Cesarean Section For Fetal Distress Research Articles

Effect of fetal distress on viability and yield of umbilical cord blood stem cells–a prospective comparative study

IntroductionDifferent factors affect the quality and viability of cord blood stem cells, and therefore the efficacy of umbilical cord stem cell transplantation. Fetal distress is one factor affecting the quantity of CD34+ cells in cord blood. This study was designed to compare the viability and yield of the umbilical cord blood stem cells of women who have undergone emergency lower segment caesarean section for fetal distress or for other causes. Materials and methodsThis cross-sectional analytical study was performed at a tertiary care hospital facility with a total sample size of 68: 34 participants had undergone emergency C-section for fetal distress, and 34 had undergone emergency C-section for other causes. Umbilical cord blood was collected ex-utero in a 350 mL bag with citrate-phosphate-dextrose solution with adenine. Three milliliter of blood were transferred to an ethylenediaminetetraacetic acid (EDTA) tube for cell counts and flow cytometry testing for CD34+. The chi-square test was used to compare the total mononuclear cell, CD34+, and viability between the groups. ResultsThe CD34+ count [mean 4.9 versus 1.1 (× 106 cells/unit)] and total nucleated cell count [mean 14.2 versus 7.5 (× 108/unit)] were significantly higher in cord blood units collected from women who delivered by C-section for fetal distress (p-value <0.05). However, the volume of umbilical cord stem cells and viability of stem cells did not vary significantly based on the presence or absence of fetal distress (p-value >0.05). ConclusionThe current study shows that umbilical cord blood collected during fetal distress has a significantly higher content of stem cells and total nucleated cells than the non-fetal distress group

Comparison Of Maternal And Perinatal Outcome Of Isolated Borderline Amniotic Fluid Index Versus Normal Amniotic Fluid In Low-Risk Pregnancies At Term

Objective: The objective of the study was to compare the maternal and perinatal outcomes in low-risk pregnancies having borderline Amniotic fluid index with normal amniotic fluid index at term. Methods: This prospective observational study, included 540 low-risk pregnant women admitted at POF Hospital Wah Cantt between 1st June 2020-31st Dec 2022. Group A had 180 women with borderline AFI having normal umbilical artery Doppler and group B had 360 women with normal AFI between 37-40 weeks, who fulfilled the inclusion criteria. The data regarding baseline characteristics and fetomaternal outcome was collected on an already designed proforma and analysis was done by using SPSS version 23. Results: The difference in overall cesarean section rate (p=0.071) and cesarean section for fetal distress (p=0.076) was not statistically significant between the two groups. The borderline AFI did not increase the risk of meconium-stained liquor (p=0.116), 5minute APGAR score &lt;7 (p=0.218), admission to NICU (p=0.064) and low birth weight (mean birth weights p=0.278) compared to normal AFI. Conclusion: Borderline oligohydramnios does not increase the risk of cesarean section and cesarean section for fetal distress. There is no increase in the risk of meconium-stained liquor, 5-minute APGAR score&lt;7, admission to NICU and low birth weight. Keywords: Amniotic fluid index, borderline oligohydramnios, cesarean section, fetal distress, meconium-stained liquor.

Cerebroplacental Ratio as a Predictor of Perinatal Outcome in Hypertensive Disorders of Pregnancy and Its Comparison With Its Constituent Doppler Indices.

Objective Doppler velocimetry is an established method of antepartum fetal surveillance in pre-eclampsia. Cerebroplacental ratio detects the centralization of fetal blood flow and the insufficiency in placental circulation. It is postulated to be a better marker of perinatal outcome than either vessel Doppler alone. The current study aims to assess the cerebroplacental ratio as a predictor of adverse perinatal outcomes and compare it to the systolic/diastolic (S/D) ratio of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy. Material and methods The present prospective observational cohort study included 100 patients with hypertensive disorders of pregnancies between 32 and 37 weeks. Ultrasound with Doppler was done and the following parameters were assessed: fetal biometry, amniotic fluid index, umbilical artery pulsatility index, middle cerebral artery pulsatility index, S/D ratio of umbilical artery, S/D ratio of middle cerebral artery, and cerebroplacental ratio. Sensitivity, specificity, positive and negative predictive values were calculated for the cerebroplacental ratio and S/D ratios of umbilical and middle cerebral arteries. McNemar's test was used for the comparison of sensitivity and specificity. Results Thirty-two patients had an abnormal cerebroplacental ratio. Adverse perinatal outcomes such as a cesarean section for fetal distress, small for gestational age, APGAR < 7 at 1 and 5 minutes, NICU admission, and perinatal mortality were more in the group with abnormal cerebraplacental ratio and the difference was statistically significant. Conclusion The cerebroplacental ratio is a more reliable predictor of adverse perinatal outcomes and should be routinely calculated during obstetrical Doppler for antepartum fetal surveillance in case of hypertensive disorders of pregnancy. It suggested that the cerebroplacental ratio may be calibrated in the software of the Doppler ultrasonography machine for routine use in high-risk pregnancies.

Perinatal Outcome in High-Risk &amp; Severe-Risk Pregnancy- A Study in a Tertiary Care Hospital

Introduction: High-risk &amp; severe-risk pregnancies are characterized by increased risks of complications for both the mother and the fetus, which can result from several factors such as maternal age, medical situations, lifestyle habits, and previous pregnancies. These complications are a major concern, mostly in developing countries like Bangladesh, where maternal and infant mortality rates remain high. Maternal complications associated with high-risk and severe-risk pregnancies may include maternal death, severe bleeding, sepsis, and hypertensive disorders, while fetal complications may include preterm delivery, fetal growth restriction, and stillbirth. The objective of this study was to investigate the perinatal outcomes of high-risk and severe-risk pregnancies. Methods: This prospective purposive study was carried out on the admitted patients in the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2007 to December 2007. Total hundreds of risk groups pregnant women (N=100) were enrolled in the study among them eighty-five (n=85) scoring 3-6 included as high risk pregnancy and fifteen (n=15) scoring 7 or more included as severe-risk pregnancy. All relevant data were recorded for each individual study subject on predesigned data collection sheet. All collected data were compiled and analyzed by computer-based statistical software (Instat). Chi-square tests were performed to compare the prevalence of study variables where, p &lt; 0.05 considered the level of significance with 95%CI. Ethical clearance of this study was obtained from the Institutional Review Board (IRB) of BSMMU, Dhaka, Bangladesh. Results: In the high-risk group (n=85), around one-fourth of the patients (22,25.9%) and in a severe- risk group (n=15), one patient (1,6.7%) underwent vaginal delivery, Caesarean section was done in sixty-three patients (63,74.1%) in high-risk pregnant women and fourteen patients (14,93.3%) in severe-risk pregnant women respectively. The distribution of risk group and mode of delivery is statistically highly significant (P &lt;0.001). Out of sixty-three patients (n1=63), nineteen (19, 30.2%) were required to be delivered by caesarean section for fetal distress and fifteen (15, 30.16%) were malpresentation. Out of forty-one patients (n2=14), the most common indications were a history of previous caesarean section with multiple risk factors in eight patients (8, 57.1%). Birth asphyxia was present in nine neonates (9, 13.6%) in a high-risk group (n = 65) and a severe- risk group (n2=14), and birth asphyxia was present in five neonates (5, 35.7%). Based on the outcome, in high-risk pregnancy (n=85), four neonates (4, 4.5%) died and in severe-risk pregnancy (n=15), one (1, 6.3%) died. Conclusion: The study found various obstetric complications and outcomes associated with high-risk and severe-risk pregnancies. The results indicated a significantly higher proportion of caesarean sections performed in severe-risk pregnancies compared to high-risk pregnancies. Moreover, the overall outcome was favorable, with only five neonatal deaths reported among the one hundred maternal risk groups.

Study of Relationship between Postpartum Umbilical Cord Blood Ph and Neonatal Outcome in Patients Undergoing Emergency Caesarean Section for Fetal Distress

Study of Relationship between Postpartum Umbilical Cord Blood Ph and Neonatal Outcome in Patients Undergoing Emergency Caesarean Section for Fetal Distress

Fatal COVID-19 in a neonate after probable late intrauterine transmission.

We report the case of a 35-week gestation infant girl born by emergent cesarean section for fetal distress in a woman with recent coronavirus disease 2019 (COVID-19). Tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using polymerase chain reaction (PCR) on the infant at 24 and 48 hours of life were negative. However, at 72 hours of life, the infant's respiratory status worsened, and a repeat SARS-CoV-2 PCR was positive. The infant developed leukopenia, thrombocytopenia, and progressive respiratory failure, and died on the ninth day of life. Pathologic examination of the placenta revealed findings consistent with COVID-19 placentitis, and SARS-CoV-2 RNA staining was positive, suggesting intrauterine transmission of the infection.

A Clinical Study on Maternal and Perinatal Outcome of Oligohydramnios

Background : Oligohydramnios is one of the pregnancy associated common complications facing by obstetrician which is associated with adverse maternal and perinatal outcome such as birth defects, miscarriage, intrauterine growth restriction, still birth, preterm birth, increased operative interference etc. Objective: To assess the impact of oligohydramnios on maternal and perinatal outcome. Methods: This cross-sectional descriptive study was conducted at Department of Obstetrics and Gynecology, BSMMU, Dhaka from October 2017 to March 2018.Total 50 patients were enrolled by purposive sampling method according to the inclusion and exclusion criteria. Clinical evidence of oligohydramnios was looked for &amp; confirmed by ultrasonography (USG). Based on Amniotic fluid index (AFI)measurements patients were divided into two groups. Those who have AFI &lt;5cm and 5-8cm. The significance of difference or comparison of means was measured by Chi square test. Maternal and perinatal outcome in pregnancies with oligohydramnios were compared with those with 5-8cm amniotic fluid volume. Results: The mean age of the study population was 23.3±4.06 years and majority of the cases were multipara (56%) and presented at term (58%). Borderline oligohydramnios (AFI 5-8cm) was found in 74% cases and severe oligohydramnios (AFI &lt;5cm) were found in 26% cases. Most common etiological factor was idiopathic. Fifteen cases (30%) had vaginal delivery and caesarean section rate 70%, no maternal mortality occurred in this study, perinatal mortality rate was 10%, low birth weight baby was 63.6% and NICU admission rate was 53.8%. Conclusion: An antepartum or intrapartum oligohydramnios is associated with significantly increased incidence of caesarean section for fetal distress and increased incidence of low-birth-weight babies and increased rate of neonatal complications. Northern International Medical College Journal Vol. 12 No.1 July 2020, Page 489-492

Intrauterine growth restriction and perinatal outcome among oligohydramnios pregnancies

Background: Successful outcome of obstetric well-being is to assess by obtaining healthy mother and child in modern obstetrics. Assessment of fetal well-being is important in timely diagnosis of fetal compromise and management. Amniotic fluid serves a major role in the development of the fetus. Aims and Objectives: The present study aims to evaluate the oligohydramnios pregnancies admitted in IPD of G &amp; O, Bankura Sammilani Medical College &amp; Hospital in terms of intrauterine growth restriction (IUGR) and perinatal outcomes. Materials and Methods: The study was conducted at Bankura Sammilani Medical College and Hospital, West Bengal, in terms of IUGR and perinatal outcomes from April 2020 to September 2021 among 80 antenatal mothers diagnosed to have oligohydramnios and subsequently admitted in-patients-department. Thorough history taking and clinical examination was done. Template was generated in MS Excel sheet and analysis was done on SPSS software. Results: Among 80 antenatal mothers diagnosed with oligohydramnios, the mean age of patients was 22.0750±4.1484. 21 (26.25%) patients had NICU admission and 56 (70.0%) patients had IUGR. In the study, 1 (1.25%) patient was perinatal death and 79 (98.75%) patients survived. In without IUGR, the mean birth weight (mean±SD) of patients was 2.7483±0.2222. In without IUGR, 1 (4.2%) patient had NICU admission. In with IUGR, 20 (35.7%) patients had NICU admission. Conclusion: Ultrasonography plays a major role in early diagnosis of IUGR. IUGR was associated with cesarean section for fetal distress, and NICU admission among oligohydramnios can be predicted using umbilical artery Doppler velocimetry.

Outcomes of Monoamniotic Twin Pregnancies from the First Trimester Onward

Introduction: Monochorionic monoamniotic (MCMA) twins are rare, and information is lacking on pregnancy outcomes from the first trimester onward. This study compares the pregnancy and neonatal outcomes between MCMA and monochorionic diamniotic (MCDA) twin pregnancies from the first trimester onward. We also report on the outcomes of MCMA twin pregnancies continuing after 28 weeks and on the neurodevelopmental outcomes of MCMA twins. Methods: A retrospective single-center cohort study of MCMA and MCDA twin pregnancies followed from the first trimester with a fortnightly ultrasound scan. We excluded pregnancies with a major anomaly diagnosed on the first-trimester ultrasound scan. MCMA twin pregnancies were offered inpatient monitoring from 28 weeks onward, and an elective cesarean section was advised between 32 and 33 weeks. MCDA pregnancies were managed as inpatients only if medically indicated, and an elective birth between 36 and 37 weeks was recommended. Results: We analyzed the outcomes of 52 MCMA and 671 MCDA twin pregnancies. In MCMA twins, the fetal and neonatal survival rate was 81/104 (78%) versus 1,192/1,342 (89%) in MCDA twins (p = 0.016). Double intrauterine demise (IUD) was more common in MA than in DA pairs (13% vs. 3%) (p = 0.002). No IUD occurred in the 40 MCMA pregnancies that continued after 28 weeks, but five women (13%) required an urgent cesarean section for fetal distress. Thirty-eight of 52 eligible infants (73%) underwent a neurodevelopmental assessment. Thirty-three (87%) had cognitive and motor development scores within normal limits. Four infants had mild cognitive or motor impairment, and one infant was diagnosed with spastic diplegia. Conclusion: MCMA twins are associated with decreased survival rates compared to MCDA due to increased rates of double IUD. After 28 weeks, about one in eight women required an urgent delivery for fetal distress. Most infants had normal neurodevelopmental outcomes.

Third trimester uterine artery Doppler for prediction of adverse perinatal outcomes.

Abnormal uterine artery Doppler (UtAD) studies early in gestation have been associated with adverse pregnancy outcomes. However, their association with complications in the third trimester is weak. We aim to review the prediction ability for perinatal complications of these indices in the third trimester. Abnormal UtAD waveforms in the third trimester are associated with preeclampsia, small-for-gestational age infants (SGA), preterm birth, perinatal death, and other perinatal complications, such as cesarean section for fetal distress, 5 min low Apgar score, low umbilical artery pH, and neonatal admission to the ICU, particularly in SGA infants. UtAD prediction performance is improved by the addition of maternal characteristics as well as biochemical markers to prediction models and is more precise if the evaluation is made closer to delivery or diagnosis. This review shows that the prediction accuracy of UtAD for adverse pregnancy outcomes during the third trimester is moderate at best. UtAD have limited additive value to prediction models that include PlGF and sFlt-1. Serial assessments rather than a single third trimester evaluation may enhance the prediction performance of the UtAD combined models.

417 IS ACCELERATED GROWTH VELOCITY A RISK FACTOR OF ADVERSE PERINATAL OUTCOME

Introduction: Large for gestational age and macrosomia are known risk factors of adverse perinatal outcome. Less is known on the association between accelerated growth velocity and placental insufficiency which results in such adverse outcomes as intrauterine death, reduced Apgar scores and cesarean section for fetal distress. Aim of the study: The aim of this study was to assess the incidence of accelerated growth velocity (AGV) and its relationship with adverse perinatal outcome. Methods: This is a retrospective cohort study. The study included singleton deliveries that had an ultrasound performed between 28-32 weeks of gestation and subsequently delivered at our maternity unit. We defined appropriate-for-gestational-age (AGA) as between the 10-90th centile, large-for-gestational-age (LGA) as above the 90th centile, by the Intergrowth chart. Accelerated growth velocity was defined as increase by at least 50 centiles between birthweight and estimated fetal weight on ultrasound at 28-32 weeks of gestation. Composite neonatal outcome, intrauterine fetal death and neonatal death were assessed in the following groups: LGA, LGA+AGV, AGA+AGV, AGA. Results: The final database of combined ultrasound and delivery records comprised of 2209 records (AGA n=1688, AGA+AGV n=86, LGA n=391, LGA+AGV n=44; 88.56%, 4.51%, 20.51%, 2.31% respectively). The highest risk of APO was in AGA neonates with AGV 26.74%, followed by LGA with AGV 18,18%. The lowest risk of APO was among LGA neonates 16.37%. Conclusions: The role of accelerated growth velocity needs further assessment. The highest risk of APO is among AGA neonates with AGV. This could be explained by the disproportion between fetal and placental size resulting in placental insufficiency.

Relationship of Amniotic Fluid Index (AFI) Between Maternal and Perinatal in Patients

Background: Alcohol amniotic, a protecting fluid that surround the embryo. It protects from concussion, pressure, desiccation, reminiscent of the aquatic origin of life. Adequate amount of amniotic fluid is essential requirement for the normal development and it acts like a cushion against trauma, agitation and accidental impulsions. It has also bacteriostatic properties and prevents the infection of many bacterial infections.&#x0D; Aim: To assess the maternal and fetal outcome in cases with normal and abnormal Amniotic Fluid Index levels.&#x0D; Results: The mode of delivery was spontaneous vaginal delivery followed by Assisted VD, Elective CS, Emergency CS respectively. It was affected by amount of liquor since, low AFI group 35 (75%) patients ended up in cesarean section for fetal distress. While in control group 63(18.3%) patients had caesarean section.&#x0D; Conclusion: Early neonatal death was seen in 0.2%, 4.5% and 70.5% newborns were born to pregnant women with normal AFI, oligohydramnios respectively. 70.5% neonates born to pregnant women with oligohydramnios had NICU admission. All cases were admitted in NICU because of respiratory distress.

Neonatal Arrhythmia

Arrhythmias are seldom observed in the newborn period and rarely lead to serious consequences. Because they may be a continuation of fetal arrhythmias, newborn arrhythmias are different from those occurring at later ages. Here we describe a case of a newborn presented with tachycardia at birth. A female baby of 1950 grams born by emergency cesarean section for fetal distress at 36 weeks of gestation. Fetal tachycardia of 251 bpm was detected prenatally. Electrocardiography showed supraventricular tachycardia (SVT). Hematological and biochemical tests done were within normal limits. Echocardiography revealed normal anatomy with severe tachycardia, dilated chambers with moderate to severe TR with moderately reduced ventricle function. For persisting SVT intravenous adenosine was administered with no significant decrease in heart rate, then continuous intravenous amiodarone infusion was started resulting in a transient decrease in heart rate, however again increased, hence baby was started on intravenous digoxin which responded well. Repeated echocardiography showed normal cardiac chambers and function. Baby was discharged on maintenance oral digoxin and was gradually weaned and stopped after 12 months of age. Neonatal arrhythmias is not an uncommon condition in newborns, however it should be early recognized and evaluated for a better outcome of the baby. Although the frequency of arrhythmias in the newborn period is not high, SVT are the most frequently observed arrhythmias in this period.

Cerebroplacental ratio in predicting adverse perinatal outcome: a meta-analysis of individual participant data.

ObjectiveTo investigate if cerebroplacental ratio (CPR) adds to the predictive value of umbilical artery pulsatility index (UA PI) alone – standard of practice – for adverse perinatal outcome in singleton pregnancies.Design and settingMeta‐analysis based on individual participant data (IPD).Population or sampleTen centres provided 17 data sets for 21 661 participants, 18 731 of which could be included. Sample sizes per data set ranged from 207 to 9215 individuals. Patient populations varied from uncomplicated to complicated pregnancies.MethodsIn a collaborative, pooled analysis, we compared the prognostic value of combining CPR with UA PI, versus UA PI only and CPR only, with a one‐stage IPD approach. After multiple imputation of missing values, we used multilevel multivariable logistic regression to develop prediction models. We evaluated the classification performance of all models with receiver operating characteristics analysis. We performed subgroup analyses according to gestational age, birthweight centile and estimated fetal weight centile.Main outcome measuresComposite adverse perinatal outcome, defined as perinatal death, caesarean section for fetal distress or neonatal unit admission.ResultsAdverse outcomes occurred in 3423 (18%) participants. The model with UA PI alone resulted in an area under the curve (AUC) of 0.775 (95% CI 0.709–0.828) and with CPR alone in an AUC of 0.778 (95% CI 0.715–0.831). Addition of CPR to the UA PI model resulted in an increase in the AUC of 0.003 points (0.778, 95% CI 0.714–0.831). These results were consistent across all subgroups.ConclusionsCerebroplacental ratio added no predictive value for adverse perinatal outcome beyond UA PI, when assessing singleton pregnancies, irrespective of gestational age or fetal size.Tweetable abstractDoppler measurement of cerebroplacental ratio in clinical practice has limited added predictive value to umbilical artery alone.

Umbilical cord length affects the efficacy of amnioinfusion for repetitive variable deceleration during labor

Objectives Although amnioinfusion (AI) for repetitive variable deceleration has been reported to reduce the frequency of variable deceleration and cesarean section (CS) rate, CS is sometimes unavoidable even after therapeutic AI. The purpose of this study was to investigate prenatal factors related to the efficacy of therapeutic AI during labor. Methods This retrospective study investigated 80 singleton pregnancies that underwent transcervical therapeutic AI for repetitive variable deceleration during labor. AI was performed with 500 mL of warmed saline through an intrauterine pressure catheter by gravity infusion. Prenatal factors related to emergency CS for fetal distress even after therapeutic AI were investigated. Results Emergency CS was performed for 12 of the 80 cases due to fetal distress. Z-score for umbilical cord length was significantly smaller in the CS group (−0.68 SD) than in the vaginal delivery group (0.15 SD, p < .001). No CSs were performed in cases with Z-score for umbilical cord length >–0.05 SD. No significant differences between CS and vaginal delivery groups were seen in gestational age at delivery, cervical dilatation at AI, birth weight, Z-score of birth weight, incidence of the nuchal cord or incidence of abnormal umbilical cord insertion. Conclusions Therapeutic AI for repetitive variable deceleration was considered useful, in many cases avoiding emergency CS. Short umbilical cord length (lower Z-score) was related to emergency CS after therapeutic AI for repetitive variable deceleration. Umbilical cord length may offer an important factor for assessing the risk of fetal distress that is difficult to avoid, if methods to accurately determine umbilical cord length can be developed.

Prediction of adverse perinatal outcome by cerebroplacental ratio in women undergoing induction of labor.

To investigate the performance of screening for adverse perinatal outcome by the cerebroplacental ratio (CPR) measured within 24 h prior to induction of labor. This was a prospective observational study of 1902 singleton pregnancies undergoing induction of labor at ≥ 37 weeks' gestation. Doppler ultrasound was used to measure the pulsatility index (PI) in the umbilical artery (UA) and fetal middle cerebral artery (MCA) within 24 h before induction of labor. The measured UA-PI and MCA-PI and their ratio were converted to multiples of the median after adjustment for gestational age. Univariable and multivariable logistic regression analysis was used to determine whether CPR improved the prediction of adverse perinatal outcome provided by maternal characteristics, medical history and obstetric factors. The detection rate (DR) and false-positive rate (FPR) of screening by CPR were estimated for Cesarean section for presumed fetal distress and adverse neonatal outcome, which included umbilical arterial or venous cord blood pH ≤ 7 and ≤ 7.1, respectively, 5-min Apgar score < 7, admission to the neonatal intensive care unit for > 24 h or hypoxic ischemic encephalopathy. A combination of maternal and pregnancy characteristics, including age, weight, racial origin, previous obstetric history, pre-eclampsia, gestational age at delivery and amniotic fluid volume, identified 39% of pregnancies requiring Cesarean section for fetal distress at a FPR of 10%; addition of CPR did not improve the performance of screening. In screening for adverse neonatal outcome by a combination of parity and CPR, the DR was 17% at a FPR of 10%. Low CPR, measured within 24 h prior to induction of labor, is associated with increased risk of Cesarean section for fetal distress and adverse neonatal outcome, but the performance of CPR for such surrogate measures of fetal hypoxic morbidity is poor. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Re-evaluation of abruptio placentae and other maternal complications during expectant management of early onset pre-eclampsia.

Expectant management of appropriately selected cases of early pre-eclampsia in a dedicated, tertiary in-patient setting with frequent non-invasive maternal and fetal surveillance, prolongs pregnancy, improves perinatal outcome and mitigates the impact of maternal complications. As the rate of abruptio placentae in a large descriptive study performed nearly 20 years ago was 20%, a study to re-evaluate the rate of abruptio placentae and other maternal complications was performed. A retrospective study that included all women admitted for expectant management with stable early pre-eclampsia (≥24 and <34 weeks' gestation) was performed at Tygerberg Hospital, a secondary and tertiary referral centre in South Africa over a period of 12 months. Abruptio placentae and other maternal complications. During the study period, 9137 women were delivered at the study institution. The data of 102 of 106 women admitted for expectant management of early pre-eclampsia were available. Thirty-four (33%) reached the elective delivery threshold of 34 weeks. Seventeen women (17%) experienced ≥1 complication. There were four cases (4%) each with abruptio placentae, HELLP syndrome and renal insufficiency. Three of the cases with abruptio placentae were asymptomatic, only being diagnosed at caesarean section for fetal distress. Nine women developed mild/moderate ascites. There were no admissions to the critical care unit and no deaths. Abruptio placentae occurred in 4% of women managed expectantly with early pre-eclampsia and was most often asymptomatic before delivery.

Fetal distress, options of anesthesia, and immediate postdelivery outcome at state specialist hospital Akure

Background: When abnormalities of the fetal heart rate are recognized promptly and dealt with, asphyxia and therefore perinatal morbidity and mortality can be reduced. The objective of fetal monitoring during labor is the prediction and diagnosis of fetal asphyxia before fetal/newborn morbidity with particular reference to brain damage occurs. Fetal distress is one of the conditions in which the obstetrician is required to hasten the process of delivery. This urgency is also usually transferred to the anesthetists, whereas the burden of adverse fetal outcome falls squarely on the pediatrician. Objective: This study found out the form of anesthesia mostly used for caesarean sections (CS) in cases of fetal distress, its appropriateness in terms of achieving management goals, and advantages over the other form of anesthesia. Study Design: This study is a retrospective descriptive cross-sectional study. Materials and Methods: Records of patients that had caesarean section for suspected fetal distress over a period of 5 years were reviewed. The fetal status at the point of making diagnosis, type of anesthesia used, suite-arrival-incision-interval, and the baby's condition after surgery were retrieved from the case notes. Data were analyzed with the Statistical Package for Social Sciences (SPSS) version 20.0. Frequencies and proportions of data from the type-of-anesthesia groups were compared. Variables were compared for significance using Chi-square. Results: Most of the surgeries for fetal distress were done under spinal anesthesia in 90% of the patients. Suite arrival-to-incision interval which is largely affected by type of anesthesia was within 1 h 30 min in 91.6% of those that had spinal anesthesia compared to 100% for those that had general anesthesia (GA). P value = 0.000. APGAR score of Conclusion: The predominant type of anesthesia used for caesarean section for fetal distress from this study was spinal anesthesia which had better neonatal outcome.

A Successful Pregnancy in Women with Uterine Didelphys

We report a didelphys uterus in 36 years female diagnosed intra-operatively who underwent Cesarean Section for fetal distress. The fetus was found in one uterus while another uterus was empty.

Doppler measurements of both umbilical arteries do not improve predictive value for adverse perinatal outcomes in small-for-gestational age fetuses

ObjectiveTo assess agreement of Doppler ultrasound measurements of the two umbilical arteries in small-for gestational age (SGA) fetuses, and to compare discriminative ability between the two arteries for adverse perinatal outcome. Study DesignWe analysed a prospective cohort of singleton SGA pregnancies, in which the pulsatility index (PI) of both umbilical arteries was standardly measured by Doppler ultrasound in the free-floating umbilical cord. The outcome of interest was a composite adverse outcome, defined as perinatal death, Apgar score <7 at 5 min, cesarean section for fetal distress, and neonatal intensive care unit admission. ResultsA total of 531 measurements were performed in 124 patients. Mean absolute difference between PI measured in the two umbilical arteries was 0.14 (95% CI: 0.12 to 0.15), showing good agreement with an ICC of 0.830 (95% CI: 0.801 to 0.854). Perinatal outcomes were available for 101 patients, of which 48 patients (48%) had a composite adverse perinatal outcome. We found no significant differences between AUCs for prediction of an adverse outcome based on lowest, highest and mean PI values in the two umbilical arteries (AUCs = 0.75, 0.74, 0.75 with p = 0.91). As a comparison, the AUC of a PI value obtained in a single, randomly selected umbilical artery was 0.74. ConclusionThe two umbilical arteries show good agreement in terms of their PI values in the free-floating umbilical cord, and do not differ in terms of their discriminative ability for adverse perinatal outcome in SGA fetuses. We found no evidence of an added value of standard Doppler measurement of both umbilical arteries.