Introduction: Premature rupture of membranes (PROM) is defined as the rupture of the amniotic sac before the onset of labor, potentially increasing the risk of infection, hypoxia, and a low APGAR score in newborns. The APGAR score assesses neonatal health immediately after birth and can be influenced by maternal and delivery factors, including PROM duration. Methods: This analytical observational study used a cross-sectional design involving 119 term pregnant women with PROM, selected through purposive sampling from medical records at Dr. H. Abdul Moeloek Regional General Hospital, Lampung Province, in 2024. The independent variable was PROM duration (<12 hours or >12 hours), and the dependent variable was the neonatal APGAR score (>7 or <7). Data analysis employed the Chi-square test with a 95% confidence level. Results: Most respondents (83.2%) experienced PROM lasting <12 hours, and 79% of newborns had APGAR scores >7. Chi-square analysis revealed no statistically significant association between PROM duration and APGAR score (p = 0.092; OR = 0.93). Although a higher proportion of low APGAR scores occurred in the >12-hour PROM group, the relationship was insignificant. Conclusion: The study indicates no significant correlation between PROM duration in term pregnancies and neonatal APGAR scores. Prompt medical interventions may mitigate potential risks, reducing the impact of PROM duration on immediate neonatal outcomes. These findings highlight the importance of timely obstetric management and suggest further research with larger sample sizes to explore other contributing factors.

This study aimed to evaluate the predictive value of inflammatory biomarkers fibrinogen/albumin ratio (FAR), platelet/albumin ratio (PAR), and AST/platelet ratio (APRI) in identifying poor neonatal outcomes among pregnancies complicated byIHCP. This retrospective comparative study included 165 pregnant women diagnosed with IHCP and 155 healthy pregnant women matched for age and gestational age, who delivered at a tertiary care hospital between January 2023 and January 2025. Demographic, clinical, laboratory, and perinatal characteristics were reviewed. FAR, PAR, and APRIwere calculated from standard laboratory data. A composite poor neonatal outcome was defined as the presence of at least one of the following: Apgar score <7 at 5 min, respiratory distress syndrome (RDS), meconium aspiration, neonatal sepsis, or admission to the neonatal intensive care unit (NICU). Diagnostic performance was assessed using receiver operating characteristic (ROC) curves and multivariate logistic regression. FAR and APRI values were significantly higher in the IHCP group compared to controls (p<0.05). Among neonates with adverse outcomes, only FAR levels were significantly elevated (p=0.015). However, its discriminative ability was limited (AUC=0.607; sensitivity: 58 %, specificity: 63 %) and it was not an independent predictor in multivariate analysis. FAR and APRI levels are elevated in pregnancies with IHCP, yet FAR alone demonstrates limited predictive value for adverse neonatal outcomes. It may serve as a supportive, rather than standalone, marker. Further large-scale prospective studies are warranted.

Abstract Background Zhang’s guideline and the 1994 WHO partograph are both used to monitor labor progress. Zhang’s guideline defines labor’s active phase as cervical dilation of 6 cm (vs. 4 cm in the 1994 WHO partograph) and emphasizes individualized care with extended labor observation. Conversely, the 1994 WHO partograph uses a standardized “action line” for earlier intervention. This study compared Zhang’s guideline and the1994 WHO partograph in managing hypertensive disorder of pregnancy (HDP), specifically evaluating labor interventions, maternal age disparities, and postpartum outcomes. Methods This retrospective cohort study analyzed clinical data from 5806 nulliparous women with singleton full-term pregnancies who were diagnosed with HDP between 2010 and 2023. Participants were stratified into the 1994 WHO partograph (January 2010–August 2014, N = 2100) and Zhang’s guideline cohorts (September 2014–December 2023, N = 3706). The primary endpoints were the intrapartum cesarean and postpartum hemorrhage (PPH) rates. Secondary endpoints included the rates of labor intervention (oxytocin augmentation, artificial membrane rupture, and lateral episiotomy), forceps-assisted delivery, and neonatal asphyxia (5-min Apgar score &lt; 7). Results Zhang’s guideline significantly reduced the intrapartum cesarean (10.96% vs.13.33%, P &lt; 0.0001) and labor intervention rates (16.06% vs.43.62%, P &lt; 0.0001) but increased the rates of PPH (20.02% vs.11.24%, P &lt; 0.0001) and forceps-assisted delivery (19.67% vs.7.90%, P &lt; 0.0001). Zhang’s guideline group included a higher of advanced maternal age (AMA, ≥ 35 years) pregnancies (20.72% vs.9.24%, P &lt; 0.0001) and assisted reproductive technology (ART) usage (6.99% vs.0.90%, P &lt; 0.0001). The frequency of neonatal asphyxia did not differ between the groups. Multivariate analysis illustrated that the use of Zhang’s guideline (odds ratio [OR] = 2.101, P &lt; 0.0001), prolonged labor (OR = 1.607, P = 0.0052), and intrapartum cesarean section (OR = 6.024, P &lt; 0.0001) were independent risk factors for PPH. Conclusions Compared with the 1994 WHO partograph, Zhang’s guideline for managing HDP effectively reduced intrapartum cesarean sections and labor interventions. Zhang’s guideline also proved more adaptable to pregnancies involving AMA and ART without increasing the risk of neonatal asphyxia. However, its implementation was associated with higher rates of PPH and forceps delivery. Notably, the protocol itself emerged as an independent risk factor for PPH.

The survival rates of neonates are significantly influenced by gestational age, with further differences observed internationally. Survival rates for live births at 22 and 23 weeks of gestation range from 3.7% to 56.7% and from 20.0% to 79.3%, respectively. Despite advancements in neonatal care, the mortality rate in these preterm infants remains high, and the factors influencing mortality remain unclear. In this study, we conducted a comparative analysis of the risk of death within 72h of birth in neonates born at 22 and 23 weeks' gestation. This single-center, retrospective study analyzed 185 patients admitted to the neonatal intensive care unit between January 2006 and December 2023. Maternal information, placental pathology, out-of-hospital births, and neonatal information were compared between patients who did and did not succumb to mortality within 72h. A logistic regression model was created with death within 72h as the outcome variable, and fetal bradycardia, 5-min Apgar score, Umbilical arterial pH (UA pH), and tension pneumothorax as explanatory variables. Parameter estimation was performed using the likelihood method. In the death within 72h after birth group, differences were observed in the mode of delivery determined by fetal bradycardia (4/15 cases, 26.7%), 1-min Apgar score (1, 95% confidence interval [CI]: 1-3 points), 5-min Apgar score (5, 95% CI: 2-6 points), UA pH (7.24, 95% CI: 7.11-7.32), and tension pneumothorax (7/15 cases, 46.7%). In the logistic regression model estimating risk factors of death within 72h, the expected values of the regression coefficients and 95% CI were as follows: fetal bradycardia (7.89, 95% CI: 1.31-48.40), 5-min Apgar score (1.43, 95% CI: 1.04-2.03), UA pH (6.10, 95% CI: 0.09-300.93), and tension pneumothorax (8.79, 95% CI: 2.35-35.46). Death within 72h of birth in neonates born at 22-23 weeks gestation is associated with fetal bradycardia, low 5-min Apgar scores, and tension pneumothorax. Optimizing prenatal care, timely resuscitation, and neonatal management strategies may improve survival outcomes.

The association between benzodiazepine receptor agonist (BZRA) exposure and adverse perinatal outcomes remains inconclusive. This study aimed to assess the risks of adverse pregnancy and neonatal outcomes associated with maternal BZRA exposure across pregnancy trimesters. Data from 170,144 maternal BZRA users and 1,098,172 nonusers were obtained from the Taiwan's National Health Insurance database. We used cross-sectional study design with inverse probability of treatment weighting (IPTW) to evaluate the association between maternal BZRA exposure during each trimester and adverse pregnancy outcomes. The pregnancy period was classified into 4 intervals: preconception, first trimester, second trimester, and third trimester. Logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Maternal BZRA exposure was associated with an increased risk of stillbirth (IPTW-OR 1.19, 95% CI 1.14-1.25), preterm birth (IPTW-OR:1.11, 95% CI 1.09-1.13), low birth weight (IPTW-OR:1.05, 95% CI 1.03-1.07), Apgar score < 7 (IPTW-OR:1.17, 95% CI 1.12-1.22), and cesarean delivery (IPTW-OR:1.15, 95% CI 1.14-1.17) compared with nonusers. By timing, preconception exposure was modestly associated with preterm birth and cesarean delivery, and first-trimester exposure showed similar associations. The associations were most pronounced in the second trimester, with significantly elevated risks of stillbirth (2.29, 95% CI 2.11-2.48), preterm birth (1.38, 95% CI 1.33-1.43), Apgar score < 7 (2.05, 95% CI 1.92-2.20), low birth weight (1.35, 95% CI 1.29-1.40), small for gestational age (1.07, 95% CI 1.03-1.11), cesarean Sect.(1.21, 95% CI 1.18-1.24), and overall congenital malformations (1.27, 95% CI 1.13-1.43). This study observed a small but statistical association between BZRA exposure and several adverse pregnancy outcomes, which extended from the pre-pregnancy period through all trimesters. Clinicians should carefully weigh the risks and benefits when treating women who are pregnant or planning pregnancy.

Placental abnormalities are a significant determinant in fetal development and the main cause of maternal and perinatal death. However, regular postpartum placenta inspection is not widespread, and the placenta continues to be a poorly studied and comprehended human organ. The present study aims toward the morphometric evaluation of the placental indices and its association with neonatal indices. A total of 83 study participants were selected from among the pregnant women. Placental indices, including placenta appearance, placenta shape, number of cotyledons, placenta thickness, placenta weight, and placenta volume, were analyzed. Neonatal indices, including birth weight, APGAR score, body length, head circumference, abdominal circumference, gender, and ponderal index, were analyzed. Association of placental indices with neonatal indices was carried out. Normal placenta, presence of a high number of cotyledons, higher placenta thickness, higher placenta weight, and higher placenta volume were significantly associated with APGAR score >7. There was no significant difference in the placenta shape in terms of APGAR score. Low birth weight was significantly associated with calcified placenta appearance and retroplacental clot, lower number of cotyledons, lower placental weight, and lower placenta volume. There was no significant difference in the placenta shape in terms of birth weight. The present study provides important insights about the morphometric evaluation of the placental indices and its association with neonatal indices. A more comprehensive study on placental and umbilical cord parameters is necessary to expand the current knowledge.

BabySaver and NeoBeat devices have the potential to enable bedside neonatal resuscitation, with an intact cord in the presence of the mother. We assessed the feasibility and acceptability of using them together for neonatal resuscitation in a low-resource setting. This was a mixed methods study conducted over a period of 11 months at Mbale Hospital in Uganda. We enrolled 150 mother-infant dyads into a pre-post study. During the pre-implementation phase, neonatal resuscitation was conducted based on the existing standard of care whilst in the post-implementation phase we evaluated the BabySaver and NeoBeat. Our primary outcome was the proportion of babies resuscitated at the bedside with an intact cord. Using in-depth interviews and an inductive thematic analysis approach, we also explored experiences of health workers and mothers with use of the BabySaver and NeoBeat. Bedside resuscitation increased significantly in the post-implementation period (9.3% versus 45.3%, p < 0.001 while early cord clamping decreased (26.7% versus 12.0%, p = 0.042). The median time to successful resuscitation was shorter post-implementation (5 versus 8 minutes, p < 0.001). Infants in the post-implementation phase had higher axillary temperatures at birth and at 0-, 10-, 20-, and 30-minutes post-resuscitation. Neonatal morbidity was lower: APGAR score <7 at 5 minutes (aPR: 0.36; 95%CI: 0.26-0.50), transfer to postnatal ward with mother (aPR: 9.27; 95%CI: 2.23-38.48), transfer to neonatal unit (aPR: 0.66; 95%CI: 0.56-0.78). Health workers found the devices easy to use, and bedside resuscitation reassured mothers, fostering trust and satisfaction. Barriers included misconceptions about delayed cord clamping, hypothermia concerns, cross-infection risks, and difficult use in theatre. The BabySaver and NeoBeat improved bedside neonatal resuscitation and reduced morbidity. Bedside resuscitation was also acceptable to the health workers and mothers. Scaling up should address misconceptions about delayed cord clamping and optimize usability in theatre settings where many asphyxiated infants are delivered.

Background: Intrapartum fetal problems remain an important cause of illness and death around birth, especially in low-resource settings. Admission CTG is commonly used to quickly check fetal well-being, but its ability to predict problems varies. AFI, which reflects placental function and long-term fetal condition, may improve this assessment. Objectives: To assess the reliability of admission CTG alone and CTG+AFI in predicting fetal distress, maternal outcomes, and neonatal outcomes. Methods: This comparative descriptive study was carried out at CSI Kalyani Multispecialty Hospital, Chennai, over two years (October 2012–October 2014). A total of 150 term pregnant women in labour were included and divided into two equal groups: Group I—CTG alone, and Group II—CTG+AFI. CTG tracings were labelled as normal, suspicious, or abnormal. AFI was grouped as oligohydramnios (≤5 cm), borderline (5.1–8 cm), and normal (8.1–20 cm). Outcomes studied were fetal distress, type of delivery, Apgar scores, and need for NICU admission. Results: Normal CTG was seen in most women—88% in Group I and 89.3% in Group II. Oligohydramnios was present in 11% of cases. Abnormal CTG had a strong link with fetal distress (50%), LSCS (100%), and NICU admission (50%). When both CTG and AFI were abnormal, prediction improved further: fetal distress was seen in 75% and NICU admission in 50%. Specificity was high (98%) and NPV was good (91.8%), but sensitivity stayed low (37.5%). Conclusion: Admission CTG is a useful screening tool with high specificity to rule out fetal compromise. Adding AFI improves the ability to predict fetal distress and the need for maternal intervention. However, abnormal CTG or AFI patterns also lead to more operative deliveries without a matching improvement in newborn outcomes. Careful interpretation is needed to avoid unnecessary interventions.

BackgroundBabySaver and NeoBeat devices have the potential to enable bedside neonatal resuscitation, with an intact cord in the presence of the mother. We assessed the feasibility and acceptability of using them together for neonatal resuscitation in a low-resource setting.MethodsThis was a mixed methods study conducted over a period of 11 months at Mbale Hospital in Uganda. We enrolled 150 mother-infant dyads into a pre-post study. During the pre-implementation phase, neonatal resuscitation was conducted based on the existing standard of care whilst in the post-implementation phase we evaluated the BabySaver and NeoBeat. Our primary outcome was the proportion of babies resuscitated at the bedside with an intact cord. Using in-depth interviews and an inductive thematic analysis approach, we also explored experiences of health workers and mothers with use of the BabySaver and NeoBeat.ResultsBedside resuscitation increased significantly in the post-implementation period (9.3% versus 45.3%, p < 0.001 while early cord clamping decreased (26.7% versus 12.0%, p = 0.042). The median time to successful resuscitation was shorter post-implementation (5 versus 8 minutes, p < 0.001). Infants in the post-implementation phase had higher axillary temperatures at birth and at 0-, 10-, 20-, and 30-minutes post-resuscitation. Neonatal morbidity was lower: APGAR score <7 at 5 minutes (aPR: 0.36; 95%CI: 0.26–0.50), transfer to postnatal ward with mother (aPR: 9.27; 95%CI: 2.23–38.48), transfer to neonatal unit (aPR: 0.66; 95%CI: 0.56–0.78). Health workers found the devices easy to use, and bedside resuscitation reassured mothers, fostering trust and satisfaction. Barriers included misconceptions about delayed cord clamping, hypothermia concerns, cross-infection risks, and difficult use in theatre.ConclusionThe BabySaver and NeoBeat improved bedside neonatal resuscitation and reduced morbidity. Bedside resuscitation was also acceptable to the health workers and mothers. Scaling up should address misconceptions about delayed cord clamping and optimize usability in theatre settings where many asphyxiated infants are delivered.

We aimed to evaluate the efficacy and safety of using/not using the antiviral drug tenofovir disoproxil fumarate (TDF) in preventing mother-to-child transmission (MTCT) of hepatitis B virus (HBV) among pregnant women with high serum HBV DNA viral loads. This retrospective study included 512 pregnant women with HBV infection and a high serum HBV DNA load (> 2 × 105 IU/mL) diagnosed and treated at our hospital between January 2018 and April 2023. Based on the treatment received, 314 women were identified as the TDF-treated group, while the remaining 198 comprised the TDF-unexposed group. All newborns received hepatitis B immune globulin and hepatitis B vaccine immediately after birth. Serum HBV DNA, HBsAg, HBeAg, total cholesterol (TC), and alanine aminotransferase (ALT) levels were compared before treatment and prior to delivery. The HBV infection rates of newborns (HBV DNA, HBsAg, HBeAg positivity), maternal adverse events, cesarean section rates, and pregnancy outcomes were also analyzed. Before delivery, serum HBV DNA, HBsAg, HBeAg, and ALT levels decreased in both groups, with significantly greater reductions in the TDF-treated group (P < 0.05). No significant differences were observed in TC levels, adverse drug reactions, cesarean section rates, or adverse pregnancy outcomes (P > 0.05). the HBV DNA, HBsAg, and HBeAg positivity rates of newborns were significantly lower in the TDF-treated group than those in the TDF-unexposed group (P < 0.05). Neonatal body mass index, 1-min Apgar scores, and adverse neonatal outcomes did not differ significantly between groups (P > 0.05). TDF tablets can prevent MTCT of HBV in pregnant women with high HBV DNA loads. The treatment increases the seroconversion rates of HBV DNA, HBeAg, and HBsAg in mothers and infants, and shows a favorable safety profile without severe adverse outcomes.

While fetal hypoxia-ischemia is a known trigger for meconium aspiration syndrome (MAS), many infants develop MAS without it, suggesting other risk factors. We examined the association between MAS and the presence and severity of fetal inflammatory response (FIR) on placental histopathology. A single-center retrospective cohort study of term infants with meconium-stained amniotic fluid (MSAF) born at Parkland Hospital (2010-2018). Maternal and infant demographics and clinical data were recorded. Placental histopathologic evidence of FIR was classified per Amsterdam criteria. MAS was defined as respiratory distress in an infant with MSAF requiring NICU admission and ≥48 hours of respiratory support and/or radiographic findings of MAS. Among 1,696 term neonates with MSAF, 118 (6.9%) developed MAS. Univariate analysis showed that MAS was associated with post-term delivery, non-reassuring fetal heart patterns, cesarean delivery, thick meconium, low Apgar scores, severe acidosis, and presence of FIR (all P < 0.001). On multivariate analysis, FIR remained significant (adjusted OR 2.50, 95% CI 1.41-4.82). Moderate to severe FIR conferred 5-times higher odds for developing MAS (adjusted OR 5.43, 95% CI 2.83-10.40). FIR, particularly its severity, is an independent predictor of MAS, highlighting intrauterine inflammation as a key mechanism alongside hypoxia-ischemia. Fetal Inflammatory Response (FIR) is independently associated with Meconium Aspiration Syndrome (MAS) Increasing severity of FIR confers progressively higher risk of MAS. This is the first study to demonstrate a dose-response relationship between FIR severity on MAS. These observations highlight the role of intrauterine inflammation in MAS pathogenesis and provide new insight into its impact on term neonates.

Background: Prenatal depression is a common but often underdiagnosed condition that may adversely influence both pregnancy outcomes and early infant development. First-time mothers may be particularly vulnerable due to limited experience with pregnancy-related emotional and physical changes. Objective: To examine the association between prenatal depressive symptoms and birth outcomes, as well as early developmental milestones, among first-time mothers. Methods: A cross-sectional analytical study was conducted at an obstetric care facility in Lahore. A total of 100 primigravida women aged 18–40 years were enrolled during late pregnancy or early postpartum. Prenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with a cutoff score of ≥13 indicating significant depressive symptoms. Delivery outcomes—including gestational age, birth weight, Apgar scores, and mode of delivery—were extracted from medical records. Early infant development at 4–12 weeks was assessed using the Ages and Stages Questionnaire–3 (ASQ-3). Statistical analysis included t-tests, chi-square tests, and Pearson correlations, with p&lt;0.05 considered significant. Results: Thirty mothers (30%) screened positive for prenatal depression. Depressed mothers delivered earlier (mean 37.6 ± 1.9 vs. 38.4 ± 1.6 weeks, p=0.031) and had infants with lower birth weight (2719 ± 402 g vs. 2978 ± 368 g, p=0.004). Preterm birth (&lt;37 weeks) was more frequent among depressed mothers (24.0% vs. 9.4%, p=0.048). Infants of depressed mothers had significantly lower ASQ-3 scores across communication, gross motor, fine motor, problem-solving, and personal–social domains (all p&lt;0.05). EPDS scores showed negative correlations with gestational age, birth weight, and all developmental domains. Conclusion: Prenatal depression is associated with adverse birth outcomes and early developmental delays among infants of first-time mothers. Routine screening and early mental health support during antenatal care may improve both maternal and infant well-being.

Background Hemodynamically significant patent ductus arteriosus (hPDA) in premature infants is a common congenital cardiac anomaly associated with substantial morbidity and mortality. Traditional diagnostic methods like echocardiography face challenges such as expertise requirement and inconsistent accessibility. This study investigates the efficacy of the Random Forest machine learning model in predicting hPDA in premature infants, aiming to provide a non-invasive, objective, and reliable alternative. Methods This retrospective study analyzed data from 657 premature infants hospitalized between 2014 and 2019. Patients were categorized into hPDA and asymptomatic PDA (aPDA) groups. The Random Forest classification model, implemented in JASP software, utilized prenatal, natal, and postnatal clinical data, including gestational week, birth weight, and the need for resuscitation at birth. Model performance was assessed using metrics such as accuracy, Area Under the Curve, F1 score, Matthews Correlation Coefficient, recall, precision, and feature importance. Results The Random Forest model demonstrated strong predictive performance, achieving a test accuracy of 91.7%, an AUC of 0.950, an F1 score of 0.923, and an MCC of 0.775. Notably, the recall for the hPDA group was 100%. Gestational week, birth weight, and the need for resuscitation at birth were identified as the most significant predictors. The model also revealed complex relationships, showing variables deemed statistically insignificant by classical methods (e.g., gender, 5th-minute APGAR score, oligohydramnios) to be significant within the Random Forest framework. Conclusions The Random Forest model effectively predicts hPDA risk in premature infants, offering superior predictive power compared to classical statistical analyses. This approach has the potential to enhance early detection, facilitate timely interventions, and support personalized treatment strategies, thereby improving patient outcomes. Further validation through large-scale, multi-center prospective studies is essential for its integration into clinical practice.

Spinal schwannomas are rare during pregnancy and pose unique diagnostic and therapeutic challenges, as their symptoms may mimic common gestational complaints. We report the case of a 28-year-old woman, gravida 3 para 2, who presented at 33 weeks + 1 day of gestation with progressive left lower limb weakness. Magnetic resonance imaging (MRI) performed at 33+5 weeks revealed an extradural tumor at the D9 vertebral level, causing significant spinal cord compression. A multidisciplinary team—including obstetrics, neurosurgery, anesthesiology, and neonatology—developed a sequential management strategy. At 34 weeks gestation, the patient experienced spontaneous preterm premature rupture of membranes. Labor was induced using a Foley catheter, and she delivered a healthy female infant weighing 2.15 kg, with Apgar scores of 7 and 8 at one and five minutes, respectively. At 34+4 weeks, she underwent D9 laminectomy and complete tumor excision under general anesthesia. Histopathological examination confirmed a benign schwannoma. Postoperatively, her neurological deficits improved markedly, and by day 11 she had regained near-normal strength in her lower limbs. This case underscores the importance of early recognition of neurological deficits during pregnancy, the utility of MRI for timely diagnosis, and the critical role of multidisciplinary collaboration. Individualized planning and well-coordinated obstetric and neurosurgical interventions can lead to favorable outcomes for both mother and child in these rare but high-risk clinical situations.

To evaluate the association between delivery mode and perinatal outcomes in small-for-gestational-age (SGA) newborns in breech presentation. A retrospective multicenter study included births between January 1, 2017, and December 31, 2022, in five maternity hospitals in the Auvergne-Rhône-Alpes region. The included newborns were delivered in breech presentation and classified at birth as small-for-gestational-age (birth weight < 10th percentile) according to AUDIPOG curves. Outcomes of spontaneous or induced vaginal deliveries were compared to those of planned cesarean sections in SGA fetuses in breech presentation. Neonatal morbidity was assessed using arterial pH at birth, 5-minute Apgar scores, and neonatal or neonatal intensive care unit admissions. Crude and adjusted associations were estimated using odds ratios (OR) and their 95% confidence intervals (CI). Among 53,006 live births, 2941 (5.5%) were breech presentations, and 176 SGA newborns were included. An arterial pH < 7.2 was significantly more frequent after vaginal delivery compared to planned cesarean (adjusted OR 4.9; 95% CI 1.59–15.2). However, no significant difference was observed for a 5-minute Apgar score < 7 (adjusted OR 0.38; 95% CI 0.061–1.7). Neonatal or NICU admissions were significantly higher in the vaginal delivery group compared to planned cesarean (adjusted OR 3.83; 95% CI 1.4–10), while no significant difference was found for NICU admission alone (adjusted OR 1.31; 95% CI 0.3–5.2). Term vaginal delivery of an SGA fetus in breech presentation is associated with lower arterial pH levels at birth, with no significant difference in 5-minute Apgar scores. These results are consistent with findings observed when comparing delivery modes for non-SGA fetuses in breech presentation.

Objective. To determine the features of the course of pregnancy, the influence of the infertility factor and the cycle of stimulation of superovulation on obstetric and perinatal outcomes in patients with pregnancy after in vitro fertilization (IVF) complicated by gestational diabetes mellitus (GDM). Material and methods. The outpatient and inpatient records of 116 patients with singleton pregnancies that occurred after IVF in the period from 2018 to 2022 were retrospectively studied at V.I. Krasnopolsky Moscow Regional Scientific Research Institute of Obstetrics and Gynecology. The main group consisted of 77 (66%) patients after IVF with GDM, the comparison group consisted of 39 (34%) patients after IVF who did not develop GDM. The infertility factor, IVF protocol, GSM detection period, method and duration of delivery, and the presence of obstetric and perinatal complications were analyzed in the examined patients. All pregnant women in the studied groups were closely monitored by obstetricians, gynecologists and endocrinologists in order to timely diagnose and treat possible pregnancy complications. Statistical processing of the obtained data was performed using the Statistica v application software package. 13.3 (TIBCO, USA). Results. As a result of the study, there were no statistically significant differences between the groups in terms of short and long IVF protocols that could affect obstetric and perinatal outcomes. The groups were comparable in terms of infertility. There were no statistically significant differences in the incidence of obstetric complications in the examined groups. Diet therapy prevailed as a treatment method in the group with GDM (n=56 out of 77; 72.7%). In the early GDM group, 11 patients were on diet therapy, 7 on insulin therapy, and the onset was noted from 8 weeks of gestation. Delivery in the GDM group was more often performed by planned cesarean section (49.4%), in the comparison group — more often through natural birth routes (41.0%), however, there were no statistically significant differences between the groups in the frequency of delivery methods. The assessment of the condition of newborns on the Apgar scale of 8 and 9 points was statistically significantly more common in the group of patients with GDM than in the comparison group — in 94.8 and 79.5%, respectively. Conclusion. Assessment of the possibility of developing early GDM in patients after the use of IVF is extremely important, as it contributes to adequate pre-pregnancy preparation. The division of risk factors for developing GDM after IVF into modifiable and non-modifiable factors contributes to improving the management strategy for patients in order to achieve optimal obstetric and perinatal outcomes. In the study, it was shown that the presence of an infertility factor, the use of a superovulation stimulation cycle in an IVF program, and the development of GDM in the examined patients did not significantly affect the timing of delivery, as well as the occurrence of obstetric and perinatal complications. Despite these findings, patients with a history of infertility who developed GDM after undergoing IVF are considered complicated patients who are at a high risk of developing complications during pregnancy and type 2 diabetes in the future. A personalized multidisciplinary approach is needed for each patient with infertility, both during preconception period, as well as when entering the IVF protocol, during pregnancy, when it is complicated by GDM.

Mothers' level of education and infant health. Causal effects of the introduction of a school reform in Norway.

Validation of a point-of-care serum progesterone cut-off for caesarean section timing in the bitch and its effect on neonatal outcomes.

Nonvigorous newborns often require immediate resuscitation, and early cord clamping (ECC) is the conventional approach. Alternative strategies, such as intact cord resuscitation (ICR) and umbilical cord milking (UCM), may provide additional benefits without compromising safety. To compare the effectiveness and safety of different umbilical cord management strategies for nonvigorous newborns. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines and searched six databases for randomized controlled trials comparing different umbilical cord management approaches in nonvigorous newborns. Outcomes assessed included resuscitation effectiveness, hematological parameters, neonatal morbidities, and mortality. The Cochrane Collaboration tool RoB2 was used to assess the risk of bias. Ten studies with 2,541 newborns were included, with seven studies contributing to the meta-analysis. No significant differences were observed in resuscitation requirements, Apgar scores, or mortality between ECC, ICR, and UCM. However, at 5 minutes, ICR showed a small but statistically significant higher Apgar score compared with other interventions (mean difference [MD] = 0.3, 95% confidence interval [CI] [0.05, 0.55]). Additionally, heart rate was lower in the intact ICM (I-UCM) group (MD = -34.75 beats/min, 95% CI [-61.84, -7.66]). Cut UCM was associated with significantly higher serum ferritin levels at 6 weeks (MD = 40.44 µg/L, 95% CI [26.45, 54.43]). Initial hematocrit levels were also higher in the ICR group compared with ECC. ICR and UCM might be safe and effective alternatives to ECC for nonvigorous newborns, with potential hematological benefits. However, further large-scale studies are needed to confirm these findings and evaluate long-term neurodevelopmental outcomes. · ICR and UCM might be safe and effective alternatives to ECC for nonvigorous newborns.. · Heart rate was lower in the I-UCM group.. · ICR showed statistically significant higher Apgar.. · Cut UCM was associated with significantly higher serum ferritin levels at 6 weeks..

A 12-hour versus 24-hour magnesium sulfate intravenous regimen in postpartum women with preeclampsia: a randomized clinical trial.