Cord Prolapse Research Articles

To Identify Common Risk Factors Associated with IUFD in Rangpur Medical College Hospital, Rangpur, Bangladesh

Introduction: Intra uterine fetal death is always an unacceptable event not only by the expecting mother and family but also by the obstetrician. Both the woman & the obstetrician become desperate to know the cause of IUFD & its prevention in future pregnancy. In more than 50% cases causes of fetal death cannot be determined. Objective: To identify common risk factors associated with IUFD. Methods: It was a cross sectional study was conducted in the department of Obstetrics & Gynaecology, Rangpur Medical College Hospital, Rangpur over the period of 6 months dated from July 2017 to December 2017. Sample size: 50 cases. All pregnant woman after 28 weeks of gestational age who were admitted in antenatal ward of the Gynae & Obstetric department of Rangpur Medical College Hospital, Rangpur. During the study period all the patients with IUFD & Fetuses who does not show any signs of births were the study population of this study. Result: Total 50 patients included in your study. Table-I shows that most of the women with IUFD cases fall in the age group of 20-30years 76% and 72% of women had primary level of education. Most of the patient 70%were from middle class. All were housewife. Majority (88%) were from rural area. Majority 52% were primigravida, 50% were>36weeks of gestational age, history of abortion were in 14% cases & IUFD in 04% cases. None of the patient took regular antenatal care, most of the Patient (72%) took irregular ANC, and 28% of patient did not take any ANC. Hypertensive disorder was the major risk factors 34% which include chr. HTN. 08%, preeclampsia 10% & eclampsia 16%, Other risk factors were PROM 16%, Prolong labor and obstructed labour 12%, GDM 06%, Rupture uterus with previous C/S 10%, Placental factor 08%, Cord prolapse 06%, Severe IUGR 04%, no risk factors found in 04% cases. 72% of the cases had mild anaemia, 60% were normotensive & 40% had high blood pressure, Scar tenderness were found in 20% cases who had H/O C/S. the patient 58% had Hb% 08-10gm/dl, all were Rh+ve mother, PPBS raised in 06% cases. In USG liquor volume normal 20%, mild to moderate oligohydramnios in 44%, moderate to severe oligohydramnios in 20% & severe oligohydramnios in 16% cases. Shows vaginal delivery had occurred in 86% cases. 14% need operative intervention among which 10% laparotomy were due to rupture uterus & 04% LSCS were due to scar tenderness. Maternal outcome in 84% cases were uneventful. Wound infection occured in 12% cases & Puerperial sepsis occurred in 04% cases. Conclusions: PIH, PROM were leading causes of IUFD. Majority of women who had IUFD were emergency admission who had not received adequate antenatal care. A significant proportion of IUFD is preventable by health education to patients and community for regular antenatal care, about warning signs during antenatal period, hospital delivery and early referral.

Study of Childbirth with A Single Scar Uterus at the "Major Moussa Diakite" Reference Health Center in Kati, Mali

The management of childbirth in a scarred uterus is one of the most debated subjects in modern obstetrics, due to the considerable increase in caesarean section rates and many other risks of complication such as disunion of the old scar. Objective: To study childbirth with a single scar uterus at the Kati Reference Health Center. Method: This was a prospective cross-sectional study, which ran from 1 January to 31 December 2021. It focused on parturients with a single myometrial scar, a vertex presentation of the foetus, a clinically normal pelvis, a uterine height of less than 36 centimeters, a single foetal pregnancy and an intergenesic interval of more than one year. Results: Out of a total of 2521 deliveries, seventy (70) women met the criteria of our study, or a frequency of 28%. The average age of parturients was 30, with extremes ranging from 18 to 42. Only 20% of our parturients had completed four antenatal consultations. They were carried out in 78.5% of cases by qualified staff. Eight out of ten of our parturients (81.4%) came on their own, and in seven out of ten cases (70.0%) in the active phase of childbirth. Delivery was by natural route in almost seven out of ten cases (65.7%), compared with caesarean section in 34.3% of cases. The indications for caesarean section were dominated by dynamic dystocia (66.7%), followed by failure to engage (12.5%), acute foetal distress (12.5%) and umbilical cord prolapse (8.3%). Previous vaginal delivery prior to caesarean section was associated with a successful uterine test (P=0.019). Maternal complications were haemorrhage due to uterine atony (1 case) and disunion of the old caesarean scar (1 case). We recorded two macerated stillbirths and one case of early neonatal death linked to extreme prematurity, and six cases of neonatal suffering. Conclusion: Childbirth in a scar uterus is a high-risk delivery, and strict adherence to the conditions under which it is carried out is essential to improve the maternal and ....

A Hidden Burden On Public Health: Adolescent Pregnancy And Increased Adverse Perinatal Outcomes

ABSTRACT
 Objective: Adolescent pregnancy, associated with increased adverse pregnancy outcomes, is a major public health problem. This study aimed to assess adverse perinatal outcomes in adolescent pregnancies by comparing them with adult pregnancies. 
 Methods: 1104 adolescent and 2463 adult pregnant women were included. Presence of fetal anomaly, gestational diabetes, preeclampsia-eclampsia, intrauterine growth restriction, intrahepatic cholestasis, polyhydramnios, placenta previa, in utero mort fetus, uterine rupture, placenta abruption, umbilical cord prolapse, acute fetal distress, preterm birth, cesarean section, labor arrest, birth weight, macrosomia, dystocia, birth trauma, APGAR scores, neonatal intensive care unit admission, postpartum hemorrhage, hysterectomy, blood transfusion, and postpartum infection were recorded. 
 Results: Rates of acute fetal distress, preterm birth, low birth weight, neonatal intensive care unit admission, postpartum hemorrhage, and blood transfusion were higher while birth weight, APGAR scores of fifth minutes, the rates of cesarean section, prolonged and arrested labor, gestational diabetes, and macrosomia were lower in adolescents. In regression analysis, being adolescent pregnant increase the risk of acute fetal distress by 1.4 times (aOR=1.439;95%CI=1.030-2.01, p=0.033), preterm birth by 1.7 times (aOR=1.692; 95%CI=1.104-2.596, p=0.016) and decrease the risk of gestational diabetes (aOR=0.182; 95%CI=0.116-0.286, p

Effect of the case-based learning method combined with virtual reality simulation technology on midwifery laboratory courses: A quasi-experimental study

ObjectiveThis study aimed to evaluate the effect of case-based learning (CBL) method with virtual reality (VR) simulation technology (CBL-VR) on midwifery laboratory courses. MethodsA quasi-experimental design was employed. A total of 135 midwifery students were recruited from Nursing College of Guilin Medical University in China from September 2020 to January 2022. Intervention group recruited students from the Class of 2019 (n = 59) and control group recruited students from the Class of 2018 (n = 76). The intervention group students received the CBL-VR method based on traditional laboratory teaching, the contents of course included four sections: eutocia (6 class hours), dystocia (6 class hours), umbilical cord prolapse (2 class hours), and neonatal asphyxia and resuscitation (4 class hours), 40 min per class hour. The control group students received the traditional laboratory teaching. Students’ academic performance, Self-Directed Learning (SDL) Ability Questionnaire, and the education satisfaction questionnaire were used to evaluate the teaching efficacy between two groups. ResultsAfter intervention, the intervention group students achieved higher scores than the control group in individual operation ability (90.88 ± 2.14 vs. 89.24 ± 3.15), team operation ability (90.97 ± 2.33 vs. 81.28 ± 5.45), and midwifery case analysis ability (88.64 ± 3.19 vs. 86.70 ± 2.56) (P ＜0.01). Prior to the implementation of the course, there was no difference in the SDL ability scores between the two groups of students (P ＞ 0.05). However, following the course intervention, the SDL ability scores of the intervention group were higher than those of the control group (94.78 ± 6.59 vs. 88.12 ± 8.36), and the scores in all dimensions of the intervention group were also higher (P < 0.05). Additionally, more than 94% of the students indicated that CBL-VR method developed comprehensive abilities, including independent-study enthusiasm, independent thinking, collaboration, and communication. ConclusionUsing the CBL-VR method in midwifery lab courses improved students’ course performance, SDL ability, and comprehensive ability. Students highly recognized the effectiveness of this approach.

Retrospective Analysis of Pregnancy Outcomes Following External Cephalic Version for Breech Presentation.

We explored the feasibility and safety of external cephalic version (ECV) for cases of breech presentation. We retrospectively analyzed data from 158 singleton pregnant women with breech presentation at 36 weeks gestation, admitted to Guangzhou Hospital of Integrated Traditional and Western Medicine from January 2018 to March 2022. 42 underwent ECV, categorized as the ECV group, while 116 without ECV comprised the control group. Systematic collection and evaluation of pregnancy outcomes were conducted for both groups. Within the control group, 16 cases experienced a spontaneous transition to head presentation, among which 14 cases resulted in successful vaginal deliveries. In 2 cases, cesarean deliveries were performed due to fetal macrosomia and persistent posterior occipital presentation. Furthermore, 2 cases of breech presentation in pregnant women were successfully delivered vaginally through breech traction, necessitating an emergency procedure due to the wide opening of the uterus. Within the ECV group, 28 cases were successfully inverted to the cephalic presentation. Among them, 1 case underwent an emergency cesarean delivery due to fetal distress during cephalic delivery, 3 cases required cesarean deliveries due to abnormal labor, and 24 cases were successfully delivered vaginally. The comparative analyses showed that the cesarean section rate (18/42 vs 100/116) and non-cephalic delivery rate (14/42 vs 100/116) in the ECV group were significantly lower than those in the control group (P < 0.001). There was no statistically significant differences between the two groups with respect to the rate of newborns with Apgar score < 7 (1/42 vs 3/116), premature rupture of membrane (3/42 vs 20/116), acute fetal distress (2/42 vs 2/116), and cord prolapse (0/42 vs 1/116) (P > 0.05). ECV can effectively reduce the rate of cesarean delivery and non-cephalic deliveries. However, it but requires strict adherence to indications and continuous monitoring.

Incidence and risk factors for umbilical cord prolapse in labor when amniotomy is used and with spontaneous rupture of membranes: A Swedish nationwide register study.

Umbilical cord prolapse (UCP) is a rare but severe obstetric complication in the presence of a rupture of the membranes. Although it is not possible to prevent a spontaneous rupture of the membranes (SROM), it is possible to prevent an amniotomy, which is a commonly used intervention in labor. This study aimed to explore the incidence and risk factors that are associated with UCP in labor when amniotomy is used vs SROM. A retrospective nationwide register study was conducted of all births in Sweden from January 2014 to June 2020 that were included in the Swedish Pregnancy Register (n = 717 336). The main outcome, UCP, was identified in the data by the International Classification of Diseases (ICD-10) diagnosis code O69.0. Multiple binary logistic regression analysis was used to identify the risk factors. Amniotomy was performed in 230 699 (43.6%) of all pregnancies. A UCP occurred in 293 (0.13%) of these cases. SROM occurred in 298 192 (56.4%) of all cases, of which 352 (0.12%) were complicated by UCP. Risk factors that increased the odds of UCP for both amniotomy and SROM were: higher parity, non-cephalic presentation and an induction of labor. Greater gestational age reduced the odds of UCP. Risk factors associated with only amniotomy were previous cesarean section and the presence of polyhydramnios. Identified risk factors for UCP in labor with SROM were a higher maternal age and maternal origin outside of the EU. UCP is a rare complication in Sweden. Beyond confirming the previously recognized risk factors, this study found induction of labor and previous cesarean section to be risk factors in labor when amniotomy is used.

Umbilical cord prolapse in a sub-Saharan setting: Incidence and perinatal mortality rate-A 4-year retrospective review.

SynopsisPerinatal morality due to umbilical cord prolapse found in our study is comparable to that in high‐income settings.

Clinical simulation training for the adequate management of obstetrics emergencies: A narrative review.

Obstetric emergencies are critical situations that jeopardize the health of both the mother and the baby during pregnancy or childbirth. This study aimed to validate the effectiveness of clinical simulation training in managing these situations. We conducted a narrative review of studies published between 2008 and 2022, collected from databases including Scopus, Sciencedirect, PubMed, Springer, Scielo, and Google Scholar. Data from studies that met our inclusion criteria were meticulously gathered and summarized. Our findings strongly emphasize that clinical simulation emerges as a highly effective tool in the training of healthcare professionals. This training translates into substantial improvements in various aspects, including performance, knowledge, confidence, satisfaction, attitudes, self-efficacy, teamwork abilities, and the skills necessary to confront critical obstetric situations such as postpartum hemorrhage, eclampsia, shoulder dystocia, maternal cardiac arrest, umbilical cord prolapse, and cesarean sections. Importantly, this training reduces the inherent risks associated with learning on real patients and aligns with the highest ethical standards. Additionally, our results underscore that interdisciplinary collaboration in the management of obstetric emergencies proves to be an effective strategy for providing comprehensive patient care. However, it is crucial to highlight that, in order to ensure patient safety and promote a teamwork approach, it is imperative for healthcare professionals to receive adequate training and be duly qualified. Although we acknowledge that implementing clinical simulation training can entail significant costs and require substantial resources, we firmly believe that this strategy continues to hold immeasurable value in the education of professionals in this field. Ultimately, we anticipate that future high-quality research will further fortify the evidence base regarding best practices in clinical simulation training for obstetric emergencies, thus contributing to enhanced patient outcomes and the overall quality of healthcare in this critical domain.

Neonatal factors associated with immediate low Apgar score in newborn babies in an intermediate hospital in Namibia: a case control study.

Apgar score is conducted to a baby immediately after birth checking how the baby tolerated the birth process and outside the uterus. To describe the neonatal factors associated with immediate low Apgar score and analysing the associations among factors associated with low Apgar score in new-born babies. A quantitative, case-control, descriptive research design was used. Study population were all maternal records of deliveries conducted between 01 January 2019 and 31 December 2019. Simple random sampling was used to select the sample size for 194 cases and 194 controls using a 1:1 case-control ratio. Records indicating low Apgar scores were the cases while normal Apgar scores were the controls. A total of 388 maternal files were reviewed. Data were collected using a document review checklist and analysed using SPSS version 26. The study found that, neonatal factors associated with immediate low Apgar score are; gestational age, foetal presentation, cord prolapse, cord around the neck and the importance of cardiotocography interpretation as they had a P-value > 0.005. Gestational age, birth weight, foetal presentation, cord around the neck and lack of cardiotocography assessment were found to be associated with immediate low Apgar score.

Impact of extending criteria for home care management in Preterm Prelabor Rupture of Membranes.

Preterm prelabor rupture of membranes (PPROM) is a frequent obstetrical condition with risks of maternal and neonatal morbidity and mortality. Home hospitalization (HH) management is an alternative to conventional hospitalization (CH) which remains controversial, and there has been little study of eligibility criteria. To study obstetrical and perinatal outcomes of PPROM between 24 and 34 gestational weeks in patients discharged to homecare after 4 days, based on a policy of expanded discharge criteria. Retrospective before-and-after study over 10 years in a single French level III perinatal center. In period A (2009-2013), discharge criteria were restrictive and in period B (2015-2019), more extended discharge criteria were adopted. The primary outcome was the incidence of confirmed early-onset neonatal sepsis (EOS). The proportion of patients discharged to home hospitalization increased from 28/170 (16.5) in period A to 39/114 (34.2) in period B (p < 0.01). Regarding the primary outcome, no statistically significant difference in EOS rates was observed between periods (11/153 (7.1) vs 5/110 (4.5), p=0.37). The incidence of a composite outcome combining severe perinatal complications (intrauterine fetal demise, placental abruption and cord prolapse) did not significantly increase during period B (7/170 (4.1) vs 4/114 (2.7), p=0.37). There was no significant difference between the periods for chorioamniotitis (9.41% in period A and 11.4% in period B, p=0.58). Severe maternal or neonatal complications rates did not increase when criteria for home hospitalization were expanded. Larger, prospective studies are needed to confirm the results of such a strategy.

EP19.13: Activity restriction does not lower the risk of umbilical cord prolapse or footling in women with preterm premature rupture of membranes

EP19.13: Activity restriction does not lower the risk of umbilical cord prolapse or footling in women with preterm premature rupture of membranes

ASSESSMENT OF FACTORS INCREASING THE RISK OF PRELABOUR RUPTURE OF MEMBRANES AND ITS EFFECT ON FETOMATERNAL OUTCOME

Background: Premature rupture of membranes (PROM) refers to a patient who is beyond 37 weeks gestation and has presented with rupture of membranes (ROM) prior to the onset of labor. Patient with PROM presents with leakage of fluid, vaginal discharge and pelvic pressure, but they are not having contraction. It occurs in 3 percent of pregnancies and is the cause of approximately one third of preterm deliveries. It can lead to significant perinatal morbidity, including respiratory distress syndrome, neonatal sepsis, umbilical cord prolapse, placental abruption, and fetal death. Appropriate evaluation and management are important for improving neonatal outcomes. The risk of intrauterine infection increases with the duration of ROM. Evidence supports the idea that induction of labor, as opposed to expectant management, decreases the risk of chorioamnionitis without increasing the cesarean delivery rate. Methods: - This present observational study was conducted at Obstetrics &amp; Gynecology, Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria will be studied from 1st April 2021 to 30th September 2022 (18 months). After were Institutional ethical committee. among the patients diagnosed as premature rupture of membrane with women complain of leaking attending antenatal OPD and antenatal ward. On admission detailed history was taken. General and Systemic examination were done including Per Abdomen, Per Speculum and per vaginum carried out and investigations were done as per protocol. Diagnosis of PROM was confirmed by any of this method. Continuous monitoring of maternal and fetal condition done, antibiotics was given intra/ post natal period. P/ V exam were done when necessary. Investigations done and maternal and fetal outcome were noted. Results: The prevalence of premature rupture of membranes (PROM) was found to be 4.1%, with a corresponding perinatal mortality rate of 0.18 per 1000 deliveries. Approximately 33% of the cases involved pre-term premature rupture of membranes (PROM), while the remaining 67% were term PROM. Among the cases with preterm PROM, 10% of the perinatal deaths occurred. The average age of the female participants was 36.9 years, with a standard deviation of 2.1 years. The median number of children per participant was 1, with a range of 1 to 5 children. A notable correlation was observed between the gestational age at which premature rupture of membranes (PROM) occurred in women and the latency period (p&lt; 0.001). There was a significant association between the gestational age at which premature rupture of membranes (PROM) occurred and foetal birth weight, APGAR score, and Neonatal Intensive Care Unit (NICU) admission (p&lt;0.05). A statistically significant distinction was observed between the implemented intervention and the method of delivery (p=0.009). Conclusion: The incidence of PROM at term was high and conservative/ expectant management was effective. The latency period and fetal outcomes such as birth weight, apgar score and NICU admission were determined by the gestational age at which PROM occurred.

Decision-to-delivery interval and neonatal outcomes in intrapartum umbilical cord prolapse

BackgroundRapid delivery is important in cases of umbilical cord prolapse to prevent hypoxic injury to the fetus/neonate. However, the optimal decision-to-delivery interval remains controversial.ObjectiveThe aim of the study was to investigate the association between the decision-to-delivery interval in women with umbilical cord prolapse, stratified by fetal heart rate pattern at diagnosis, and neonatal outcome.Study designThe database of a tertiary medical center was retrospectively searched for all cases of intrapartum cord prolapse between 2008 and 2021. The cohort was divided into three groups according to findings on the fetal heart tracing at diagnosis: 1) bradycardia; 2) decelerations without bradycardia; and 3) reassuring heart rate. The primary outcome measure was fetal acidosis. The correlation between cord blood indices and decision-to-delivery interval was analyzed using Spearman’s rank correlation coefficient.ResultsOf the total 103,917 deliveries performed during the study period, 130 (0.13%) were complicated by intrapartum umbilical cord prolapse. Division by fetal heart tracing yielded 22 women (16.92%) in group 1, 41 (31.53%) in group 2, and 67 (51.53%) in group 3. The median decision-to-delivery interval was 11.0 min (IQR 9.0–15.0); the interval was more than 20 min in 4 cases. The median cord arterial blood pH was 7.28 (IQR 7.24–7.32); pH was less than 7.2 in 4 neonates. There was no correlation of cord arterial pH with decision-to-delivery interval (Spearman’s Ρ = − 0.113; Ρ = 0.368) or with fetal heart rate pattern (Spearman’s Ρ = .425; Ρ = .079, Ρ = − .205; Ρ = .336, Ρ = − .324; Ρ = .122 for groups 1–3, respectively).ConclusionIntrapartum umbilical cord prolapse is a relatively rare obstetric emergency with an overall favorable neonatal outcome if managed in a timely manner, regardless of the immediately preceding fetal heart rate. In a clinical setting which includes a high obstetric volume and a rapid, protocol-based, response, there is apparently no significant correlation between decision-to-delivery interval and cord arterial cord pH.

A Postpartum Uterine Dehiscence in a Pregnant Woman with Brucellosis; A Cases Report

Introduction Uterine Dehiscence (UD) is a rare complication and very dangerous complication of cesarean section (CS). Brucellosis is a threatening infection in pregnant women with severe obstetrics outcomes such as spontaneous abortion, premature delivery, intrauterine infection. We presented a case with preterm delivery with continuing high fever due to uterine fascial dehiscence after CS, who were infected to brucellosis. Case: A 26-year-old woman with gravidity 1, referred to the obstetrical department at 30 weeks of gestation due to Preterm Premature rupture of membranes (PPROM). After vaginally sonography, the patient underwent emergency CS due to fetus FHR drop and umbilical cord prolapse. From second day after CS, the patients fever increased and Doppler sonography shows low fluid and hematoma in the uterus and evidence in favor of a lesion collection that was evacuated with laparotomy and uterine fascial dehiscence was detected. Moreover, wound debridement conducted and during laparotomy the adhesions were released. The Wright-Coombs 2ME test showed she was infected to brucellosis. Conclusion: Uterine fascia dehiscence in lower uterine segment incision is a rare but is a potentially dangerous for mothers. However, preterm deliveries due to PPROM and high uncontrolled fever after CS, are conditions that practitioners should considering the uterine dehiscence to their differential diagnoses. Nevertheless, the occurrence of dehiscence due to brucellosis infection is questionable and require more evaluation.

Effect of Body Mass Index on Adverse Neonatal Outcomes in Patients With Emergency Cesarean Deliveries [ID: 1381091

INTRODUCTION: The objective of this study was to evaluate the association of body mass index (BMI) with adverse neonatal outcomes in pregnant patients with emergency cesarean delivery (CD). METHODS: This was a retrospective cohort study of singleton nonanomalous pregnancies between 23 and 42 weeks from 2007 to 2012 in California. Pregnancies resulting in an emergency CD were stratified based by ICD-9 codes for cord prolapse, or uterine rupture. Outcomes included neonatal intensive care unit (NICU) admission, Apgar scores less than 3 at 5 minutes, infant death, respiratory distress syndrome (RDS), neonatal seizures, and hypoglycemia. After stratifying by cause of emergency CD, multivariable logistic regression models were used to evaluate associations of BMI at delivery with adverse neonatal outcomes. Models were adjusted for maternal race and ethnicity, age, education level, insurance, parity, smoking status, and prenatal care. RESULTS: Of this cohort, 1,368 had an emergent CD in the setting of cord prolapse, and 992 had an emergent CD in the setting of a uterine rupture. Of individuals with cord prolapse, patients whose BMI was classified as obesity class II had decreased odds of NICU admission, and those whose BMI was classified as obesity class III had decreased odds of NICU admission and RDS. Of individuals with a uterine rupture, patients whose BMI was classified as overweight had decreased odds of all neonatal outcomes analyzed. Those with a BMI classified as obesity class I had decreased odds of all neonatal outcomes except for neonatal seizures. Those with a BMI classified as obesity class II had decreased odds of lower Apgar scores, NICU admission, infant death, and RDS. Those with a BMI greater than 50 had increased odds of RDS and hypoglycemia. CONCLUSION: Higher BMI was associated with decreased risk of many adverse neonatal outcomes in the setting of patients delivering emergently with cord prolapse or uterine rupture. These findings may be useful in appropriately managing patients presenting with emergent CD.

Trends of Neonatal Hypoxic-Ischemic Encephalopathy Prevalence and Associated Risk Factors in the United States, 2010 to 2018

ABSTRACT Neonatal hypoxic ischemic encephalopathy (HIE) is one of the most common causes of neonatal morbidity and mortality worldwide. It has an overall mortality rate ranging from 15% to 25%, with up to 50% of survivors developing long-term neurological disabilities. Therapeutic hypothermia (TH) has been the only effective treatment for moderate to severe HIE in neonates ≥35 weeks of gestation. Infants with mild HIE previously had been excluded from studies, but a recent study reported approximately 16% developed a disability at 18 to 22 months of age. Despite treatment, up to 29% of neonates with HIE still develop adverse outcomes. To decrease the prevalence of neonatal HIE, prevention is key and a better understanding of associated maternal, perinatal, and neonatal risk factors is needed. The aim of this study was to assess trends of HIE prevalence and use of TH, mortality, and clinical neonatal outcomes. This was a cross-sectional analysis using National Inpatient Sample data sets from 2010 to 2018. Included were newborn infants diagnosed with HIE or asphyxia, who were ≥35 weeks of gestation and had a birth weight ≥2500 g. Excluded were those with congenital heart disease, congenital central nervous system anomalies, congenital lung anomalies, congenital abdominal wall defects, gastroschisis or omphalocele, multiple congenital anomalies, common syndromes, and chromosomal disorders. Of the 32,180,617 infants included in the analysis, 31,249,100 were term infants (&gt;35 weeks). The prevalence of all degrees of HIE for term infants was approximately 0.1%. There was a modest increase from 0.093% during the years 2010 and 2012 up to 0.097% during 2016 and 2018. Approximately 21% of cases were managed with TH. More infants with moderate HIE received TH than those with severe HIE (29.9% vs 19.9%; P &lt; 0.01). Fewer infants with mild or unspecified HIE received TH than those with severe HIE (17.7% and 17.3%, respectively; P &lt; 0.01). From 2010 to 2018, the use of TH increased overall and within each grade of HIE (P &lt; 0.01). The mortality rate was higher in term infants with all degrees of asphyxia than the general population (10.8% vs 0.06%; P &lt; 0.01). Over time, the mortality rate in term infants decreased from 12.3% in 2010 to 8.3% in 2018 (P &lt; 0.01). The analysis included 931,517 were late preterm infants (35–36 weeks of gestation). The combined prevalence for all grades of HIE was 0.23% and did not change significantly over the years. Approximately 21% of late preterm infants were managed with TH. More infants with moderate HIE received TH than those with severe HIE (26.9% vs 20.1%). Fewer infants with mild HIE received TH (13.2%), and no significant difference was observed in infants with unspecified HIE compared with those with severe HIE (18.7% vs 20.1%). The use of TH increased has increased in late preterm infants over the years. The strongest factors associated with HIE were placental infarction or insufficiency, placental abruption, and cord prolapse. Female infant sex, maternal Hispanic ethnicity, and maternal Asian race were associated with lower risk of HIE. In conclusion, HIE prevalence remained essentially the same at 1 per 1000 live births. Use of TH increased, and mortality decreased over time. The strongest factors associated with HIE were placental factors.

A Quantitative and Qualitative Investigation of Factors Associated with Caesarean Section Deliveries in Sri Lanka Assessing National Trends and Views of Local Healthcare Professionals in Colombo in 2015

Background A caesarean section (CS) is an operation to deliver a baby through incisions made to the mother’s abdominal wall and uterus, either before or after labor has started. An emergency CS is performed for certain medical indications such as placenta praevia or umbilical cord prolapse, and it most frequently occurs once labor has started. Elective CS are planned CS. They could be performed for non-medical reasons such as maternal request. Aim CS rates in Sri Lanka have been rising over the past decades. This study investigates reasons for the rise in CS rates through qualitative and quantitative analyses. Methods Qualitative data analysis involved interviews which were conducted in a teaching hospital in Colombo, Sri Lanka. Twenty (20) healthcare professionals in Obstetrics and Gynecology were interviewed. A semi-structured questionnaire, consisting of 15 opened and closed questions, was the basis for the interview. Quantitative analysis was performed on Demographic and Health Survey (DHS) data from 2006-2007. Variables included mother’s age, education level and residence. Chi-squared (χ2) and regression analysis using statistical package for the social sciences version (SPSS) was performed to determine if these variables were associated with CS. Results From qualitative analyses of the interviews, the main themes identified were the healthcare professionals’ views on causes of the rising CS rates, parties involved in the decision-making process, benefits and risks of elective CS and availability of support or alternative options. Quantitative analysis of DHS data showed variables such as residence, province, and education level were significantly associated with CS (p&lt;0.01). Urban residences, living in Colombo and extremes in education levels had the greatest likelihood of a CS. Age, although statistically not significant, is clinically important as literature reviewed showed that CS tend to be more prevalent in extremes of age. Conclusion Analysis revealed the importance of factors associated with CS. Targeting areas that showed the greatest prevalence of CS is an effective strategy to address rising rates

PROCIDENCE DU CORDON: EXPERIENCE DE LA MATERNITE DU CHU HASSAN II DE FES EN 2020, SERIE DE 24 CAS

The prolapse of the umbilical cord constitutes an obstetric emergency during the period of laborinvolving the fetal prognosis. It is defined as the fall of the cord in front of the presentation, the membranes being ruptured. Knowledge of the risk factors often makes it possible to prevent this pathology and to diagnose it early by increasing vigilance. It can occur when the fetal presentation is cephalic but also when it is transverse or podalic which are moreover more at risk because they constitute a hindrance to the fetomaternal accommodation. Our study is retrospective and descriptive, spread over a period of one year extending from January to December 2020 and relating to a series of 24 cases of cord prolapse in the maternity ward at the CHU Hassan II in Fez. All cases of cord prolapse occurring after 24 weeks of pregnancy were included in the study.

Successful pregnancy in the blind hemicavity of Robert’s uterus: a rare case report and brief literature review

BackgroundRobert’s uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert’s uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert’s uterus.Case presentationA 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert’s uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions.ConclusionsPregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.

Perinatal antecedents of moderate and severe neonatal hypoxic ischaemic encephalopathy: An Australian birth cohort study.

Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long-term morbidity. The aim of this study was to investigate key antecedents of moderate and severe HIE in a large contemporary birth cohort. A retrospective cohort study of births meeting criteria was conducted between 2016 and 2020 at the Mater Mothers' Hospital, Brisbane, Australia. This is a quaternary perinatal centre and Australia's largest maternity hospital. Univariate and multivariate Firth logistic regression were used to account for imbalanced frequency classes between non-HIE and HIE groups. Maternal variables and intrapartum factors were investigated for associations with neonatal moderate and severe HIE. Overall, 133 of 46 041 (0.29%) infants were diagnosed with HIE: 77 (0.17%) with mild HIE and 56 (0.12%) with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency caesarean birth, emergency caesarean for non-reassuring fetal status or failure to process, intrapartum haemorrhage and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture and placental abruption). Neonatal risk factors included male sex, late preterm gestation (35+0 -36+6 weeks), Apgar score less than four at 5min, severe respiratory distress requiring ventilatory support and severe acidosis at birth. This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly with evolution in modern obstetric care.