Expectant Management Research Articles

Institutional work as response to institutional complexities in hybrid elite sport and sport for all organizations

ABSTRACT Research question This study aimed to examine how actors across different organizational levels respond to institutional complexity when facilitating elite sport and sport for all. By applying institutional work to understand responses to institutional complexity better, we examined the individual actors’ organizational roles and why and how they transformed the complexity in performing day-to-day work. Research methods Data were collected in a bottom-up approach using qualitative focus groups and in-depth interviews. 149 representatives within Norwegian sport organizations contributed to the study, including coaches, club managers, directors, managers in national sport organizations, and the president of the Norwegian Olympic and Paralympic Committee and Confederation of Sports (NIF) Results and findings Institutional complexity is differently characterized at the different organizational levels. One common issue across levels is that the institutional complexity of sport for all and elite sport is seen as challenging, especially in the local sport clubs where institutional logics turn into day-to-day activity. The main source of the challenge is unifying the youth players and practitioners’ different skills and ambitions, which propagates upwards in the organization. How actors respond to complexity varies within the organizational levels and the different sports. Tensions stemming from complexity are often neglected by the political argument of ‘the trickle down and up effects’, which to a considerable extent lacks empirical evidence. Implications We recommend local sport managers prioritize expectation management to counteract a conflict of interests between institutional logics. It is necessary that national governing bodies better align their policies with the interest and organizational capacity of local clubs.

Pelvic floor dysfunction after intervention, compared with expectant management, in prolonged second stage of labour: A population-based questionnaire and cohort study.

To investigate the effect of vacuum extraction (VE) or caesarean section (CS), compared with expectant management, on pelvic floor dysfunction (PFD) 1-2 years postpartum in primiparous women with a prolonged second stage of labour. A population-based questionnaire and cohort study. Stockholm, Sweden. A cohort of 1302 primiparous women with a second stage duration of ≥3 h, delivering from December 2017 to November 2018. The 1-year follow-up questionnaire from the Swedish National Perineal Laceration Register was distributed 12-24 months postpartum. Exposure was VE or CS at 3-4 h or 4-5 h, compared with expectant management. Pelvic floor dysfunction was defined as at least weekly symptoms of urinary incontinence, pelvic organ prolapse or a Wexner score of ≥4. The risk of PFD was calculated using Poisson regression with robust variance estimation, presented as crude and adjusted relative risks (RRs and aRRs) with 95% confidence intervals (95% CIs). The implication of obstetric anal sphincter injury (OASI) on pelvic floor disorders was investigated through mediation analysis. In total, 35.1% of women reported PFD. Compared with expectant management, the risk of PFD was increased after VE at 3-4 h (aRR 1.33, 95% CI 1.06-1.65) and 4-5 h (aRR 1.34, 95% CI 1.05-1.70), but remained unchanged after CS. The increased risk after VE was not mediated by OASI. Pelvic floor dysfunction was common in primiparous women after a prolonged second stage, and the risk of PFD increased after VE but was unaffected by CS, compared with expectant management. If a spontaneous vaginal delivery eventually occurred, allowing an extended duration of labour did not increase the risk of PFD.

Eighteen years of experience in laparoscopic implantation of artificial urinary sphincter in women with intrinsic sphincter deficiency

Introduction and objectives: Artificial urinary sphincter (AUS) is a treatment option for women with stress urinary incontinence (SUI) after failure of previous surgery or as a primary procedure in severe intrinsic sphincter deficiency (ISD). The aim of the study was to assess the long-term efficacy and risk factors for surgical revision and definitive explantation of AUS laparoscopic implantation in female patients.Methods: A retrospective review of all women submitted to AUS implantation between April 2005 and March 2023 was conducted. The AUS was implanted via transperitoneal laparoscopic approach, by two experienced surgeons. The primary endpoint was postoperative continence. Continence was defined as no leakage and no pad usage or leakage and/or pad usage with no impact on social life and failure as leakage and/or pad usage impacting social life. As secondary outcomes, clinical predictive factors for AUS revision and definitive explantation were evaluated.Results: In the last 18 years, females with a mean age of 68±12 years-old were submitted to laparoscopic implantation of AUS. Early overall complication rate was 16%, but only one case was Clavien-Dindo ≥3. After a median follow-up of 67 months, 22.2% of the patients needed a device revision, the majority due to mechanical device dysfunction. AUS definitive explantation was performed in 16%, mainly due to urethral/vaginal erosion (9.9%) and infection (6.2%). Patients with age ≥70 years and follow-up ≥10 years significantly predisposed for device revision. At the time of the last follow-up, 72% of the patients were keeping the urinary continency.Conclusions: Laparoscopic AUS implantation in females is an effective treatment for SUI due to ISD. Meanwhile, adequate patient selection, multidisciplinary evaluation and careful expectation management are essential to achieving good results, concerning their significant complication rate.

RegistrAME: the Spanish self-reported patient registry of spinal muscular atrophy

BackgroundSpinal Muscular Atrophy (SMA) is a rare neuromuscular disorder characterized by progressive degeneration of motor neurons and muscle weakness resulting in premature death or severe motor disability. Over the last decade, SMA has dramatically changed thanks to new advances in care and the emergence of disease-specific treatments. RegistrAME is a self-reported specific disease registry with an accurate curation system. It has collected data on SMA patients in Spain since 2015, gathering demographic, clinical, and patient-reported outcome data, all of which are patient-relevant. RegistrAME is part of the TREAT NMD network. This study aims to describe the advantages and disadvantages of a self–reported SMA registry, as well as the different variables of interest in the health status of RegistrAME patients.ResultsIn total, 295 living patients with a confirmed diagnosis of SMA-5q were included (aged 1 to 77 years; mean 20.28). Half of the patients (50.2%) were ≥ 16 years old; 22.03% were type 1, 48.47% were type 2, 28.82% were type 3, and 0.7% were type 4. All functional statuses (non-sitter, sitter, and walkers) could be observed in each SMA type. Adult patients harbored the least aggressive SMA types, however, they presented the greatest level of disability. Patients with SMA type 1 had scoliosis surgery about five years earlier than patients with SMA type 2. None of the type 1 patients who achieved ambulation were wheelchair-free outdoors. This was also evident in 62.5% of type 2 walker patients and 44% of type 3 walker patients. Of the SMA type 1 patients, 40% had a gastrostomy (of which 84% had two SMN2 copies). One in five children with SMA type 1 (one to seven years of age) were ventilation-free.ConclusionsThe information provided by RegistrAME in a “real-world” setting allows better management of family expectations, an adequate approach to the disease and patients’ needs, as well as a better understanding of the impact of the disease. It also helps monitor the evolution of care, which will result in the need for updated guidelines.

Predictors of Poor Outcomes in Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Fetal Growth Restriction

Introduction: The aim of the study was to identify predictors of poor outcomes in monochorionic diamniotic twin (MCDA) pregnancies with selective fetal growth restriction (sFGR), irrespective of the umbilical artery (UA) Doppler abnormalities. Methods: Single-center retrospective analysis of MCDA twins diagnosed with sFGR that opted for expectant management between 2010 and 2021. The presence of any of the following variables in the growth-restricted fetus: low amniotic fluid volume (DVP ≤2 cm), lack of a cycling bladder, absent or reversed flow in the ductus venosus (DV) with atrial contraction, and elevated middle cerebral artery peak systolic velocity (MCA-PSV) defined as ≥1.50 multiples of the median was categorized as complicated. sFGR cases were classified as simple in the absence of the above-mentioned variables. Results: Overall, 63.3% of cases qualified as simple, and 36.7% were complicated. Intertwin EFW discordance was higher in the complicated category (26 vs. 33%, p = 0.0002). The median gestational age at delivery was earlier (33 weeks vs. 30.5 weeks, p = 0.002), and the likelihood of survival was lower in the complicated category (p < 0.0001). The likelihood of two survivors to discharge was lower in type I complicated cases (70% in complicated type I vs. 97.1% in simple type I, p = 0.0003). On logistic regression analysis, an increase in the “complicated” score negatively correlated with two survivors to discharge (p < 0.0001). An ROC curve was created, and the AUC was 0.79. Increasing intertwin EFW discordance also decreased the probability of two survivors to discharge. Conclusion: The presence of oligohydramnios, lack of a cycling bladder, abnormal DV Doppler, and elevated MCA-PSV in the growth restricted fetus is associated with poor perinatal outcomes and a lower likelihood of having two survivors to discharge. The addition of intertwin EFW discordance to these variables helped improve the survival predictability.

Nonimmune hydrops fetalis in a primigravida in the third trimester: A case report

Background: Hydrops fetalis is abnormal fluid accumulation within at least two fetal compartments, which may include pericardial effusion, pleural effusions, ascites, and skin edema. In the absence of red cell alloimmunization, hydrops fetalis is nonimmune (NHIF) and affects approximately 1 in 2000 pregnancies. Case presentation: A 33-year-old primigravida presented to the high-risk clinic for further management following an abnormal obstetric scan. Her antenatal follow-up was uneventful. She was blood group O, and rhesus positive. Physical examination was unremarkable. Abdominal examination revealed a fundal height of 32 weeks, which corresponded to her date. The first obstetric scan performed in the third trimester revealed a live baby with features of hydrops fetalis. Management included couple counseling, multidisciplinary discussion with a fetomaternal specialist, dexamethasone injection for fetal lung maturation, and expectant management. Discussion: The parents agreed to keep the pregnancy to term and plan for vaginal and cesarian deliveries reserved for obstetric indications. Nonimmune hydrops fetalis is associated with severe perinatal morbidity and significant maternal risk. The main causes of NIHF are chromosomal, fetal infection, and fetal cardiovascular problems. Conclusion: NIHF is rare, and a high index of suspicion is required for antenatal diagnosis. This affords parents tailored information and choices and supports multidisciplinary care with the additional aim of recognizing cases where fetal therapy may be appropriate, including timing for delivery.

Ovarian masses and pregnancy: About 2 cases and literature review (experience of Gyneco-obstetrics service 2 Fez)

Management of adnexal masses during pregnancy can be challenging for the patient and clinician. The specter of a possible malignant tumor may influence the decision to intervene rather than the expected management. The etiologies of ovarian masses vary depending on the age of the parturient, and therefore, benign entities such as functional ovarian cysts, benign cystic teratomas, and serous cystadenomas predominate. In cases of malignancy, these are generally germ cell tumors and borderline, low-grade ovarian tumors. Ultrasound is the primary modality used to detect ovarian masses and assess the risk of malignancy. Morphological criteria identify benign cysts more precisely than malignant tumors. Tumor markers are mainly used to monitor disease status after treatment rather than to establish the diagnosis of ovarian tumor due to lack of specificity, as several markers can be elevated by pregnancy itself (e.g. , CA-125, β-hCG). We report the cases of 2 patients who consulted the emergency room in a context of pelvic pain during pregnancy whose clinical examination aimed first to eliminate an emergency, notably a torsion of the adnexa, then to explore using ultrasound the etiology and characterize the objectified ovarian mass. The care is specific during pregnancy. Expectant management is recommended for most pregnant patients with asymptomatic, unsuspicious cystic ovarian masses. Surgical intervention during pregnancy is indicated for large and/or symptomatic tumors and those that appear highly suspicious for malignancy on imaging tests. The extent of surgery depends on the intraoperative diagnosis of a benign or malignant tumor. Conservative surgery is most often performed. More aggressive surgery is indicated for ovarian malignancies, including surgical staging. Although rarely necessary, chemotherapy has been used during pregnancy with minimal fetal toxicity in patients with advanced ovarian cancer, in which the risk of maternal mortality outweighs fetal consequences.

Changes in patient-reported satisfaction and quality-of-life 6 months after rhinoplasty

Rhinoplasty is a challenging and demanding procedure in plastic surgery. Surgical success, patient satisfaction, and improved quality-of-life are important outcomes. This study aimed to evaluate patient-reported satisfaction with appearance, treatment, and decision outcomes as well as quality-of-life after rhinoplasty using validated questionnaires. The role of patient demographics on outcomes was also studied. Patients who underwent a primary rhinoplasty were selected for this cohort study. Patient-reported satisfaction with appearance, treatment, and decision as well as quality-of-life were evaluated with the Utrecht Questionnaire and FACE-Q at intake and 6months postoperatively. Overall, 380 patients were included. Patients reported a more positive subjective perception of nasal appearance (VAS score) at 6months post-surgery compared with preoperative scores (7.9±1.6 vs 3.2±1.4, p<0.05). Furthermore, higher quality-of-life and body image scores were observed at 6months postoperatively compared with preoperative scores (7.7±3.5 vs 15.2±4.4, p<0.05). Patients reported high satisfaction with treatment outcome (70.3±23.4) as well as with their decision to undergo surgery (75.9±23.4) on a scale of 0-100 at 6months postoperatively. Patients reached similar postoperative scores regardless of their intake scores. Patients ≥30years and patients with a history of cosmetic surgery were less satisfied postoperatively. Despite differences in appearance satisfaction at intake, most patients showed greater satisfaction with appearance, treatment, and decision outcomes as well as quality-of-life 6months postoperatively. However, older age and a history of cosmetic surgery influenced these outcomes negatively. These factors should be considered during preoperative management of outcome expectations.

Patient perspectives and experiences with psilocybin treatment for treatment-resistant depression: a qualitative study

Psilocybin is the most researched classic psychedelic for Treatment-Resistant Depression (TRD). While optimizing set and setting are considered essential for efficacy and safety, patient perspectives on these aspects have rarely been investigated. To address this knowledge gap, the current paper explored the experiences of 11 TRD patients (8 women, 3 men) participating in a double-blind randomized clinical trial with a single session of oral (1, 10 or 25 mg) psilocybin treatment. After qualitative analysis, three major themes were identified: (1) challenges with trust-building and expectation management; (2) navigating the experience; and (3) the need for a more comprehensive treatment. Subthemes of the first theme include a general distrust in mental healthcare, trust in study therapists, limited time for preparation, and managing expectations. The second theme included the following subthemes: trusting to surrender, profound and overwhelming experiences, and music as a guide. The third theme addressed a desire for multiple psilocybin sessions, and challenges with sensemaking. Patients’ perspectives provided important insights into potential optimization of psilocybin treatment of TRD, including individualized preparation, investment in trust-building, offering additional psilocybin sessions, providing access to sustained (psycho)therapy with trusted therapists, and personalizing treatment approaches, which may also enhance real-world adaption of these treatments.

Doppler ultrasound of umbilical and middle cerebral artery in third trimester small-for-gestational age fetuses to decide on timing of delivery for suspected fetal growth restriction: A cohort with nested RCT (DRIGITAT).

To assess the association of the umbilicocerebral ratio (UCR) with adverse perinatal outcome in late preterm small-for-gestational age (SGA) fetuses and to investigate the effect on perinatal outcomes of immediate delivery. Multicentre cohort study with nested randomised controlled trial (RCT). Nineteen secondary and tertiary care centres. Singleton SGA pregnancies (estimated fetal weight [EFW] or fetal abdominal circumference [FAC] <10th centile) from 32 to 36+6 weeks. Women were classified: (1) RCT-eligible: abnormal UCR twice consecutive and EFW below the 3rd centile at/or below35 weeks or below the 10th centile at 36 weeks; (2) abnormal UCR once or intermittent; (3) never abnormal UCR. Consenting RCT-eligible patients were randomised for immediate delivery from 34 weeks or expectant management until 37 weeks. A composite adverse perinatal outcome (CAPO), defined as perinatal death, birth asphyxia or major neonatal morbidity. The cohort consisted of 690 women. The study was halted prematurely for low RCT-inclusion rates (n = 40). In the RCT-eligible group, gestational age at delivery, birthweight and birthweight multiple of the median (MoM) (0.66, 95% confidence interval [CI] 0.59-0.72) were significantly lower and the CAPO (n = 50, 44%, p < 0.05) was more frequent. Among patients randomised for immediate delivery there was a near-significant lower birthweight (p = 0.05) and higher CAPO (p = 0.07). EFW MoM, pre-eclampsia, gestational hypertension and Doppler classification were independently associated with the CAPO (area under the curve 0.71, 95% CI 0.67-0.76). Perinatal risk was effectively identified by low EFW MoM and UCR. Early delivery of SGA fetuses with an abnormal UCR at 34-36 weeks should only be performed in the context of clinical trials.

Historical and contemporary management of infantile hemangiomas: a single-center experience.

Objective: This study explores the 22-year evolution of Infantile Hemangiomas (IHs) treatment strategies at a single-center hospital, aiming to establish an individualized IHs management protocol. Methods: Retrospective review of IHs infants 2000-2022 at the Department of Plastic Surgery, Jiangxi Provincial Children's Hospital. Results: In our study of 27,513 IHs cases, 72.2% were female, with the median age at first hospital visit being 25 days. The majority of cases had localized and superficial lesions primarily on the head, face, and neck (67.5%). Ulceration rates fell from 21.1% to 12.6% with the introduction of propranolol. Management strategies have shifted over time, with the proportion of cases undergoing expectant management dropping from 32.9% to 12.4%. Since 2008, 26.1% of patients were treated with oral propranolol, largely replacing corticosteroids. Topical β-blockers have been used in 12.1% of cases, leading to a reduction in local injection therapy from 20.8% to 13.2%. Laser therapy, introduced in 2016, has been used in 13.8% of cases, while surgical excision has dropped from 25.0% to 8.5% due to alternative treatment options. Combination therapy was used in 8.8% of cases post-2015, indicating a rising trend. Drawing from the evolution of IHs management strategies, an individualized protocol for the management of IHs was successfully established. Conclusion: Treatment for IHs has evolved over recent decades, with less invasive medical interventions increasingly replacing more invasive methods. Furthermore, a personalized treatment protocol established in this study could boost the cure rate of IHs while minimizing potential side effects and complications.

Effects of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial on Elective Induction and Obstetric Outcomes in Term Nulliparous Patients

(Abstracted from Obstet Gynecol 2023;142:242–250) A few years ago, the ARRIVE trial (A Randomized Trail of Induction Versus Expectant Management) reported that elective induction of labor at 39 weeks of gestation in low-risk nulliparous patients decreased the risk of cesarean birth and of hypertensive disorders of pregnancy compared with expectant management. This presented a possible means to decrease the high rates of cesarean delivery among this patient group.

Surgery is safe and improves survival in extremely old aged patients with breast cancer: A retrospective study

AbstractIntroductionIn 2019, 11% of breast cancers are diagnosed at age 80 or above and this group of older patients constitutes 27% of breast cancer deaths. Previous clinical trials demonstrated comparable survival in older patients given hormonal therapy alone versus standard surgical treatment. However, newer studies showed that surgical treatment in older patients is associated with reduced all‐cause and cancer‐related mortality. Our study aims to compare the survival of older patients with breast cancer who received surgery versus hormonal therapy alone or expectant management, analyse the factors affecting survival and compare the local complication rates.MethodsPatients treated under the New Territories East Cluster breast clinic with breast cancer diagnosed at age 80 or above were included in the study. Patients with metastatic disease were excluded. All medical records on the Hospital Authority Clinical Management System were retrospectively reviewed. Predictors including whether surgery was performed, human epidermal growth factor receptor 2 (HER2) status, oestrogen receptor (ER) status, T stage, N stage and activities of daily living status were assessed.ResultsSeventy‐eight consecutive patients with breast cancer (median age 85, range 80‐99) from 2004 to 2020 were included. Of these, 39 (50%) received surgery, whereas 39 (50%) did not. Patients who received surgery have a longer survival time (median 113 months vs 62 months; log‐rank test P = .001). Univariate analysis and multivariate Cox regression model demonstrated that surgery and ER status affect survival. Patients who received surgery also have a lower incidence of local tumour progression and skin ulceration (χ21 = 6.3, P = .012).ConclusionIn older patients with newly diagnosed breast cancer, surgical treatment is associated with a better survival and lower rates of local progression and complications. Surgery is advised even in older patients as long as they are fit for surgery.

Morbidity in Expectant Management of Pre-viable Preterm Prelabor Rupture of Membranes

Morbidity in Expectant Management of Pre-viable Preterm Prelabor Rupture of Membranes

The Impact of Physical Activity on the Outcomes of Active Surveillance in Prostate Cancer Patients: A Scoping Review

Introduction: Active surveillance has emerged as a valid therapeutic option in patients with low-risk prostate cancer, allowing for the deferral of definitive treatment until the time of possible disease progression. Although it is known that physical activity plays a protective role in the onset and progression of this tumor, its impact on patients with low-risk disease who are managed with active surveillance remains unclear. Our scoping review aims to summarize the existing evidence on this subject. Evidence Acquisition: On 9 April 2023, a systematic search was conducted using the PubMed and Scopus databases. The search employed the combination of the following terms: (“prostate cancer” OR “prostate tumor”) AND (“active surveillance”) AND (“physical activity” OR “physical exercise” OR “physical intensive activity” OR “intensive exercise”) AND (“lifestyle”). Out of the 506 identified articles, 9 were used for the present scoping review, and their results were reported according to the PRISMA-ScR statement. Evidence Synthesis: We discovered a lack of uniformity in the assessment of PA and its stratification by intensity. There was no consensus regarding what constitutes cancer progression in patients choosing expectant management. In terms of the impact of PA on AS outcomes, conflicting results were reported: some authors found no correlation, while others (six of total studies included) revealed that active men experience smaller increases in PSA levels compared to their sedentary counterparts. Additionally, higher levels of exercise were associated with a significantly reduced risk of PCa reclassification. Conclusion: Due to the heterogeneity of the methodologies used in the available studies and the conflicting results reported, it is not possible to draw definitive conclusions concerning the role physical activity may play in the risk of prostate cancer progression in men managed with active surveillance.

Planned Delivery or Expectant Management for Late Preterm Pre-eclampsia in Low-Income and Middle-Income Countries (CRADLE-4): A Multicentre, Open-Label, Randomized Controlled Trial

(Abstracted from Lancet 2023; 402:386–396) Preeclampsia is a disorder of pregnancy that proposes a disproportionately high risk to women in low- and middle-income countries (LMICs); it is one of the leading causes of maternal morbidity and mortality worldwide and is estimated to have an annual death toll of greater than 40,000. The only treatment with proven effectiveness for preeclampsia is delivery, but there are risks to both mother and infant associated with preterm delivery that contribute to both of their short- and long-term outcomes.

Translation of mechanistic advances in preeclampsia to the clinic: Long and winding road.

As one of the leading causes of premature birth and maternal and infant mortality worldwide, preeclampsia remains a major unmet public health challenge. Preeclampsia and related hypertensive disorders of pregnancy are estimated to cause >75 000 maternal and 500 000 infant deaths globally each year. Because of rising rates of risk factors such as obesity, invitro fertilization and advanced maternal age, the incidence of preeclampsia is going up with rates ranging from 5% to 10% of all pregnancies worldwide. A major discovery in the field was the realization that the clinical phenotypes related to preeclampsia, such as hypertension, proteinuria, and other adverse maternal/fetal events, are due to excess circulating soluble fms-like tyrosine kinase-1 (sFlt-1, also referred to as sVEGFR-1). sFlt-1 is an endogenous anti-angiogenic protein that is made by the placenta and acts by neutralizing the pro-angiogenic proteins vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). During the last decade, this work has spawned a new era of molecular diagnostics for early detection of this condition. Antagonizing sFlt-1 either by reducing production or blocking its actions has shown salutary effects in animal models. Further, in early-stage human studies, the therapeutic removal of sFlt-1 from maternal circulation has shown promise in delaying disease progression and improving outcomes. Recently, the FDA approved the first molecular test for preterm preeclampsia (sFlt-1/PlGF ratio) for clinical use in the United States. Measuring serum sFlt-1/PlGF ratio in the acute hospital setting may aid short-term management, particularly regarding step-up or step-down of care, decision to transfer to settings better equipped to manage both the mother and the preterm neonate, appropriate timing of administration of steroids and magnesium sulfate, and in expectant management decisions. The test itself has the potential to save lives. Furthermore, the availability of a molecular test that correlates with adverse outcomes has set the stage for interventional clinical trials testing treatments for this disorder. In this review, we will discuss the role of circulating sFlt-1 and related factors in the pathogenesis of preeclampsia and specifically how this discovery is leading to concrete advances in the care of women with preeclampsia.

Neonatal Survival and Morbidity Following Expectant Management of Previable Premature Rupture of Membranes at a Single Center

Neonatal Survival and Morbidity Following Expectant Management of Previable Premature Rupture of Membranes at a Single Center

Likelihood of primary cesarean section following induction of labor in singleton cephalic pregnancies at term, compared with expectant management: An Australian population-based, historical cohort study.

There has been increased use of both induction of labor (IOL) and cesarean section for women with term pregnancies in many high-income countries, and a trend toward birth at earlier gestational ages. Existing evidence regarding the association between IOL and cesarean section for term pregnancies is mixed and conflicting, and little evidence is available on the differential effect at each week of gestation, stratified by parity. To explore the association between IOL and primary cesarean section for singleton cephalic pregnancies at term, compared with two definitions of expectant management (first: at or beyond the week of gestation at birth following IOL; and secondary: only beyond the week of gestation at birth following IOL), we performed analyses of population-based historical cohort data on women who gave birth in one Australian state (Queensland), between July 1, 2012 and June 30, 2018. Women who gave birth before 37+0 or after 41+6 weeks of gestation, had stillbirths, no-labor, multiple births (twins or triplets), non-cephalic presentation at birth, a previous cesarean section, or missing data on included variables were excluded. Four sub-datasets were created for each week at birth (37-40). Unadjusted relative risk, adjusted relative risk using modified Poisson regression, and their 95% confidence intervals were calculated in each sub-dataset. Analyses were stratified by parity (nulliparas vs. parous women with a previous vaginal birth). Sensitivity analyses were conducted by limiting to women with low-risk pregnancies. A total of 239 094 women were included in the analysis, 36.7% of whom gave birth following IOL. The likelihood of primary cesarean section following IOL in a Queensland population-based cohort was significantly higher at 38 and 39 weeks, compared with expectant management up to 41+6 weeks, for both nulliparas and paras with singleton cephalic pregnancies, regardless of risk status of pregnancy and definition of expectant management. No significant difference was found for nulliparas at 37 and 40 weeks; and for paras at 40 weeks. Future studies are suggested to investigate further the association between IOL and other maternal and neonatal outcomes at each week of gestation in different maternal populations, before making any recommendation.

PERINATAL AND MATERNAL OUTCOME OF PREECLAMPSIA WITH SEVERITY FEATURE MANAGED EXPECTANTLY AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE (SPHMMC), 2021, ADDIS ABABA, ETHIOPIA. A CROSS SECTIONAL STUDY

ABSTRACT Background Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It is labeled as Preeclampsia with severe features when one of the severity signs occurs. Worldwide, Preeclampsia occurs in up to 7.5 percent of pregnancies and 10 - 15 % of direct maternal deaths are associated with preeclampsia and eclampsia. Majority of adverse maternal and perinatal outcome occur in Preeclampsia with severe features and when Preeclampsia occurs remote from term ( ). Objective The main objective of this study was to determine the maternal and perinatal outcome of Preeclampsia with severe features managed expectantly at SPHMMC in one year period. Materials and Methods: Facility based cross-sectional study was conducted. The study participants were selected consecutively by including all mothers admitted during the study period (January 2021 to December 2021 G.C.) with the diagnosis of Preeclampsia with severe features to SPHMMC that fulfill the inclusion criteria. Data taken was, the patients chart and a direct patient interview using pre-tested &amp; structured questionnaire. Collected data was entered in to Epi info version 7 &amp; analysis was made through SPSS version 25. Descriptive statistics, tables &amp; figures was used to describe the study finding. Result –the mean days of prolongation of pregnancy was 11.5 days with slight increment of maternal complication from expected proportion that completely resolved postpartum. The most common maternal complications were HELLP syndrome (15.1%) and abruptio placenta (7.2%). There were 21 perinatal deaths (08 still births and 13 neonatal deaths) that give perinatal mortality rates of 276 per 1000 live births. The rate of NICU admission was 66.7% and the neonatal survival to seventh day was 71.7%. Only 66(90.4%) of the women were a good candidate for expectant management. Magnesium sulphate and steroid (dexamethasone) at admission was given 100% but 8.2% of the mothers didn’t get magnesium sulphate during intra partum and post partum period. Conclusion / Recommendation - Proper selection of pregnant mothers with pre-eclampsia with severity feature and Close and frequent maternal and fetal surveillance during expectant management is associated with a good perinatal outcome without significant difference in maternal complication. Key Words: pre-eclampsia ,Perinatal outcome, maternal complication.