Appearance, Pulse, Grimace, Activity, Respiration Research Articles

Height Adjusted Dose versus Height-Weight Adjusted Dose of Intrathecal Hyperbaric Bupivacaine for Caesarean Delivery for Preventing Maternal Hypotension: A Prospective, Double-Blinded, Randomized Controlled Study

Background: Spinal anesthesia for cesarean section is associated with significant hypotension due to sympathetic blockade and can cause adverse maternal and fetal outcomes. Although hypotension is considered to be dose-dependent, choosing a dose of bupivacaine to achieve an adequate level of blockade without causing hypotension is a challenge. Methods: Ninety-six eligible parturients posted for elective cesarean section under spinal anesthesia were divided into two groups. Group H received intrathecal bupivacaine dose calculated as per patients’ height and Group HW received intrathecal bupivacaine dose calculated as per patients’ height and weight chart. Heart rate and mean blood pressure were monitored in both groups. Time required to achieve sensory block up to T6, complete motor block, the dose of ephedrine required to treat hypotension, the incidence of complications, and neonatal appearance, pulse, grimace, activity, respiration (APGAR) scores were noted. Results: Hypotension occurred in 35.56% of parturients in Group H and 16.28% of parturients in Group HW, which was statistically significant. The mean dose of 0.5% bupivacaine was 9.12 mg in Group HW and 9.4 mg in Group H (P value = 0.02). The mean dose of Ephedrine was 12 ± 5.8 mg in Group H compared to 6.0 mg in Group HW, which was statistically significant. The time needed to achieve sensory and complete motor block were comparable in both groups. Conclusion: Height-weight-adjusted intrathecal hyperbaric bupivacaine achieved comparable sensory and motor block with lesser incidence and severity of hypotension compared to height-adjusted dose.

The Effect of Birth Hour on Neonatal Morbidity and Mortality in Very-Low Birth Weight Infants in a Teaching Hospital.

With the increase in the preterm birth rate, the factors influencing mortality and morbidity in very-low-birth weight neonates have gained importance in recent years. The results of available studies on the influence of birth hour on the mortality and morbidity rates of preterm infants are contradictory. Moreover, no study on this topic has been conducted in our region. This retrospective cohort study was conducted on 127 very-low-birth weight newborns based on birth hour. The newborns were divided into 2 groups, the first born during working hours (7:00 am to 11:59 pm) and the second born during after-hours care (12-6:59 am). Mortality and major diseases were compared using Statistical Package for the Social Sciences by Fisher's exact tests, Pearson's chi-squared test, and independent t-tests. The statistical significance level for all analyses was set at P < .05 and the CI at 95%. Based on the results of this study in terms of neonatal mortality and major morbidities such as intraventricular hemorrhage and the need for prolonged mechanical ventilation, no significant difference was found between the 2 groups, but the difference in appearance, pulse, grimace, activity, respiration (APGAR) score at the fifth minute was statistically significant and was lower at the working hours. The results of the study may be due to appropriate allocation of resources, assignment of tasks, and professionalism of care in our study area. Further study is needed to determine the differences in clinical care processes that cause these results.

Clinical Outcome of Dinoprostone Vaginal Pessary and Dinoprostone Intracervical Gel on Induction of Labor: An Observational Study

Abstract Background: Labor induction is a common and essential procedure in obstetrics. Various new formulations of prostaglandins are currently being used for labor induction. Trials are being conducted regularly using new formulations to see the efficacy and outcome of labor induction. Materials and Methods: Prospective observational study was conducted to compare the clinical outcome of dinoprostone pessary (DP) and intracervical dinoprostone gel (DG) on induction of labor. The objectives were to study the efficacy on induction-to-delivery duration, to compare the time taken from application to initiation of labor, and the number of applications required. The study also compared the need for oxytocin augmentation, cesarean rate, and neonatal outcomes after delivery. Results: In the DP group, 86.7% of patients required single application and 68.4% of patients in the DG group required double application. In 91.6% of patients in the DG group and 68.3% of patients in the DP group labor were initiated in &lt;12 h. About 11.7% in the DP group and 6.7% of patients in the DG group required more than 24 h for labor initiation. Requirement of oxytocin augmentation was less in the DP group compared to the DG group (48.3% vs. 53.3%). Requirement of cesarean delivery was 40% in the DP group and 26.7% in the DG group, and the difference was not statistically significant. Ninety percentage among DP groups and 100% in DG groups were having clear liquor. No patient in either group delivered neonate with Appearance, Pulse, Grimace, Activity, Respiration (APGAR) &lt;7 at 1 min and &lt;9 in 5 min or required neonatal intensive care unit (NICU) admission. Conclusion: In patients with similar demographic and obstetric profiles, DG had a faster induction-to-delivery time. DG had faster initiation of labor within 12 h. There was no significant difference in the requirement of augmentation with oxytocin in either group. Delivery outcomes such as cesarean rate, meconium-stained liquor, neonatal APGAR, and NICU admission were comparable in both groups.

Correlation of Mid-Trimester Spot Urinary Albumin: Creatinine Ratio With the Adverse Pregnancy Outcome.

Background Urinary albumin creatinine ratio (ACR) is a known method of measurement of microalbuminuria. Microalbuminuria may be an early marker of endothelial dysfunction which can lead to various complications during the course of pregnancy. The objective of our study was to evaluate the correlation of mid-trimester spot urinary ACR with the pregnancy outcome. Material and methods We performed a prospective cohort study in the department of Obstetrics & Gynaecology,All India Institute of Medical Sciences, Bhopal, for a period of one year. We studied 130 antenatal women between 14 and 28 weeks of gestation after obtaining written informed consent. The patients with ongoing urinary tract infection (UTI), pre-existing hypertension, or diabetes were excluded. Urinary samples were examined for spot ACR, and the women were followed untildelivery. Primary maternal outcomes were development of gestational hypertension, pre-eclampsia, gestational diabetes mellitus (GDM), and preterm labour. Neonatal outcome was assessed in terms of birth weight, the APGAR (Appearance, Pulse, Grimace, Activity, Respiration) scores, and neonatal intensive care unit (NICU) admission. Results In our study, mean urinary ACR was 19.07±12.94 mcg/mg and median urinary ACR (IQR) was 18 (9.43-25.25) mcg/mg. Prevalence of microalbuminuria in our study was 19.2%. It was observed that urinary ACR level was significantly higher in women with maternal complications like GDM, gestational hypertension, preeclampsia, and preterm labour. Also, mean urinary ACR of women who developed preeclampsia was higher (37.53±31.85)compared to women who developed gestational hypertension (27.40±9.71). Urinary ACR level was significantly higher in babies with low APGAR scores and in babies who needed NICU admission (p value < 0.05). The sensitivity and specificity of spot urinary ACR to predict GDM and preeclampsia were found to be good as calculated from the receiver operating curve. Conclusion We found definite correlation of higher values of mid-trimester urinary ACR with the adverse pregnancy outcome.

Comparison of Cord Blood pH, Haematological Parameters and APGAR Score of New-Born with Maternal and Peri-Natal Risk Factors: A Prospective Observational Study

Introduction: Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score is used worldwide to assess newborn health immediately after birth. The combination of pH analysis, haematological parameters of cord blood samples and APGAR score compared with the maternal and peri-natal risk factors will help us identify the cause of low APGAR. Aim: To compare the pH of cord blood, haematological parameters, Neutrophil-Lymphocyte Ratio (NLR) and APGAR score with high-risk maternal and peri-natal factors. Materials and Methods: This is a prospective observational study, conducted over a period of six months, at Chettinad Hospital and Research Institute, Chennai. The cord blood samples of 40 newborns (20 normal and 20 high-risk pregnancy) were collected for assessing pH and haematological parameters (complete haemogram, nucleated Red Blood Cells (RBCs), reticulocyte count). APGAR scores were obtained from clinical records. The data obtained in the study was analysed using the International Business Management (IBM) Statistical Package for Social Sciences (SPSS) statistics version 23.0. Results: The authors compared 20 cases of newborns with maternal risk-factors with 20 newborns with no risk factors, and found that low APGAR and acidic pH of cord blood, high NLR was associated with risk factors present in the ante-natal and peri-natal period. Conclusion: The present study observed that a low APGAR, low acidic pH of cord blood, high NLR was seen in mothers with adverse risk factors during pregnancy, compared to the mothers with no associated co-morbidities. Hence, the presence of riskfactors during pregnancy should warrant a close follow-up of the new-born in the immediate postpartum period.

Effect of Therapeutic Touch on Maternal and Neonatal Outcomes in Primiparous Women: A Systematic Review and Meta-Analysis

Introduction: Childbirth is one of the most wonderful yet painful experiences in a woman’s life. Non pharmacological interventions like Therapeutic Touch (TT) can improve labour experiences in women. Aim: To assess the effect of TT on labour pain intensity, neonatal Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score and admission to neonatal intensive care unit in primiparous women. Materials and Methods: In this review, PubMed-MEDLINE, Google Scholar, Cochrane CENTRAL databases were searched till February 2022, for prospective studies fulfilling inclusion and exclusion criteria. Randomised controlled trials comparing TT and massage therapy with usual intranatal care in primiparous women with singleton foetus and without any risk factors for pregnancy were included in this review. Two independent reviewers extracted data and assessed the quality of the trials. The results were presented in form of forest plots. Results: A total of 13 studies, including 1302 primiparous women, were included in the review for qualitative analysis. Amongst them ten studies involving 621 women included meta-analysis of labour pain intensity. Nine studies were included in the metaanalysis of the active phase of labour and four studies included in the transitional phase and one study in the fourth stage of labour. Eight studies used the Visual Analogue Scale (VAS) to assess pain intensity. Overall, there was a small reduction in pain intensity of primiparous women receiving massage/TT compared to routine care {SMD: -0.96 (95% CI: -1.33, -0.60)}. Significant reduction of pain intensity was found in active {SMD: -0.79 (95% CI: -1.26, -0.32)} and transitional phase of labour {SMD: -1.18 (95% CI: -1.67, -0.69)}. No significant reduction of neonatal admission to the intensive care unit and APGAR score &lt;7 at 5 minutes {RR: 0.71 (95% CI: 0.31, 1.62)} was found. Conclusion: TT has beneficial effect on reduction of Labour pain intensity in primiparous women. But no detectable effect was found for neonatal outcomes.

The Multidisciplinary Guidelines for Diagnosis and Referral in Cerebral Visual Impairment.

IntroductionCerebral visual impairment (CVI) is an important cause of visual impairment in western countries. Perinatal hypoxic-ischemic damage is the most frequent cause of CVI but CVI can also be the result of a genetic disorder. The majority of children with CVI have cerebral palsy and/or developmental delay. Early diagnosis is crucial; however, there is a need for consensus on evidence based diagnostic tools and referral criteria. The aim of this study is to develop guidelines for diagnosis and referral in CVI according to the grade method.Patients and MethodsWe developed the guidelines according to the GRADE method 5 searches on CVI (children, developmental age ≤ 18 years) were performed in the databases Medline, Embase, and Psychinfo, each with a distinct topic.ResultsBased on evidence articles were selected on five topics: 1. Medical history and CVI-questionnaires 23 (out of 1,007). 2. Ophthalmological and orthoptic assessment 37 (out of 816). 3. Neuropsychological assessment 5 (out of 716). 4. Neuroradiological evaluation and magnetic resonance imaging (MRI) 9 (out of 723). 5. Genetic assessment 5 (out of 458).ConclusionIn medical history taking, prematurity low birth weight and APGAR (Appearance, Pulse, Grimace, Activity, Respiration) Scores (<5) are important. Different questionnaires are advised for children under the age of 3 years, older children and for specific risk groups (extremely preterm). In ophthalmological examination, eye movements, specially saccades, accommodation, crowding, contrast sensitivity and visual fields should be evaluated. OCT can show objective signs of trans-synaptic degeneration and abnormalities in fixation and saccades can be measured with eye tracking. Screening of visual perceptive functioning is recommended and can be directive for further assessment. MRI findings in CVI in Cerebral Palsy can be structured in five groups: Brain maldevelopment, white and gray matter lesions, postnatal lesions and a normal MRI. In children with CVI and periventricular leukomalacia, brain lesion severity correlates with visual function impairment. A differentiation can be made between cortical and subcortical damage and related visual function impairment. Additional assessments (neurological or genetic) can be necessary to complete the diagnosis of CVI and/or to reveal the etiology.

Prevalence and outcomes of twin pregnancies in Botswana: a national birth outcomes surveillance study

ObjectivesThis study aims to evaluate the prevalence and outcome of twin pregnancies in Botswana.SettingThe Tsepamo Study conducted birth outcomes surveillance at 8 government-run hospitals (~45% of all births in Botswana)...

Pregnancy Outcomes With COVID-19 Lessons Learned From the Pandemic.

BackgroundSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that causes Coronavirus disease has caused one of the most damaging pandemics in the recorded human history.ObjectiveTo assess pregnancy outcomes with COVID-19 lessons learned from the pandemic.Study designThis retrospective observational study was conducted at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, a level 3 COVID hospital in Northern India, with a patient pool of all the antenatal females diagnosed COVID 19 positive via a positive quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) test of maternal pharyngeal and nasal swab samples in the given time period of three months and ten days, i.e., May 25, 2020 to September 3, 2020. In conjunction with maternal outcomes, neonatal outcomes including evidence of perinatal transmission of SARS-CoV-2 was assessed by testing neonatal pharyngeal swab samples.ResultsOut of 100 COVID-19 positive patients, the average age of women was 26.2 years, 73 women (73%) were asymptomatic, and 50 patients (50%) women had associated co-morbidities such as anaemia in 38 (38%) women, gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH) in four patients (4%) each, respectively. No case of spontaneous abortion in early gestation was reported. Out of 100 patients, 32 (32%) patients delivered during their stay, out of which 17 women (53.1%) delivered via cesarean section which was performed mainly due to obstetric indications. One maternal death was reported due to antepartum eclampsia which was unrelated to COVID-19 complications. Five neonates were born prematurely, out of which three were delivered followed by spontaneous premature preterm rupture of membranes (PPROM).The Appearance Pulse Grimace Activity Respiration (APGAR) score was recorded to be ≥9 at the five minutes mark in 28 out of 30 live babies (93.3%) and the birth weight of the babies ranged from 1.8 to 3.5 kg) with an average birth weight of 2.71 kg. Two neonatal deaths were reported due to respiratory distress. There were two documented intrauterine demise (IUD) cases both due to PIH. Furthermore, all 30 live neonates tested for SARS CoV-2 had negative results.ConclusionThe spectrum of Coronavirus infection leans more towards asymptomatic and mild symptomatic clinical presentation. Favourably, the likelihood of spontaneous preterm birth was not escalated in our current study and remained low. The rate of intrauterine fetal demise and neonatal death were less. As none of the neonates tested positive for COVID-19, there is no corroborative proof of vertical perinatal transmission.

Effects of L-arginine on preeclampsia risks and maternal and neonatal outcomes: A systematic review and meta-analysis

Objective: To summarize whether the supplementation of L-arginine in pregnant women helps in management of preeclampsia and its impact on maternal and neonatal outcomes. Methods: Studies conducted from the past 17 years (1999 to 2016). were referred from database like Cochrane Central Registry of Controlled Trials (CENTRAL), Scopus, Google Scholar and PubMed. Out of 134 studies, 7 studies were included. L-arginine versus placebo was considered for quantitative analysis. Modified Cochrane data extraction form was used to collect the data. The risk of bias was assessed using Cochrane’s risk of bias assessment tool in RevMan 5.4 and the summary of findings was determined using GradePro software. Results: L-arginine showed a significant reduction of preeclampsia [odds ratio (OR) 0.38; 95% confidence interval (CI) 0.25, 0.58)]. There was a significant reduction in systolic blood pressure [mean difference (MD) -2.47; 95% CI -4.53, -0.42] and diastolic blood pressure (MD -0.97; 95% CI -3.83, 1.89). The effects of L-arginine on secondary outcomes like maternal gestational age, latency, neonatal weight, and appearance, pulse, grimace, activity, respiration (APGAR) score at 1st and 5th minute were not statistically significant. Conclusions: L-arginine supplementation is effective in lowering systolic and diastolic blood pressure of preeclamptic patients. However, it has no noticeable effects on maternal and neonatal outcomes.

Impact of COVID-19 on Maternal and Neonatal Outcomes in Pregnancy: A Prospective Study

Introduction: The Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global public health crisis. Pregnant women are known to be disproportionately affected by respiratory illnesses, which are associated with increased infectious morbidity and high maternal mortality rates. Aim: To study the management of COVID-19 in pregnancy and its perinatal outcome. Materials and Methods: This prospective observational study was conducted in the Obstetrics and Gynaecology Department from March 2020 to September 2020. To evaluate the effects of COVID-19 in pregnancy and to determine the maternal and fetal outcomes in COVID-19 positive patients. In order to evaluate the pattern of caesarean and vaginal deliveries in COVID-19 and non COVID-19 patients, chi-square test was done. Results: A total of 150 COVID-19 positive patients were admitted to the COVID-19 labour room and out of them 142 (94.67%) were antenatal and 8 (5.33%) were postnatal. Total number of the deliveries in this period was 80 (53.33%) and out of them vaginal deliveries were 35 (23.33%) and caesarean section were 45 (30%). A 6 (7.50%) babies with poor Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score were admitted to the Neonatal Intensive Care Unit (NICU) and 70 (87.50%) had good APGAR after delivery, four had Intrauterine Death (IUD). Conclusion: The pregnant women with suspected COVID-19 who need medical care should be transferred to a hospital equipped with sufficient health facilities and fully trained clinicians to take proper care of critically ill obstetric patients for effective management.

Determinants of neonatal hypothermia among neonates admitted to neonatal intensive care unit northwest, Ethiopia, case-control study

Background Neonatal mortality is a global public health problem disproportionally high in developing country including Ethiopia. Hypothermia plays a significant role in neonatal mortality. This study was conducted to identify determinants of neonatal hypothermia among neonates admitted to the neonatal intensive care unit (NICU) of public hospitals. Methods and materials Institutional based unmatched case-control study was conducted in Bahir Dar town public hospitals among neonates admitted in the NICUs in 2019. A total of 387 participants were included in the study. Pretested, structured questionnaire, and data extraction checklist were used to collect results. Data analysis was done by using Stata version 14 . Results Low birth weight (adjusted odd ratio (AOR)=3.01, 95%CI: 1.50–5.58), nighttime delivery (AOR = 1.90, 95%CI: 1.13–3.13), lack skin to skin contact (AOR = 2.43, 95%CI: 1.42–4.16), delayed initiation of breast feeding (AOR = 2.24, 95%CI: 1.30–3.88), not wearing cape (AOR = 1.87, 95%CI: 1.07–3.26), and low Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score (AOR = 2.17, 95%CI: 1.15–4.10) were determinant variables of the neonatal hypothermia. Conclusions Skin to skin contact, initiation of breast feeding, birth weight, time, low APGAR score, and not wearing cape were identified as independent determinates of neonatal hypothermia.

Comparison of APGAR Score of Newborns with Mode of Delivery and Its Associated Factors

Newborn baby should be assessed immediately soon after the birth and the APGAR (Appearance, Pulse, Grimace, Activity, Respiration) score is the most commonly used, simple and most effective method of immediate newborn assessment. The aim of the study was to compare the newborn APGAR score on first and fifth minute in two different mode of delivery; Normal Vaginal delivery (NVD) and Cesarean Delivery (CD) and its contributing factors. A cross-sectional study design with comparative research approach was adopted to conduct the research. Total 200 singleton babies (100 NVD and 100 CD) were selected and APGAR score was checked in the first and fifth minutes from baby’s birth record. Data were analyzed using descriptive and inferential statistics. Results showed that 88 and 95 percentage of neonatal APGAR scores in 1st and 5th minutes were more than seven, respectively. There were no significant statistical differences between APGAR score of 1st and 5th minutes in two methods of delivery (t=0.067 and 0.066 on 1st minute and 5th minute respectively, p&gt;0.05). However, premature newborns, low birth weight, mother’s age and weight of mother, no of parity has effect on APGAR score. The study findings concluded that not the method of delivery has any effect on the low Apgar score of babies on birth but the factors such as prematurity, maternal age, mother’s weight, no of parity, low birth weight has significant association on low APGAR score of babies.&#x0D; Int. J. Soc. Sc. Manage. Vol. 7, Issue-3: 176-182

Role of amniotic fluid echogenicities in the prediction of fetal outcome

Background: The amniotic fluid (AF) is a highly complex and dynamic system that is studied as a data point to interpret fetal well-being. Homogeneously, echogenic AF is due to the presence of innumerable echogenic particles in the fluid and is an uncommon finding. Echogenic AF has been attributed to meconium, blood, and vernix caseosa. The current study was undertaken to evaluate the significance of echogenic AF in the assessment of fetal outcome. Objective: The objective was to study the significance of echogenic AF in the assessment of fetal outcome. Materials and Methods: The present study was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Srinagar, from May 2019 to December 2019. A total of 34 participants with ultrasonographic evidence of echogenic liquor were included in the study. They were followed till the delivery for the determination of the fetal outcome. The fetal outcome was studied in terms of Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score; neonatal intensive care unit (NICU) admission rate; and stillbirth rate. Results: Out of 34 participants, 18 participants had vernix caseosa, 8 had meconium, 6 had blood, and 2 had clear liquor amnii. Out of 18 participants with vernix, all 18 fetuses had APGAR score >7/10 with no NICU admission and no stillbirth. Out of eight participants with meconium, six babies had APGAR score

The Correlation between Hemoglobin Concentration during Pregnancy with the Maternal and Neonatal Outcome.

BACKGROUND:The prevalence of anaemia is higher among women, including pregnant women. The estimation was about 24.8% of the population in the world suffering anaemia. Anaemia during pregnancy is a big problem because it can contribute morbidity and mortality, either in mother or newborn. The impacts of anaemia during pregnancy included post-partum haemorrhage, low birth weight (LBW), preterm delivery, and low Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score.AIM:This study aimed to determine the correlation between haemoglobin concentration during pregnancy and the outcome of mothers and newborns.METHODS:It was a cohort study that included 200 pregnant women in second or third trimester at antenatal care of Sundari General Hospital Outpatient Clinic on February until September 2018. The participants were interviewed using a questionnaire, and their blood was checked to measure haemoglobin concentration using portable Easy Touch Hemoglobinometer. In the next three until six months, the following investigation was conducted to assess the maternal and neonatal outcome.RESULTS:The result of this study showed among the maternal outcome, only antepartum haemoglobin concentration had a statistically significant correlation with the haemoglobin concentration during pregnancy (p < 0.05), meanwhile, among the neonatal outcome. LBW was the only factor that statistically significantly correlated to the haemoglobin concentration during pregnancy (p < 0.05).CONCLUSION:We can conclude that once anaemia occurs in pregnant women, then the women kept suffering from anaemia with its correlation was statistically significant.

Evaluating outcomes of mother-infant pairs using dolutegravir for HIV treatment during pregnancy.

Objectives:Dolutegravir (DTG), a second-generation integrase inhibitor, is an effective treatment for HIV but its safety and efficacy are not well established in pregnancy. Here, we assess maternal and infant outcomes of mother–infant pairs using DTG-containing regimens during pregnancy.Methods:We performed a retrospective cohort analysis of pregnant women with HIV on DTG from two urban clinics in the United States, 2015–2018. Maternal outcomes included viral suppression (viral load of <20 copies/ml prior to delivery), development of resistance, and tolerability to DTG. Infant outcomes included preterm delivery (birth at <37 weeks), small for gestational age (SGA, weight <10th percentile), infant HIV status at birth, birth defect(s), and Appearance, Pulse, Grimace, Activity, Respiration (APGAR) scores. We performed a trend analysis to assess DTG use over time.Results:A total of 66 women used DTG during pregnancy and the proportion on DTG increased each year: in 2015, 8% (5/60) of women were on DTG, versus 22% (15/67) in 2016, 42% (30/71) in 2017, and 59% (16/27) in 2018 (P < 0.05). Among women who delivered (n = 57), 77.2% were undetectable at delivery. There were no drug resistance and no reported side effects during pregnancy. Infants had a mean APGAR score of 8 (SD 1.5) at 1 min and 9 (SD 0.8) at 5 min; 31.6% were born prematurely and 15.8% were SGA, and 2 infants had a birth defect. No cases of HIV transmission occurred.Conclusion:Our findings suggest that DTG can be an effective treatment during pregnancy. Infant outcomes (preterm deliveries and birth defects) need to be investigated in larger studies.

Effects of Occupational Tobacco Exposure on Mother and Foetus in Beedi Rollers

Background and objectives: Beedi rolling is a popular household occupation amongst the economically poor female population of coastal Karnataka districts. This study aimed to identify the effects of occupational tobacco exposure on the beedi rolling pregnant mother and her neonate. The objectives were to study the maternal outcomes with respect to hypertension in pregnancy, anemia, abruptio-placenta, preterm labor and the neonatal outcomes such as low birth weight, low appearance, pulse grimace, activity, respiration (APGAR) and clinical assessment of nutrition status (CANS) score. Methods: This prospective cohort study was conducted in a tertiary care hospital in Mangaluru from February 2014 to June 2015. A sample size of 500 was calculated with a 95% confidence level and 85% power. Cohort groups of 250 each were randomized as beedi rollers and non-beedi rollers based on the history of exposure and were prospectively followed till delivery. Results: The study results showed overall complications of 37.6 % among the beedi rollers which was clinically and statistically significant. Among the beedi rollers, 22.4% mothers had hypertension in pregnancy, of which 13.4%, had gestational hypertension, 8.2% pre-eclampsia, 0.4% had eclampsia, 27.6% were anaemic, and 9.6% had fetal growth restriction. There was no increase in the incidence of preterm labor, abrubtio-placenta. Our study also showed an increased risk of low birth weight (29.4%), but no significant difference in APGAR scores and CANS score among both groups. Based on the ROC curve we found, rolling 425 beedis can be taken as a safe limit during pregnancy with a sensitivity of 73.4% and specificity of 53.2% and 22 weeks period of gestation can be taken as safe limit up to which beedis can be rolled during pregnancy with a sensitivity of 61.7% and specificity of 64.1%. Clinical significance: In this study, dreadful complications can be attributed to beedi rolling. Majority of it can be prevented by health education and simple preventive measures such as using masks and gloves while rolling beedis for which further studies are warranted.

Low serum vitamin D level is associated with intrahepatic cholestasis of pregnancy.

Intrahepatic cholestasis of pregnancy (ICP) is a unique hepatic disorder of pregnancy and is related to adverse maternal and perinatal outcomes. The pathogenesis of the disease is not clear and appears to be multifactorial. There is increasing evidence that vitamin D (Vit D) plays a role in hepatobiliary homeostasis and in various liver diseases. We aimed to investigate the association between serum Vit D level and ICP. A total of 40 pregnant women with ICP and 40 healthy pregnant women were included in this controlled cross-sectional study. Their demographic characteristics, including age, body mass index (BMI), gestational week, gravidity and parity, and laboratory parameters, including 25(OH) Vit D3 levels, liver function tests, fasting and postprandial bile acid concentrations, were recorded. Gestational age at delivery, birth weight (BW), neonatal intensive care unit (NICU) admission, meconium staining of amniotic fluid and appearance pulse grimace activity respiration (APGAR) score at 5 min were obtained from medical records for assessment of perinatal outcomes. There was no significant difference between groups in terms of demographic characteristics. The mean serum 25(OH) Vit D3 level was significantly lower in pregnant women with ICP compared to control pregnant women (8.6 ± 4.9, 11.3 ± 6.1; P =0.033), and it was significantly lower in severe disease than mild disease (6.9 ± 2.1, 10.3 ± 6.2, respectively; P =0.029). We also found that lower serum 25(OH) Vit D3 levels were significantly and inversely correlated with fasting and postprandial bile acid levels. However, in subgroup analyses in ICP pregnant women, there was no difference in mean 25(OH) Vit D3 levels for women with or without perinatal complications. Our study suggests that low levels of 25(OH) Vit D3 were associated with ICP disease and its severity. However, further larger studies are needed to evaluate the effect of Vit D in the pathogenesis and outcome of the disease.

Physiological and behavioral patterns of normal-term thoroughbred foals

Abstract Foaling is a crucial period in mares' life and their newborns, resulting in a number of physiological and behavioral challenges, which may have predictable effects on foal's welfare and well-being. The aim of this study was to assess the patterns of circulating adrenocorticotropic hormone (ACTH), cortisol, and glucose concentrations in newborn foals born by full-term delivery, by taking into account the potential correlations with Appearance, Pulse, Grimace, Activity, Respiration (APGAR) scores. Newborn respiratory rate, rectal temperature, birth weight, time to stand up, time to suck, and allantochorion weight were also considered. Eight thoroughbred foals, 5 colts and 3 fillies, were assessed 20 minutes (T0) and 30 days (T1) after birth. One-way analysis of variance showed a significant effect of time on ACTH ( P = 0.0024) and cortisol ( P = 0.003) concentrations, with the highest concentrations at T0. Significant positive correlations between ACTH and cortisol values at T0 (r = 0.67; P P P P

The Prevalence, Trend, and Associated Demographic Factors of Neural Tube Defects at Orotta National Referral Maternity Hospital, Asmara: Retrospective Record Review Study

Neural Tube Defects (NTDs) are congenital structural abnormalities of the brain (anencephaly) and vertebral column (spina bifida) that represented as one of the most common congenital malformations of neonates worldwide. A four-year and eight months (January 1 st , 2007 to August 31 st , 2011) retrospective record review study on prevalence, trend, and associated demographic factors of NTD was conducted at Orotta National Referral Maternity Hospital, Asmara, Eritrea. The prevalence, trend and associated demographic factors were assessed by data extraction from hospital delivery register and patient cards. Associations between variables of maternal age, parity, and infant gender and primary outcomes were determined using χ 2 analyses and Poisson regression modeled cumulative incidence and controlled for confounders. Out of 39, 803 total deliveries 185 neonates were found to have NTDs related abnormalities, but 156 neonates identified with complete and well-documented registers, medical records and charts showing a prevalence of 3.9 per 1000 deliveries. The most commonly identified NTDs were Anencephaly 75(48.1%), Hydrocephalus 29 (18.6%), Spina bifida 27 (17.3%), and Multiple NTDs 25 (16.0%). Marital status, ethnicity, religion, and maternal history of abortion were found to have no enough evidence, but women who delivered neonates with NTDs who had parity less than four 125 (80.1%) and age below 30 years 108 (69.2%)were observed to have higher chances. All the Anencephalic neonates were delivered by vaginal delivery, Majority (66 (88%)) with a weight of less than 2000 grams and were female by sex 55(74.3%); whereas 13(44.8%) Hydrocephalic neonates were delivered by Caesarian section and 26 (92.9%) had a weight greater than 2000 grams. The Appearance Pulse Grimace Activity Respiration(APGAR) score results were founded to be zero for all anencephalic neonates and for 17 (74%) of multiple NTD; while 40 percent of and 46 percent of neonates with spina bifida and hydrocephalus, respectively, had no APGAR at five minutes. Over the years of the study a significant increase in the trend of NTDs were observed, mainly that of anencephaly. The increase was 1.5 percent (p < 0.05). The results of Poisson analysis indicated an exceptional statistically significant increase of anencephaly only. The trend of NTDs in neonates was observed to increase significantly, mainly anencephaly. The study findings noted younger women (less than 30 years) and with parity less than four were at higher risk than those of older age and higher parity. NTDs can be prevented and reduced with folic acid supplementation and fortification of principal foods.