Apgar Score Research Articles

The diagnostic and prognostic value of serum angiopoietin-like 4 level in neonatal respiratory distress syndrome.

Neonatal respiratory distress syndrome (NRDS) is the most common respiratory disease in preterm infants (PIs). The implication of Angiopoietin-like 4 (ANGPTL4) was reported in lung diseases. We delved into the role of serum ANGPTL4 in NRDS diagnosis/prognosis. Totally 256 PIs were prospectively selected, including 128 NRDS infants and 128 non-NRDS PIs. NRDS infants were assigned into Survival and Death groups. ANGPTL4 level in PIs and its diagnostic and prognostic value for NRDS were separately assessed by ELISA and receiver operating characteristic curve. The independent risk factors (IRFs) for death in NRDS infants were analysed by multivariate logistic regression. NRDS infants exhibited reduced gestational age, birth weight, and 5min Apgar score. ANGPTL4 level rose in NRDS infants, and increased with NRDS severity. Serum ANGPTL4 level was negatively correlated with 5 min Apgar score in NRDS infants. The area under the curve of serum ANGPTL4 for the diagnosis of NRDS was 0.902, with 88.28% sensitivity, 86.72% specificity, and 255.98ng/mL cut-off value; the AUC for the diagnosis of severe NRDS was 0.741, with 66.67% sensitivity, 79.52% specificity, and 625.5ng/mL cut-off value. Low gestational age, birth weight and 5 min Apgar score, severe NRDS, and elevated serum ANGPTL4 levels were IRFs for death in NRDS infants. NRDS infants with increased serum ANGPTL4 level displayed decreased survival rate and short survival time. ANGPTL4 exhibited high diagnostic value and predictive value for death in NRDS, and it served as a biomarker for the diagnosis and prognosis of NRDS.

A cross-sectional study on posttraumatic growth and influencing factors among parents of premature infants

ObjectivePreterm birth is a significant public health concern that negatively affects parents’ mental health. Posttraumatic growth (PTG) is a positive response to trauma that can effectively help parents cope with the stress of preterm birth. However, few studies have investigated PTG among parents with preterm infants. This study aimed to examine the level and influencing factors of PTG among parents with preterm infants and to explore its relationship with social support coping styles.MethodsA cross-sectional study was conducted among 160 parents of premature infants in a hospital in Shenzhen, China, from May 2022 to August 2022. Parents’ demographic information and birth-related characteristics were collected through a self-designed general information questionnaire. PTG was assessed using the Chinese version of the Posttraumatic Growth Inventory (PTGI). Social support and coping style were measured using the Social Support Scale(SSS) and the Ways of Coping Questionnaire(WCQ). Pearson correlation analysis was used to investigate the relationship between PTGI and WCQ and SSS .A stepwise multiple linear regression analysis was performed to explore independent influencing factors of PTG.ResultsThe parents had an average PTG score of 66.41 ± 10.37, with 81.11% having a low and medium level of PTG. The total score of coping style of parents of premature infants was (34.28 ± 4.97) points, which was in the middle and upper level; the total score of social support of parents of premature infants was (14.28 ± 4.97) points, which was in the middle level. In addition, older gestational age at birth (B = 2.396, P < 0.001) ,higher Apgar score at 5 min at birth (B = 2.117, P = 0.023), positive coping style (B = 0.850, P < 0.001), and higher social support score (B = 1.978, P < 0.001) were associated with higher PTG scores.ConclusionParents of preterm infants have low to medium levels of PTG, indicating much room for improvement. Older gestational age, higher Apgar score at five minutes at birth, positive coping styles, and high levels of social support were associated with higher PTG levels. Our findings provide helpful guidance for the development of effective and targeted intervention programs to improve parents’ PTG and well-being.

The Impact of Increased Maternal Body Mass Index on Fetomaternal Outcome in Labour and Delivery

Background: Maternal obesity during pregnancy is now seen as one of the most common risk factors that can lead to negative outcomes for both mothers and their babies. Obesity is becoming a more significant concern in the field of obstetrics, and it is imperative that we prioritize its management. Objective: The aim of the study is to evaluate and compare the fetomaternal outcome among pregnant women with different BMI. Materials and Methods: This cross sectional analytical study was conducted on the admitted patients with full term singleton pregnancy in labour in the Department of Obstetrics &amp; Gynecology of Sir Salimullah Medical College and Mitford Hospital from July 2021 to January 2022. A total of 150 pregnant women with full term singleton pregnancy in labour were selected fulfilling the inclusion and exclusion criteria. Informed written consent was taken from each respondent. All data relevant to variables of the study was collected in a data collection sheet. Results: Study revealed a significant difference between normal and overweight BMI in Anaemia, with 34 (45.33%) vs 12 (16%) p&lt;0.001. Gestational Diabetes Mellitus 4 (5.33%) vs 13 (17.33%), respectively p 0.02, Preeclampsia 5 (6.67%) vs 14 (18.67%), respectively p 0.02, Large for Gestational Age 2 (2.67%) vs 11 (14.7%), respectively p 0.009, and Small for Gestational Age 12 (16.0) vs 4 (5.33%), respectively p 0.03. Macrosomia (&gt;4.0kg), APGAR score &lt; 7 at 1min and NICU admission were significantly higher in overweight/obese mother compare to normal weight group (p&lt;0.05). Conclusion: Overweight/obese during pregnancy carries high maternal and fetal risks. Increase in the need for induction of labor, instrumental delivery, caesarean section was associated with pregnancies complicated with overweight/obese.

Impacts of Ramadan fasting during pregnancy on pregnancy and birth outcomes: An umbrella review.

Despite a large number of primary research studies, and systematic and narrative reviews, there is no consensus on the impact of fasting during Ramadan while pregnant on pregnancy and birth outcomes. Currently, there is no evidence-based guideline for Muslim women regarding Ramadan fasting during pregnancy and clinicians cannot provide firm recommendations. To review the current evidence regarding the impact of Ramadan fasting during pregnancy on pregnancy and birth outcomes. We conducted an umbrella review of all systematic and narrative reviews examining the impacts of fasting during Ramadan while pregnant on pregnancy and birth outcomes by searching PubMed, CINAHL, and Cochrane Registry of Systematic Reviews databases between November 2023 and February 2024. We included all systematic and narrative reviews examining the impacts of Ramadan fasting on pregnancy and birth outcomes. The primary outcome was the change in birth weight, gestational age at birth, fetal growth indices, and Apgar score as well as the risk of delivery by cesarean section and the risks of gestational diabetes and pre-eclampsia. We summarized the data using narrative synthesis and descriptive statistics as appropriate. This study was registered with PROSPERO, ID: CRD42023478819. Out of 943 published reports identified across all database searches, 13 systematic and narrative reviews were included, of which three were systematic reviews with meta-analysis, six were systematic reviews without meta-analysis, and the remaining four were narrative reviews. There is no sufficient evidence that Ramadan fasting during pregnancy may reduce gestational age at birth or increase the risk of preterm birth (PTB). There is little evidence to support the hypothesis that maternal Ramadan fasting may reduce birth weight or increase the risk of low birth weight (LBW). Systematic reviews showed pooled estimates of odds ratios ranging between 0.93 (95% confidence interval [CI] 0.60-1.44) and 0.99 (95% CI 0.72-1.37) for PTB, and between 1.05 (95% CI 0.87-1.26) and 1.37 (95% CI 0.74-2.53) for LBW. There is no sufficient evidence that Ramadan fasting during pregnancy may increase the risk of delivery by cesarean section, gestational diabetes, or the risk of pre-eclampsia. None of the reviews reported evidence regarding the impacts of fasting during pregnancy on rare but clinically significant pregnancy and birth outcomes such as stillbirth, miscarriage, congenital anomalies, or neonatal deaths. There is little evidence that Ramadan fasting during pregnancy can negatively impact pregnancy and birth outcomes. Primary research studies on this issue suffered from significant methodologic limitations and systematic reviews showed significant heterogeneity for several pregnancy and birth outcomes. High-quality primary research studies that collect data on multiple confounders and effect modifiers are needed to investigate this issue and help reaching evidence-based recommendations.

The effects of dance on maternal childbirth: a systematic review and meta-analysis

BackgroundPrevious guidelines have clearly stated that dance is safe and beneficial during pregnancy and for childbirth. However, due to the small sample size of individual studies and different interventions, there were inconsistencies about the effect of dance on maternal childbirth.MethodsWe included studies evaluating the effect of dance on women in labor. Risk of bias was assessed using the revised Risk of bias assessment tool for randomized controlled trials (RCTs). Data analyses was performed using Review Manager Software version 5.4.ResultsA total of 12 RCTs comprising 1,486 pregnant women were included in the analysis. We found that the rate of natural childbirth and satisfaction with delivery were higher in the dance group than in the control group.The pain at 30 min and at 60 min after the intervention were lower in the dance group than in the control group. Meanwhile, the duration of the first stage, the second stage and the total labor duration was shorter in the dance group than in the control group.However, there were no statistically significant differences in the pain at 90 min after intervention, the duration of the third stage, and the rate of the normal 1-minute Apgar scores > 7 points between the two groups.ConclusionsDance during labor could reduce labor pain to an extent, shorten the duration of labor, promote natural childbirth, and improve satisfaction with labor, with no adverse effects on neonatal outcomes.Trial registrationThe protocol for this review was prospectively registered in the international prospective register of systematic reviews (PROSPERO) under the registration number CRD42022351001.

Prevalence, characteristics, and adverse birth outcomes of teen births in West Virginia: A population-based study.

Despite falling teen birth rates in the United States, there is a disproportionate burden of teen births in rural regions. The study aims to investigate the characteristics of teenage mothers and examine the relationships between teen birth and adverse birth outcomes in the rural Appalachian state of West Virginia (WV). Data was obtained from a population-based cohort (Project WATCH) of all singleton live births in WV between May 2018 and April 2023. The primary exposure variable was mothers who gave birth when they were less than 20 years old (teenage births v. adult). Primary outcomes included birthweight, gestational age, NICU admission, 5-minute Apgar score, and breastfeeding status. Of 86,447 live births, 5,310 (6.15%) were birth to teenage mothers. Maternal characteristics of teenage mothers included minority racial groups, lower education, Medicaid, rural residence, and inadequate prenatal care. Teenage births were associated with lower mean birthweight aMD [b = -49.31g. (-65.37, -33.24)], low birthweight [<2500g. vs. ≥2500 g., aRR = 1.11 (1.0, 1.24)], and small for gestational age [v. appropriate for gestational age, aRR = 1.21 (1.12,1.30)]. Teenage mothers were less likely to exclusively breastfeed at discharge [aRR, 1.20 (1.11, 1.28)]. Analyses adjusted for maternal race/ethnicity, education, health insurance, smoking, substance use, prenatal care, diabetes, and residence type. Teenage births are high in WV and are linked to adverse infant outcomes. These findings may help identify at-risk groups for support and provide policymakers with information to design effective interventions to prevent teenage births and its negative outcomes.

Challenging Management of Pregnancy Complicated by Eisenmenger Syndrome; A Case Report

Women with diagnosed case of Eisenmenger syndrome are usually advised to avoid pregnancy because of high mortality rate 30% to 50%, which increase up to 65% in case of caesarean section. Literature survey showed, few case reports on successful pregnancy outcome with proper multidisciplinary approach in tertiary hospital those who wanted to continue pregnancy with informed written consent about high mortality rate patient with Eisenmenger syndrome who become pregnant are at a particular risk of rapidly progressive cardiopulmonary decompensation, thrombotic complications and sudden death2,3, because pregnancy related physiological changes are poorly tolerated in Eisenmenger syndrome. Prevention and early termination is advisable3,5. For patient who present in later stages of pregnancy, carefully coordinated multidisciplinary care involving experienced specialists from obstetrics, anesthesiology, cardiology, neonatology and critical care medicine is necessary to optimize the chances of survival for both mother and baby. We here present a case report of a 25- year -old 2nd gravida, P:1(VD-IUD) admitted in Fetomaternal medicine department, BSMMU with 36 weeks pregnancy with uncorrected ventricular septal defect(VSD), Eisenmenger syndrome, severe pulmonary hypertension ( 94mmHg), left ventricular dysfunction (EF-&lt;39%), Fetal growth retardation (Wt-1600gm), oligohydramnios (AFI-5.6cm), Gestational diabetes mellitus (on diet) with Hypothyroidism. By meticulous multidisciplinary approach Caesarean section done and shifted to Coronary care unit (CCU). She delivered a growth restricted (birth wt1500gm) male baby with Apgar score: 8 and managed in Neonatal care unit (NICU). University Heart Journal 2024; 20(1): 36-39

Pulmonary aspiration during pregnancy or immediately postpartum in the UK: A population-based case-control study

Background Pulmonary aspiration of gastric contents is the most frequent cause of death associated with complications of airway management during general anaesthesia. Pregnancy increases aspiration risk owing to factors including delayed gastric emptying and increased intragastric pressure. We describe the incidence, risk factors, management, and outcomes of maternal pulmonary aspiration in pregnancy in the UK. Methods We conducted a population-based surveillance and case-control study. Between September 2013 and August 2016, all UK consultant-led obstetric units prospectively identified cases of pulmonary aspiration among parturient women using a pre-defined case definition, and reported them via the UK Obstetric Surveillance System (UKOSS). Controls (n=1982) were obtained from four UKOSS studies conducted between 2005 and 2014. We calculated the incidence of pulmonary aspiration using 2013–2015 maternities as the denominator. We explored potential risk factors for aspiration using univariable logistic regression and described outcomes. Results We identified 12 cases of pulmonary aspiration, giving an incidence of 5.2 per 1,000,000 maternities (95% CI 2.69-9.09). Cases were significantly less likely than controls to be multiparous (unadjusted odds ratio [uOR] 0.255, 95% CI 0.069-0.946), and significantly more likely to undergo caesarean section (uOR 24.89, 95% CI 3.18-194.85) and to receive general anaesthetic for caesarean section (p&lt;0.001). Gestation was significantly shorter in cases than controls (uOR 0.782, 95% CI 0.702-0.870). Women who aspirated were significantly more likely to be admitted to the intensive therapy unit than controls (p&lt;0.001). Infants of women who aspirated had significantly lower Apgar scores and were more likely to be admitted to the neonatal intensive care unit or to be stillborn compared with infants of women in the control group. Conclusions Pulmonary aspiration is rare in UK obstetric anaesthetic practice; however, it remains a risk of general anaesthesia. Despite a large study population, our analyses lacked power to evaluate many potential risk factors. Future research should focus on developing methods to accurately identify pregnant women at risk of aspiration.

Perinatal and Delivery Outcomes Following Amniocentesis: A Case-Control Study in the Polish Population.

Background: Amniocentesis is a widely used invasive prenatal diagnostic procedure, recognized for its high sensitivity and low risk of complications. This study aims to evaluate the association between amniocentesis and pregnancy outcomes, such as miscarriage, preterm rupture of membranes (PROM), and preterm birth, as well as perinatal outcomes. Methods: A case-control study was conducted at the Regional Hospital in Kielce, Poland, from 2016 to 2022, involving 1834 patients, 225 of whom underwent amniocentesis, while 1609 did not receive any invasive diagnostics. Data were collected from medical records and included maternal factors such as age, BMI, delivery mode, complications, and newborn condition. Results: The study found no statistically significant differences between the study and the control groups regarding pregnancy or perinatal characteristics. Miscarriage occurred in 1.9% of the patients in the amniocentesis group, with no cases in the control group. Rates of preterm delivery were similar between groups (8.33% in the study group vs. 5.74% in the control group, p > 0.05). Postnatal outcomes, such as birth term, birth weight, and Apgar scores, were comparable across both groups. Fetal growth restriction was slightly more frequent in the study group (2.8% vs. 0.8%). One neonatal death was observed in each group. The relative risk of complications following amniocentesis was 1.69 (CI 0.38-7.24). Conclusions: Amniocentesis is a safe invasive prenatal procedure. It should be offered to every pregnant woman when necessary. Before the procedure, the patient should be clearly informed of the risk related to amniocentesis but at the same time reassured that the complication rate is very low.

Effect of short inter-pregnancy interval on perinatal and maternal outcomes among pregnant women in SSA 2023: Systematic review and meta-analysis.

After a live birth, the recommended interval before attempting the next pregnancy is at least 24 months (birth to pregnancy interval) in order to reduce the risk of adverse maternal, perinatal and infant outcomes. Short inter pregnancy interval associated with adverse perinatal and maternal outcomes. The objective of this review was to determine the effect of short inter pregnancy interval on perinatal and maternal outcomes in Sub-Saharan Africa 2023. A systematic and a comprehensive literature searching mechanism were used without any restriction, through Google scholar, PubMed, Scopus, Web of Sciences, and Grey literature databases for reporting the effect of short inter pregnancy interval. The JBI approach to critical appraisal, study selection, data extraction, and data synthesis was used for this review. All statistical analyses were done using STATA version17 software for windows, and meta-analysis was used with a random-effects method. The results are presented using texts, tables and forest plots with measures of effect and 95% confidence interval. Thirteen studies were included in this review and most of the studies level of heterogeneity across the study was considerable, mainly due to methodological variations, Statistical heterogeneity, and population and intervention variations of included studies. The effect of short inter pregnancy interval on perinatal and maternal outcome were low birth weight(RR (RR (95% CI) 1.98 (1.48, 2.47); I2:62.97%, preterm birth (RR (95% CI) 1.67 (1.31, 2.03); I2:51%, intra uterine growth retardation(RR (95% CI) 3.78 (2.07, 5.49); I2: 8.52%, low APGAR score(RR (95% CI) 3.49 (1.41, 5.57)); I2: 71.11%, premature rapture of membrane(RR (95% CI) 2.87 (1.22, 4.51)); I2: 49.22%, perinatal mortality(RR (95% CI) 2.95 (1.10, 4.81)); I2: 54.37% and maternal anemia(RR (95% CI) 3.06 (2.12, 3.99)); I2: 74.74%. As per our review the main effect of short inter pregnancy interval is low birth weight, preterm birth, intra uterine growth retardation, low APGAR score, premature rapture of membrane, perinatal mortality and maternal anemia. This might be very useful for healthcare policymakers and NGOs to emphasize on it.

Prevalence of Hypocalcemia in Infants of Mothers with Gestational Diabetes

Objective: To evaluate the prevalence of newborn hypocalcemia among infants of mothers with gestational diabetes. Study Design &amp; Setting: This cross-sectional study was conducted at PNS Shifa Hospital, Karachi, from November 2023 to March 2024 Methodology: Each mother's fasting blood sugar level was evaluated by drawing 5 ml of blood. At 24 hours after delivery, sterile blood samples (2 cc) were taken to determine the neonate's calcium level; a serum calcium level below 7 mg/dl was regarded as hypocalcemia. All information was gathered using a research template that was created in-house. Serum calcium was measured using the Arsenazo III method, and serum albumin was assessed using the bromocresol green (BCG) method. Results: The mean ± S.D. of the maternal age of the study participants was 26.83 ± 3.87 years. The mean ± S.D. of the gestational age of the study participants was 37.35 ± 0.86 weeks. The mean ± S.D. of fasting glucose levels of the study participants was 104.5 ± 15.1 mg/dl. A total of 27.5% of infants born to mothers with gestational diabetes had hypocalcemia. Infants' median Apgar scores at 1 and 5 minutes were 6 and 9, respectively. The prevalence of hypocalcemia in newborns was highest among mothers aged 21–30, though this difference was not statistically significant (p = 0.139). Conclusion: The results showed that 27.5% of infants born to mothers with gestational diabetes had hypocalcemia. Maternal age did not have a statistically significant association with hypocalcemia in newborns.

Fetal Therapy for Severe Drug-Resisted Tachyarrhythmia With Progressive Hydrops by Fetoscopic Transesophageal Pacing: A Successful Attempt in Single Chinese Fetal Medicine Center.

To describe the outcome of a case of severe drug-resistant fetal tachyarrhythmia with progressive hydrops treated with fetoscopic transesophageal pacing (FTEP). A case of fetal tachyarrhythmia complicated by progressive hydrops is presented. The fetus, diagnosed at 26+2weeks of gestation, had supraventricular tachycardia with a mechanism suggestive of atrial reentry. Maternal treatment included digoxin, sotalol and amiodarone, which were ineffective in controlling the arrhythmia. After failure of pharmacological therapy, FTEP was performed. A male baby was delivered by cesarean section, with the Apgar scores of 10 at 1min, 5 and 10min at 35+2weeks of gestation. An initial neonatal electrocardiogram demonstrated normal sinus rhythm. Follow-up is now up to 1year, without tachyarrhythmia or cardiac dysfunction. FTEP offers a potential rescue therapy for cases of severe drug-resistant fetal tachyarrhythmia associated with progressive fetal hydrops and cardiac dysfunction.

Insights from a publicly funded homebirth program.

There are high levels of consumer demand for homebirth in Australia, however access is limited due to a wide range of factors, including associated costs of a private midwife and the limited number of publicly funded homebirth models. Homebirth with a qualified midwife, networked into a health system, is a safe option for women with a low-risk pregnancy. This paper has two aims. The first is to describe the implementation of a publicly funded homebirth service with an employed mentor. The second is to provide the outcomes from a matched cohort of women who received care from the same Midwifery Group Practice [MGP] who gave birth at home, compared with those who gave birth in hospital. The retrospective comparative cohort study used routinely collected perinatal data from the hospital's electronic database (eMaternity) from July 2018 - October 2021. The cohort of interest were women who received care through MGP. They were identically matched by parity, age, Body Mass Index (BMI), spontaneous labour and gestation of 37-42 weeks. A description of the employed midwifery mentor to implement this model of care is also provided. 100 women gave birth at home during the study period. They were more likely to have a physiological birth (p < 0.001), intact perineum (p < 0.0001), and less likely to have a postpartum haemorrhage (p < 0.0001) compared to the matched cohort of women who birthed in hospital. There were less assisted births and caesarean section births for women who transferred from home to hospital (p < 0.0001). No statistical differences were seen between groups for postpartum haemorrhage, and Apgar score of < 7 at 5 minutes. This study demonstrated favourable outcomes for women receiving MGP who planned to birth at home compared to those women who chose a hospital birth. This is consistent with the existing literature that place of birth makes a difference. A description of the role of a mentor in supporting the sustainability of a publicly funded homebirth program is provided. Further research is recommended to evaluate the mentor's role in implementing and sustaining the model.

Fetomaternal Outcomes In Women Scheduled For C-Section In General And Spinal Anesthesia

Objective: Cesarean section (C-section) is one of the most routinely performed surgical procedures globally, with anesthesia having a significant role in deciding maternal and newborn outcomes. Study Design: A Cross sectional study Place and Duration of the Study: Study setting was Allied Health Sciences, Superior University, Lahore and duration of the study was six months jan 2024 to june 2024 Methodology: This comparative study included 100 women scheduled for elective C-sections, evenly divided into GA (n=50) and SA (n=50) groups. Demographic data, including age, BMI, parity, and gestational age, were recorded. Perioperative metrics including anesthetic induction duration, anticipated blood loss, hemodynamic stability, and recovery durations were assessed. Neonatal outcomes, encompassing APGAR scores, NICU admissions, and birth weights, were recorded. Results: Spinal anesthesia (SA) demonstrated superior outcomes compared to general anesthesia (GA) in cesarean sections, evidenced by reduced blood loss (500 ± 80 mL vs. 600 ± 100 mL), abbreviated hospital stays (3 ± 1 days vs. 4 ± 1 days), and enhanced patient satisfaction (9.0 ± 0.8 vs. 7.5 ± 0.8). In SA, neonatal outcomes improved with higher APGAR scores at 1 minute (8.6 ± 0.9 vs. 8.2 ± 1.1) and 5 minutes (9.8 ± 0.5 vs. 9.5 ± 0.7) and fewer NICU admissions (8% vs. 10% South Africa exhibited diminished postoperative systolic and diastolic blood pressure (120 ± 10 mmHg vs. 125 ± 12 mmHg and 72 ± 6 mmHg vs. 75 ± 7 mmHg), along with a decreased heart rate elevation (85 ± 9 beats/min vs. 90 ± 10 beats/min). SA demonstrated a reduced anesthetic induction duration (7 ± 1 min vs. 10 ± 2 min) and expedited postoperative ward transfer (10 ± 2 min vs. 15 ± 3 min). Regression analysis showed that preoperative vitals, age, BMI, and hospital stay duration predicted postoperative results. Cesarean patients exhibited enhanced perioperative stability, expedited recovery, and more satisfaction with spinal anesthesia. Conclusion: General anesthesia (GA) causes more blood loss, slower recovery, and lower patient satisfaction than spinal anesthesia (SA) for cesarean sections. SA also improves newborn outcomes and perioperative stability. Keyword: maternal, fetal, outcomes, Cesarean section, Spinal, General anesthesia

Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda

BackgroundGlobally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led initiatives, particularly those aimed at improving the use of dynamic birth positions, intrapartum support, and perineal protection, affect these outcomes.ObjectiveTo explore how the use of dynamic birth positions, intrapartum support, and perineal protection impact the incidence of perineal injuries and the 5-min Apgar score within the context of a midwife-led quality improvement intervention.MethodsA cohort of 630 women with uncomplicated full-term pregnancies was recruited from a hospital in Uganda. Observations and questionnaires assessed birth positions, intrapartum support, perineal protection, health outcomes and maternal characteristics. Primary outcomes included perineal injuries and the 5-min Apgar scores. The primary outcomes were analysed using descriptive data, with trends visualised through a run chart to assess changes during the midwife-led Quality Improvement intervention. Secondary outcomes included postpartum haemorrhage, admission to neonatal intensive care, newborn resuscitation, skin-to-skin care, and breastfeeding initiation.ResultA statistically significant association was found between women having intact perineum (i.e., no perineal injuries) and giving birth in a dynamic birth position [AOR; 0.6 (95% CI 0.4 – 0.90)], receiving intrapartum support [AOR; 0.9 (95% CI 0.9 – 1.0)], and using perineal protection measures [AOR; 0.3 (95% CI 0.2 – 0.5)]. Newborns with an Apgar score below seven at five minutes were significantly associated with intrapartum support [AOR; 0.8 (95% CI 0.7 – 1.0)] and perineal protection [AOR; 0.3 (95% CI 0.1 – 0.8)]. However, after adjustment, no significant association was found between Apgar score and birth positions [AOR; 0.5 (95% CI 0.2 – 1.5)]. Perineal injuries and low Apgar scores significantly decreased (p < 0.001) during the Midwife-led Quality Improvement intervention period.ConclusionThis study demonstrates that low 5-min Apgar scores and perineal injuries decreased during a midwife-led Quality Improvement intervention focusing on dynamic birth positions, intrapartum support, and perineal protection strategies.Clinical trialThis study is registered on ClinicalTrials.gov as of 14th February 2022, under registration number NCT05237375.

The Correlation of Maternal Leukocyte and NLR with APGAR Score in Caesarean Section at RSUD Dr. Soetomo 2023

Background: Excessive inflammation can lead to morbidity and mortality in pregnant women and infants. The level of inflammation can be indicated by leukocyte levels and NLR. Caesarean section is performed to save both mother and baby, but it is associated with poor neonatal outcomes, as evidenced by lower APGAR scores. Research on the correlation between leukocyte levels, NLR, and APGAR scores in neonates born via caesarean section is still limited. Therefore, this study is important to conduct. Method: This is an observational retrospective study. The object of this study was patients who underwent caesarean section delivery with the following characteristics: no premature rupture of membranes or prolonged stages of labor, no signs of infection, no congenital anomalies, and a single, full-term, live pregnancy. The variables of this study were maternal NLR and APGAR score. Result: The median leukocyte counts for elective and emergency caesarean section was 9.48 ×109/L, while the median NLR for both groups was 4.14 and 5.21, respectively. The median first-minute APGAR score for elective and emergency caesarean sections were 7 and 6, respectively, while the fifth-minute APGAR score was 8 in both groups. In the elective group, no significant correlation was found between leukocyte levels and NLR with first and fifth-minute APGAR scores (p &gt; 0.05). In the emergency caesarean section group, no significant correlation was found between leukocyte levels and the first-minute APGAR score (p &gt; 0.05), but a significant correlation was found for the fifth-minute APGAR score (p &lt; 0.05). A significant correlation was found between NLR and both first and fifth-minute APGAR scores (p &lt; 0.05). Conclusion: There are significant correlations between maternal leukocyte and NLR with APGAR score in emergency caesarean section, particularly in 5-minute APGAR score.

Effect of phenylephrine infusion on postpartum blood loss after cesarean delivery: a placebo-controlled, randomized clinical trial.

Preclinical studies have documented the role of alpha-adrenergic agonists in myometrial contraction. Phenylephrine is frequently used to prevent and treat post-spinal hypotension during cesarean delivery. We hypothesized phenylephrine would reduce postpartum blood loss due to alpha-1 receptor-mediated uterine and vascular smooth muscle contraction. This translational study aimed to evaluate the role of phenylephrine in reducing postpartum blood loss due to alpha-1 receptor mediated uterine and vascular smooth muscle contraction. This was a prospective, randomized, placebo-controlled, blinded, pilot, clinical trial. Low-risk parturients undergoing cesarean delivery under spinal anesthesia were recruited in this study. The women were randomized to receive phenylephrine or placebo (normal saline) infusion. Each mL of phenylephrine contained 60 micrograms. The study drug began simultaneously with the start of spinal anesthesia, and was stopped at the end of surgery. The infusion rate was started at 50 mcg/min and was titrated to maintain the systolic blood pressure between 80% and 120 % of baseline. The primary outcome measure was postpartum blood loss till 24 hours postpartum, and it was assessed using a surgical swab weighing technique added to suction canister blood contents. The secondary outcomes were incidence of hypertension, hypotension, Apgar score, cord blood gas analysis and neonatal intensive care unit admission (NICU) admission. One hundred six women received study drugs and were eligible for final analysis. The demographic data, obstetric profiles, and medications were comparable. In the phenylephrine group, the mean postpartum blood loss (median [interquartile range]) was significantly lower ([420 {349-502} vs 494 {397-600} mL; p=.009]). Additionally, a significantly lower number of women had >500 mL of blood loss in the phenylephrine group (26.4% vs 47.1%; p=.02). Furthermore, more women in the control arm needed blood transfusion (37.7% vs 16.9%; p=.01). Six women each had bradycardia and hypertension in the phenylephrine group. NICU admission, Apgar score, and umbilical artery PH were comparable. Continuous phenylephrine infusion led to a statistically significant but clinically inconsequential reduction in postpartum blood loss in low-risk parturients undergoing cesarean delivery under spinal anesthesia.

The perceived workload of first-line healthcare professionals during neonatal resuscitation.

Neonatal resuscitation is stressful for healthcare professionals as measured using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). Little is known regarding the perceived workload and associated factors among healthcare professionals including medical doctors (MDs) and nurses/midwives who have differences in training and experiences. We aimed to characterize and compare the perceived workload between MDs and nurses/midwives who provided neonatal resuscitation. In a prospectively designed, cellphone-based surveillance, perceived workload and stress of MDs and nurses/midwives during neonatal resuscitation was evaluated using a modified multi-dimensional NASA-TLX survey in three tertiary Neonatal Intensive Care Units in China. The NASA-TLX data on mental, physical, temporal demand, performance, effort, and frustration were independently rated by participants and collated to a composite score of all dimensions. Demographics of participants and deliveries were also collected for statistical analyses using univariate comparison and multiple linear regression. From 410 valid surveys (187 (46%) MDs; 223 (54%) nurses/midwives), significant differences were noted between MDs and nurses/midwives including working years and dimensional and overall NASA-TLX scores. While MDs had lower overall NASA-TLX scores than nurses, their scores were inversely related with simulation-based training. More team members presence during resuscitation was associated with higher NASA-TLX scores. Other independent factors associated with NASA-TLX scores included gestational age, Apgar score at 1min, year of practice for MDs and all resuscitation questions asked by nurses/midwives. MDs and nurses/midwives attending deliveries had different perceptions in workload and stress which could be lowered from simulation-based training in neonatal resuscitation.

Effects of thalassemia minor on umbilical artery blood flow and perinatal outcomes in pregnancy: A retrospective cohort study.

The aim of the present study was to compare the fetal umbilical artery blood flow parameters in the third trimester and perinatal outcomes between pregnant women with and without thalassemia minorin South China. This was a retrospective cohort study. Doppler ultrasound was used to detect fetal umbilical artery hemodynamics in pregnant women with or without thalassemia minor during the third trimester. The main parameters assessed were umbilical artery peak systolic flow velocity/end-diastolic flow velocity (S/D), resistance index (RI), pulsation index (PI), and relevant perinatal outcomes. This study included 540 pregnant women, 180 with thalassemia minor and 360 being healthy controls. In the third trimester, the thalassemia minor group had higher umbilical artery S/D (P = 0.002), RI (P = 0.002), and PI (P = 0.012) than healthy pregnant women, as well as lower levels of hemoglobin (Hb) (P < 0.001) and higher ferritin levels (P < 0.001). Compared to the non-thalassemia group, neonatal body weight in the thalassemia minor group was significantly lower (P = 0.001). Additionally, the incidence of maternal anemia (odds ratio [OR] 3.92; 95% confidence interval [CI]: 2.57-5.99, P < 0.001), low birth weight (OR 15.35; 95% CI: 1.71-137.93, P = 0.015), fetal distress (OR 2.18; 95% CI: 1.12-4.26, P = 0.023), neonatal asphyxia (OR 12.81; 95% CI: 1.40-117.33, P = 0.024), oligohydramnios (OR 18.25; 95% CI: 2.21-150.36, P = 0.007) and Apgar score <7 at 1 min after birth (OR 7.97; 95% CI: 1.53-41.54, P = 0.014) was significantly higher in the thalassemia minor group. Pregnant women with thalassemia minor have higher umbilical artery S/D, RI and PI during the third trimester and a higher risk of adverse perinatal outcomes.

Clinical implications of a Couvelaire uterus with placental abruption: A retrospective study.

This study aimed to clarify the maternal and neonatal outcomes based on the presence or absence of a Couvelaire uterus with placental abruption. This single-center retrospective study was conducted at a tertiary perinatal center in Japan, including patients diagnosed with acute placental abruption who delivered live births via cesarean section between 2016 and 2023. Patients were divided into two groups based on the presence or absence of a Couvelaire uterus during surgery: the Couvelaire and normal uterus groups. Maternal and neonatal outcomes were assessed. This study included 76 patients: 24 in the Couvelaire group and 52 in the normal uterus group. No patients underwent hysterectomies. The Couvelaire group had significantly higher intraoperative blood loss (median 1152 vs 948 g, P = 0.010), blood transfusion rates (58% vs 31%, P = 0.022), fibrinogen administration rates (38% vs 13%, P = 0.038), intensive care unit/high care unit admission rates (29% vs 7.7%, P = 0.013), and disseminated intravascular coagulation complication rates (25% vs 7.7%, P = 0.038). There were no differences in birth weight, gestational age (median 2387 vs 2065 g, P = 0.082), Apgar score <4 at 5 min (4.2% vs 3.9%, P = 0.95), umbilical artery blood pH <7.1 (25% vs 22%, P = 0.82), and neonatal death (4.2% vs 1.9%, P = 0.57). A Couvelaire uterus indicated adverse maternal outcomes but not neonatal ones. Its presence necessitates preparation for blood transfusions and/or intensive patient follow-up.