Obstetric Examination Research Articles

Pioneering point-of-care obstetric ultrasound integration in midwifery education – the MEPOCUS study

BackgroundUltrasound technology is indispensable in perinatal care due to its non-invasive and painless nature, offering vital insights into foetal development and childbirth. With the academisation of midwifery in Germany, there is a growing necessity to incorporate ultrasound training into midwifery education. This paper discusses the development and implementation of an introductory obstetric ultrasound curriculum tailored for midwifery students, focusing on fundamental ultrasound techniques in obstetrics.Materials and methodsWe used Kern’s six-step approach of curricular development comprising [1] problem identification and general needs assessment [2], needs assessment of the targeted learners [3], goals and objectives [4], educational strategies [5], implementation, and [6] evaluation and feedback. The individual components of the curriculum were meticulously designed based on comprehensive literature reviews, thorough consultations with experienced ultrasound experts and evaluated needs of participants prior to the course instruction.ResultsTwenty-seven ultrasound-naive midwifery students participated in the newly developed obstetric ultrasound course. Structured as a modular and integrated framework, the course aimed to provide theoretical and practical instruction in basic obstetric ultrasound, with intrapartum sonography and focused assessment with abdominal sonography for trauma (FAST) as key supplementary specialisations. The results demonstrated a significant increase in the students’ overall knowledge and practical skills, as evidenced by the median post-course total score rising from 20 to 60 out of 75 (p < 0.001) in the objective structured clinical examination (OSCE) and from 9 to 19 out of 20 (p = 0.001) in the knowledge test. Additionally, students reported high satisfaction with the course and noted substantial personal benefits.ConclusionThe integration of basic obstetric ultrasound training within the midwifery curriculum is feasible and effective to teach fundamental knowledge and skills of obstetric ultrasound examinations to midwifery students. Expansion, standardisation and regulatory structures are critical components for a continued improvement and realistic integration into midwifery educational frameworks and thus the further development of the midwifery profession.

A novel frameshift deletion variant of ARSL associated with X-linked recessive chondrodysplasia punctata 1: a case report and literature review of prenatal, confirmed cases

BackgroundX-linked recessive chondrodysplasia punctata 1 (CDPX1) is a rare congenital skeletal dysplasia characterized by stippled epiphyses, nasal hypoplasia, and brachytelephalangy. ARSL (formerly known as ARSE), a member of the sulfatase gene family located on Xp22.3, has been identified as the causative gene for CDPX1. The high clinical and genetic heterogeneity of CDPX1 presents a challenge to prenatal diagnosis.Case presentationA G1P0 woman in her 30s with an unremarkable prenatal course presented in the second trimester. Maternal diseases, tobacco, alcohol, and drug history during pregnancy were denied. Obstetrical ultrasound examination revealed a flattened nose and a flattened midface with echogenic alterations of lumbar spinous process in the fetus. Amniocentesis was performed for genetic testing. A normal karyotype and a negative result of CNV-seq were obtained. However, Whole exome sequencing (WES) in trios revealed a hemizygous ARSL variant [NM_000047.3:c.1108del p.(Trp370Glyfs*35)] in the fetus, which was maternally inherited as confirmed by Sanger sequencing. This variant was absent from the genomAD and HGMD databases. According to the ACMG guidelines, this variant was interpreted as likely pathogenic (PVS1 + PM2_Supporting). The couple decided to terminate the pregnancy. After induction of labour, a severe nasal hypoplasia was noted; and brachytelephalangy was not remarkable. Postmortem digital X-ray imaging revealed symmetrical stippled epiphyses of the vertebrae in all spine regions and enlargement of spinous process of L1-L4 vertebrae.ConclusionA novel frameshift deletion variant of ARSL and the associated fetal phenotype have been identified. This study provides useful information for prenatal diagnosis and genetic counseling of CDPX1.

Concordant fatal congenital anomaly in twin pregnancy: a case report and review of the literature

BackgroundWhen a pregnant mother finds out she has a fetus with a congenital defect, the parents feel profound worry, anxiety, and melancholy. Anomalies can happen in singleton or twin pregnancies, though they are more common in twin pregnancies. In twins, several congenital defects are typically discordant.Case summaryWe present a rare case of concordant fatal anomaly in twin pregnancy in a 22-year-old African patient primigravida mother from Western Ethiopia who presented for routine antenatal care. An obstetric ultrasound scan showed anencephaly, meningomyelocele, and severe ventriculomegaly. After receiving the counseling, the patient was admitted to the ward, and the pregnancy was terminated with the medical option. Following a successful in-patient stay, she was given folic acid supplements and instructed to get preconception counseling before getting pregnant again.ConclusionThe case demonstrates the importance of early obstetric ultrasound examination and detailed anatomic scanning, in twin pregnancies in particular. This case also calls for routine preconceptional care.

Integrating ChatGPT in Orthopedic Education for Medical Undergraduates: Randomized Controlled Trial.

ChatGPT is a natural language processing model developed by OpenAI, which can be iteratively updated and optimized to accommodate the changing and complex requirements of human verbal communication. The study aimed to evaluate ChatGPT's accuracy in answering orthopedics-related multiple-choice questions (MCQs) and assess its short-term effects as a learning aid through a randomized controlled trial. In addition, long-term effects on student performance in other subjects were measured using final examination results. We first evaluated ChatGPT's accuracy in answering MCQs pertaining to orthopedics across various question formats. Then, 129 undergraduate medical students participated in a randomized controlled study in which the ChatGPT group used ChatGPT as a learning tool, while the control group was prohibited from using artificial intelligence software to support learning. Following a 2-week intervention, the 2 groups' understanding of orthopedics was assessed by an orthopedics test, and variations in the 2 groups' performance in other disciplines were noted through a follow-up at the end of the semester. ChatGPT-4.0 answered 1051 orthopedics-related MCQs with a 70.60% (742/1051) accuracy rate, including 71.8% (237/330) accuracy for A1 MCQs, 73.7% (330/448) accuracy for A2 MCQs, 70.2% (92/131) accuracy for A3/4 MCQs, and 58.5% (83/142) accuracy for case analysis MCQs. As of April 7, 2023, a total of 129 individuals participated in the experiment. However, 19 individuals withdrew from the experiment at various phases; thus, as of July 1, 2023, a total of 110 individuals accomplished the trial and completed all follow-up work. After we intervened in the learning style of the students in the short term, the ChatGPT group answered more questions correctly than the control group (ChatGPT group: mean 141.20, SD 26.68; control group: mean 130.80, SD 25.56; P=.04) in the orthopedics test, particularly on A1 (ChatGPT group: mean 46.57, SD 8.52; control group: mean 42.18, SD 9.43; P=.01), A2 (ChatGPT group: mean 60.59, SD 10.58; control group: mean 56.66, SD 9.91; P=.047), and A3/4 MCQs (ChatGPT group: mean 19.57, SD 5.48; control group: mean 16.46, SD 4.58; P=.002). At the end of the semester, we found that the ChatGPT group performed better on final examinations in surgery (ChatGPT group: mean 76.54, SD 9.79; control group: mean 72.54, SD 8.11; P=.02) and obstetrics and gynecology (ChatGPT group: mean 75.98, SD 8.94; control group: mean 72.54, SD 8.66; P=.04) than the control group. ChatGPT answers orthopedics-related MCQs accurately, and students using it excel in both short-term and long-term assessments. Our findings strongly support ChatGPT's integration into medical education, enhancing contemporary instructional methods. Chinese Clinical Trial Registry Chictr2300071774; https://www.chictr.org.cn/hvshowproject.html ?id=225740&v=1.0.

Retinal Microvascular Characteristics and Outcomes in Hypertensive Disorders of Pregnancy.

Background Hypertensive disorders of pregnancy (HDP) is a continuum of chronic hypertension, gestational hypertension, preeclampsia, and eclampsia in increasing severity, associated with a higher risk of complicated pregnancies and poor neonatal outcomes. This multisystem involvement can be assessed by fundoscopy, which serves as an indicator for generalized microvascular abnormalities. Our study aims to evaluate the correlation of hypertensive retinopathy with the severity of HDP and maternal and fetal outcomes. Materials and methods The study was conducted at a tertiary care hospital in Vijayapura from October 2021 to March 2022 among admitted cases of HDP. Detailed history, blood pressure (BP) measurement, obstetric examination, and fundoscopy were performed for all cases. Patients were followed up until the 10th postnatal day. The mode of delivery, birth weight, gestational age at birth, and any other neonatal outcomes were noted. Results We included 94 preeclampsia/eclampsia patients with a median age of 23 years, 51 (54.3%) being primigravida. Patients with chronic hypertension, gestational hypertension, and chronic hypertension superimposed by preeclampsia/eclampsia were excluded. The most common symptom in mothers was headache (23.4%), followed by blurring of vision (20.2%) and epigastric pain (5.3%) with a significant association (p < 0.05). Thirty-two cases (34%) had preterm deliveries with a positive association with the severity of retinopathy (p < 0.05). The magnitude of hypertensive retinopathy was 56.3% (53 cases), the severity of which significantly correlated to the severity of HDP (p < 0.05). We report 8.5% neonatal mortality and 22.3% small for gestational age (SGA) with a positive association with HDP severity (p < 0.05). There was no correlation between serum creatinine levels and the severity of retinopathy and fetal outcome. Conclusion The occurrence and severity of hypertensive retinopathy increase with increasing severity of HDP. Complaints, such as headache, blurred vision, and epigastric pain, are reported higher in cases with retinopathy. The severity of retinopathy may be used as an indicator of fetal morbidity; however, studies with large sample sizes and advanced tools are required to quantify the cause-effect relationship. The retinopathy associated with HDP resolves naturally with BP control postnatally.

Ophthalmological Disorders and Laboratory and Clinical Indicators in Women with Hypertensive Pregnancy Complications

Introduction. Hypertensive disorders during pregnancy, despite many epidemiological studies, scientific developments, and the improvement of laboratory and instrumental techniques for searching for predictors of preeclampsia, are a serious problem of perinatal obstetrics. One of these areas may be an in-depth ophthalmological examination.The aim of the work is to perform an analysis of ophthalmological disorders and laboratory, clinical parameters in women with hypertensive complications of pregnancy.Materials and methods. A retrospective analysis of 573 cases of hypertensive pregnancy complications was performed. The age of the patients ranged from 15 to 50 years. All patients received a standard general clinical and obstetric examination, examined by an ophthalmologist. A correlation analysis of some laboratory and clinical signs of arterial hypertension (AH) and preeclampsia (PE), including ophthalmological signs of PE, was carried out. Results: PE was accompanied by retinal angiopathy in 67 % of cases. In 9 cases (1.86 %), peripapillary edema was detected in PE. In the presence of peripapillary edema, earlier delivery dates and a lower Apgar score were observed in the newborn. Macular edema was registered in 3 cases (0.62 %) against the background of gestational diabetes mellitus.Conclusion. Comparative analysis has shown the presence of correlations between signs of hypertensive complications of pregnancy and changes in the organ of vision. The expansion of ophthalmological research may provide new markers-indicators for the differential diagnosis of hypertensive complications of pregnancy, assessment of the severity of the condition, dynamic monitoring and choice of management tactics for patients with hypertensive complications of pregnancy.

Clinical Profile of Patients Presenting With Eclampsia at a Semi-urban Tertiary Care Center.

Introduction Pregnancies complicated by hypertensive disorders contribute to enormous burden on economy and health-care facilities.Eclampsia is one of the clinical markers of near-miss mortality. To achieve optimal outcomes, efforts should be directed at both periphery and tertiary care levels. This study aimed to compare the feto-maternal outcome in patients presenting with eclampsia and a matched control population. Methodology A comparative observational study was conducted among 70 cases and 70 controls. Detailed historyand general and obstetrical examinations were carried out. Data was extracted from case files, labor room, and ICU records. Maternal and fetal outcomes were noted from January 2023 to January 2024. Statistical software STATA 14.2 (StataCorp LLC, College Station, Texas, USA) was used for data analysis. Observational descriptive statistics and chi-square and Fisher extract tests were applied. Results In our study, the incidence of eclampsia was 0.7% (70 per 1000 live births). The maternal mortality rate was 102.8/100000 live births and the perinatal mortality rate was 10.2/ 1000 live births in our study. The study observed a relatively young aged population and a significant bulk of cases belonged to late gestation or post-partum. Events like HELLP syndrome, abruption, liver, and renal failure were found to be frequently linked to eclampsia. Neonatal asphyxia (P-0.005), NICU requirement 41.43% vs 29% (P<0.01) preterm delivery 45.7% vs 14% (P=<0.001), and low birth weight were more commonly observed among the cases than the controls. Conclusions Eclampsia was found to be a significant contributor to elevated rates of morbidity and mortality in mothers and newborns. Poor antenatal care, severe anemia, and late referrals were some of the modifiable risk factors. Health care and economic burden on society is immense due to the significant utilization of intensive care and high dependency units.

Fulfilling The Right to Health of Pregnant Women Through Obstetric Ultrasound Examination at Antenatal Care (ANC) at The Palu City Health Center - Central Sulawesi, Indonesia

The government's efforts to reduce the maternal mortality rate (MMR) through quality and standard antenatal care examinations using ultrasonography (USG) is a manifestation of the Government's responsibility to fulfill citizens' health rights, especially maternal health rights. This research was located in the city of Palu, Central Sulawesi Province (Indonesia). The research question that will be discussed in this paper is: how is the implementation of the right to health of pregnant women in obtaining quality and standard antenatal care services (obstetric ultrasound examinations) at community health centers in the city of Palu? Furthermore, from the results of the analysis of research questions, it was concluded that: a) the Palu city government has demonstrated responsibility in providing health services for pregnant women that meet standards; b) fulfillment of the right to health of pregnant women through obstetric ultrasound examinations in antenatal care has not reached the target; c) Pregnant women's compliance with having their pregnancy checked at the Community Health Center so that they get an obstetric ultrasound examination by a doctor shows that there are disparities.

Thyrotoxicosis in Partial Mola Hidatidosa

Thyrotoxicosis is a clinical condition associated with excessive thyroid hormone levels. Symptoms can range from asymptomatic to life-threatening due to thyroid storm. Thyrotoxicosis in hydatidiform moles is a rare condition but has a high mortality rate, so etiological studies are still needed for optimal management. Case Report: Patient Mrs. T, 25 years old Hindu, Balinese, 12 weeks pregnant (Gravida 1 Para 0 abortion 0), came to the obstetrics ER on September 24, 2023 with complaints of discharge from the birth canal since the morning, nausea (+), often shaking, easily tired and often sweaty. physical examination obtained blood pressure 100/60mmHg, pulse 78x/min, respiratory rate 20x/min, axillary temperature 36.80C oxygen saturation 99%. From obstetric examination, fundus uteri height ½ center, vaginal toucher vulva vagina within normal limits, portiono (-) fluxus (+), laboratory examination obtained HCG 387,392.8 mIU/m, FT4 31.05 pmol/L (N: 9-22), TSH &lt;0.01 uIU/mL (N: 0.4-4.2) ultrasound results describe honey comb appearance and histopathology results describe partial mola. Evacuation by curettage was performed, resulting in reduced serum ?-hCG levels and reduced thyroid hormone levels. Discussion: The patient was diagnosed with partial hydatidiform mole and thyrotoxicosis. Hydatidiform moles can cause thyrotoxicosis. This condition is caused by the structure of ?- hCG which resembles TSH so that it can activate TSH receptors. After evacuation of hydatidiform moles, normal TSH and FT4 levels will be obtained. Conclusion: The female patient with thyrotoxicosis due to hydatidiform moles had the moles evacuated, resulting in normal thyroid hormone levels.

Time to scale-up point-of-care ultrasound (POCUS) in obstetrics and gynaecology in Nigeria

The availability, affordability and portability of high-resolution-ultrasound machine in recent years have made ultrasound an indispensable point-of-care diagnostic and procedural tool in current practice of Obstetrics and Gynaecology. POCUS is a goal-directed (focused/emergency) ultrasound examination performed by the healthcare provider in the consulting office or patient’s bedside to make a specific diagnosis that will direct timely and definitive treatment of the patient. It improves clinical outcomes, prevents hospital delays, promotes swift definitive treatment, reduces cost and enhances patient satisfaction without exposure to ionizing radiation. It is a readily available care in Obstetrics and Gynaecology. Skills acquisition in POCUS should be incorporated in teaching programs for midwives, medical students, resident doctors and consultants. This review aims to summarize the literature on the advances in ultrasound technology, indications and practice guidelines for clinicians’ POCUS examinations in Obstetrics and Gynaecology. Recommendations to fill the gaps in the current training and skills acquisition in Nigeria are proposed.

Deep Learning-Based Architecture for Down Syndrome Assessment During Early Pregnancy Using Fetal Ultrasound Images

Down's syndrome, also known as trisomy 21, is a prevalent genetic condition characterized by intellectual disability and developmental delay in children. The current study has prioritized the development of precise screening techniques for trisomy 21 in the initial stages of pregnancy in order to facilitate prompt diagnosis. This study presents an innovative paradigm for categorizing sagittal views in obstetric ultrasound examinations, specifically identifying Nuchal Translucency, a crucial component within the fetal brain, during the 11th to 14th weeks of pregnancy. The suggested deep learning-based system effectively detects the presence of the essential cerebral structure known as Nuchal Translucency, hence aiding in the diagnosis of Down's syndrome. A dataset comprising more than 1100 pre-processed 2D sagittal-view ultrasound images was gathered to train, test, and validate the proposed convolutional neural network model. The model results were utilized to quantify neurotensin levels and assess the presence of Down's syndrome by image classification. The performance of the model was assessed by measuring its sensitivity, specificity, and area under the curve metrics. These metrics were then compared to those of human experts who had received training in prenatal and ultrasound techniques. Notably, the suggested model attained an outstanding area under the curve score of 0.97. Our study suggests the most common non-invasive method for screening pregnant women for fetal abnormalities is ultrasound, which examines the unborn organs. The application of deep learning and machine learning techniques has significantly enhanced the diagnosis. In order to detect or anticipate conditions like Down syndrome, it assesses the intercranial structures of the developing embryo during the early stages of pregnancy. Developing an improved iteration of this model could serve as the foundation for an effective automated system for diagnosing Down's syndrome in its early stages within a clinical environment.

A Study of Pregnancy Outcome in Various High Risk Pregnancies

Background: A High risk pregnancy is identified as pregnancy in which there is a risk of adverse outcome in the mother and / or baby that is greater than the incidence of that outcome in general population. All pregnancies are at risk even though most of the pregnancies and childbirth worldwide are uneventful. Almost 15% of all the pregnant women can develop potentially life-threatening complications which mightrequire skilled care with some requiring major intervention for survival. Methods: This prospectivestudy was carried out in 220 cases being brought in OBG dept of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. Results: Of the 220 antenatal cases studied, 99 cases (45%) of them had pre-eclampsia. Malpresentation pregnancies contributed to about 36% of cases and Anemia were seen in 13 cases (6%). The mode of delivery was caesarean section in 70 cases (31.2%). Normal vaginal delivery were done in 94 cases (42.8%). Instrumental deliveries were seen in 11 cases (5%). Conclusion: High risk pregnancy, Caesarian section, Normal vaginal delivery of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.

A Randomized Trial of Intravenous Labetalol Versus Oral Nifedipine in Acute Blood Pressure Control in Hypertensive Emergencies of Pregnancy

Background: Hypertension in pregnancy, called a disease of degree is more of a sign than a disease by itself. Hypertensive disorders of pregnancy, including chronic hypertension, with or without superimposed pre-eclampsia/eclampsia, gestational hypertension, HELLP syndrome, pre-eclampsia with or without severe features or eclampsia present a significant risk of morbidity to both mother and fetus. Effective pharmacologic therapy modifies the course of the disease. The effective use of anti-hypertensive therapy should be based on well designed controlled clinical trials and the experience of the clinician with the drugs. Hypertensive disorders complicate 5-10% of all pregnancies worldwide. 1 Dangerous hypertension is a harbinger of cerebrovascular accidents, eclampsia, hypertensive encephalopathy and other end organ damage with a poor perinatal outcome. 2 Methods: This prospective randomized double blind comparative clinical trial with randomization done using computer generated numbers study was carried out in 100 cases being brought in OBG department of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. The pregnant women were randomized with computer generated numbers into two groups to receive either oral nifedipine or intermittent intravenous labetalol injections. Results: There is no significant difference in the parity of both the groups. Majority of the patients constituting 80% of group A and 58% of group B were primigravida. 69% enrolled in the study were primigravida. There is a higher incidence of pre-eclampsia in the first pregnancy. The majority of the patients had gestational age of 34 to 36 weeks constituting 48% on the whole with 50% and 46% respectively in group A and B. The recruited patients did not significantly differ in gestational age

Reliability of the carousel simulator for assessing labor cervical dilation in medical obstetrics education.

To determine the reliability of the Carousel simulator in medical education for obstetric examinations. Cervical dilation examination training in pregnant women exposes patients to additional uncomfortable and health-risk procedures, a gold standard, and does not objectively evaluate the medical student's competence. We studied the reliability of training internship medical students in obstetrics. Participating students were assigned to take the examination of digital assessment of the cervical dilation on the simulator. Classes performed 12 consecutive randomly blind predetermined cervical dilation examinations using the Carousel simulator. The exact answer and the answer with certainty within ±1 cm were registered and analyzed. Incorrect or outlier answers were considered with a cutoff of ≥2 cm from the dilation. A dispersion graph for each centimeter of dilation simulation was constructed. Sixty-six medical obstetricians took part, performing 396 examinations. Thus, we observed 49 outliers (12.37%) in simulated assessments. According to the analysis, we did not observe outliers from dilation 1 to 4 cm; dilation 7 to 9 cm had a higher index of outlier measurements. We did not consider any dilation simulation dispersion graphic as a null correlation. A strong correlation was seen in the dilation 1 to 6 cm and the dilation 10 cm. The dilations 7, 8, and 9 cm showed a weak correlation. The Carousel simulator model is a reliable method for student learning. The simulator is an essential study tool capable of reducing the embarrassment and possible harm caused by the excessive and repetitive number of invivo digital vaginal examinations. Novel studies are proposed to improve the simulator device and method, mainly to estimate the adequate repetitions and training needed before invivo practice.

Association Between Cord Blood Placental Growth Factor Level, Fetal Doppler Parameters and Neonatal Growth Measures

Background: Placental growth factor (PlGF) contributes to fetoplacental circulatory system development, whichever revealed to have an effect on the fetal size and growth. Objectives: To explore the inference between umbilical cord blood [fetal] PlGF, fetal doppler parameters, gestational age and neonatal growth parameters particularly birth weight, birth length, head circumference and mid arm circumference. Research protocol: This cross-sectional investigation was implemented on 50 pregnant women in their third trimester, aged 18-35years and their full term newborns. Full history taking, gestational age, general and obstetric examination and ultrasound investigation, fetal biometrics and doppler ultrasound were carried out. Umbilical cord blood PlGF was quantified using ELISA. All the enrolled neonates were submitted to full clinical examination by pediatrician and their anthropometric parameters were measured before breast feeding started. Results: Umbilical artery pulsatility index (UAPI) revealed significant negative correlation with neonatal weight and PlGF level. Meanwhile, gestational age (GA) showed significant positive correlation with the neonatal anthropometric parameters including mid arm circumference (MAC), head circumference, weight, length, weight Z score, length Z score, head Z score weight to length (W/L) and weight to length Z score (W/L Z Score). Also, significant positive correlation between PlGF and gestational age as well as the neonatal anthropometric measurements was registered except head Z Score. Multiple linear regression analysis for PlGF with UA PI and neonatal weight indicated that UAPI and neonatal weight were significant predictors for fetal PlGF. Conclusions: The current data illuminate the effect of fetal placental growth factor on neonatal adverse growth pattern. Additionally, fetal placental growth factor with fetal doppler parameters could be a promising predictive biomarkers to intervene neonates at risk for adverse childhood outcomes.

ОПЫТ ЛЕЧЕНИЯ ПОСЛЕРОДОВОГО ЭНДОМЕТРИТА У КОРОВ

The purpose of the study is to conduct a comparative analysis of the therapeutic effectiveness of a local antiseptic drug based on tea tree essential oil for acute postpartum catarrhal endometritis in cows. The study was conducted at the Department of VNB, Obstetrics and Physiology of Farm Animals of the Krasnoyarsk State Agrarian University, on the basis of the dairy farm of the Balakhta District of the Krasnoyarsk Region. The object of the study is red-motley cows. Research methods: obstetric and gynecological medical examination of breeding stock; the diagnosis of acute postpartum catarrhal-purulent endometritis was established during a clinical and gynecological examination of fresh cows, which inclu-ded thermometry, rectal and vaginal examination. The diagnosis was considered confirmed when pathological discharge of a catarrhal nature appeared from the uterus during rectal massage. Two experimental groups of fresh cows were formed according to the principle of analogues (based on live weight, age, lactation, clinical manifestation of the form of acute endometritis). In the 1st experimental group, scheme № 1 was used: a 25 % oil solution of tea tree essential oil was administered intrauterinely in a dose of 20 ml daily once a day until clinical recovery; eleovit 8 ml was administered intramuscularly on the 1st and 5th days of treatment; uteroton 10 ml was administered intramuscularly daily once a day for 3 days; 0.05 % chlorhexidine solution 200 ml – intravaginally; rectal massage of the uterus once a day. In the 2nd experimental group, treatment regimen № 2 was used, which differed from regimen № 1 by using a 50 % oil solution of tea tree essential oil in a similar dosage. The best therapeutic effect in the treatment of acute catarrhal endometritis was obtained using scheme № 2 using a 50 % oil solution of tea tree essential oil. Du¬ring the seven-day course of treatment, therapeutic effectiveness was obtained in 60.0 % of cases; prolongation of the course of therapy led to the recovery of all animals in this experimental group. The ave¬rage duration of treatment for the group was 8.0 days.

Dystocia Due to Secondary Partial Uterine Inertia in a New Zealand White Rabbit

A one-year-old Doe weighing 1.2 kg was brought to Teaching Veterinary Clinical Complex, FVAS, BHU-Mirzapur, with a history of giving birth to three dead bunnies 3 days before and after that not show any signs of kindling. Vulvul lips were swollen, congested and edematous. The Perineal area was smeared with uterine discharge. Doe had Inappetence dehydration for 3 days. Doe was previously treated with inj. oxytocin @ 1 to 3 IU I/M and inj. Epidosin @ 8mg/ kg I/M along with calcium gluconate @ 0.25 ml/kg slow I/V before 24 hrs. Abdominal palpation revealed the presence of fetal mass. Lateral abdominal radiograph showed the presence of one fetus’s skeleton located in the pelvic cavity. Based on the history and obstetrical examination it was diagnosed as a case of dystocia due to secondary partial uterine inertia. A male dead bunny was relived through exploratory laparotomy under general anaesthesia (premeditated with inj. xylazine 5 mg/kg body weight and induction with isoflurane 3-5%). Doe had an uneventful recovery following exploratory laparotomy with proper postoperative care. Dystocia due to secondary partial uterine inertia is a rare case in rabbits and it can be managed through exploratory laparotomy with proper post-operative care.

Significance of cervical secretion culture in predicting maternal and fetal outcome in pregnant women with premature rupture of membranes: a retrospective cohort study.

Background: To investigate the clinical value of cervical secretion culture in pregnant women with premature rupture of membranes (PROM) in predicting maternal and fetal outcomes. Methods: We retrospectively reviewed clinical records of pregnant women who underwent obstetric examination and delivered in Fujian Maternal and Child Healthcare from December 2013 to December 2016. Pregnant women with a clear diagnosis of PROM, who underwent cervical secretion culture immediately after hospital admission were selected for the study. The primary outcome was the occurrence of chorioamnionitis. The secondary outcome was neonatal admission to the neonatal intensive care unit (NICU). Correlation between maternal and fetal outcomes and the results of the cervical secretion culture was analyzed by one-way analysis and multifactorial analysis, respectively. The predictive efficacy of cervical secretion culture was evaluated using receiver operating characteristic curve (ROC), area under the curve (AUC) and the integrated discrimination improvement (IDI). Results: A total of 7,727 pregnant women with PROM were included in the study. Of them, 1812 had positive cervical secretion cultures (635 positive for mycoplasma infection, 475 for bacterial, 637 for fungal, and 65 for chlamydial infections). Pregnant women with positive mycoplasma and bacterial cultures had higher rates of developing chorioamnionitis compared to women with negative cervical secretion cultures (9%, 12% vs. 1%, respectively). Similarly, positive mycoplasma and bacterial cultures were associated with higher rate of the preterm (before 34 weeks) labor (3%, 3% vs. 1% in women with negative cultures, respectively), and neonatal admission to the NICU (9%, 11% vs. 7%, respectively). After adjusting for various confounding factors, our analysis demonstrated that a positive cervical secretion culture for mycoplasma or bacterial pathogens remained an independent risk factor for chorioamnionitis. Cervical secretion culture outcome was less effective in predicting chorioamnionitis (AUC 0.569) compared to white blood count (WBC) (AUC 0.626) and C-reactive protein (CRP) levels (AUC 0.605). The IDI of the combined predictive model incorporating WBC, CRP, maternal fever and cervical secretion culture results was 0.0029. Conclusion: Positive cervical secretion cultures, especially for mycoplasma and bacteria, are associated with higher incidence of adverse maternal and fetal outcomes. However, the predictive value of this test is poor, and cannot be efficiently used for predicting chorioamnionitis.

Pre-term labour: A study on evaluation of causes and outcome.

Despite recent advances in medicine, the incidence of pre-term birth is increasing globally. Approximately 70% of neonatal deaths, 36% of infant deaths, and 25-50% of cases of neurological impairment in children can be attributed to pre-term births. Identification of risk factors in women, supervised obstetric care during pregnancy, female empowerment, and patient education are strategies to minimize the burden of preterm deliveries. A prospective cross-sectional study was conducted over a 1-year period among 658 women in the Department of Obstetrics and Gynecology, Pramukhswami Medical College, Anand, Gujarat. Detailed history, general, and obstetrical examinations were carried out. Maternal and foetal outcomes were noted. Statistical software STATA 14.2 was used for data analysis. The incidence of pre-term birth in our study was 34.95%. The incidence of late pre-term, very term, and extremely pre-term was 28.42%, 4.71%, and 1.82%, respectively. Pre-mature rupture of the membrane was observed among 20.34% of patients with late pre-term labour. IUGR was identified in 9.52% and 15.94% of the very and late pre-term births, respectively. A statistically significant difference was found in the 1 minute and 5 minute Apgar scores between pre-term babies and term babies. Pre-maturity is a huge health and financial burden in rural and semi-urban central Gujarat. Pre-mature rupture of membranes, previous MTP, extreme physical activity, and maternal anaemia were the major risk factors linked with pre-term labour. Poor neonatal outcomes like LBW, IUGR, and a low Apgar score were significantly associated with the babies delivered pre-mature in our study.

Health professionals' experiences and views on obstetric ultrasound in Tanzania: A cross-sectional study.

Obstetric ultrasound is considered important for determining gestational age, identifying single or multiple pregnancies, locating the placenta and fetal anomalies and monitoring fetal growth and pregnancy-related complications in order to improve patient management. To explore health professionals' perspectives on different aspects of obstetric ultrasound in Tanzania regarding self-reported skills in performing ultrasound examinations and what could improve access to and utilization of obstetric ultrasound in the clinical setting. Cross-sectional study. Data was collected between November and December 2017 using a questionnaire based on previous qualitative research results from the CROss Country UltraSound Study (CROCUS Study). Seventeen healthcare facilities in 5 urban and semiurban municipalities in the Dar-es-Salaam region were included, with 636 health professionals participating (physicians, n = 307 and midwives/nurses, n = 329). Most health professionals (82% physicians, 81% midwives/nurses) believed that obstetric ultrasound was decisive in the clinical management of pregnancy. Results indicate proficiency gaps across disciplines: 51% of physicians and 48.8% of midwives/nurses reported no or low-level skills in assessing cervical length. Similarly, deficiencies were observed in evaluating the four-chamber view of the fetal heart (physicians: 51%, midwives/nurses: 61%), aorta, pulmonary artery (physicians: 60.5%, midwives/nurses: 65%) and Doppler assessments (umbilical artery: physicians 60.6%, midwives/nurses 56.1%). Compared to midwives/nurses, physicians were significantly more likely to agree or strongly agree that utilization would improve with more ultrasound machines (odds ratio (OR) 2.13; 95% confidence intervals (CI) 1.26-3.61), better quality of ultrasound machines (OR 2.27; 95% CI 1.10-4.69), more training for health professionals currently performing ultrasound (OR 2.11; 95% CI 1.08-4.17) and more physicians trained in ultrasound (OR 2.51; 95% CI 1.30-4.87). Improving the provision of obstetric ultrasound examinations in Tanzania requires more and better-quality ultrasound machines, enhanced training for health professionals and an increased number of physicians trained in ultrasound use. To further increase the accessibility and utilization of obstetric ultrasound in maternity care in Tanzania, it is essential to provide training for midwives in basic obstetric ultrasound techniques.