Neonatal Consequences Research Articles

Practical Considerations for Using Continuous Glucose Monitoring in Patients with Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is the most prevalent metabolic complication during pregnancy. GDM is associated with adverse perinatal, neonatal, and long-term health consequences. Studies have demonstrated that the use of continuous glucose monitoring (CGM) reduces the incidence of maternal and neonatal complications in pregnant women with type 1 diabetes. Although the use of CGM in GDM has not been well studied, a growing body of evidence is showing potential benefits in the GDM population. This article discusses the advantages and challenges of CGM and provides practical guidelines for using this technology in the GDM population.

Maternal and Neonatal Consequences of Early Augmentation of Labor Among Women With Spontaneous Onset of Labor: A National Population-Based Study.

While some labor interventions are essential in preventing maternal and neonatal morbidity, there is little evidence to support systematic early augmentation of labor (EAL). Our objective was to assess the association between EAL and cesarean delivery rate, postpartum hemorrhage and adverse neonatal outcomes. Population-based study using data from the 2016 French Perinatal Survey. Women with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. "EAL" was defined by artificial rupture of the membranes (AROM) and/or oxytocin within 1 h of admission and/or duration between interventions of less than 1 h. Women without EAL were women without labor augmentation or without EAL. The primary endpoint, cesarean delivery and the secondary endpoints were compared between women with and without EAL using univariate analysis. A multivariable logistic regression was adjusted on the suspected confounders and a propensity score approach was then performed. Among the 7196 women included, 1524 (21.2%) had EAL. Cesarean delivery rates were significantly higher in the EAL group compared with the no EAL group, 8.40% versus 6.15% (p < 0.01). EAL was associated with cesarean delivery in the multivariable analysis aOR 1.45 95% CI [1.15-1.82] and in the cohort matched on the propensity score, OR 1.56 [1.17-2.07]. EAL was not associated with severe postpartum hemorrhage, low 5-min Apgar score, low neonatal cord pH or transfer to NICU. EAL is frequent, involving one in five spontaneous laboring women in France. This practice is associated with an increased cesarean delivery risk.

Impact of Arterial Hypotension During Spinal Anesthesia for Cesarean Delivery on the Newborn at Kouba Hospital

Introduction: Spinal anesthesia is commonly used for cesarean deliveries but can lead to maternal hypotension, a frequent complication that may adversely affect the fetus. The objective of this study was to determine the incidence of post-spinal hypotension for cesarean delivery and identify associated risk factors. Methods: This was a prospective descriptive study conducted at Kouba Hospital over one month. Inclusion criteria were patients admitted for scheduled or emergency cesarean under spinal anesthesia after informed consent, without absolute contraindication to spinal anesthesia, baseline blood pressure ≥100 mmHg, and heart rate ≤100 bpm. Patients were excluded if hypotensive, vagotonic, had pre-existing cardiac disease, or received general anesthesia. All patients received 8 mg 0.5% bupivacaine, 2.5 μg sufentanil, and 100 μg intrathecal morphine with standard monitoring and 250 ml fluid preloading. Hypotension was defined as ≥20% decrease from baseline blood pressure. Data collected included demographics, obstetric history, and anesthetic/surgical details. Analysis was done using EPI Info software. Results: 42 parturients were included, mostly ASA II, with mean BMI 26.5±4.1 kg/m2 and gestational age 37.4±2.1 weeks. 50% had a history of hypotension in previous cesareans, and 68% underwent emergency cesarean. Sensory block reached T4 level on average. Hypotension incidence was 80%, with 40% requiring additional fluids and mean 15±10 mg ephedrine. Despite hypotension, most neonates had satisfactory Apgar scores. High BMI, emergency cesarean, and previous hypotension history were significantly associated with increased hypotension risk. Discussion: The high 80% hypotension incidence aligns with literature reports of 70-90%, likely exacerbated by using isobaric/hypobaric rather than hyperbaric bupivacaine. Identified risk factors were consistent with published data. Prompt management likely prevented major neonatal consequences. Conclusion: Intraoperative hypotension is frequent after spinal anesthesia for cesarean delivery. Guidelines recommend a standardized approach with fluid loading, vasopressors, and lateral tilt positioning to prevent maternal and fetal complications. Larger studies are needed to further characterize risk factors.

The Incidence of Intrahepatic Cholestasis of Pregnancy and its Maternal, Fetal, and Neonatal Adverse Outcomes: A Systematic Review and Meta-Analysis.

Intrahepatic cholestasis of pregnancy (ICP) is a problem with an increasing incidence and negative maternal, fetal, and neonatal consequences. This problem is becoming increasingly important. This systematic review and meta-analysis aimed to determine the incidence of ICP and its adverse maternal, fetal, and neonatal adverse outcomes based on primary research studies. This systematic review and meta-analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines and was conducted between June and September 2023 using the following keywords: obstetric cholestasis OR intrahepatic cholestasis AND pregnancy OR pregnant OR prenatal OR antenatal OR perinatal OR maternal OR fetal OR neonatal. Quality assessment of the studies was performed using the Critical Appraisal Checklists developed by the JBI Institute. Data were synthesized using meta-analysis methods. The analysis included 10 studies published between 2013 and 2023. The meta-analysis showed that the incidence of ICP was 1.7% (odds ratio [OR], 0.021; 95% CI, 0.012-0.027), whereas maternal, fetal, and neonatal adverse outcomes included cesarean birth (OR, 2.938; 95% CI, 1.467-5.881), preterm birth or preterm prelabor rupture of membranes (OR, 4.241; 95% CI, 1.996-9.009), hypertensive disorders of pregnancy (OR, 3.715; 95% CI, 1.545-8.929), maternal infection (OR, 3.301; 95% CI, 2.917-3.737), neonatal intensive care unit admission (OR, 2.715; 95% CI, 1.458-5.056), birth weight less than or equal to 2500 g (OR, 2.518; 95% CI, 1.296-4.892), and small for gestational age (OR, 1.915; 95% CI, 1.424-2.573). This systematic review and meta-analysis revealed that ICP has a high incidence and several maternal, fetal, and neonatal adverse outcomes. Therefore, midwives and other health professionals must be aware of these outcomes and provide appropriate care to pregnant individuals with ICP.

Fatel Medicine in Clinical Practice

Fetal medicine is a specific field of medicine dedicated to the care and management of the expanding blastula during pregnancy. It contains an off-course range of demonstrative and therapeutic methods proposed to guarantee the health and happiness of two together, the future baby and the expectant parent. This abstract investigates the relevance and meaning of the before-birth cure in contemporary dispassionate practice.In the current age, fetal medicine has supported extraordinary advancements on account of contemporary technologies and a deeper understanding of what happens before birth. Ultrasound imaging, for instance, has enhanced the necessary finish for monitoring before birth, detecting irregularities, and assessing the overall energy of the embryo. Non-obtrusive prenatal experimentation (NIPT) has transformed the early detection of ancestral disorders, permissive prompt interventions, and cognizant accountability for persons. Fetal medicine offers further conditions; it offers a spectrum of healing attacks that can significantly impact gestational consequences. Intrauterine before-birth surgeries, such as curing processes for inborn heart defects or spina bifida, elucidate the field’s volume to mediate and improve the value of history for affected babies. Furthermore, before birth, the cure plays an important role in directing extreme-risk pregnancies. It authorizes close monitoring of motherly and prenatal well-being, ensuring that potential problems are recognized and addressed immediately. This is specifically critical in cases of multiple pregnancies, motherly healing environments, or fetal tumor limits. The field’s significance is further underscored by allure skills to foster early sticking between persons and the unborn adolescent. Seeing the embryo through ultrasound scans and engaging in discussions about allure, fitness, and what’s happening can enhance the heated relationship ‘between expectant parents and their babies. In conclusion, before birth, medicine has enhanced a necessary component of new clinical practice. It offers an inclusive approach to fetal care, including diagnostics, healing interventions, and psychological support for expectant parents. As electronics continue to advance and our understanding of before-birth incidents deepens, before-birth medicine’s part in guaranteeing healthy pregnancies and improving neonatal consequences will certainly stretch to expand and develop.

Maternal and neonatal consequences of cystocele and rectocele in the delivery process.

The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.

Perinatal Stressors and Consequences for Neonates with Critical Congenital Heart Disease.

The prenatal diagnosis of congenital heart disease (CHD) is a traumatic event that can cause expectant parents to experience anxiety, depression, and toxic stress. Prenatal exposure to stress may impact neonatal postoperative outcomes. In addition, expectant parents may have other psychosocial stressors that may compound maternal stress. We investigated the relationship between stress in pregnancies complicated by prenatally diagnosed CHD and their neonatal outcomes. A pilot retrospective cohort study of pregnancies with prenatally diagnosed critical CHD (2019-2021) was performed. The collected data included pregnancy characteristics and neonatal and postoperative outcomes (including the need for exogenous corticosteroid treatment (ECT)). In order to quantify prenatal stressors, a composite prenatal stress score (PSS) was established and utilized. In total, 41 maternal-fetal dyads were evaluated. Thirteen (32%) neonates had single-ventricle anatomy. The need for ECT after CHD surgery was associated with higher pregnant patient PSS (p = 0.01). PSS did not correlate with birthweight, infection, or hypoglycemia in the neonatal period. Prenatal stress is multifactorial; higher PSS is correlates with post-bypass ECT, suggesting that a stressful intrauterine environment may be associated with worse neonatal postoperative outcomes.

Short and Medium-Term Maternal and Neonatal Outcomes After COVID-19 Infection

Background: Comparing the maternal and neonatal complications of COVID-19 with a healthy control group is important to identify the most accurate and up-to-date information about the effects of this disease on the health of mothers and neonates. Objectives: The study aimed to determine the maternal and neonatal complications and consequences related to COVID-19 infection. Methods: This case-control study was conducted from February 2021 to February 2022 on women who were infected with COVID-19 during their pregnancy to evaluate the short and medium-term maternal and neonatal outcomes and compare them in the control group. Maternal outcomes, such as the rate of miscarriage, preterm delivery, stillbirth, and type of delivery, as well as gestational diabetes and preeclampsia, were evaluated. Indeed, neonatal complications, including hearing impairment, low birth rate, intrauterine growth restriction, and the rate of hospitalization in the neonatal intensive care unit, were evaluated and compared between groups. Results: In total, 600 women (300 cases in each group) participated in the study. The results showed that the frequency of cesarean delivery in patients with COVID-19 was 38%, while this rate was 20% in the control group. This difference was significant. It was also found that pregnant women suffering from COVID-19 had significantly more preterm labor. Babies born to mothers infected with COVID-19 had a significantly higher hospitalization rate in the intensive care unit than in the control group. Other maternal and neonatal complications were not significantly different between the two groups. Conclusions: Women who are infected with COVID-19 during pregnancy face new maternal and newborn complications. Therefore, it is necessary to carry out further research on the long-term effects of COVID-19 on the health of the mother and baby in order to determine the appropriate strategies for the prevention and treatment of these complications.

Effects of Metformin Among Type 2 Diabetes Pregnant Women: A Preliminary Study

Diabetes mellitus (DM) is a chronic but non-contagious metabolic disease that is characterized by elevated levels of blood sugar. In pregnancy it increases various risk factors, such as adverse maternal, fetal, obstetric, and neonatal consequences. Gestational diabetes (GD) is associated with abnormalities in placental development including impairments in trophoblastic differentiation. Insulin therapy is the best treatment for both mother and fetus. On the other hand, Metformin is an oral anti-hyperglycaemia agent that is commonly used to treat type 2 diabetes (T2D) pregnant and non-pregnant women worldwide. But its role in gestational diabetes management remains controversial. It prevents the production of hepatic glucose, increases fatty acid oxidation, enhances insulin sensitivity, decreases lipid synthesis, and impedes gluconeogenesis. From the scientific researches of scientists obtained that hypoglycaemia is not a concern of Metformin. In this review article the benefits and possible negative impacts of Metformin use during pregnancy are discussed in briefly.

Predictive Ability of Ultrasound on Neonatal Diagnoses and Consequences on Prenatal Care Utilization.

Fetal anomalies suspected on fetal ultrasound may cause significant stress for patients. Some findings resolve or have minimal clinical significance for the neonate. Our purpose is to evaluate fetal ultrasound accuracy and false-positive results and determine the clinical impact on maternal counseling. A retrospective review was performed on electronic medical records for women receiving prenatal care at Harbor-UCLA Medical Center who had abnormal findings on fetal ultrasounds between January 2015 and December 2018. Corresponding neonatal medical records were reviewed for the suspected condition(s). χ2 and Fisher exact tests were conducted to assess associations between fetal ultrasounds and neonatal outcomes. Two hundred eight mothers and 237 babies (including all 29 sets of twins) were included in the final analysis. Fetal ultrasounds were significantly associated with neonatal findings for the following conditions (sensitivity, specificity): anatomical disorder of extremities (0.72, 0.97), anatomical disorder of the face/skull/brain (0.67, 0.91), congenital anomaly of gastrointestinal tract (0.75, 0.98), congenital heart disease (0.75, 0.91), genetic disorder (0.72, 1.00), growth restriction (1.00, 0.85), kidney disorder (0.55, 0.98), and large for gestational age (0.80, 0.98). The highest false-positive rates occurred in congenital heart disease (65.4%), anatomical disorder of the face/skull/brain (64.3%), and growth restriction (54%). Fetal ultrasound highly correlates with neonatal findings for many congenital conditions. However, it can also be associated with a high false-positive rate for certain diagnoses; maternal counseling should include the limitations of ultrasound, including the potential for false-positive results.

Effect of vitamin A on maternal, fetal, and neonatal outcomes: An overview of deficiency, excessive intake, and intake recommendations.

Vitamin A imbalance during pregnancy and lactation is a global public health concern with potentially negative consequences for fetuses and neonates. Inadequate vitamin A intake during this critical period can lead to anemia, weakened immune function, night blindness, and increased susceptibility to infections. Conversely, excessive intake of vitamin A can result in birth defects, hypercalcemia, and psychiatric symptoms. This review aims to identify risk factors contributing to vitamin A deficiency in pregnant women and its impact on maternal,fetal, and neonatal outcomes. It also examines the effects of high-dose vitamin A supplementation during pregnancy on offspring health. By analyzing existing literature and recommendations, the review emphasizes the significance of vitamin A in the development of various body systems and organs. It provides a comprehensive overview of the effects of vitamin A during pregnancy and lactation, encompassing deficiencies, excessive intake, and supplementation guidelines. The need for further research in this field is highlighted. In conclusion, maintaining a balanced vitamin A status is crucial during pregnancy to promote better outcomes for fetuses and newborns. Effective monitoring and intervention strategies are essential to address vitamin A deficiency and excess in pregnant women, thereby improving fetal and neonatal health.

Seroprevalence of VZV and HSV-2 Antibodies among Women of Childbearing Age Referring to Health Centres of Mashhad, Iran: The Need for Consideration of VZV Vaccination Program.

Infections with herpes simplex virus type 2 (HSV-2) and varicella-zoster virus (VZV) are associated with serious maternal and neonatal health consequences. The literature review reveals a research gap regarding the seroprevalence of HSV-2 and VZV among women of reproductive age in Mashhad, Northeast of Iran. The present study aims to evaluate the seroprevalence of these viruses among a group of women in Mashhad, Iran. Sera were collected by health center personnel using a cluster sampling method from healthy women with specific age characteristics residing in three distinct socioeconomic regions of the city. The participants, aged 20-35, were divided into three groups (20-25, 26-30, and 31-35 years). The levels of VZV and HSV-2 IgG antibodies were evaluated using commercial ELISA kits. Subsequently, the results were analyzed using SPSS software. A total of 93 women were included in the study. Anti-HSV-2 IgG antibody was detected in 3 out of 93 participants (7.5%), while anti-VZV IgG antibody was found positive in 80 out of 93 individuals (83.3%). The HSV-2 positive cases were concurrently positive for the VZV antibody. There was no significant difference in the positivity of anti-HSV-2 and anti-VZV antibody positivity within age groups or socioeconomic status (P > 0.05). The high seroprevalence of VZV among nonvaccinated participants indicates a widespread presence of the virus and underscores its potentially serious impact on community health. Therefore, it is recommended that a VZV vaccination program be considered by the health system. Furthermore, the reactivation of latent HSV-2, whether symptomatic or asymptomatic, during pregnancy should not be disregarded as a life-threatening threat.

THE EFFECT OF ENOS GENE POLYMORPHISM AND NITRIC OXIDE METABOLISM INDICATORS ON THE NEONATAL CONSEQUENCES IN PREMATURE BABIES BORN FROM MOTHERS WITH METABOLIC SYNDROME

Metabolic syndrome is considered to be a cluster of disorders that directly contribute to the development of cardiovasculardisease and are characterized by chronic systemic infl ammation. Numerous epidemiological data indicate that an adverseintrauterine environment, caused by the peculiarities of the nutritional status or placental insuffi ciency in a woman with metabolic syndrome, can “program” the susceptibility of the fetus to further development of cardiovascular and metabolic diseases, has an impact on cognitive and behavioral development. Nitric oxide (NO) plays a critical role in the pathogenesis of components of the metabolic syndrome. Children born prematurely have a high incidence of brain damage, which can lead to motor, cognitive, behavioral, social and sensory disorders.The purpose the research was the study of the effect of the eNOS gene polymorphism and indicators of nitric oxidemetabolism on the neonatal consequences in prematurely born children from mothers with metabolic syndrome.Material and methods. A study was conducted in which 100 premature infants were included. Two groups were formed: the main group (n=34), which included preterm infants (birth weight 2145.29±148.19 g and gestational age 33.18±0.55 weeks) of mothers with metabolic syndrome, and the comparison group (n=66), which included preterm infants (birth weight 2295.99±101.45 and gestational age 34.03±0.45 weeks) of mothers without metabolic syndrome. The children underwent a genetic study – determination of the polymorphism of the eNOS gene, as well as the level of nitrites, nitrates and nitrosothiols in the urine.By decision of the bioethics commission No. 217 dated 12.06.2023, the materials of the scientifi c work comply with the Rulesof Humane Treatment of Patients.Traditional methods of parametric and nonparametric statistics were used; nonparametric methods were used to analyzequalitative characteristics expressed mainly in percentages. The methods of parametric statistics were used to check the normality of the distribution of quantitative characteristics using the Kolmogorov- Smirnov criterion.Statistical processing of the obtained results was carried out using the package of application programs EXCEL-2003® andSTATA version 11 for Windows (StataCorp, Texas, USA).The work was carried out as part of the scientifi c and experimental work of the Department of Pediatrics #1 with Neonatologyof the Poltava State Medical University “To develop clinical and laboratory criteria, methods of predicting and preventingmetabolic disoders in young children (state registration number 0120U102856).Results. The most common diseases in the infants of the studied groups were the consequences of intrauterine hypoxia(44.1%) and respiratory failure requiring artifi cial lung ventilation (50.0%), although no signifi cant diff erences were foundin the prevalence of these conditions. We identifi ed the presence of signifi cant associations between the consequences ofintrauterine hypoxia and the levels of nitrates (OR 1.19; 95% CI 1.01-1.40; p=0.042), nitrosothiols (OR 1.19; 95% CI 0.99-1.42;p=0.050) and the polymorphic genotype 4aa/ab of the eNOS gene (OR 0.28; 95% CI 0.12-0.67; p=0.004). Analysis of systemichemodynamics revealed no signifi cant diff erences in baseline values between preterm infants with and without intrauterinehypoxia, but we did observe an association with urine output on day 3 of life.To fi nally clarify the complex infl uence of indicators of nitrate metabolism on the development of intrauterine hypoxia andto predict the development of consequences of this condition in premature infants, the following indicators are included in theregression prognostic model: the level of nitrates, nitrites, 4aa/4ab genotype and urine output on the third day of life. As theresearch results show, there is a direct reliable relationship with nitrates and an inverse relationship with nitrites, 4aa/4abgenotype and urine output. This prediction model has high operating characteristics – the area under the ROC curve is 0.8168.Some mechanisms of the infl uence of maternal metabolic syndrome on the development of relevant disorders in newborns areknown, including disorders of nitric oxide synthesis, endothelial dysfunction, and oxidative stress. In our study, the consequences of intrauterine hypoxia were reliably associated with an increase in the concentration of urinary nitrates and a decrease in nitrites, as well as the absence of the 4aa/ab genotype, which is associated with reduced release of nitric oxide. There is evidence that nitric oxide can have both protective and deleterious eff ects, depending on factors such as nitric oxide synthase isoform and duration of exposure to hypoxia.Conclusions. In preterm infants born to mothers with metabolic syndrome, elevated urinary nitrate levels and the absenceof the eNOS 4aa/ab genotype increase the likelihood of suff ering the consequences of intrauterine hypoxia.

Effectiveness of Nifedipine in the Treatment of Threathened Preterm Labour

Background: Preterm birth is one of the most important and major causes of perinatal morbidity and mortality wordwide. Strategies should be adopted to decrease the incidence of pre-term labour and delivery to avoid the associated drastic fetal and neonatal consequences. Objective: To evaluate the effectiveness of Nifedipine in the treatment of spontaneous preterm labour. Material and Methods: This is a Randomised control trial which was conducted in the department of Obstetrics and Gynecology, Hayatabad Medical Complex, from 1st June 2022 to 30th November 2022. Total 50 pregnant women with singleton pregnancy with threatened preterm labor between 28 and 34 weeks of pregnancy on LMP were included.Results: Total 10 (20.0%) patients had a delay in delivery up to &lt; 2 days while 40 (80.0%) patients had a delay in their deliveries for &gt; 2 days, therefore, effectiveness of Nifedipine in the treatment of spontaneous threatened preterm labor was achieved in 40 (80%) patients in terms of delay in their deliveries. Conclusion: This study demonstrated that Nifedipine successfully delayed spontaneous preterm labor for &gt; 48 hours and thus gave sufficient time for in utero transfer and corticosteroid effect.Keywords: Nifedipine, Preterm labor, Tocolysis.

Exploring factors influencing skin incision to the delivery time and their impact on neonatal outcomes among emergency cesarean deliveries indicated for non-reassured fetal heart rate status.

The time interval between skin incision and delivery (S-D) is crucial in determining neonatal outcome; however, little is known about the influencing factors and their impact on neonatal outcomes, particularly among emergency cesarean deliveries (ECD) indicated for fetal distress. This study investigated the factors influencing S-D time and their effects on neonatal outcomes among mothers who underwent ECD for non-reassured fetal heart rate status. This retrospective cohort study involved 426 mother-infant pairs over four years. We retrieved data from the medical records, including baseline characteristics, perioperative data, and neonatal outcomes. Using multivariable logistic regression analysis, adjusted odd ratios, and a 95% confidence interval, potential factors influencing S-D time and their impacts on neonatal outcomes were assessed. A p-value of less than 0.05 was considered statistically significant. Factors independently associated with longer S-D time (>8 min) were mothers who had previous CD (AOR 5.9: 95% CI 2.2-16.1), obese mothers (AOR 6.2: 95% CI 1.6-24.5), and the second stage of labor (AOR 5.3: 95% CI 2.4-11.7). Adverse neonatal outcomes, including a 5th minute Apgar score of less than 7, the need for NICU admission, and neonatal death, were significantly higher in the longer S-D time interval [47.7% vs. 8.9%; p-value 0.001], [21.9% vs. 9.1%; p-value 0.001], and [32% vs. 11.8%; p-value = 0.004], respectively. Obese mothers and the second stage of labor, but not previous CD, adversely impact neonatal outcomes. Longer S-D times are significantly associated with adverse neonatal outcomes. Factors that prolong the time interval between skin incision and delivery may or may not necessarily be associated with adverse neonatal outcomes. Considering surgical techniques that shorten the incision-delivery time and preparation for advanced neonatal care for risky subjects would help reduce detrimental neonatal consequences.

Bochdalek Hernia: A Comprehensive Review of Pathophysiology, Clinical Presentation, Diagnostic Modalities, and Contemporary Management Strategies

Bochdalek hernia, a rare congenital diaphragmatic anomaly, has garnered substantial attention due to its intricate pathophysiological underpinnings and multifaceted clinical implications. This article endeavors to provide an exhaustive analysis of Bochdalek hernia, encompassing its embryological origins, intricate pathophysiology involving the posterolateral diaphragmatic defect, and the subsequent herniation of abdominal contents into the thoracic cavity. A meticulous exploration of the clinical presentation underscores the considerable variation in symptomatology, ranging from asymptomatic cases incidentally detected on imaging, to severe respiratory distress and life-threatening consequences in neonates. The diagnostic armamentarium, including radiographic, ultrasonographic, and tomographic modalities, is scrutinized with a focus on their respective sensitivities and specificities in discerning this anatomical aberration. In light of contemporary advancements, the article elucidates the expanding role of three-dimensional reconstructions and minimally invasive techniques in achieving accurate diagnosis and surgical planning. Furthermore, the management landscape is delineated, encompassing conservative approaches for asymptomatic cases, urgent surgical interventions for acute presentations, and the nuanced perioperative considerations for neonates and pediatric patients. A comprehensive overview of surgical techniques, ranging from traditional open procedures to the evolving realm of robotic-assisted and laparoscopic repairs, is provided, with emphasis on individualized strategies tailored to patient-specific factors. In summation, this article offers a comprehensive and sophisticated exploration of Bochdalek hernia, amalgamating embryology, pathophysiology, clinical presentation, diagnostic modalities, and contemporary management paradigms. It is envisaged that this review will serve as a valuable resource for medical practitioners, surgeons, and researchers, fostering an enriched understanding of this intricate condition and facilitating informed decision-making in its management.

Diagnosis and Management of Perinatal Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) can emerge or be exacerbated during the perinatal period with serious emotional and physiologic consequences for parents and neonates. Many clients with OCD with perinatal onset will have no known risk factors, and up to 57% of those suffering from postpartum depression show symptoms of OCD, making proper and timely identification an essential skill. Recent developments in available treatments can lead to drastic improvements in symptomology and management. The purpose of this article is to provide an overview of recent research into OCD in the perinatal period with an emphasis on identification and management of the disorder.

Investigating the Relationship Between Structural Determinants of Health and Domestic Violence Against Pregnant Women Based on the World Health Organization Model

Background: Domestic violence is recognized as a global health problem. In recent years, understanding the factors affecting violence against women has become one of the most prominent issues. Objectives: This study aimed to identify the relationship between the structural determinants of health and domestic violence against pregnant women. Methods: This descriptive cross-sectional study was conducted on 560 volunteer pregnant women, aged 28 - 35 weeks, who were referred to healthcare centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran, Iran, during 2021 - 2022, using a multistage cluster sampling method. The data collection tools used in this research included questionnaires on demographic and gynecologic/obstetric factors, socioeconomic status, and domestic violence. The collected data were analyzed by measuring descriptive and inferential statistics using the chi-square test and multivariate logistic regression analysis. Results: Based on the results, more than 50% of women were subjected to domestic violence during pregnancy (66.3% emotional violence, 10.2% physical violence, and 9% sexual violence). Domestic violence showed a significant relationship with the majority of the structural determinants of health (P &lt; 0.005). Based on the logistic regression model, demographic/obstetric and socioeconomic factors explained 73% and 85.3% of the variance in domestic violence, respectively. Certain structural social determinants of health acted as protective factors against domestic violence toward pregnant women, as the possibility of domestic violence was lower in women with high school education, working spouses, and high income (OR = 0.310, 0.217, and 0.255, respectively). Conclusions: This study showed that more than half of Iranian women experienced domestic violence during pregnancy. To prevent adverse maternal and neonatal consequences, it is necessary to identify these women and introduce them to support centers.

Diagnostic Value and Prognostic Significance of Nucleated Red Blood Cells (NRBCs) in Selected Medical Conditions.

Nucleated red blood cells (NRBCs) are premature erythrocyte precursors that reside in the bone marrow of humans of all ages as an element of erythropoiesis. They rarely present in healthy adults' circulatory systems but can be found circulating in fetuses and neonates. An NRBC count is a cost-effective laboratory test that is currently rarely used in everyday clinical practice; it is mostly used in the diagnosis of hematological diseases/disorders relating to erythropoiesis, anemia, or hemolysis. However, according to several studies, it may be used as a biomarker in the diagnosis and clinical outcome prognosis of preterm infants or severely ill adult patients. This would allow for a quick diagnosis of life-threatening conditions and the prediction of a possible change in a patient's condition, especially in relation to patients in the intensive care unit. In this review, we sought to summarize the possible use of NRBCs as a prognostic marker in various disease entities. Research into the evaluation of the NRBCs in the pediatric population most often concerns neonatal hypoxia, the occurrence and consequences of asphyxia, and overall neonatal mortality. Among adults, NRBCs can be used to predict changes in clinical condition and mortality in critically ill patients, including those with sepsis, trauma, ARDS, acute pancreatitis, or severe cardiovascular disease.

DETERMINING THE PATHOGENS OF NEONATAL SEPSIS AT THE NATIONAL CHILDREN'S HOSPITAL (2019 – 2021)

Sepsis is a life-threatening condition responding to an infectious agent causesdamage to tissues and organs. Sepsis causes serious consequences in neonates due tohighrates of mortality and sequelae and disability. Currently, the treatment ofneonatal sepsis is still facing many difficulties due to late diagnosis, inappropriateantibiotic selection for the pathogen model. The mortality rate of the disease is stillhigh. Determining the pathogens of neonatal sepsis at the National Children'sHospital (2019 – 2021). A descriptive study was conducted on 85 positive bloodculture samples of full-term infants admitted to the Neonatal Center of VietnamNational Children’s Hospital in the period from 12/2019 to 4/2021.Gram-negative bacteria accounted for the highest percentage 51%, Grampositive bacteria accounted for 38.8%, Candida accounted for 9.4%. S. aureus is thecommon cause of disease (28.2%), E. coli and K. pneumonia account for a highproportion (16.5%). Antibiotics with high sensitivity are vancomycin, aztreonam,moxiflocaxin, ertapenem, levofloxacin, meronem.