Apgar Score Research Articles

Association between sleep problems during pregnancy and postpartum depressive symptoms as well as condition of newborn at delivery.

Pregnancy-related anatomic, physiologic, and hormonal factors can occur at different stages of pregnancy and affect sleep disturbances. The relationship between sleep problems during pregnancy and postpartum depressive symptoms as well as neonatal condition at delivery have not been well described. This study hypothesized that sleep problems are associated with postpartum depressive symptoms and adverse neonatal outcomes at delivery. This study conducted a prospective study for perinatal women (n = 683, 30.54 ± 5.11 years old) to evaluate sleep problems during pregnancy using the Pittsburgh sleep quality index (PSQI) and Berlin questionnaire, postpartum depressive symptoms using Edinburgh postnatal depression scale (EPDS), and clinical signs of neonatal condition at delivery using the Apgar score. PSQI total score during pregnancy were significantly higher in those with postpartum depressive symptoms than those without 1 month after delivery. PSQI score in the third trimester was significantly associated with postpartum depressive symptoms even after adjustment for relevant confounding factors and self-reported lifetime depression (odds ratio = 1.19, 95% confidence interval = 1.03-1.36, p = 0.015). The Apgar score at 5 min after birth was significantly lower in those with obstructive sleep apnea (OSA) than those without OSA in the second and third trimesters, although mean scores were within the normal range. This study revealed that sleep problems during pregnancy influence postpartum depression 1 month after delivery. OSA during pregnancy may lead to risks of delivery. Attention should be paid to sleep health during pregnancy to ensure the mental health of mothers and a safe delivery.

635 Do Apgar scores predict outcomes among extreme preterm infants?

635 Do Apgar scores predict outcomes among extreme preterm infants?

A Comparative Study on the Relationship Between Placental Weight and Neonatal Outcomes Among Anaemic Mothers and Non-Anaemic Mothers in Selected Hospital, Rajnandgaon, Chhattisgarh

Abstract: Maternal anemia is a common pregnancy complication that may impact placental function and fetal development. This study aims to compare placental weight and neonatal outcomes among anemic and non-anemic mothers to determine the potential effects of maternal anemia on fetal growth and neonatal health. A comparative cross-sectional study was conducted among 200 mothers (100 anemic, 100 non-anemic) who delivered at term in a tertiary care hospital. Placental weight, neonatal birth weight, Apgar scores, and neonatal complications were recorded. Statistical analysis, including independent t-tests, chisquare tests, and Pearson correlation, was performed to examine differences between the two groups. The average placental weight was slightly lower in anemic mothers (495 ± 55 g) compared to non-anemic mothers (510 ± 50 g), though not statistically significant (p = 0.16). Neonates of anemic mothers had significantly lower birth weights (2600 ± 500 g vs. 2700 ± 450 g, p = 0.03) and lower Apgar scores at 1 minute (7.4 vs. 8.2, p = 0.02) and 5 minutes (8.3 vs. 9.0, p = 0.01). Neonatal complications, including respiratory distress and NICU admissions, were more frequent among the anemic group, but the difference was not statistically significant (p = 0.08). A moderate positive correlation was found between placental weight and neonatal birth weight (r = 0.45 for anemic, r = 0.52 for non-anemic).Maternal anemia is associated with lower neonatal birth weight and reduced Apgar scores, indicating possible fetal distress. Although placental weight differences were not statistically significant, the findings highlight the importance of managing maternal anemia to improve neonatal health outcomes. Further studies with larger samples are recommended to confirm these findings and explore additional contributing factors

The prevalence of episiotomy and associated factors at Shahrara Teaching Hospital in Kabul, Afghanistan

BackgroundEpisiotomy is done to expand the birth canal but can cause serious complications. It is still commonly performed in many parts of the world representing a quality-of-care and quality-of-life challenge. There is currently no data regarding the prevalence of episiotomy in Afghanistan. The aim of this study was to determine the prevalence of episiotomy and associated factors in women who delivered at a teaching hospital in Kabul, Afghanistan.MethodsA retrospective, cross-sectional study was conducted at Shahrara Teaching Hospital. The study sample included all women at Shahrara Teaching Hospital with vaginal delivery during the first six months of 2023. Demographic and clinical information was gathered from medical records. Descriptive statistics were calculated. Logistic regression was performed to assess the independent predictors of episiotomy.ResultsA total of 1,288 women had vaginal delivery during the study period and 306 (23.76%) delivered using episiotomy. Higher parity was associated with lower odds of episiotomy (OR: 0.01 95% CI 0.007–0.022; p < 0.0001) and a longer duration of labor during stage 2 was associated with higher odds of episiotomy (OR: 1.04 95% CI 1.01–1.07; p = 0.02). An association between Apgar score at the first minute of birth was also associated with higher odds of episiotomy (OR: 1.72 95% CI 0.98–3.03; p = 0.06) although this did not reach statistical significance at a value of p < 0.05. Also of note, the majority of patients received oxytocin (72.2%) and only 1 vacuum delivery was performed representing two additional quality-of-care issues.ConclusionsThis study is the first to estimate the prevalence of episiotomy in Afghanistan. The rate of episiotomy found in this study was higher than WHO recommendations but lower compared to studies from other low-income or middle-income countries in Asia and Africa. Additional efforts, including national guidelines or policies and workforce training, are needed to further reduce the rate.

Effect of delivery hospital busyness on early mortality in small preterm infants: a Finnish population-based cohort study in 2006–2016

ObjectivesTo evaluate the effect of delivery hospital busyness on the postnatal condition and the perinatal mortality among small preterm infants born at ≤32+0 gestational weeks.DesignThe daily delivery volume distribution is...

Impact of epidural analgesia on outcomes of vaginal birth after cesarean delivery.

To assess the association between Epidural Analgesia (EA) during Vaginal Birth After Cesarean (VBAC) and delivery mode (spontaneous or instrumental vaginal delivery). Secondary objectives include maternal and neonatal outcomes. In this retrospective population-based cohort study, all women who underwent a VBAC with and without EA, between the years 1996-2016 at the Soroka University Medical Center (SUMC) were included. Women who delivered by cesarean section (elective and non-elective) and those who gave birth to a newborn with chromosomal abnormalities or major malformations, and multifetal gestations were excluded. Demographical, clinical, and obstetrical characteristics were recorded, and pregnancy complications and adverse perinatal outcomes were compared between the groups. The primary outcome was the type of delivery. Univariate analysis was followed by a multivariate analysis to control for confounders. A p value of < 0.05 was considered statistically significant. During the study period, 17,516 women who have had a previous CS met the inclusion criteria, of which 15% (n = 2652) used EA during labor, while the rest of the cohort 85% (n = 14,864) were non-EA users. Women in the EA group had higher rates of instrumental delivery and postpartum hemorrhage (PPH) as well as higher rates of oxytocin augmentation and a longer second stage of labor. The use of EA was found to be an independent risk factor for instrumental delivery after controlling for maternal age, ethnicity, parity, DM (diabetes mellitus), hypertensive disorders of pregnancy, oxytocin augmentation, prolonged second stage of labor, induction of labor, fertility treatments and oligohydramnios. However, no significant differences were observed regarding neonatal outcomes including perinatal mortality, birth weight, Apgar scores and shoulder dystocia rates. EA for women undergoing a VBAC was associated with higher rates of instrumental delivery and PPH, oxytocin augmentation and a longer second stage of labor compared with women without EA. However, neonatal outcomes did not differ between the groups.

Cerebral palsy and perinatal mortality in children born in Norway to immigrant mothers.

To compare the prevalence and clinical characteristics of cerebral palsy (CP), and perinatal mortality, in children born to non-immigrant mothers with children born to immigrant mothers. This was a registry-based cross-sectional study. Data on children born from 2000 to 2016 were extracted from the Medical Birth Registry of Norway and linked to the Norwegian Quality and Surveillance Registry for Cerebral Palsy. The mother's country of birth was categorized into three groups: non-immigrant (born in Norway); immigrant from high-income countries (HICs); and immigrant from low- and middle-income countries (LMICs) (born abroad giving birth in Norway). Birth prevalence of CP and prevalence of perinatal mortality per 1000 live births were calculated. Odds ratios (ORs) for CP among live-born children of non-immigrant mothers compared to mothers from HICs and LMICs were calculated using logistic regression, both unadjusted and adjusted for each risk factor for CP. Pearson χ2 tests were used to compare the proportions of clinical characteristics. The prevalence of CP among non-immigrant mothers was 2.11 per 1000 live births, 1.44 among mothers from HICs, and 1.71 among mothers from LMICs. The OR for CP in mothers from HICs was 0.68 and 0.81 in mothers from LMICs. Despite mothers from LMICs having higher proportions of consanguinity and lower folate intake, and their children having lower Apgar scores, the ORs for CP were unchanged after adjusting for these. Yet, children born to mothers from LMICs had higher perinatal mortality; their children with CP had higher proportions of intellectual disability. The lower birth prevalence of CP among children born to mothers from LMICs was unexpected. Yet, children born to mothers from LMICs had higher perinatal mortality, which could impact the number of live-born children with CP.

P-362. Outbreak of neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023

Abstract Background Sepsis is a leading cause of neonatal mortality and morbidity worldwide, notably in Kyrgyzstan. In January 2023, six neonatal sepsis deaths were reported within two weeks at a 157-bed maternity hospital, which usually has &amp;lt; 2 cases/month. We investigated to identify sources of infection and risk factors.Table 1.Factors associated with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023*AOR- adjusted odds ration; ** CI- confidence interval; ***1. Healthy population (Reference group): Apgar scores at 1 and 5 min above 7; Unhealthy population: Apgar scores at 1 min below 7 and at 5 min below 7; Improved population: least one below 7 Methods A concurrent case-control study included infants (&amp;lt; 28 days old) born at the hospital in January 2022-February 2023 and diagnosed with sepsis. Controls met same criteria and were born +/- 1 day from cases without sepsis. In February 2023, we collected rectal, nasopharyngeal, and high-touch environmental areas swabs in a single-day cross-sectional sample of hospitalized case-patients and mothers for culturing and MALDI-TOF. We used logistic regression to identify factors associated with sepsis.Figure 1.Two clusters of Acinetobacter baumannii detected among newborns with neonatal sepsis in a maternity hospital in Kyrgyzstan, 2022-2023 Results The study comprised 129 cases and 509 controls. More cases than controls weighed &amp;lt; 2500g at birth (52% vs 5%, p&amp;lt; 0.01), had anhydrous interval of ≥12 hours (43% vs 29%, p&amp;lt; 0.01), had Apgar scores of &amp;lt; 7 at 1 minute (83% vs 20%, p&amp;lt; 0.01), were more likely to receive both ventilation and an invasive device (98% vs 1%, p&amp;lt; 0.01) and to be admitted to the intensive-care unit (ICU) (82% vs 17%, p&amp;lt; 0.01) (Table 1). Sepsis was associated with birth weight of ≤2500g vs greater (adjusted odds ratio: 5.6; 95% confidence interval: [2.1-15.1]), infant blood transfusion vs no (9.9 [3.8-26.0]), use of ventilation and invasive device vs no (144 [28.8-729.7]), Apgar scores at 1 and 5 minutes &amp;lt; 7 vs greater (2.8 [1.0-7.8], urinary tract disease in mother vs not (3.5 [1.1-10.6]), and anhydrous interval ≥12 hours vs less (2.6 [1.2-5.5]). Acinetobacter baumannii resistant to cephalosporins, aminoglycosides, and fluoroquinolones was detected in 8/8 pharyngeal swabs from case-patients in two ICU rooms, forming two distinct clusters (Figure 1). Acinetobacter baumannii was not detected in environmental sampling, but the hospital had conducted deep cleaning shortly before the environmental team arrived. Conclusion Resistant Acinetobacter baumanni likely contributed to the outbreak. The hospital conducted environmental cleaning, replaced non-disposable instruments (cannulas, masks, tubes) and updated infection control practices. Neonatal sepsis cases dropped sharply to &amp;lt; 2/month by May 2023. Disclosures All Authors: No reported disclosures

Retrospective analysis of the effect of electronic cardiotocography on selected birth and neonatal variables among 4172 women from a Single Centre in Warsaw, Poland.

Cardiotocography (KTG) is widely used for continuous or intermittent assessment of fetal heart function. This study aimed to compare the effects of continuous and intermittent KTG during labour on selected variables. In a retrospective study, 4172 medical records of Warsaw Hospital (Poland) patients were analysed. The study group consisted of 2111 women with continuous KTG during labour and the control group of 2061 women with periodic KTG. The median age of the women was 30 years, and the median gestation period was 40 Hbd. Most of the women lived in urban areas (87.15%), were in a relationship (82.05%) and had a higher education (86.60%). In the group with intermittent OCT, delivery by caesarean section was indistinguishably more frequent (OR = 1.06; 95% CI = 0.87-1.30), there were significantly fewer grade II perineal ruptures (OR = 1.65, 95% CI = 1.07-2.55), grade III- and IV perineal ruptures (OR = 5.13, 95% CI = 1.12-23.53) and oxygen therapy (OR = 1.76, p = 0.004). More infants with Apgar scores ≤ 7 points at the fifth minute (OR = 0.34, 95% CI = 0.12-0.094), requiring nCPAP (Nasal Continuous Positive Airway Pressure) (OR = 0.56, 95% CI = 0.39-0.86) and resuscitation [OR = 0.37, 95% CI = 0.17-0.79]) were born in the group with periodic ECG. The analysis showed that the group of women with continuous OCT during labour had a lower risk of acid-base disorders (OR = 0.45, 95% CI = 0.21-0.98) CONCLUSIONS: Continuous KTG during labour in high-risk women increases the likelihood of instrumental delivery (using vacuum) and perineal incision compared with periodic KTG. The use of intermittent ECG during labour reduces the number of newborns with Apgar scores ≤ 7 points and decreases the number of neonatal interventions such as nCPAP and resuscitation.

P-2154. Cryptosporidium in pregnancy and the impact upon pregnancy outcomes

Abstract Background Cryptosporidiosis, an infectious disease caused by the protozoan parasite Cryptosporidium, poses a significant threat to individuals with compromised immune systems. Over the past four years, a notable rise in the incidence of cryptosporidiosis has been observed in Israel, including among pregnant women. Despite this increase, little is known about the impact of cryptosporidiosis on obstetrical outcomes. The objective of this study was to evaluate the influence of Cryptosporidium infection on pregnancy outcomes.Figure 1Epidemic curve, cryptosporidiosis in pregnant women, Maccabi Healthcare Services Methods A retrospective case-control study. Pregnant women with positive results on multiplex real-time PCR stool tests for Cryptosporidium were compared to pregnant women with negative results, matched by age, week of pregnancy during the stool test, and sector. Medical records of the study cohort were reviewed for symptoms, treatments, pregnancy outcomes including termination, gestational age, birth weight, Apgar score, and head circumference. Significance was determined using Fisher's exact or Chi-square tests.Table 1Baseline patient characteristics and symptoms, pregnant women infected with cryptosporidium Results Between January 2020 and December 2023, 2512 pregnant women underwent PCR stool testing. Of them, 96 individuals were positive for Cryptosporidium, mostly in 2022 (Figure 1). Their median age was 31 years and ranged 23-42 years with medium-high socioeconomic status (37 and 39 women, respectively) (Table 1). Among those who tested positive, 93 out of 96 (96.7%) reported symptoms of diarrhea, and the infection was self-limiting in all cases, with none requiring specific treatment. In comparison to matched controls, no statistically significant differences were observed in the rates of intrauterine growth retardation, birth weight, delivery week, miscarriage, Apgar score, and head circumferences among the infants born to mothers with Cryptosporidium infection. Conclusion This study sheds light on the clinical course of Cryptosporidium infection in pregnant women, emphasizing a generally favorable outcome without the necessity for therapeutic intervention. Further research may be warranted to explore the potential long-term effects and to refine preventive measures for this specific population. Disclosures Shirley Shapiro Ben David, MD, GSK: Lecturer|Pfizer: Grant/Research Support|Pfizer: Lecturer

Evaluation of the utility of the sFlt-1/PlGF ratio in pregnancy complicated by pre-eclampsia - single-center study. Preliminary analysis.

To evaluate relationship between sFlt-1/PlGF ratio, clinical characteristics and outcomes of pre-eclampsia. Retrospective analysis of 29 pregnant women with pre-eclampsia who had measured sFlt-1/PlGF ratio was conducted using electronic medical records from Obstetrics and Perinatology ward of University Hospital in Cracow. Women median age: 33.5 years, number of pregnancies: one 52%, two 15%, three 18%,more than three 15%, number of deliveries: one 59.3%, two 37%, three 3.7%, median body mass index during hospitalization: 29.4 kg/m². Chronic diseases apart from hypertension: 67% of women (diabetes 37%, hypothyroidism 26%, obesity 11%). Median newborns birth weight: 1640 g, median Apgar score at 5 minutes: 8, median umbilical cord blood pH: 7.32. Fetal growth restriction: 28.6% of cases. All deliveries were by c-section. Median gestational age at delivery: 32 weeks. sFlt-1/PlGF ratio was inversely correlated with gestational age at delivery (r = -0.42, p = 0.02). The median sFlt-1/PlGF ratio was higher in women with severe pre-eclampsia (n = 15) than in those with mild pre-eclampsia (n = 14) (211 vs. 57, p < 0.001). sFlt-1/PlGF ratio of > 85 had a sensitivity of 80% and a specificity of 71% for predicting severe pre-eclampsia. sFlt-1/PlGF ratio is useful in assessing the severity and prognosis of pre-eclampsia. sFlt-1/PlGF ratio should not be used as a sole criterion for making clinical decisions, but as an adjunct to other clinical and laboratory parameters.

Evaluating the ability of fullPIERS calculator to predict adverse maternal outcomes in pre-eclampsia at Charlotte Maxeke Johannesburg Academic Hospital.

To evaluate the ability of the fullPIERS model to predict adverse maternal outcomes in patients diagnosed as early-onset pre-eclampsia at Charlotte Maxeke Johannesburg Academic Hospital, South Africa. Retrospective record review and analysis of 134 patients admitted with early-onset pre-eclampsia. Demographic data, symptoms, and investigation results relevant to the fullPIERS calculator present on admission were collected. Adverse maternal outcomes occurring before the end of 7 days from admission were recorded. Descriptive analysis was conducted, χ2 and Wilcoxon rank-sum tests were used to evaluate the association between fullPIERS parameters, score, and adverse outcomes. Performance of fullPIERS score was evaluated by positive and negative predictive values, sensitivity, specificity, and receiver operating curve analysis. The median age was 34 years (interquartile range [IQR] 28-37 years). A total of 131 deliveries were recorded at a median gestation of 31 weeks (IQR 29-33 weeks). Most deliveries (71; 54.2%) were due to fetal indications and 102 (77.9%) were by cesarean section. A total of 20 (15.1%) patients had adverse maternal outcomes. Three (2.6%) neonates were delivered with Apgar score less than 7 at 5 minutes and were all admitted to the neonatal intensive care unit. FullPIERS formula predicted adverse maternal outcomes with positive and negative predictive values of 100% and 94.9%, respectively, and sensitivity and specificity of 70% and 100%, respectively. The area under the receiver operating characteristic curve was 0.88 (95% confidence interval 0.75-0.95), which shows good discrimination. FullPIERS model is a useful adjunct in identifying patients at high risk of adverse outcomes from early-onset pre-eclampsia; this allows timely and appropriate management.

A comparative analysis of methods of preinduction cervical ripening and induction of labor in Poland and in Germany (Part II): maternal and neonatal outcomes

The benefits and risks of delivery should always be considered before initiating preinduction cervical ripening and labor induction. Understanding the benefits and potential complications is crucial for healthcare professionals to make informed decisions and provide optimal care. The research was conducted retrospectively between January 2019 and July 2022. It involved the analysis of the medical records of 154 pregnant women staying in the Clinic of Obstetrics and Gynecology in the city of Szczecin and 150 pregnant women hospitalized in the Clinic of Obstetrics and Gynecology in the town of Schwedt/Oder in Germany. Inclusion criteria were consent to participate and the implementation of internal written protocols in line with national guidelines for labor induction. The research concerned a group of pregnant women with postdate pregnancy, calculated according to the Naegele’s rule and confirmed by the USG examination conducted in the first trimester of the pregnancy, as well as an unfavorable cervix that received less than 6 points in the Bishop score. Moreover, the pregnant patients with a low biophysical profile and an abnormal record of CTG or comorbidities were also included, as these factors determined the classification of the group above. The study did not include patients who had undergone cesarean section. The average change in evaluation of the cervix marked on the Bishop Score was higher in Germany, and it was 2.7 points, whereas in Poland, it was 1.6 points. The largest percentage of the scores on the Apgar Scale in the first, third and fifth minutes after birth was in the norm and indicated a good health condition of infants. They reached 8 to 10 points in both countries. Significantly more infants in Germany received pH from the umbilical cord within the limits of the norm. And it marks the welfare of neonates (7.20–7.45). The duration of hospitalization in Poland was shorter than in Germany. It was 3.8 days in the case when the median equalled 3. The number of days of preinduction cervical ripening and induction was similar in both countries. The levels of haemoglobin were comparable in both countries. The most common postpartum complications in Poland and Germany were first-degree perineal tears, episiotomies and anemia. Among the postpartum complications, cervical tears, revision of the uterine cavity, and episiotomy were significantly more common in Poland. First- and second-degree perineal tears were more frequent in Germany.

Mediolateral episiotomy and obstetric anal sphincter injuries in nullipara: a propensity score matching study

BackgroundObstetric anal sphincter injuries are a notable adverse outcome of vaginal deliveries, with incidence rates ranging from 0.25% to 6%. Key risk factors for these injuries include primiparity and operative vaginal deliveries. In recent decades, the use of episiotomy as a preventive measure for obstetric anal sphincter injuries has been subject to extensive scrutiny. The objective of this study was to investigate the role of mediolateral episiotomy in preventing obstetric anal sphincter injuries during vaginal deliveries or vacuum-assisted deliveries within the context of selective use.MethodsRetrospective study of all nulliparous women with a singleton gestation who underwent term vaginal delivery or vacuum-assisted delivery. A propensity score matching with a 1:1 ratio was employed to adjust for confounders. Primary outcome was obstetric anal sphincter injury rate, and the secondary outcome was a composite neonatal outcome (umbilical artery pH < 7.1, neonatal intensive care unit admission, and 5-min Apgar score < 7).ResultsThe study cohort comprised 22,738 deliveries: 77.0% vaginal deliveries (17,518/22,738) and 23.0% vacuum-assisted deliveries (5,220/22,738) with episiotomy rates of 38.5% (6,751/17,518) and 75.8% (3,959/5,220), respectively. Separate analyses were conducted for the matched vaginal delivery group (n = 13,500) and the matched vacuum-assisted delivery group (n = 2,518). No significant differences in obstetric anal sphincter injury rates were observed in the vaginal delivery (OR 1.15, 95% CI 0.78–1.69) or vacuum-assisted delivery (OR 0.58, 95% CI 0.31–1.05) groups. However, in the vacuum-assisted delivery group, episiotomy demonstrated a borderline protective effect against obstetric anal sphincter injuries. Further adjustment for the duration of the second stage of labor duration in vacuum-assisted deliveries revealed a significant protective effect of episiotomy against obstetric anal sphincter injuries, with a number needed to treat of 28 (95% CI 15—224) in cases of prolonged second stages of labor. Episiotomy in vaginal deliveries was associated with a higher rate of composite neonatal outcome (OR 1.23, 95% CI 1.04–1.45), while vacuum-assisted deliveries showed no such association (OR 1.11, 95% CI 0.86–1.44).ConclusionsIn context of selective use, mediolateral episiotomy has no significant protective effect on obstetric anal sphincter injuries in women undergoing vaginal delivery. However, there is a possible benefit in vacuum-assisted delivery, especially when considering the duration of the second stage of labor.

Time to recovery of neonatal sepsis and its predictors in public hospitals of North Shoa Zone, Central Ethiopia

BackgroundNeonatal sepsis remains one of the most common causes of morbidity and mortality among neonates in developing countries. It can cause severe morbidities and sequelae, even though patients survive. Prolonged recovery time of neonatal sepsis leads to hospitalization, increased cost of treatments, antimicrobial resistance, disseminated intravascular coagulation, respiratory failure, septic shock, brain lesions, renal failure, and cardiovascular dysfunction, and eventually death. Thus, this study aimed to identify the time-to-recovery of neonatal sepsis and its predictors among newborns admitted to public hospitals in the North Shoa Zone, Central Ethiopia.MethodsA retrospective cohort study was conducted among 508 septic neonates admitted to selected public hospitals in the North Shoa Zone between March 1, 2021, and March 1, 2023. A systematic random sampling method was used to select eligible medical records. The data were collected through the open data kit (ODK) Collect Android app and consequently exported to STATA version 17 for analysis. The data were analyzed using both univariable and multivariable Cox regression models. The adjusted hazard ratio (AHR) with its corresponding 95% confidence interval (CI) was employed.ResultsOf all septic neonates, 441 were recovered. The predictors of time-to-recovery of neonatal sepsis were premature rupture of membrane (PROM) (AHR = 0.37; 95% CI: 0.21, 0.63), intrapartum fever (AHR = 0.49; 95% CI: 0.32, 0.75), chest-indrawing (AHR = 0.50; 95% CI: 0.36, 0.68), fifth-minute appearance, pulse, grimace, activity, and respiration (Apgar) score less than seven (AHR = 0.54; 95% CI: 0.38, 0.77), gestational age between 37 and 42 weeks (AHR = 1.35; 95% CI: 1.06, 1.70), septic shock (AHR = 0.52; 95% CI: 0.31, 0.85).ConclusionThe median time to recovery from neonatal sepsis in this study was comparable to the previous studies. Premature rupture of membranes, intrapartum fever, term gestational age, low fifth minute Apgar score, chest indrawing, and septic shock were the predictors of time-to recovery of neonatal sepsis. Therefore, birth attendants are advised to closely adhere to the obstetrics management protocols when providing care for women who have intrapartum fever and premature rupture of membranes, as this will help to minimize neonatal sepsis and the subsequent delay in recovery.

Clinical Characteristics and Influencing Factors of Feeding Intolerance After Surgery for Neonatal Necrotizing Enterocolitis

Background: Feeding intolerance (FI) following surgery for neonatal necrotizing enterocolitis (NEC) can impact recovery and prognosis, making the early identification of FI risk essential for optimizing management and improving outcomes. Methods: We retrospectively collected data from patients who underwent surgery for NEC between January 2013 and December 2023. Multivariate binary logistic regression was performed to identify independent factors influencing postoperative feeding intolerance. Results: Of the 519 infants enrolled in this retrospective study, 155 (29.9%) were diagnosed with feeding intolerance, while 364 (70.1%) were identified as having feeding tolerance. Compared to infants with feeding tolerance, those with feeding intolerance had lower birth weight, smaller gestational age, and lower Apgar scores (all p &lt; 0.01). A 5 min Apgar &lt; 7 (OR 4.794; 95%CI 1.339–17.156), the interval between diagnosis and surgery (OR 0.973; 95%CI 0.947–1.000), and primary anastomosis resection (OR 0.278, 95%CI 0.139–0.555) were identified as significant factors influencing postoperative feeding intolerance. The results remained consistent after performing propensity score matching analysis. Feeding intolerance may result in prolonged hospital stays, and more complications such as retinopathy of prematurity, intestinal failure-associated liver disease, and intraventricular hemorrhage. Conclusions: A lower 5 min Apgar score, shorter interval from diagnosis to surgery and intestine resection with ostomy are associated with a higher incidence of FI after surgery. FI after NEC surgery can prolong recovery and increase family burden.

Retrospective Analysis of the Correlation between Umbilical Blood Flow Index and Maternal and Fetal Outcomes in Pregnant Women with Gestational Diabetes.

Aims/Background Gestational diabetes mellitus (GDM) is a common complication during pregnancy. This retrospective study investigates the correlation between umbilical blood flow index and maternal-fetal outcomes in pregnant women with GDM, aiming to contribute to evidence-based risk assessment and management strategy in this high-risk obstetric population. Methods This retrospective study recruited 119 pregnant women with GDM who were admitted to the Yichang Central People's Hospital, between January 2022 and January 2024. Based on the umbilical blood flow index, the study participants were divided into a normal umbilical blood flow (UBF) index group (n = 56) and a high UBF index group (n = 63). Colour Doppler ultrasound was used to assess umbilical blood flow, and relevant data on maternal, fetal, and neonatal outcomes were obtained from the hospital's electronic medical records. Results We observed that, compared to the normal UBF index group, the high UBF index group exhibited significantly higher rates of adverse pregnancy outcomes, including the cesarean section (p = 0.022), preterm delivery (p = 0.020), gestational hypertension (p = 0.019), neonatal hypoglycemia (p = 0.015), as well as increased incidence of neonatal complications such as respiratory distress syndrome (p = 0.009), neonatal jaundice (p = 0.022), neonatal intensive care unit (NICU) admission (p = 0.015), lower 5-minute Apgar scores (p = 0.013), and neonatal sepsis (p = 0.005). Furthermore, significant differences were observed in fetal biometric parameters and placental morphology between the two groups (fetal weight: p = 0.003; estimated fetal weight percentile: p = 0.017; femur length: p = 0.018; placental weight: p = 0.019; placental volume: p = 0.021). Additionally, correlation analyses indicated significant associations between umbilical blood flow index and maternal and fetal outcomes (p < 0.05). Conclusion We observed a significant correlation between umbilical blood flow indices and maternal and fetal outcomes in pregnant women with gestational diabetes mellitus, implying its utility as a non-invasive parameter for risk stratification and personalized management in this high-risk obstetric population.

The benefit of additional embolization after perioperative balloon occlusion of pelvic artery during cesarean hysterectomy in placenta accreta spectrum.

Cesarean hysterectomy in the placenta accreta spectrum (PAS) remains challenging due to difficulty in controlling perioperative bleeding. To compare the effectiveness and safety of perioperative balloon occlusion with versus without pelvic artery embolization in PAS women who underwent a cesarean hysterectomy. A total of 26 pathological confirmed cases of PAS were retrospectively reviewed and categorized into two groups: perioperative balloon occlusion at either the anterior division of the internal iliac artery or uterine artery followed by gelfoam embolization (n = 12, study group) and perioperative balloon occlusion alone (n = 14, control group). Intraoperative estimated blood loss (EBL), a unit of packed red blood cell (pRBC) transfusion, surgical time, transfer to the intensive care unit (ICU), postoperative hospitalization days, postoperative complications, and Apgar scores were compared between the two groups. The median and interquartile range (IQR) intraoperative EBL in the study group (1200 mL [700-2100 mLl]) was significantly lower compared to those in the control group (1900 mL [1300-3200 mL]) (P = 0.044). There was no significant difference between the study and control groups in units of pRBC blood transfusion, surgical time, transfer to the ICU, postoperative length of stay, postoperative complications, and mean Apgar score at 1 min and 5 min. The perioperative combination of balloon occlusion followed by embolization of the pelvic artery before cesarean hysterectomy is more effective in reducing blood loss than perioperative balloon occlusion alone in PAS with no difference in postoperative complications or neonatal outcomes.

Is there an association between lateral uterine localization of the placenta and pregnancy outcomes?

To evaluate the association between lateral placentation and adverse perinatal outcomes, including rates of small for gestational age (SGA) neonates, hypertensive (HTN) disorders, and preterm delivery, as well as postpartum hemorrhage and retained placenta. This retrospective cohort studyincluded all women with singleton pregnancies who underwent a trial of labor after reaching 24weeks of gestation, at a single tertiary medical center, over a period of6years. The study group included women with lateral placentation. Controls were women with anterior, posterior, or fundal placentation. Power analysis indicated that 882 women in each group would be sufficient to detect an increased rate of the primary outcomes: preterm delivery, hypertensive disorders or SGA in the lateral placenta group. Secondary outcomes were Apgar score, cord pH and retained placenta. Overall, 1,817 (7.6%) women had lateral placenta and 21,991 (92.4%) anterior, posterior, or fundal placentation. No significant differences were observed between groups in the rates of hypertensive disorders, SGA or preterm birth. Lateral placentation was associated with a longer third stage of labor (11.1 ± 8.6min vs. 10.4 ± 7.2min, p = 0.001) and higher rate of retained placenta (5.7% vs. 4.2%, p = 0.002). Multivariate regression found that lateral placentation was independently associated with longer third stage of labor. Lateral placentation was not associated with increased rates of hypertensive disorders, preterm birth or SGA infants. It was linked to a longer third stage of labor but without a significant impact on maternal or perinatal complications.

Assessing the Impact of Distance Traveled and Birth Volumes of Hospital Maternity Units on Newborn Outcomes: Population-Based Cohort Study.

The centralization of childbirth and newborn care in large maternity units has become increasingly prevalent in Europe. While this trend offers potential benefits such as specialized care and improved outcomes, it can also lead to longer travel and waiting times, especially for women in rural areas. This study aimed to evaluate the association between hospital maternity unit (HMU) volumes, road travel distance (RTD) to the hospital, and other neonatal outcomes. We conducted a population-based cohort study including all live births in hospitals without intensive care units between 2016 and 2019 in the Lombardy region, Italy. Given the hierarchical structure of our data (births nested within hospitals), we employed log-binomial regression models with random intercepts to estimate relative risks and 95% CIs for evaluating the association between HMU volumes (≥1500 births/year) and RTD (<5 km) with the risk of being transferred and/or death after birth (primary outcome). Secondary outcomes included a low Apgar score at 5 minutes and low adherence to antenatal care (ANC). We controlled for several potential confounders including adherence to the ANC pathway for the primary and low Apgar outcomes. To explore the influence of HMU volumes on the primary outcome, we identified the fractional polynomial model that best described this relationship. Of 65,083 live births, 71% (n=45,955) occurred in low-volume hospitals (<1000 births/year), 21% (n=13,560) involved long-distance travel (>15 km), 1% (n=735) were transferred and/or died after birth, 0.5% (n=305) had a low Apgar score at 5 minutes, and 64% (n=41,317) completely adhered to ANC. The risk of transfer and/or death increased as HMU volume decreased, ranging from 1% for hospitals with 1000-1500 births/year to a 3.6-fold high risk for hospitals with <500 births/year (compared to high-volume hospitals). Travel distance did not affect the primary outcome. Neither HMU volume nor RTD were associated with low Apgar scores. Conversely, the risk of complete adherence to ANC decreased with lower HMU volumes but increased with shorter RTD. Additionally, high-volume hospitals demonstrated a decreasing trend in the frequency of the primary outcome, with transfer and/or death rates ranging from 2% to 0.5% and flattening to 0.5% in hospitals, with activity volume ≥1000 mean births/year. Our findings showed an excess risk of neonatal transfer and/or death for live births in HMUs with low activity volumes without an intensive care unit. In contrast, RTD primarily affected adherence to ANC. Moreover, data suggest that 1000 births/year could be an optimal cutoff for maternity hospitals to ensure an appropriate standard of care at delivery.