow-up till the termination of their pregnancies, mothers suffering from SCH had statistically significantly higher incidence of maternal complications such as hypertensive disorders in pregnancy (P=0.001), abortion (P&lt;0.001), postpartum hemorrhage (P=0.020) and also fetal adverse outcomes, such as intrauterine growth restriction (P=0.018), fetal premature birth (P=0.035), and low birth weight (P=0.004) when compared with euthyroid mothers. Conclusion: The burden of SCH high in the study population, and it was significantly associated with a number of different maternal as well as fetal complications and adverse outcomes.

The Impact of Maternal Weight With Fetal Outcome; A Cohort Study In An Underdeveloped Region Of Pakistan

Objective: This study has been conducted to observe the association of maternal weight with fetal outcomes among women in an underdeveloped region of interior Sindh. Methods: This was an observational study conducted at CMH Hospital Choor, from 1st November 2021 to 30th April 2022, on 84 pregnant women. All antenatal women as early as 16 weeks presented for antenatal visits, were included. Their BMI (body mass index) was calculated. Their increase in weight during pregnancy was noted. Any pre-existing medical complications (hypertension) antenatal or intrapartum complications (including Anemia, Preterm labour, IUGR, and fetal distress) were noted in the mother. The fetal APGAR score was calculated. The passage of meconium and, the need for NICU admission were noted. Results: There is a positive but insignificant and weak correlation between maternal and birth weight using Pearson correlation analysis. The correlation between the above two variables is 0.069 which is positive but weak. It was found that there was a significant association between low maternal weight and NICU admission of the baby at delivery, p-value &lt; 0.05. There were 33 cases (39%) with low maternal weight of 35-46kg and 51 (61%) cases with normal weight of 47-58 kg. There was only one case of meconium aspiration. Conclusion: Women who had low BMI during the antenatal period were observed to be associated with increased morbidity and poor perinatal outcome of the fetus in terms of poor APGAR score, meconium staining and need for NICU admission. Keywords: BMI, IUGR, preterm labour, meconium staining, APGAR score

Long working hours and obstetric complications: A cross-sectional study among female doctors

ObjectiveTo investigate the effects of long working hours on pregnancy complications and obstetric outcomes among female doctors working in tertiary care hospitals of Karachi. Study designA cross-sectional study was conducted on 149 female MBBS graduates (mean age: 33.5 ± 7.3 years) who had conceived at least once, currently working in two tertiary-care hospitals of Karachi. Data was collected through a self-administered questionnaire containing questions regarding demography and course of 1st pregnancy of the participants including working hours, antenatal and natal complications. Means and standard deviations were calculated for continuous variables with frequencies and percentages for categorical variables. The association between long working hours and different antenatal and natal complications was investigated using Chi-square test and T-test. ResultsOut of 149 participants included in final analysis, 85.9 % doctors gave birth to alive babies while 12.8 % had miscarriages and 1.3 % had stillbirth. Mean working hours during the three trimesters were found to be 53.76, 53.66 and 48.7, respectively. 43 % doctors experienced at least one antenatal complication during their pregnancy. Women who worked more than or equal to 55 h per week during 1st, 2nd and 3rd trimester of their pregnancy experienced more antenatal complications than women who worked less than 55 h (p-value=0.042, 0.021 and 0.018 respectively). 61.7 % females experienced at least one natal complication, most common of which was induction of Labour (39.1 %). Natal complications were significantly associated with increased workload during 2nd trimester (mean 58 vs 46 h, p-value 0.040). Doctors belonging to surgical specialty had 2.7 times higher risk of developing at least one natal complication than doctors of medical specialty (95 % Cl: 1.235–5.870). ConclusionLong working hours during pregnancy are associated with antenatal complications among female doctors. Natal complications were only significantly related to long working hours during 2nd trimester of pregnancy, however, female surgeons are more prone to develop natal complications than doctors belonging to medical specialties.

Knowledge and attitudes of midwives towards collaboration with traditional birth attendants for maternal and neonatal healthcare services in rural communities in South Africa

ObjectivesWe assessed the knowledge and attitude of registered midwives towards collaborating with traditional birth attendants for maternal and neonatal healthcare services in rural communities. DesignA descriptive cross-sectional survey was followed in this study. ParticipantsRegistered midwives in selected clinics in the City of Tshwane Municipality. Participants were recruited by stratified random sampling. Data was collected at the Thirty-four primary healthcare facilities in Gauteng province, South Africa. Measurement and resultsA self-assessment questionnaire was administered to 304 registered midwives. Two-hundred and sixty respondents returned the questionnaire representing a response rate of 86.6 % which was statistically significant. The majority of Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants). Only 30.8 % (n = 80) of midwives knew of the roles of traditional birth attendants for maternal and neonatal healthcare (MNH) services. With respect to knowledge, there was significant associated with the Professional category (p < 0.015). In terms of attitude, registered midwives displayed negative attitudes towards collaborating with traditional birth attendants (mean = 46.8, SD=2.1). Approximately half (54.2 %, n = 140) of midwives were amenable towards collaborating in the provision of antenatal care, and 70.4 % (n = 183) of midwives agreed to collaborate with traditional birth attendants for extended roles such as accompanying women to health facilities. Association of demographic data and level of attitude showed there was significant relationship (p < 0.05) between registered midwives’ level of education and their attitude towards collaboration. Key conclusionsMidwives demonstrated positive attitude towards collaborating with traditional birth attendants at the antenatal care level only. Midwives were not amenable to collaboration at the level of intrapartum and postpartum care. Implications for practiceBased on our results, collaboration should be at antenatal care level to allow for early detection, treatment, and prevention of antenatal complications thus reducing maternal mortality and morbidity.

Pregnancy outcomes post-kidney transplantation across 23 years.

Pregnancy in kidney transplant recipients has become increasingly common. However, pregnancy carries higher risks to these patients compared to the general population. To describe pregnancy outcomes in kidney transplant recipients. We conducted a single-centre retrospective cohort study of kidney transplant recipients who delivered after 20 weeks gestation at a quaternary hospital in Victoria, Australia, between 2000 and 2022 inclusive. The study included 37 pregnancies from 27 patients, accounting for 38 infants. Over half of recorded pregnancies occurred in the past five years (56.8%, n = 21). There were high rates of pre-existing hypertension (75.7%, n = 28). Pregnancy-induced hypertension and pre-eclampsia were common antenatal complications (21.6%, n = 8 and 48.6%, n = 18 respectively). Soluble fms-like tyrosine kinase-1 / placental growth factor ratios were elevated in all patients who developed severe pre-eclampsia (16.2%, n = 6). The median gestational age at birth was 36.4 weeks (range 20-40.4, Q1 32.9, Q3 37.6) and 59.5% (n = 22) of births were preterm. Unplanned caesarean without labour was the most common mode of birth (35.1%, n = 13). The overall caesarean rate was 62.1% (n = 23). Post-partum haemorrhage complicated over half of pregnancies (56.8%, n = 21). Fifty percent (n = 19) of infants were admitted for neonatal care, in particular neonatal intensive care, and had low birthweights under 2500 g. While there was a transient deterioration in kidney function, there was no graft rejection within one year of birth. Clinicians should consider the high rates of pre-existing hypertension, preterm birth, and caesarean birth when counselling and managing pregnant kidney transplant recipients.

PREGNANCY OUTCOME IN ADVANCED MATERNAL AGE IN COMPARISON WITH YOUNGER PREGNANT WOMEN – A COMPARATIVE STUDY IN CENTRAL REFERRAL HOSPITAL, GANGTOK, SIKKIM

Objectives: The aim of the study was to compare maternal and neonatal outcome in pregnancy in advanced maternal age (&gt;35 years) in comparison with pregnancy outcome in younger mothers of age 20–34 years. Methods: This was a retrospective and comparative study conducted in the Department of Obstetrics and Gynecology of Central Referral Hospital, Gangtok, Sikkim. Institutional ethical committee approved the study. One thousand three hundred and thirty-five women were included in this study. Data of these mothers were retrieved from the MRD records and reviewed. Pregnancy outcomes were studied in terms of antenatal, intranatal, and postpartum complications. Each adverse obstetrical outcome was assessed if it has made a significant association with maternal age. Perinatal outcome was also compared. Results: The mean maternal age was significantly higher in Group A (38.2±0.66) as compared to Group Y (25.85±4.41) and the difference was found to be statistically highly significant (p&lt;0.0001). LSCS rate was more in advanced maternal age group as compared to patients &lt;35 years and the difference was statistically significant (p=0.0009). Comparison for both the groups for gestational diabetes, gestational hypertension, anemia, preterm labor, prelabor rupture of membranes, and postpartum hemorrhage shows these pathologies to be more common in Group A. In Group A, the common causes of LSCS were patient request (41.39%) followed by FGR with abnormal Doppler (26.01%) whereas in Group Y common indications for LSCS included previous LSCS (36.56%) patient request (27.56%). Group A had a higher incidence of low birth weight (52 vs. 65, p&lt;0.0001), large-for-gestational-age babies (&gt;4 kg) (15 vs. 12, p&lt;0.0001), NICU admission due to low APGAR score (35 vs. 42, p&lt;0.0001), and pre-term births (43 vs. 10, p&lt;0.0001). Conclusion: Advanced maternal age pregnancies are associated with increased incidence of maternal medical disorders, cesarean section, and postpartum haemorrhage as well as adverse perinatal outcome.

Bilateral Renal Cortical Necrosis and Reversible Cerebral Vasoconstriction Syndrome in a Case of Severe Postpartum Haemorrhage

Bilateral Renal Cortical Necrosis (BRCN) is a rare but serious condition characterised by the ischaemic necrosis of both kidneys’ cortical tissues. Concurrently, Reversible Cerebral Vasoconstriction Syndrome (RCVS) manifests as a transient constriction of cerebral blood vessels. The fusion of these two rare entities within the context of severe Postpartum Haemorrhage (PPH) poses a unique diagnostic and therapeutic dilemma for healthcare practitioners. This case study documents the intricate and severe complications experienced by a 32-year-old primiparous woman following abruptio placenta with Intrauterine Foetal Death (IUFD). The patient presented with massive vaginal bleeding, leading to an emergency Lower Segment Caesarean Section (LSCS) where bilateral uterine artery ligation and bilateral internal iliac artery ligation were performed to control haemorrhage. Despite initial interventions, the patient’s condition deteriorated, leading to signs of shock, haemoperitoneum, sepsis, Acute Kidney Injury (AKI), and cerebral complications. The medical journey unfolded with an urgent re-laparotomy, draining haemoperitoneum and conducting a subtotal hysterectomy. This case highlights the critical importance of a multidisciplinary approach involving obstetrics, nephrology, and intensive care, in managing such complex postpartum complications. Vigilant monitoring, collaborative decision-making, and meticulous postoperative care played pivotal roles. The successful outcome was attributed to early recognition, aggressive supportive measures, and timely interventions, including haemodialysis. The challenges faced underscore the need for accessible obstetric care, awareness about antenatal complications, and community-focused initiatives. Further research is warranted to unravel the intricate connections between PPH, RCVS, and associated complications, enhancing our understanding and improving patient outcomes in similar critical cases.

Genetic Diagnosis in Neonatal Encephalopathy With Hypoxic Brain Damage Using Targeted Gene Panel Sequencing.

Neonatal encephalopathy (NE) is a neurological syndrome that presents with severe neurological impairments and complications. Hypoxic-ischemic encephalopathy is a major contributor to poor outcomes, being responsible for 50%-80% of admissions to neonatal intensive care units. However, some cases of NE accompanied by hypoxic brain damage cannot be solely attributed to hypoxia-ischemia. We aimed to identify diverse pathogenic genetic variations that may be associated with cases of NE accompanied by hypoxic brain damage rather than hypoxia-ischemia. We collected data from 34 patients diagnosed with NE accompanied by hypoxic brain damage over a 10-year period. Patients with the following specific conditions were excluded: 1) premature birth (<32 weeks), 2) no history of hypoxic events, 3) related anomalies, 4) neonatal infections, 5) antenatal or perinatal obstetrical complications, 6) severe hypoxia due to other medical conditions, and 7) early death (within 1 week). A comprehensive review of clinical and radiological features was conducted. A genetic diagnosis was made in 11 (32.4%) patients, with pathogenic variants being identified in the following 9 genes: CACNA1A (n=2), KCNQ2 (n=2), SCN2A (n=1), SCN8A (n=1), STXBP1 (n=1), NSD1 (n=1), PURA (n=1), ZBTB20 (n=1), and ENG (n=1). No specific treatment outcomes or clinical features other than preterm birth were associated with the results of the genetic analyses. Personalized treatments based on the results of genetic tests were attempted, such as the administration of sodium-channel blockers in patients with KCNQ2 or SCN8A variants and the implementation of a ketogenic diet in patients with STXBP1 or SCN2A mutations, which demonstrated some degree of effectiveness in these patients. Genetic analyses may help in diagnosing the underlying etiology of NE and concurrent hypoxic brain damage, irrespective of the initial clinical features.

First Trimester Maternal Body Mass Index and Ges-tational Weight Gain and Their Association with Feto-Maternal Outcomes

Introduction: Women of reproductive age have also been impacted by the significant rise in the prevalence of obesity. A significant predictor of poor outcomes for the health of the mother and the newborn is excessive gestational weight increase. The study was conducted with an objective to study first trimester maternal Body Mass Index and gestational weight gain and their association with maternal and perinatal outcomes.&#x0D; Methodology: This was a prospective observational clinical study conducted in 196 primigravida patients presenting in a tertiary care hospital in central India. BMI of women were recorded during the first trimester and followed up to assesses gestational weight gain. Early pregnancy BMI and gestational weight gain were compared with various feto maternal outcome.&#x0D; Results: The mean of First trimester BMI was 21.3 kg/m2. In Overweight category, 65.2% had high weight gain (WG) while in obese, 26.1% had High WG. Type of delivery and NICU admission rate significantly differ in BMI categories (p &lt;0.05). LSCS rate were higher in overweight and obese category. Preterm babies and post-partum hemorrhage were higher in higher WG categories; however, the difference was non-significant (p&gt;0.05).&#x0D; Conclusion: This study conclude that First trimester underweights and overweight/obesity is associated with higher antenatal, intra-natal and postnatal complications as well as neonatal complications. Caesarian rate and instrumental deliver are also common in First trimester overweight and obese women. Preeclampsia is associated with extreme of First trimester BMI.

Major Sickle Cell Disease in Pregnant Women at University Teaching Hospital of Cocody in Cote d'Ivoire, a Low Resources Country

Background: Sickle cell disease (SCD) is one of the most prevalent genetic disorders, including major SCD and SC Trait (SCT) genotypes. Many studies have shown a negative association between major SCD and pregnancy. However, they are underestimated in Cote d’Ivoire statistics. To provide consistent data on SCD in pregnancy, we compare outcomes between women with normal hemoglobin (Hb) genotype and major SCD. Methods: A retrospective, and case-control study in the University Hospital of Cocody, from 2015 to 2018, analyzed maternal and fetal outcomes, comparing the Cases Group: major SCD (HbSS, HbSC) and Control Group: normal hemoglobin (Hb) genotype A. Only pregnancies with gestations longer than 28 weeks were included. No cases of thalassemia or variant of hemoglobin were found. Local protocols recommended systematic use of vasodilators or analgesics, folic acid, and high concentrations of inhaled oxygen during labor, associated with fluid and/or blood transfusion. We excluded sickle cell trait (SCT) genotype AS (HbAS), and incomplete data. A logistic regression was exploited to gauge the risk factors. We used SPSS version 19 (IBM Corp., Armonk, NY, USA) for statistical analysis, and calculate the adjusted odds ratio and 95% confidence interval. Results: We registered 156 major SCD (0.92%), compared to 312 HbAA. In Cases Group 27.6% were multigravidas (&gt;4), young aged (≤20) (16.0%), and well-educated (43.6%). Major SCD were HbSC (33.3%) and HbSS (66.7%). The commonest maternal antenatal complication in major SCD was anemia (p &lt; 0.0001), vaso occlusive crisis (p &lt; 0.0001), and pregnancy-induced hypertension (p &lt; 0.0001). Blood transfusions were significant in the SCD group (p &lt; 0.0001). No significant difference between the groups regarding stillbirths (p = 0.3150) was recorded. Moreover, a significant risk in the major SCD genotype was low birth weight (LBW) (p &lt; 0.0001), negative Apgar in the 5th minute (p &lt; 0.0001), vaso-occlusive crisis (VOC) (p &lt; 0.0001), and acute chest syndrome (ACS) (p &lt; 0.0019). Conclusions: The findings of the survey suggest better fetal and maternal prognosis in HbAA compared to major SCD. Multidisciplinary team management is necessary to improve those outcomes. Patient awareness and education, and early and effective prenatal care are useful to avoid those risks.

A Real World, Single-Centre Study of Young Adult Patients with Philadelphia Negative Myeloproliferative Neoplasms

Classical ‘Philadelphia negative’ myeloproliferative neoplasms (MPNs) are clonal haematopoietic disorders and include essential thrombocythaemia (ET), polycythaemia vera (PV) and myelofibrosis (MF). MPNs have a heterogenous phenotype with an inherent risk of thromboembolic and haemorrhagic complications, and risk of blastic transformation. MPNs are commonly diagnosed in the 6 th decade or later, although up to 20% of patients are diagnosed &amp;lt; 40 years. Current risk stratification and treatment guidance, however, is frequently extrapolated from older cohorts. Here, we present a comprehensive retrospective analysis of 107 MPN adolescent and young adult (AYA) patients diagnosed &amp;lt;40 years, representing 19.6% of the total outpatient MPN cohort at University College London Hospital. Median follow up was 78 months (range (r), 1 - 507). Table 1 displays clinicopathological details of the entire cohort. Median age at diagnosis was 32 years (r,13-40). There was a female preponderance (66%); 57.9% of patients were Caucasian. Most patients had a diagnosis of ET (57.9%), with 24.3% PV and 9.3% MF, respectively. The most common driver mutation was JAK2 V617F, observed in 60.7%, followed by CALR (15.9%) and MPL (1.9%); 17% of patients were classified as triple negative (TN). Where data was available (n=27), median variant allelic frequency (VAF) for JAK2 V617F was 19.7% (r, 4-75%) and for CALR 43% (r, 5.7 - 53). 9/107 (8.4%) of patients had additional pathogenic gene abnormalities, most commonly variants of NRAS (22.2%), TET2 (22.2%) and ASXL1 (22.2%). We observed a high thrombosis rate of 19.6% (21/107); the majority had a diagnosis of ET (61.9%).. In 80% of such cases, this was the heralding event leading to the MPN diagnosis. Venous thrombosis was more frequent than arterial thrombosis (68% vs 33%). In particular, there was a disproportionate number of venous thromboses at unusual sites including cerebral venous sinus and splanchnic venous thromboses, representing 40% and 33% of total events, respectively. Only 3 (2.8%) patients were found to have a co-existent thrombophilia. Younger age at diagnosis appeared to associate with a higher rate of thrombosis (60% in patients aged &amp;lt;20, 18.2% in patients aged 20-30, and 17.2% in patients aged 31-40). Thrombotic events were most common in those with a JAK2V617 mutation (23.4%), followed by those who were TN (20.0%). Only 5.9% of CALR mutated cases had a thrombotic event. In terms of cardiovascular risk factors, 13.0% (14/107) and 6.5% (7/107) of patients had diagnoses of hypertension and type 2 diabetes, respectively. Haemorrhagic events were reported in 8.4% (9/107) of patients; 3.7% (4/107) had grade 3 or 4 bleeding complications, requiring transfusion and/or surgical intervention. All who experienced haemorrhagic events were on treatment with an anti-platelet or anti-coagulant agent. 4.7% (5/107) were diagnosed with acquired von Willebrand's disease, of whom one experienced a grade 3 haemorrhagic event. No patients transformed during follow up. 33 patients reported pregnancies, with 7/33 (21%) reporting antenatal or perinatal medical complications. Over 50% (55/107) of patients were commenced on cytoreduction. Most common agents employed were pegylated interferon (45.5%; 25/55) and hydroxycarbamide (43.6%%; 24/55). No patients required combination therapy. 92/107 (86%) patients were treated with an antiplatelet agent and 9/107 (8.4%) were on anti-coagulant treatment with the majority (88.8%) receiving warfarin rather than a DOAC. AYA MPN patients have unique characteristics and heterogeneous clinico-biological features differentiating them from older MPN cohorts. Our data highlights a female preponderance, higher incidence of venous thrombosis (particularly atypical sites), and lower incidence of arterial thrombosis. Whilst traditionally younger patients are considered to have ‘low risk’ disease, this real-world study highlights a significant thrombosis rate of ~ 20% which may have associated morbidity considering the relatively longer duration of the disease course and need for cytoreductive therapy. Specific AYA MPN directed risk stratification and therapeutic algorithms are required to inform holistic and age-appropriate patient management.