Delivery Outcomes Research Articles

Determinants of Success and Complications in Vaginal Birth After Cesarean Section: A Systematic Literature Review

Trial of Labor After Cesarean (TOLAC) is the process of attempting a vaginal delivery after a prior cesarean section. TOLAC offers an alternative to repeat cesarean delivery but requires careful assessment of risks and benefits. This research aims to evaluate the factors affecting VBAC success and associated risks, providing guidance for clinical practice in determining VBAC eligibility. Relevant literature on VBAC was sourced from databases such as PubMed and Cochrane Library using the keywords "VBAC," "VBAC success," and "VBAC risks." Literature searches for these articles are conducted through databases of scientific journals such as PubMed and Google Scholar. Analysis was conducted to assess predictive factors for VBAC success, including previous vaginal delivery history, cervical conditions, and other parameters. VBAC success is significantly influenced by previous vaginal delivery history, cervical conditions at admission, and factors such as BMI and interpregnancy interval. The main risk associated with VBAC is uterine rupture, occurring in approximately 0.2–0.9% of cases. Proper management and careful risk assessment can minimize complications. VBAC can be a safe and effective option for women who meet specific criteria. Adequate monitoring and assessment are crucial to minimize risks and enhance success rates. Individual evaluation and thorough planning are essential for achieving optimal delivery outcomes. The decision to implement VBAC should be made with careful consideration of the benefits and risks to ensure safe and optimal outcomes for both mother and baby.

Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.

Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction. This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration. Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups. In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes. NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Cross-cultural design in costume: case study on totemic symbols of China and Thailand

Cross-cultural design has emerged as a pivotal domain of significance within the context of globalization. In the field of cross-cultural design, designers are tasked with addressing user requirements and identity characteristic contexts across diverse cultural backgrounds, aiming to achieve enhanced service delivery and cultural dissemination outcomes. Nonetheless, the landscape of contemporary fashion design research exhibits a noticeable dearth in studies that effectively integrate with cross-cultural design. This study selects the iconic cultural symbols of the Chinese loong (dragon) and Thai naga as case subjects, embarking upon research that employs costume design as a medium and bridge for cross-cultural design and communication. The research methodology integrates qualitative and quantitative approaches, including field investigations, participatory research, and Analytic Hierarchy Process (AHP) analysis, thereby substantiating theoretical constructs through empirical investigation. The study proposes that cross-cultural costume design, undertaken with the purpose of cross-cultural communication, can be conceptualized as a cyclical process involving multiple encoding and decoding iterations. The research elaborates on how costume, functioning as a non-verbal language, serve as a medium for facilitating cross-cultural interactions. Furthermore, the design extraction of cultural symbols is approached through a four-tiered framework. By articulating its research perspective, methodologies, and design cases, this study contributes valuable insights to researchers and practitioners engaged in cross-cultural design and related fields.

Risk of short-term cardiovascular disease in relation to the mode of delivery in singleton pregnancies: a retrospective cohort study

Cardiovascular disease (CVD) is increasing in prevalence and affects up to 4% of pregnancies in otherwise healthy persons. The specific factors that drive the development of CVD in pregnant people are poorly characterised. This study aimed to determine whether the mode of delivery in singletons affects the risk of cardiovascular morbidity and mortality within one year in patients without prior CVD. We designed a retrospective cohort study utilising the Nationwide Readmissions Database (NRD) to identify singleton delivery hospitalisations in the United States from Jan 1, 2010 to Nov 30, 2018. International Classification of Disease (ICD) versions 9 and 10 codes were used to identify patients with readmission for CVD within the calendar year of index delivery. Patients aged 15-54 who underwent a singleton vaginal or caesarean delivery were included. Patients with pre-existing CVD hospitalisations before or during delivery, ectopic pregnancies, or abortive outcomes were excluded. Participant data was retrieved from the NRD database. The primary outcome was hospital readmission, defined by ICD 9 and 10 codes for fatal or non-fatal CVD in the same calendar year as delivery. Cox proportional hazard regression models were used to adjust for confounders. These included maternal age, hospital bed size, hospital type, hospital teaching status, income quartile, insurance, and year of delivery. Additional sub-analyses were performed adjusting for hypertensive disorders of pregnancy and diabetes mellitus. Of the 14,179,299 singleton deliveries, 32% (n=4,553,492) underwent a caesarean. CVD readmissions occurred in 255.2 per 100,000 (n=11,710) caesarean deliveries compared with 133.9 per 100,000 (n=12,507) vaginal deliveries (rate difference [RD], 121.4, 95% confidence interval [CI], 114.8-127.9; hazard ratio [HR] adjusted for all confounders including hypertensive disorders of pregnancy and diabetes mellitus was 1.42, 95% CI 1.35-1.50). This association was highest in the first 0-29 days following delivery (HR 1.68, 95% CI 1.59-1.78). The risk of readmission for CVD persisted for one year. These findings suggest that caesarean delivery of singletons is associated with a higher risk of cardiovascular morbidity in patients without pre-existing CVD. This risk was highest in the first month but remained elevated for one year after delivery. These findings add to the accumulating evidence that undergoing caesarean delivery may have long-standing health implications and support the extension of the post-partum surveillance period. Limitations of this study include the lack of adjustment for body mass index, race, and parity. We were also unable to determine the reason for the caesarean delivery. None.

Magnitude and Associated Factors of Gestational Excessive Weight Gain Among Pregnancy Women at St Paul’s Hospital, Addis Ababa, Ethiopia 2024, a Crosse-Sectional Study

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Women invariably gain weight during pregnancy due to fat deposition, fluid retention, and the weight attributed to the growth of the fetus, uterus, and breasts. Gestational weight gain can influence pregnancy outcomes as well as the long-term health of both the mother and child. It is reported that nearly 50 percent of mothers worldwide experience excessive weight gain during pregnancy. Suboptimal weight gain during pregnancy is also a recognized risk factor for adverse delivery outcomes. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; To assess the magnitude of excess maternal gestational weight gain and the associated factors influencing pregnancy complications among pregnant women at St. Paul’s Hospital, Addis Ababa, Ethiopia, in 2024. &amp;lt;i&amp;gt;Methods and Materials:&amp;lt;/i&amp;gt; An institutional-based descriptive cross-sectional quantitative approach was used to conduct the study. Data were collected using both primary and secondary sources. Well-organized interviewer-administered questionnaires and a checklist were utilized. The sample size was determined using a single population formula Considering the proportion to be 50% to get the maximum possible sample size. A total of 422 mothers participated in the study, and a systematic random sampling technique was employed to select the study population. Data were collected, summarized, tabulated, and analyzed using the Statistical Package Epi-Info version 7 and SPSS version 26 software. Frequencies, proportions, and dispersions were estimated to describe the variables. Multivariate analysis was used to determine the association between explanatory variables and gestational weight gain. &amp;lt;i&amp;gt;Results:&amp;lt;/i&amp;gt; A total of 422 pregnant mothers participated in the study, resulting in a 100% response rate. The majority, 201 (47.6%), were in the age group of 20 to 25 years, and 179 (42.4%) had delivered two children. Additionally, 112 (26.5%) ate more than four times per day, and 303 (71.8%) consumed carbohydrates daily. Of the participants, 375 (88.9%) gained adequate weight, 35 (8.3%) gained excessive weight, and 12 (2.8%) gained inadequate weight during their current pregnancy. Being employed and consuming fruits and vegetables were associated with a lower likelihood of excessive gestational weight gain, while high carbohydrate consumption was linked to a higher risk of excessive weight gain. &amp;lt;i&amp;gt;Conclusion and Recommendation: &amp;lt;/i&amp;gt;A significant proportion of women (35%) gained excessive weight. Unemployment and daily carbohydrate and fruits consumption were significantly associated with excessive weight gain. Women of childbearing age should be informed about the importance of consuming fruits and vegetables and reducing carbohydrate intake during pregnancy to prevent excessive weight gain.

Association of Prenatal Maternal Fever and Neonatal Umbilical Artery Blood-Gas Analysis: Evidence from a Tertiary Center at China

Background: Neonatal umbilical artery blood-gas analysis is a diagnostic procedure performed shortly after birth to assess the acid-base balance, oxygenation, and metabolic status of a newborn infant. This retrospective study aimed to investigate the association of prenatal maternal fever with neonatal umbilical artery blood-gas analysis. Methods: A retrospective analysis was conducted on data from 333 parturients and their newborns. Demographic characteristics, clinical information, and neonatal umbilical artery blood gas analysis data were analyzed to evaluate the association between prenatal maternal fever and neonatal blood-gas analysis. Pregnant women with fever (≥38.0 °C) during labor were compared with those without fever. Neonatal umbilical artery blood gas parameters were assessed in relation to the degree and duration of maternal fever. Results: The incidence of the adverse delivery outcome of parturients with high prenatal fever and long duration of fever was significantly higher than that of the low fever, short-term fever, and normal parturients (p &lt; 0.05). The pH of neonatal umbilical veins in the high fever groups was reduced compared with the control group (p &lt; 0.05). Lactic acid (Lac) of neonatal umbilical vein in the low fever and high fever groups was enhanced compared with the control group (p &lt; 0.05). The pH of neonatal umbilical veins in the short-term fever and long-term fever groups was elevated compared with the control group (p &lt; 0.05). The umbilical artery pH and base excess (BE) were positively correlated with maternal peak fever temperature (r = 0.20, r = 0.22, p &lt; 0.05). The umbilical Lac was negatively correlated with maternal peak fever temperature (r = –0.22, p &lt; 0.05). Moreover, the umbilical artery pH and BE were positively correlated with maternal duration of fever (r = 0.29, r = 0.21, p &lt; 0.05). The umbilical artery Lac was negatively correlated with maternal duration of fever (r = –0.25, p &lt; 0.05). Conclusions: The findings suggested that maternal fever during labor was associated with alterations in neonatal umbilical artery blood gas analysis. Understanding the influence of prenatal fever on delivery outcomes is crucial for optimizing maternal and neonatal health.

Towards Health 4.0: Blockchain-Based Electronic Health Record for Care Coordination

Inter-organizational data sharing in healthcare is fraught with challenges, including diverse healthcare terminologies, incompatible data structures, and issues with data consistency and security. Establishing a unified patient record across a data-sharing network is problematic, and centralized data stores and authority providers are prime targets for cyberattacks. This study proposes a blockchain-based patient data-sharing strategy that relies on network consensus rather than a single, centralized source of trust. The consensus is based on evidence of both structural and semantic interoperability. The primary objective is to develop secure and controlled data-sharing mechanisms that enhance care coordination. The research utilized Kanban as the software development methodology to manage the project effectively. The study found that blockchain-based electronic health record (EHR) systems significantly enhance care coordination by enabling seamless data transfer and fostering trust and collaboration among healthcare providers. Key findings include improved data consistency, enhanced security, and increased interoperability across diverse healthcare systems. These results suggest that blockchain technology can play a crucial role in transforming healthcare delivery and improving patient outcomes in the context of Health 4.0. This work contributes to the ongoing discussion on leveraging blockchain technology to revolutionize healthcare systems, offering a robust framework for secure and efficient data sharing that can lead to better healthcare delivery and patient care outcomes.

Investigating the Salience of Clinical Meaningfulness and Clinically Meaningful Outcomes in Metastatic Breast Cancer Care Delivery

PURPOSE As metastatic breast cancer (mBC) treatment evolves, there is a need to understand how clinical meaningfulness, or a meaningful change in a patient's daily life, and clinically meaningful outcomes inform patient-centered care. Partnering with key stakeholders ensures patient-centered research incorporates the knowledge and expertise of advisors with lived experience. We describe a multistakeholder engagement approach to examine how people living with mBC (PLWmBC), caregivers, and health care providers interpret clinical meaningfulness and clinically meaningful outcomes and their influence on mBC treatment decision making and care. METHODS Qualitative focus groups with PLWmBC, caregivers, and health care providers were conducted and analyzed along three overarching themes: interpretations of clinical meaningfulness and clinically meaningful outcomes; treatment recommendations, preferences, and decisions; and implications for clinical practice. Patient-led and professional organizations served as research partners in study design, implementation, and interpretation of findings. RESULTS Partnerships were established with four patient-led and three professional organizations representing diverse constituencies throughout the United States. Twenty-two focus groups were conducted with 50 PLWmBC, 24 caregivers, and 41 health care providers (oncologists, n = 11; advanced practice providers, n = 13; oncology nurses, n = 17) between March and June 2023. PLWmBC and caregivers were unfamiliar with the concepts of clinical meaningfulness and clinically meaningful outcomes. Although health care providers were familiar, they did not use the terms when discussing treatment with PLWmBC. Across groups, participants emphasized the importance of meaningful outcomes beyond overall survival, including quality of life and improvement in symptoms and functioning. Participants noted that outcomes considered meaningful are individualized and dynamic. CONCLUSION This study offers insight into how partnering with patient advocacy and professional organizations can enhance research quality and aid translation of findings to clinical practice, thereby supporting patient-centered care.

Healthcare Data Analytics and Predictive Modelling: Enhancing Outcomes in Resource Allocation, Disease Prevalence and High-Risk Populations

Purpose: This study aims to explore the role of healthcare data analytics and predictive modeling in enhancing healthcare outcomes, specifically in resource allocation, disease forecasting, and identifying high-risk populations. Methodology: The research employs a comprehensive approach, utilizing various sources of healthcare data such as electronic health records (EHRs) and public health databases. Advanced analytical techniques, including machine learning, artificial intelligence, and big data analytics, are applied to derive actionable insights. Findings: The study reveals that predictive modeling significantly enhances resource optimization, enables accurate disease prevalence forecasting, and improves the identification of high-risk populations. Case studies demonstrate how these technologies lead to more efficient healthcare delivery, cost reduction, and better patient care outcomes. Unique Contribution to Theory, Policy, and Practice: This research contributes to the theoretical understanding of healthcare data analytics by integrating advanced predictive modeling techniques with real-world healthcare applications. It offers valuable insights for policymakers on the importance of investing in data infrastructure and promoting data-driven decision-making. Practically, the study provides healthcare organizations with actionable strategies to implement predictive analytics for improved resource allocation and patient care.

Comparison of Diabetes Education Content Experienced by Blind and Nonblind People With Diabetes

This survey sought to examine disparities in diabetes self-management education and support (DSMES) to illuminate gaps underlying morbidity and mortality disparities experienced by blind people with diabetes and develop a pathway for improved health care delivery and health outcomes. Blind participants were more likely to report getting DSMES on strategies to promote treatment adherence and noncompliance with medical regimen; yet, blind and nonblind participants did not differ on primary care provider visits or amount of time spent in diabetes education. These findings suggest that DSMES content may differ for blind versus nonblind participants.

A Retrospective Audit of Placental Weight and Fetal Outcome at the Lagos University Teaching Hospital, Southwest Nigeria

Abstract Background: The placenta is an organ unique to mammals that connects the developing fetus to the uterine wall. The placenta supplies the fetus with oxygen and nutrients and allows fetal waste to be disposed of effectively via maternal circulation. Objective: The objective of this study is to determine the relationship between placenta weight at delivery and fetal outcomes. Materials and Methods: This was a retrospective study carried out between January 2022 and December 2023 at the labor ward of the Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. Results: The mean age of the women was 32.5 (3.4) years. The majority of the women were between 20 and 34 years of age. The mean placental weight was 657.5 (221.5) g. Maternal obesity and increasing parity were significantly associated with larger placenta weight (P = 0.04 and 0.01, respectively). Heavier placentas were also associated with fetal macrosomia and poor Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores at 5 min (P &lt; 0.05). Conclusion: This study concludes that a heavier placenta is associated with increasing parity, more operative delivery, bigger newborns, and a higher placenta-birth weight ratio.

Effect of omicron infection on maternal and neonatal delivery outcomes: A retrospective cohort study

BackgroundPeople are very concerned about the adverse effects of Omicron infection on delivery modes, duration of labor, and the postpartum status of pregnant women and neonates. Methods382 pregnant women (Omicron group: 136 cases; non-Omicron group: 246 cases) giving birth in our hospital were collected, demographic characteristics, vaccination, clinical manifestation and medication, delivery outcomes of pregnant women and neonates were recorded. Delivery outcomes were compared between the Omicron and non-Omicron groups, acute infection and non-acute infection groups to explore the relationship between adverse delivery outcomes and Omicron infection. ResultsPregnant women in the Omicron group had a longer hospitalization time (6.3 ± 3.6 days vs.5.5 ± 2.3 days), more 2-hour postpartum hemorrhage (291.7 ± 104.9 mL vs.262.7 ± 91.2 mL) and higher neonatal-pediatric transfer rate (20.6 % vs. 2.8 %), which might be associated with fetal distress, prenatal fever and pneumonia/respiratory distress. Neonates transferred to pediatrics due to jaundice were unique in the Omicron group. Fever-pregnant women have a more prolonged second stage of labor and hospital stay while coughing or expectoration ones have a shorter third stage of labor. Delivery outcomes did not differ whether the infected pregnant women were in the acute phase and whether to use antipyretics. ConclusionOmicron infection can increase the 2-hour postpartum hemorrhage volume and the neonatal-pediatric transfer rate. The symptoms can affect the duration of labor and hospital stay. However, whether the infected pregnant women are in the acute phase or use antipyretics do not affect the delivery outcome.

Nanotechnology in Malaria Treatment: Targeted Drug Delivery Systems and Future Applications

Malaria continued to be a major global health challenge, particularly in regions with high disease burden, despite advancements in treatment options such as Artemisinin-based Combination Therapies (ACTs). The emergence of nanotechnology offered a transformative approach to malaria treatment, with its potential to improve drug delivery, bioavailability, and therapeutic outcomes. This review examined the current applications and advancements in nanotechnology for malaria treatment, focusing on the use of nanocarriers like liposomes, polymeric nanoparticles, and solid lipid nanoparticles. These systems enhanced the efficacy of antimalarial drugs by enabling targeted delivery to malaria-infected cells, overcoming drug resistance, and offering controlled release mechanisms. The review also explored emerging strategies such as combination therapies, personalized nanomedicine, responsive nanoparticles, and vaccine delivery systems. While nanotechnology holds great promise, challenges including safety, scalability, regulatory hurdles, and cost were addressed. Future directions suggest innovations such as smart nanocarriers, personalized treatments, and enhanced diagnostic integration. Methodologically, this review synthesized data from recent preclinical and clinical research to provide a comprehensive analysis of nanotechnology’s role in advancing malaria treatment. Global collaboration and interdisciplinary research will be pivotal in realizing the full potential of nanotechnology in combating malaria. Keywords: Nanotechnology, malaria treatment, drug delivery systems, liposomes, nanoparticles, targeted therapy, drug resistance

Isolated Oligohydramnios Might Be Associated With Less Favorable Delivery and Composite Neonatal Outcomes

Isolated Oligohydramnios Might Be Associated With Less Favorable Delivery and Composite Neonatal Outcomes

Establishment and validation of a predictive model for spontaneous preterm birth in singleton pregnant women

IntroductionIn the current study, we screened for highly sensitive and specific predictors of premature birth, with the aim to establish an sPTB prediction model that is suitable for women in China and easy to operate and popularize, as well as to establish a sPTB prediction scoring system for early, intuitive, and effective assessment of premature birth risk.MethodsA total of 685 pregnant women with a single pregnancy during the second trimester (16–26 weeks) were divided into premature and non-premature delivery groups based on their delivery outcomes. Clinical and ultrasound information were collected for both groups, and risk factors that could lead to sPTB in pregnant women were screened and analyzed using a cut-off value. A nomogram was developed to establish a prediction model and scoring system for sPTB. In addition, 119 pregnant women who met the inclusion criteria for the modeling cohort were included in the external validation of the model. The accuracy and consistency of the model were evaluated using the area under the receiver operating characteristic (ROC) and C-calibration curves.ResultsMultivariate logistic regression analysis showed a significant correlation (P < 0.05) between the number of miscarriages in pregnant women, history of miscarriages in the first week of pregnancy, history of preterm birth, CL of pregnant women, open and continuous cervical opening, and the occurrence of sPTB in pregnant women. We drew a nomogram column chart based on the six risk factors mentioned above, obtained a predictive model for sPTB, and established a scoring system to divide premature birth into three risk groups: low, medium, and high. After validating the model, the Hosmer Lemeshow test indicated a good fit (p = 0.997). The modeling queue C calibration curve was close to diagonal (C index = 0.856), confirming that the queue C calibration curve was also close to diagonal (C index = 0.854). The AUCs of the modeling and validation queues were 0.850 and 0.881, respectively.ConclusionOur predictive model is consistent with China’s national conditions, as well as being intuitive and easy to operate, with wide applicability, thus representing a helpful tool to assist with early detection of sPTB in clinical practice, as well as for clinical management in assessing low, medium, and high risks of sPTB.

Maternal outcomes and pre, syn, and post-partum care in the united states and five high-income countries: An exploratory comparative qualitative study

Many studies have documented differences in maternal health outcomes across high-income countries, noting higher and growing maternal mortality in the US. However, few studies have detailed the journeys of care that may underlie or influence differences in outcomes. This study explores how maternity care entitlements and experiences vary among the US and five high-income countries, to study variations in child delivery care practices. Health systems with different organizational structure, insurance coverage and with known differences in maternal care delivery and maternal health outcomes were selected. Data was collected using a structured questionnaire, comparison of secondary data, and literature scan. We find that, while prenatal care approaches were broadly similar across all six countries, there were some important differences in maternity care provision among the comparator countries: (1) the US has more fragmented coverage during pregnancy than comparator countries (2) there were differences with regards to the main provider delivering care, the US relied primarily on physician specialists rather than midwives for prenatal care and delivery which was more common in other countries, (3) the intensity of labor and delivery care varied, particularly with regards to rates of epidural use which were highest in the US and France and lowest in Japan, and (4), there was large variation in the use of postnatal home visits to assess health and wellbeing, notably lacking in the US. The US’ greater use of specialists and more intensive labor and delivery care may partially explain higher costs of care than in comparator countries. Moreover, US maternal mortality is concentrated in the pre- and postnatal periods and thus may be related to poorer access to prenatal care and the lack of an organized, community-based approach to postnatal care. Given the increase in maternal mortality across countries, policy makers should look across countries to identify promising models of care delivery, and should consider investing in more comprehensive coverage in pre- and postnatal care.

Pregnancy-induced hypertension among pregnant women attending SOS mother and child health clinic in Bakoteh, the Gambia

Background: Pregnancy-induced hypertension (PIH) is a common medical problem encountered in pregnancy and is a leading cause of perinatal and maternal morbidity and mortality in The Gambia. The study purpose was to determine the prevalence, and birth outcomes associated with Pregnancy Induced Hypertension (PIH) among women attending SOS Mother and Child Health Clinic in Bakoteh, The Gambia. Methods: Using a cross-sectional design, a total of 280 pregnant mothers participated in the study. Data was collected using a structured questionnaire. Descriptive statistics, bivariate, and multivariable logistic regression models were used. All analysis were performed using SPSS version 20. Results: About 19% (n = 53) of participants were diagnosed of PIH. Results of the multivariate logistic regression analysis showed that the pregnant women who were 25 years and below had 37% (AOR = 0.037, CI = 0.002 – 0.771) lesser odds to be diagnosed of PIH compared to those who are 34 years old or above. Similarly, those who had their first pregnancy at 30 years and below were 23% (AOR = 0.023, CI = 0.001 – 0.410) lesser odds to have PIH compared to those who are above 30 years. The risk of having PIH was found to decrease by 21% (AOR = 0.021, CI = 0.003 – 0.150) among those who had no history of high BP. Regarding the delivery outcomes, the mothers without PIH had significantly lower risk of post-partum haemorrhage (AOR = 0.028), intrauterine growth restriction (AOR = 0.045), low birth weight (AOR = 0.087), and induction of labour (AOR = 0.003), compared to those with PIH. Conclusion: This study shows that PIH is one of the major health disorders affecting pregnant women and contributing to the poor delivery outcomes in the Gambia. Early identification of the risk factors would be useful for early diagnosis and appropriate clinical monitoring and timely management of maternal and perinatal complications.

Bispectral index monitoring: Optimizing anesthesia in rigid bronchoscopy.

This study investigates the application of bispectral index (BIS) monitoring in rigid bronchoscopy to enhance anesthetic delivery and patient outcomes, a topic that remains underexplored. A retrospective analysis of 155 patients undergoing elective rigid bronchoscopy under general anesthesia was conducted. Patients were divided into BIS-monitored and conventional anesthesia groups. Inclusion criteria were adults aged over 18 years with American Society of Anesthesiologists (ASA) physical status I-IV. No significant demographic differences were found between the groups. The BIS group showed significant reductions in propofol usage (231.40 ± 74.63 mg vs. 190.19 ± 91.83 mg, p= 0.003) and prednol dosage (94.27 ± 42.56 mg vs. 79.71 ± 18.97 mg, p= 0.020). Remifentanil administration approached statistical significance (56.99 ± 34.69 mcg vs. 45.36 ± 36.75 mcg, p= 0.055). No significant demographic differences were found between the groups. The BIS group showed significant reductions in propofol usage (231.40 ± 74.63 mg vs. 190.19 ± 91.83 mg, p= 0.003) and prednol dosage (94.27 ± 42.56 mg vs. 79.71 ± 18.97 mg, p= 0.020). Remifentanil administration approached statistical significance (56.99 ± 34.69 mcg vs. 45.36 ± 36.75 mcg, p= 0.055).

Comparison of the Fetomaternal Outcome in Women With Preterm Premature Rupture of Membranes on Expectant Management Versus Delivery at 34 Weeks.

This study aimed to study feto-maternal outcomes in women with preterm prelabor rupture of membranes (PTPROM) on expectant management versus delivery at 34 weeks of gestation and correlate the period of latency and inflammatory markers with delivery outcomes. We have chosen this research topic as there is a paucity of specific guidelines regarding the optimal period of gestation for delivering women with PTPROM. The study correlated the feto-maternal outcomes in women with PTPROM on expectant management till 37 weeks versus delivery at 34 weeks with a period of latency and maternal inflammatory markers. This was a prospective observational study conducted on 262 women with PTPROM from 28-33+6 weeks of gestation. Women were monitored till 37 weeks with biweekly total leukocyte count and weekly C-reactive protein, urine routine microscopy, urine culture, high vaginal culturesensitivity, and ultrasound. Women were monitored expectantly till 37 weeks. However, intervention was done at any time during the feto-maternal compromise. There were 52 women who delivered <34 weeks and 210 women who delivered ≥34 weeks. Feto-maternal outcomes were documented. Group A was assigned to women who delivered before 34 weeks and Group B was assigned to women who delivered after 34 weeks. Statistical analysis was done using SPSS software.A p-value <0.05 was considered significant. Amongthe study group, 238 (90.8%) women were managed expectantly while 24(9.1%) required intervention. A latency of 3-4 weeks was observed in 131(50%) women.Chorioamnionitis developed in 7 women (4.4%) in group A and 13 women (4.9%) in group B. Neonates developed sepsis in 5.7% in group A and 5.8 % in group B and were comparable in both the groups (p=1.000). Early neonatal death (END) occurred in 10 (3.8%) amongwhich seven died because of low birth weight (LBW), two due to sepsis, and one due to respiratory distress. LBW was significantly associated with END (p<0.001) Conclusion: Expectant management beyond 34 weeks with close monitoring can improve neonatal outcomes without increasing maternal morbidity in women with PTPROM.

Effectiveness of the modified WHO labour care guide to detect prolonged and obstructed labour among women admitted at publicly funded facilities in rural Mbarara district, Southwestern Uganda: an ambispective cohort study.

Obstructed labour, a sequel of prolonged labour, remains a significant contributor to maternal and perinatal deaths in low- and middle-income countries. We evaluated the modified World Health Organization (WHO) Labour Care Guide (LCG) in detecting prolonged and or obstructed labour, and other delivery outcomes compared with a traditional partograph at publicly-funded maternity centers of rural Mbarara district and City, Southwestern Uganda. Since November 2023, we deployed the LCG for use in monitoring labour by trained healthcare providers across all maternity centers in Mbarara district/City. We systematically randomized a total of six health center IIIs (HCIIIs) out of 11, and all health center IVs (HCIVs), reviewed all their patient labour monitoring records for their first quarter of 2024 (LCG-intervention) and 2023 (partograph-before LCG introduction). Our primary outcome was the proportion of women diagnosed with prolonged and or obstructed labour. Our secondary outcomes included; tool completion, mode of delivery, labour augmentation, stillbirths, maternal deaths, Apgar score, uterine rupture, postpartum haemorrhage (PPH). Data was collected in RedCap and analyzed using STATA version 17. Statistical significance was considered at p<0.05. A total of 2,011 women were registered; 991 (49.3%) monitored using the LCG, and 1,020 (50.7%) using a partograph, 87% (1,741/2011) delivered from HCIVs and 270/2011 (13%) from HCIIIs. Mean maternal age (25.9; SD=5.6) and mean gestation age (39.4; SD=1.8) were similar between the two groups. A total of 120 (12.4%) cases of prolonged/obstructed labour were diagnosed (100 for LCG versus 20 for partograph), with the LCG having six times higher odds to detect/diagnose prolonged/obstructed labour compared to the partograph (aOR=5.94; CI 95% 3.63-9.73, P<0.001). Detection of obstructed labour alone increased to 12-fold with the LCG compared to the partograph (aOR=11.74; CI 95% 3.55-38.74, P<0.001). We also observed increased Caesarean section rates (aOR=6.12; CI 4.32-8.67, P<0.001), augmentation of labour (aOR=3.11; CI 95% 1.81-5.35, P<0.001), and better Apgar Score at 5 minutes (aOR=2.29; CI 95% 1.11-5.77, P=0.025). The tool completion rate was better for LCG compared to (58.5% versus 46.3%), aOR=2.11; CI 95% 1.08-5.44, P<0.001. We observed no differences in stillbirths, maternal deaths, post-partum haemorrhage (PPH) and uterine rupture. Our data shows that LCG diagnosed more cases of prolonged and or obstructed labour compared to the partograph among women delivering at rural publicly funded facilities in Mbarara city/district. We also observed increased C-sections, labour augmentation, and 5-minute Apgar scores. There were no differences in stillbirths, maternal deaths, PPH and uterine rupture. More controlled and powered studies should evaluate the two tools for other delivery outcomes, in different sub-populations.Trial registration number NCT05979194 clinical trials.gov.