Apgar Score Research Articles

Evaluation of Sectio Cesaria Response Time to Maternal and Neonatal Outcomes in Severe Preeclampsia - Eclampsia Patients

This research is finding out an overview of the response time evaluation of Sectio Cesaria in patients with severe Pre-eclampsia - Eclampsia at Sitti Khadijah 1 Muhammadiyah Hospital Makassar Branch. Severe preeclampsia and eclampsia are complications in pregnancy and childbirth that increase maternal and infant morbidity and mortality rates. To prevent the problem of eclampsia, early management of preeclampsia must be carried out properly. Cesarean sections are classified into two categories, namely SC categories 1 and 2. Category 1 Caesarean sections are SCs that must be carried out as soon as possible and most decisions must be taken within 30 minutes, namely in cases that immediately threaten the lives of the mother and baby, such as fetal distress, non-reassuring fetal status, antepartum hemorrhage, and the threat of uterine rupture. While SC category 2 is one that endangers the mother and fetus but not immediately, such as two previous CS, dystocia, hypertension in pregnancy, premature rupture of membranes, breech position, failed induction, bad obstetric history, macrosomia, cephalopelvic disproportion, facial presentation, and most decisions must be taken within 75 minutes. This research method is observational research using a cross sectional approach. The results of this research is maternal outcome most affected by SC response time <75 minutes is postoperative ICU care, and the most influential neonatal outcome is the APGAR Score. Based on the research results, it can be concluded that response time has a significant influence on maternal and neonatal outcomes in patients with severe preeclampsia - eclampsia.

Midwife-Led Versus Obstetrician-Led Perinatal Care for Low-Risk Pregnancy: A Systematic Review and Meta-Analysis of 1.4 Million Pregnancies

Background: The optimum model of perinatal care for low-risk pregnancies has been a topic of debate. Obstetrician-led care tends to perform unnecessary interventions, whereas the quality of midwife-led care has been subject to debate. This review aimed to assess whether midwife-led care reduces childbirth intervention and whether this comes at the expense of maternal and neonatal wellbeing. Methods: PubMed, Scopus, Cochrane Library, and Web of Science were systematically searched for relevant studies. Studies were checked for eligibility by screening the titles, abstracts, and full texts. We performed meta-analyses using the inverse variance method using RevMan software version 5.3. We pooled data using the risk ratio and mean difference with the 95% confidence interval. Results: This review included 44 studies with 1,397,320 women enrolled. Midwife-led care carried a lower risk of unplanned cesarean and instrumental vaginal deliveries, augmentation of labor, epidural/spinal analgesia, episiotomy, and active management of labor third stage. Women who received midwife-led care had shorter hospital stays and lower risks of infection, manual removal of the placenta, blood transfusion, and intensive care unit (ICU) admission. Furthermore, neonates delivered under midwife-led care had lower risks of acidosis, asphyxia, transfer to specialist care, and ICU admission. Postpartum hemorrhage, perineal tears, APGAR score < 7, and other outcomes were comparable between the two models of management. Conclusions: Midwife-led care reduced childbirth interventions with favorable maternal and neonatal outcomes in most cases. We recommend assigning low-risk pregnancies to midwife-led perinatal care in health systems with infrastructure allowing for smooth transfer when complications arise. Further research is needed to reflect the situation in low-resource countries.

Relationship between Abnormal CTG Findings and Perinatal Outcome

Background: Continuous monitoring of fetal well-being through cardiotocography (CTG) is a standard practice in antenatal care, aiming to detect and manage potential complications. However, interpreting CTG patterns requires expertise and understanding, especially in diverse clinical settings such as those in Bangladesh. Objective: To assess normal and abnormal CTG patterns and their implications for perinatal outcomes in a tertiary level hospital in Bangladesh. Methods: A cross sectional study was conducted on CTG recordings of pregnant women admitted to the antenatal unit of a tertiary level hospital in Bangladesh from January 2024 to June 2024. CTG pattern was abnormal based on established criteria. Perinatal outcomes including fetal distress, neonatal outcomes, and obstetric interventions were recorded and analyzed in relation to CTG findings. The aims of the study were to evaluate the abnormal cardiotocography (CTG) patterns during the antenatal period and their impact on perinatal outcomes at a tertiary level hospital in Bangladesh. Results: The incidence of fetal distress was significantly higher in cases with abnormal CTG patterns compared to normal patterns (p<0.05). Furthermore, neonatal outcomes such as Apgar scores <7 at 1 minute and 5 minutes were more prevalent in pregnancies with abnormal CTG patterns. Among the abnormal CTGs groups, who had more risk factors abnormal outcomes were more. Most of the patients in both the normal and abnormal CTGs groups were associated with DM. In abnormal CTGs groups pre-eclampsia, PROM Many pregnant women had other risk factors associated with DM. Conclusion: This study highlights the importance of accurately assessing CTG patterns in the antenatal period for predicting perinatal outcomes. The identification of abnormal CTG patterns can aid in timely interventions to prevent adverse outcomes for both the mother and the newborn.

Parity-Driven Disparities in Placenta Previa: A Comprehensive Analysis of Obstetric and Perinatal Factors

OBJECTIVE: This retrospective cohort study aimed to investigate the incidence of known risk factors for placenta previa in primiparous patients and assess the maternal and fetal outcomes associated with this condition in a tertiary hospital setting. STUDY DESIGN: Data were collected from electronic medical records of pregnant women with confirmed placenta previa who were monitored at our clinic and delivered between January 2016 and June 2024. Demographic characteristics, obstetric history, and perinatal outcomes were analyzed. Statistical analysis was conducted using SPSS version 22, and comparisons between multiparous and nulliparous women were made using appropriate tests. RESULTS: A total of 674 pregnant women were included in the study, comprising 542 multiparous and 132 nulliparous women. Significant differences were observed between the two groups in terms of anesthesia type, transfusion rates, operation duration, and hemoglobin levels. Neonatal outcomes, including APGAR scores, showed variations between multiparous and nulliparous women. However, certain outcomes such as birth weight did not differ significantly between the groups. CONCLUSION: This study provides valuable information on maternal and neonatal outcomes associated with placenta previa in multiparous and nulliparous women. The findings highlight the complex interplay between maternal parity, anesthesia choice, and clinical outcomes and underscore the importance of tailored management approaches in this population.

A Case Report of a Suspected Neonatal Alloimmune Thrombocytopenia in a Tertiary Health Institution

Fetal and neonatal alloimmune thrombocytopenia FNAIT is the leading cause of severe thrombocytopenia in the fetus and neonate leading to serious bleeding, intracranial haemorrhage and death and also intracranial haemorrhage in full-term infants. We reported a case of a 33-year-old woman who was delivered of a male neonate via Emergency lower segment Cesarean section CS on account of premature rupture of the membrane with oligo hydramnios at an estimated gestational age EGA of 29 weeks 3 days. Her blood group is O Rhesus D positive, and Genotype HbAA. No known premorbid illness. Her last confinement was of a male child delivered via CS and died within 12 hours of birth. This reported case of suspected FNAIT was a baby received alive after CS with birthweight of 1,060g and APGAR score of 7185 transiently, and was noticed to be bleeding from the mouth and anus shortly after birth. Thereafter, he had thrombocytopenia, persistent anaemia, several apneic attacks, seizures, desaturation and died after 42 hours of life despite all prompt clinical interventions. Autopsy summary includes anaemia, central cyanosis, petechial hemorrhage, diffuse alveolar damage, cerebral edema, acute tubular necrosis, small for gestational age and placental vasculopathy. Conclusion: Fetal and neonatal alloimmune thrombocytopenia is a rare disorder and yet poses a challenging diagnosis and treatment plan in resource-limited centres especially in developing countries. Although the clinical findings of the reported suspected case were not classical as previously reported by other studies, they’re pointers to our curiosity and open to further criticism.

Machine learning for forecasting initial seizure onset in neonatal hypoxic-ischemic encephalopathy.

This study was undertaken to develop a machine learning (ML) model to forecast initial seizure onset in neonatal hypoxic-ischemic encephalopathy (HIE) utilizing clinical and quantitative electroencephalogram (QEEG) features. We developed a gradient boosting ML model (Neo-GB) that utilizes clinical features and QEEG to forecast time-dependent seizure risk. Clinical variables included cord blood gas values, Apgar scores, gestational age at birth, postmenstrual age (PMA), postnatal age, and birth weight. QEEG features included statistical moments, spectral power, and recurrence quantification analysis (RQA) features. We trained and evaluated Neo-GB on a University of California, San Francisco (UCSF) neonatal HIE dataset, augmenting training with publicly available neonatal electroencephalogram (EEG) datasets from Cork University and Helsinki University Hospitals. We assessed the performance of Neo-GB at providing dynamic and static forecasts with diagnostic performance metrics and incident/dynamic area under the receiver operating characteristic curve (iAUC) analyses. Model explanations were performed to assess contributions of QEEG features and channels to model predictions. The UCSF dataset included 60 neonates with HIE (30 with seizures). In subject-level static forecasting at 30 min after EEG initiation, baseline Neo-GB without time-dependent features had an area under the receiver operating characteristic curve (AUROC) of .76 and Neo-GB with time-dependent features had an AUROC of .89. In time-dependent evaluation of the initial seizure onset within a 24-h seizure occurrence period, dynamic forecast with Neo-GB demonstrated median iAUC = .79 (interquartile range [IQR] .75-.82) and concordance index (C-index) = .82, whereas baseline static forecast at 30 min demonstrated median iAUC = .75 (IQR .72-.76) and C-index = .69. Model explanation analysis revealed that spectral power, PMA, RQA, and cord blood gas values made the strongest contributions in driving Neo-GB predictions. Within the most influential EEG channels, as the preictal period advanced toward eventual seizure, there was an upward trend in broadband spectral power. This study demonstrates an ML model that combines QEEG with clinical features to forecast time-dependent risk of initial seizure onset in neonatal HIE. Spectral power evolution is an early EEG marker of seizure risk in neonatal HIE.

The Relationship between the Improvement Level in Blood Gas Parameters in Time and Brain MRI Findings in Newborns with the Diagnosis of Hypoxic Ischemic Encephalopathy.

In this study, we aimed to evaluate the relationship between the level of improvement in blood gas parameters in the first hours of age and normal and diffusion-restriction brain magnetic resonance imaging (MRI). The study is a retrospective cohort study. Cases of the diagnosis of hypoxic-ischemic encephalopathy (HIE) who received therapeutic hypothermia in our unit between January 2022 and January 2024 were included in the study. Clinical findings, blood gas values (first, cord; second, first hours of age; third, 24th hour of age), and MRI results were recorded from the case files and compared between normal and diffusion-restricted brain MRI groups. Diffusion-restricted brain MRI was detected in 10 out of a total of 19 cases. The 5-minute Apgar score was lower (p=0.038) and mechanical ventilator support was higher (P=.003) in the diffusion-restricted MRI group than in the normal MRI group. The relationship was shown between high base excess (P=.022) in cord blood gas, low HCO₃ (p=0.025) in the 24th hour blood gas, and convulsion (P=.033) in the diffusion-restricted MRI group. Additionally, it was found that only the improvement level of the pH value in the first hour of age was significant (P=.025) in the diffusion-restricted brain MRI group than in the normal MRI group. We showed that there was a relationship between diffusion-restricted brain MRI and the improvement level in the pH value in the first hours of age of patients diagnosed with HIE who received treatment for therapeutic hypothermia.

Surgical management of delivery with placenta accreta spectrum from the perspective of perinatal obstetrics

Introduction. This article raises the issue of planning the timing and method of operative delivery in pregnant women with placenta accreta spectrum. Placenta accreta spectrum is one of the most formidable complications of pregnancy, the delivery of pregnant women with this pathology is accompanied by massive blood loss, and programmed late premature birth leads to an increase in perinatal morbidity.The objective was to evaluate the possibility of prolonging pregnancy to full term in patients with pathology of placenta accreta spectrum.Methods and materials. 94 histories of pregnant women with placenta accreta spectrum, delivered from 2017 to 2023, were analyzed. All patients were divided into 4 groups according to the topography of placenta accreta. According to the assessment of perinatal outcomes, pregnant women were divided into 2 groups: group 1 – pregnant women who delivered at 34–36 weeks of pregnancy (n=82; 87 %); group 2 – patients operated on from 37 to 39 weeks of gestation (n=12; 13 %). The statistical analysis was performed using the program StatTech v. 4.2.7.Results. Among pregnant women whose delivery ended with hysterectomy (n=32, 100 %), the largest proportion of patients had placenta accreta in the area of the parametrium and cervix (n=12, 43.75 %). The average score of newborns in group 1 was 7 points on the Apgar scale at 1 minute after extraction and 8 points on the Apgar scale at 5 minutes; in group2, the average score on the Apgar scale was 8 and 8 points at 1 and 5 minutes.Conclusion. If placenta accreta is suspected and involves the cervix, parametrium, and lower part of the posterior wall of the bladder, a hysterectomy is most likely to be performed. For such pregnant women, it is possible to shift the timing of surgical intervention to 37/38 weeks of gestation in order to improve neonatal outcomes.

Investigation of Prognosis and Related Factors of Premature Neonates

The birth of premature infants remains a challenge in many societies. This cross-sectional study investigates prenatal care and influential factors in preterm infants hospitalized in the Neonatal Intensive Care Unit (NICU) of Fatemieh Educational-Medical Center in Hamadan, Iran, from March 2018 to March 2019. We examined premature infants with a gestational age of less than 37 weeks who were admitted to the NICU. Data on demographic and maternal characteristics, length of hospital stay, maternal underlying diseases, probable causes of preterm birth, neonatal complications, treatment types, treatment-related complications, resuscitation needs, ventilation, and mortality rates were extracted from patient records. Among 388 preterm infants studied, 204 (52.6%) were female. The mean gestational age was 31.8±2.8 weeks, birth weight was 1647.4±625.6 grams, and average hospital stay was 10.2±9.3 days. The most common maternal underlying disease was pregnancy-induced hypertension or preeclampsia (22.2%), respiratory distress syndrome, jaundice, and low birth weight were the leading reasons for hospitalization (84%). Neonatal outcomes included 92 (23.7%) deaths, 25 (6.4%) intraventricular hemorrhages, 39 (10.1%) patent ductus arteriosus cases, 20 (5.2%) bronchopulmonary dysplasia cases, and 41 (10.6%) retinopathy of prematurity cases. Regression analysis revealed significant predictors of neonatal mortality, including male gender, maternal underlying diseases, need for cardiopulmonary resuscitation, low Apgar score at one-minute, lower birth weight, shorter gestational age, and NICU stay duration. This study underscores the high neonatal mortality rate among preterm infants. Implementing preventive measures, particularly addressing maternal underlying diseases and low birth weight, can significantly reduce neonatal mortality.

Predictors of Nasal Continuous Positive Airway Pressure Failure in Preterm Infants With Respiratory Distress Syndrome

Respiratory support in infants with respiratory distress syndrome (RDS) plays an important role in the reduction of mortality and complications, but the treatment fails in some infants. This study aimed to identify the predictors of continuous positive airway pressure (CPAP) failure in preterm infants with RDS. This cross-sectional retrospective study was conducted on RDS-diagnosed preterm infants admitted to the neonatal intensive care unit of Fatemieh Hospital (Hamadan city) in 2021-2022. The infants were examined in terms of risk factors for CPAP failure. Data extracted from the medical records were recorded in a checklist and analyzed with SPSS version 21 software at a confidence level of 95%. CPAP failure was recorded in 37.6% of the studied 202 infants. The need for resuscitation at birth, low gestational age, low birth weight, multiple births, low 1-min and 5-min Apgar scores, the need for higher FIO2 and PEEP, acidosis, and the need for surfactant administration were significantly associated with CPAP failure. In logistic regression, low gestational age (OR 1.30, 95% CI: 1.082-1.576) and the need for resuscitation at birth (OR 0.426, 95% CI: 0.202-0.898) were the major predictors of CPAP failure. Lower gestational age and the need for PPV in the delivery room are good predictors of CPAP failure in preterm infants with RDS, who receive nasal CPAP as primary respiratory support.

A deep dive into neonatal well-being and anesthesia in cesarean sections: From procedure to outcome.

This observational study analyzed data from 502 participants undergoing cesarean section (CS) procedures at an obstetrics and gynecology department, aiming to explore anesthesia practices, neonatal outcomes, and demographic characteristics within the cohort. Participants, aged 17 to 59 years with a mean age of 32.23 years, were enrolled based on the clinical necessity for cesarean delivery during the study period. Informed consent was obtained from each participant or their guardians before data collection, which included detailed demographic information, medical histories, specifics of the cesarean section procedure, and APGAR scores of neonates immediately postbirth (at 0 and 5 minutes). Primary outcomes focused on APGAR scores, critical indicators of neonatal health, while secondary outcomes included the distribution of patient ages, reasons for cesarean sections, and the administration of Bupivacaine during anesthesia. Data were rigorously analyzed using descriptive and inferential statistics to summarize participant demographics, anesthesia practices, and neonatal outcomes. Statistical methods included measures of central tendency and dispersion, correlation analyzes to explore associations between variables, and regression models to identify predictors of neonatal APGAR scores. The study identified a range of indications for cesarean sections, with common reasons including fetal distress and maternal health complications. Findings indicated an average APGAR score of 7.02 at 0 minutes and 7.84 at 5 minutes, reflecting generally favorable immediate neonatal outcomes. Anesthesia protocols predominantly involved Bupivacaine, with doses ranging from 1.8 to 2.2 mL, administered based on clinical requirements. In conclusion, this study underscores the importance of comprehensive data collection and rigorous statistical analysis in evaluating cesarean section procedures. Future research could further explore long-term neonatal outcomes and refine anesthesia protocols to optimize maternal and neonatal health during cesarean deliveries.

Role of prophylactic intravenous calcium in prevention of post-spinal hypotension among women with preeclampsia undergoing caesarean delivery: a placebo controlled randomized clinical trial: Randomized clinical trial of calcium vs placebo for prevention of post-spinal hypotension

BackgroundPreeclamptic women, in addition to traditional anti-hypertensive medications, often receive magnesium supplementation and are at increased risk of post-spinal hypotension Post-spinal hypotension increases the risk of fetomaternal morbidity. Calcium is a physiological antagonist of magnesium in vascular smooth muscle. Therefore, the study hypothesized that calcium is better suited for preserving systemic vascular resistance and preventing post-spinal hypotension during cesarean delivery. ObjectivesThe study aimed to evaluate the effect of prophylactic calcium administration on post-spinal hypotension in preeclamptic women receiving magnesium supplementation. MethodsThis prospective, randomized, placebo-controlled, double-blinded, two-arm parallel trial was conducted in preeclamptic women receiving magnesium sulfate supplementation undergoing cesarean delivery. The women were randomized to receive intravenous calcium or a placebo (normal saline) before spinal anesthesia. The study drug (calcium gluconate 500 mg or normal saline) was administered over 15 minutes and ended immediately before spinal anesthesia. The primary outcome measure was the incidence of post-spinal hypotension, and secondary outcome measures were postpartum blood loss and maternal and neonatal outcomes. Results100 women (50 each calcium and placebo arm) completed the study. The baseline demographic variables, mean blood pressure and heart rate were comparable. The incidence of post-spinal hypotension was significantly lower in the calcium arm compared to the placebo arm {(32% vs 60%; Relative risk (95% CI); 1.87 (1.18-2.97); p=0.007)}. The mean phenylephrine requirement (5.60±14.59 vs 14.80 ±22.42 mcg; p=0.01) and mephentermine requirement (3.30 ±5.11 mg vs 5.82 ±4.97 mg; p=0.008) was significantly lower in the calcium group. Furthermore, the calcium group's mean postpartum blood loss was significantly lower (406.90 ±94.34 vs 472.20±122.49 ml, p= 0.004). However, the Neonatal Intensive Care Unit admission rate, Apgar score, umbilical artery PH, and maternal serum calcium were comparable. ConclusionProphylactic calcium infusion significantly reduces the incidence of post-spinal hypotension during cesarean delivery in preeclamptic women receiving magnesium supplementation. Furthermore, the effect of prophylactic calcium in decreasing postpartum blood loss is encouraging. However, large trials are required to validate the findings of this study.

Effect of days of age at first blood transfusion on intraventricular hemorrhage in very low and extremely low birth weight infants

ABSTRACT Background Preterm infants are a group cohort of transfusion recipients due to their low blood volume and underdeveloped hematopoietic system. The objective of this study was to probe the effect of days of age at first blood transfusion on intraventricular hemorrhage (IVH) in very low and extremely low birth weight VLBW and ELBW infants. Research design and methods Data of 150 VLBW and ELBW infants received blood transfusion were reviewed. IVH and non-IVH groups were established. General data on infants and their mothers and data related to blood transfusion, IVH risk factors, and the predictive value of the relevant factors for IVH were analyzed. Results The IVH group had lower birth weight, hemoglobin levels on admission, and days of age at first blood transfusion and higher 5-min Apgar score ≤ 7 points and early transfusion rate. Spontaneous delivery and 5-min Apgar score ≤ 7 points were risk factors for IVH. Birth weight and days of age at first blood transfusion had predictive value for IVH in VLBW and ELBW infants. Conclusions The younger the days of age at first blood transfusion, the higher the IVH risk. It is necessary to delay the days of age at first blood transfusion and reduce early blood transfusion.

Nondiabetic Fetal Macrosomia: Causes, Outcomes, and Clinical Management.

Fetal macrosomia (FM) is common in clinical practice and carries increased risk of adverse maternal and neonatal health outcomes. Maternal diabetes mellitus (DM) is a well-known cause of macrosomia with significant research and guidelines focusing on macrosomia in this population. Less is known about causes, prevention, and clinical management for suspected FM in individuals without diabetes. The objective of this review is to describe the risk factors associated with nondiabetic FM, review risks associated with macrosomia in pregnancy, and potential treatment considerations for this condition. Original research articles, review articles, and guidelines on macrosomia were reviewed. Risk factors for macrosomia in patients without DM include previous delivery of an infant with macrosomia, excessive pregnancy weight gain, and obesity. Maternal complications of FM include higher rates of cesarean delivery, postpartum hemorrhage, and vaginal laceration. Fetal complications include shoulder dystocia, decreased Apgar scores, and increased risk of childhood obesity. Exercise during pregnancy has been shown to reduce the risk of FM. Induction of labor prior to 39 weeks is not recommended in the setting of suspected macrosomia as there is a lack of adequate evidence to support that this decreases adverse neonatal or maternal outcomes. In addition, elective cesarean delivery for suspected macrosomia is not recommended to be considered unless estimated fetal weight is greater than 5000 g in the absence of DM. Delivery of an infant with macrosomia in patients without DM has increased maternal and fetal risks. Predicting infants who will meet criteria for macrosomia is challenging. More research is needed to identify ways to accurately estimate fetal weight, interventions to prevent macrosomia, and additional ways to mitigate risk in patients without DM who have suspected FM.

INDUCTION OF LABOUR WITH SUBLINGUAL MISOPROSTOL COMPARED TO VAGINAL DINOPROSTONE IN TERMS OF NEONATAL OUTCOME IN WOMEN WITH PROLONGED PREGNANCY

Labor induction in postdate pregnancies can impact neonatal outcomes, including Apgar scores and the need for NICU care. Various induction agents, such as sublingual misoprostol and vaginal dinoprostone, offer differing efficacies. This study aims to compare the neonatal outcomes of these two agents to determine the more effective option for labor induction in postdate pregnancies. Objective: To compare neonatal outcomes, specifically Apgar scores <7 at 1 minute and NICU admissions within the first 24 hours, between neonates born to postdate women induced with sublingual misoprostol versus vaginal dinoprostone. Methods: This randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, Unit 1, Holy Family Hospital, Rawalpindi, from January 2024 to July 2024. After Institutional Research Forum approval, 200 women meeting the selection criteria were randomized via the lottery method into two groups. Group I received 25 mcg of sublingual misoprostol every 4 hours up to 4 doses, and Group II received 3 mg vaginal dinoprostone every 6 hours up to 2 doses. Neonatal Apgar scores were recorded at delivery, and NICU admissions were monitored within 24 hours. Data were documented on structured proforma and analyzed using SPSS. Results: The mean maternal age in Group I was 27.17±4.71 years and in Group II 28.33±4.25 years. Both groups had comparable gestational ages (41.60±0.49 vs. 41.68±0.46 weeks) and parity (1.64±0.79 vs. 2.05±0.83). Group I neonates had higher mean Apgar scores at 1 minute (7.25±2.08) compared to Group II (6.62±2.07), with significant group differences (p=0.04). NICU admissions were required in 30% of neonates, with 48.8% needing NICU care, and fewer admissions in Group I (p=0.04). NICU care showed a significant association with maternal age over 28 years (p=0.000) and nulliparous status (p=0.007) but was not significantly different for those under 28 years or multiparous. Conclusion: Sublingual misoprostol demonstrated superior efficacy to vaginal dinoprostone in labor induction for prolonged pregnancies, with improved neonatal outcomes, including higher Apgar scores and fewer NICU admissions. Age and parity influenced outcomes, highlighting sublingual misoprostol as an effective choice for better neonatal health.

The Linkage of Grand Multiparity with Associated Risks During Pregnancy and Childbirth: A Cross-Sectional Study at Tertiary Care Hospital

Objective: To investigate the risk factors associated with grand multiparityn during pregnancy and childbirth. Study Design: Cross-sectional study. Place and Duration of Study: Gynaecology and Obstetrics Department, Pakistan Emirates Military Hospital, Rawalpindi, Pakistan from Dec 2022 to Oct 2023. Methodology: Three hundred twenty-two (n=322) women from the Pakistan Emirates Military Hospital, labor ward, Rawalpindi, Pakistan, gynecology and obstetrics department participated in this research. Primiparous, Multiparous, and grand multiparous females were included in the study for various demographic, maternal, and neonatal factors. Results: Primiparous women were higher in number than multiparous and GMP women [202(62.7%), 109(33.8%), and 11(3.4%), respectively). Among the risk factors associated with GMP, there was a greater incidence of miscarriage, i.e., 59.1% in GMP, and Gestational diabetes (27.2% in GMP) and spontaneous preterm delivery (45.4% in GMP) were the two most common problems linked with pregnancy in GMP women. The primary neonatal consequence observed was low birth weight (32.1% in PM), with a prevalence of 32.1%. However, the percentage of infants with an APGAR score below 7 at 5 minutes was higher in the GMP (36.3%). Conclusion: When compared to other parity groups, grand multiparous Pakistani women face the same risks of maternal and newborn problems. In GMP, advanced age may have a significant impact on pregnancy outcomes. Nonetheless, grand multiparty may not be outlawed, given that women receive adequate prenatal care.

A comparative study on the clinical efficacy and pregnancy outcomes of methimazole and propylthiouracil in managing pregnancy complicated with hyperthyroidism

The objective of the study was to compare the clinical efficacy and pregnancy outcomes of methimazole and propylthiouracil in managing hyperthyroidism during pregnancy. This retrospective analysis included 100 pregnant women with hyperthyroidism, who were divided into two groups: the methimazole group (Group A) and the propylthiouracil group (Group B). Indicators such as thyroid function, liver function, pregnancy outcomes, and newborn health were closely monitored. The results revealed that both groups experienced a reduction in thyroid function indicators, with Group B showing a more modest decrease. Group B exhibited a higher incidence of liver injury but also achieved more full-term pregnancies. There were no significant differences in adverse reactions, miscarriage rates, or cesarean rates between the two groups. Apgar scores were higher in Group B, while neonatal weights were comparable. We conclude that propylthiouracil improved thyroid function more substantially than methimazole although it was associated with a higher risk of liver injury.

Short-term outcomes of oropharyngeal administration of colostrum in preterm neonates: a double-blind placebo-controlled randomized trial.

The oropharyngeal administration of colostrum (OAC) in neonates has several benefits. To investigate the short-term outcomes of OAC in preterm neonates. We performed this two-arm, double-blind, placebo-controlled randomized trial at a tertiary neonatal center in Iran in 2021-2023. The intervention and control arms received 0.2 mL of their mother's colostrum or distilled water via oropharyngeal administration every 6 h for 3 days starting from birth until 72 h of age. The main study outcomes were neonatal death, the incidence of necrotizing enterocolitis (NEC), sepsis, retinopathy of prematurity (ROP), length of hospital stay, and period to full enteral feeding. A regression analysis was used to adjust for possible confounders. A total of 126 neonates (mean gestational age, 30.05 weeks) were randomized to the intervention and placebo groups (n=63 each) and had a mean ± SD weight of 1247 ± 193 vs 1156 ± 215 g (P=0.013) and 1- and 5-min Apgar scores of 6.35 vs 5.38 (P=0.003) and 7.84 vs 7.13 (P=0.001), respectively. The mortality rate was 12.7% in the intervention group versus 14.3% in the placebo group (P=0.794). The NEC rate was significantly lower in the intervention versus placebo arm (11.1% vs. 28.6%, respectively; P=0.010), as was the clinically suspected sepsis rate (15.9% vs. 39.7%, respectively; P=0.004). The ROP and bronchopulmonary dysplasia rates did not differ significantly between groups after the adjustment for confounders. The mean length of hospital stay was shorter in the intervention group (26.1 vs. 37.32; P=0.023). Moreover, the mean duration of antibiotic therapy and period to full feeding were significantly shorter in the intervention group. OAC could effectively decrease the incidence of complications in preterm infants and facilitate earlier patient discharge.

Risk factors of hypotension during cesarean section with spinal anesthesia in parturients with COVID-19: a retrospective study in comparison with pregnant women without COVID-19.

The incidence of hypotension in parturients with coronavirus disease (COVID-19) undergoing regional anesthesia remains controversial. This study aimed to investigate the incidence of hypotension during spinal anesthesia in parturients infected with COVID-19, as well as to identify associated risk factors. This retrospective study compared COVID-19-positive parturients who underwent cesarean section under spinal anesthesia (COVID-19 group) with a control group between January 2017 and June 2022. We reviewed the medical records and collected the following information: basic patient characteristics, spinal anesthesia, and newborn-related data. Compared with the control group, the COVID-19 group did not show any significant differences in terms of hypotension occurrence and vasopressor usage. A positive correlation was noted in the COVID-19 group between heart rate and duration of hospital stay (P < 0.001, Spearman's rho = 0.422). In subgroup analysis of the COVID-19 group, group with a baseline heart rate ≥ 100 (group H) had lower Apgar scores at 1 min, longer hospital stays, and more severe COVID-19 symptoms than the with a baseline heart rate < 100 (group L). Moreover, in group H, there was a positive correlation between the heart rate and the lowest systolic blood pressure after spinal anesthesia (P = 0.012, Spearman's rho = 0.528). Parturients with COVID-19 do not appear to have a higher risk of hypotension during cesarean section under spinal anesthesia than those without COVID-19. Given the close association between preoperative heart rate and extent of hypotension in parturients with COVID-19 undergoing spinal anesthesia, vigilant monitoring of vital signs by anesthesiologists is crucial during the perioperative period.

014. Localized Meconium Peritonitis Due to Perforation of Ileum Atresia: Case Report

Background: Ileal atresia is a congenital disorder that can cause serious complications such as intestinal obstruction, intestinal ischemia, and intestinal rupture. The worldwide incidence rate is 1 in 5,000 - 10,000 births, which can be influenced by various factors such as the use of certain drugs during pregnancy, a family history of similar complaints, and premature birth which can increase the risk. One of the rare features is spontaneous walling off of the abdominal wall which resembles a cyst. From this case we found a patient who had this rare clinical presentation. Case: 3 days old baby was referred to Dr. Kariadi Semarang with a greenish lump in the epigastric region since birth, accompanied by the appearance of small intestinal obstruction. The patient was born via vaginal delivery at 39 weeks' gestation with a normal Apgar score and weight. From the history and examination that had been carried out, it was concluded that there was ileal atresia and an exploratory laparotomy was performed. A green mass was obtained which was the walling off of the ileal perforation. During the operation, another finding was found, ileal perforation caused by atresia and severe adhesions (Grade IV). The patient then underwent the Santulli procedure and laceration repair. Conclusion: Ileal atresia is diagnosed from anamnesis taking from baby has signs of obstruction such as flatulence and vomiting. The incidence of ileal atresia associated with perforation and causing peritonitis is still rare due to lack of reporting of these cases. Peritonitis, which occurs due to intestinal perforation in the jejunoileal segment, can cause the release of intestinal products, meconium, into the intra-abdominal cavity. Spontaneous walling off in this case is quite rare, and because the perforation product is sterile, it does not give a picture of inflammation.