Five-minute Apgar Scores Research Articles

Evaluation of Myocardial Injury Using Serum Cardiac Troponin-I in Asphyxiated Neonates at Enugu State University Teaching Hospital, Enugu, South-East Nigeria.

The burden of perinatal asphyxia remains high in our environment and when asphyxia is severe, vital organs are affected, with resultant multiorgan hypoxic-iscahemic injury to the heart, the brain, adrenals and other organs. To evaluate for myocardial injury in asphyxiated term neonates with hypoxic ischaemic encephalopathy using serum cardiac troponin-I (cTnI). The study was a hospital-based descriptive cross-sectional study involving sixty term asphyxiated neonates and sixty gestational age-and sex-matched controls. The subjects were term neonates with five-minute Apgar score ≤ 6 and HIE while the controls were healthy term neonates with five-minute Apgar score > 6. Five-minute Apgar score was utilized to classify asphyxia into mild, moderate and severe asphyxia. The degree of encephalopathy was determined by modified Sarnat and Sarnat criteria. The serum cTnI was measured in subjects and controls at 12-24 hours of life using Enzyme-linked immunosorbent assay technique. The serum bilirubin levels were also measured in participants to exclude hyperbilirubinemia. The median serum cTnI levels was significantly higher in the subjects (0.56ng/mL; 0.25-0.94ng/mL) than in the controls (0.50ng/mL; 0.00-0.67ng/mL), respectively; p=0.001. Similarly, the median serum cTnI level in HIE stage II (0.56ng/mL; 0.38-0.72ng/mL) or III (0.56ng/ml; 0.50-0.94ng/mL) was also significantly higher than the median value in HIE stage I (0.38ng/mL;0.25-0.72ng/mL) or in controls (0.50ng/mL; 0.00-0.67ng/mL); p<0.001. There was significant positive correlation between serum cTnI levels and severity of HIE in asphyxiated neonates (rs = 0.505, p < 0.001). serum cTnI levels were elevated in severely asphyxiated neonates with HIE. The concentration of serum cTnI demonstrated significant positive correlation with HIE severity. Hence, the presence of HIE in asphyxiated neonates should prompt an evaluation for myocardial injury using serum cTnI. Any derangement noted should warrant instituting cardiovascular support in order to improve outcome and reduce asphyxia-related mortality.

Outcomes associated with planned place of birth among low-risk pregnancies in Ontario, Canada (2012-2021): A protocol for a population-based propensity score weighted cohort study.

Evidence suggests that for low-risk pregnancies, planned home births attended by a skilled health professional in settings where such services are well integrated are associated with lower risk of intrapartum interventions and no increase in adverse health outcomes. Monitoring and updating evidence on the safety of planned home births is necessary to inform ongoing clinical and policy decisions. This protocol describes a population-based retrospective cohort study which aims to compare risk of (a) neonatal morbidity and mortality, and (b) maternal outcomes and birth interventions, between people at low obstetrical risk with a planned home birth with a midwife, a planned a hospital birth with a midwife, or a planned hospital birth with a physician. The study population will include Ontario residents who gave birth in Ontario, Canada between April 1, 2012, and March 31, 2021. We will use data collected prospectively in a provincial perinatal data registry. The primary outcome will be severe neonatal morbidity or mortality, a composite binary outcome that includes one or more of the following conditions: stillbirth during the intrapartum period, neonatal death (death of a liveborn infant in the first 28 completed days of life), five-minute Apgar score <4, or infant resuscitation requiring cardiac compressions. We will conduct a stratified analysis with three strata: nulliparous, parous-no previous caesarean birth, and parous-prior caesarean birth. To reduce the impact of selection bias in estimating the effect of planned place of birth on neonatal and maternal outcomes, we will use propensity score (PS) overlap weighting (OW) and modified Poisson regression to conduct multivariate analyses.

Do Birth Outcomes Predicted by Occipital Position Inform Definitions of Occiput Posterior and Occiput Transverse?

Fetal head position significantly influences birth outcomes, with higher rates of complications observed when the fetal head is in the Occiput Posterior (OP) position compared to Occiput Transverse (OT) or Occiput Anterior (OA) positions. There is no consensus in the current literature on the precise rotational point at which the fetal occiput shifts from posterior to transverse, reducing clarity in both scientific and clinical communication. Different studies employ varying definitions of these positions, which affects management decisions. This study aims to determine if a definable threshold exists between the directly posterior and directly transverse positions that correlates with different birth outcomes, thereby proposing a consistent and clinically useful definition for OP versus OT. We analyzed ultrasound data from 570 patients at full dilatation from five previous studies, correlating the angle of the fetal occiput (noted on a clock-face) with birth outcomes. Adverse outcomes were defined as cesarean delivery, instrumental vaginal delivery, significant postpartum hemorrhage (500 ml or more), obstetric anal sphincter injury, five-minute Apgar scores <7, arterial cord pH <7, base excess less than -12, or neonatal intensive care unit admission. The analysis was conducted using SAS version 9.4. The study found a continuous relationship between the fetal occipital angle and adverse birth outcomes without a distinct threshold separating OP from OT positions. No clear inflection point was demonstrated in pregnancy outcomes between OT and OP. The relationship between the angle of occiput position and pregnancy outcomes was continuous: the closer the fetal head was to directly OP, the higher the likelihood of adverse outcomes. Given the lack of a clear cut-off and to improve consistency in future research, we recommend dividing the occiput position into four quadrants of 90 degrees each. This classification could standardize reporting and potentially improve clinical decision-making regarding fetal position during labor.

The Five-minute Apgar Score and its Association with Neurodevelopmental Disorders in 24-month-old Peruvian Children from a National Reference Hospital in Lima (P11-8.002)

The Five-minute Apgar Score and its Association with Neurodevelopmental Disorders in 24-month-old Peruvian Children from a National Reference Hospital in Lima (P11-8.002)

Validity of a Delphi consensus definition of growth restriction in the newborn for identifying neonatal morbidity

BackgroundSmall-for-gestational age (SGA) is defined as a birthweight below a birthweight-percentile threshold, usually the 10th percentile, with the 3rd or 5th percentile used to identify severe SGA. SGA is used as a proxy for growth restriction in the newborn, but SGA newborns can be physiologically small and healthy. This definition also excludes growth restricted newborns who have weights above the 10th percentile. To address these limits, a Delphi study developed a new consensus definition of growth restriction in the newborn based on neonatal anthropometric and clinical parameters, but it has not been evaluated. ObjectivesTo assess the prevalence of growth restriction in the newborn according to the Delphi consensus definition and to investigate associated morbidity risks compared to definitions of SGA using birthweight-percentile thresholds. Study designData come from the 2016 and 2021 French National Perinatal Surveys which include all births ≥22 weeks and/or with birthweights ≥500 grams in all maternity units in France over a one-week period. Data are collected from medical records and interviews with mothers after the delivery. The study population included 23,897 liveborn singleton births. The Delphi consensus definition of growth restriction was birthweight <3rd percentile or at least 3 of the following criteria: birthweight, head circumference or length <10th percentile, antenatal diagnosis of growth restriction or maternal hypertension. A composite of neonatal morbidity at birth, defined as five-minute Apgar score <7, cord arterial pH <7.10, resuscitation and/or neonatal admission, was compared using the Delphi definition and usual birthweight-percentile thresholds for defining SGA using the following birthweight percentile groups: <3rd, 3rd-4th and 5th-9th percentiles. Relative risks were adjusted (aRR) for maternal characteristics (age, parity, body mass index, smoking, educational level, pre-existing hypertension and diabetes, and study year) and then for the consensus definition and birthweight percentile groups. Multiple imputation by chained equations was used to impute missing data. Analyses were carried out in the overall sample and among term and preterm newborns separately. Results4.9% (95% confidence intervals (CI): 4.6-5.2) of newborns were identified with growth restriction, of whom 29.7% experienced morbidity, yielding a aRR of 2.5 (95% CI: 2.2-2.7) compared to newborns without growth restriction. Compared to birthweight ≥10th percentile, morbidity risks were higher for low birthweight percentiles (<3rd aRR=3.3 (95%CI: 3.0-3.7), 3rd-4th RR=1.4 (95%CI:1.1-1.7), 5th-9th RR=1.4, (95%CI:1.2-1.6)). In adjusted models including the definition of growth restriction and birthweight percentile groups and excluding birthweights <3rd percentile, which are included in both definitions, morbidity risks remained higher for birthweights at the 3rd-4th percentile (aRR=1.4, 95% CI: 1.1-1.7) and 5th-9th percentile (aRR= 1.4, 95%CI: 1.2-1.6), but not for the Delphi definition of growth restriction (aRR= 0.9, 95%CI: 0.7-1.2). Similar patterns were found for term and preterm newborns. ConclusionThe Delphi consensus definition of growth restriction did not identify more newborns with morbidity than definitions of SGA based on birthweight percentiles. These findings illustrate the importance of evaluating the results of Delphi consensus studies before their adoption in clinical practice.

Association between Polycystic Ovary Syndrome (PCOS) and Pregnancy Complications

Background: Polycystic ovarian syndrome (PCOS) pregnant women appear to be more vulnerable to poor maternal and neonatal outcomes. The purpose of this study was to assess the outcome of pregnancies in women with PCOS. Methord: This descriptive study was conducted at a tertiary care hospital Jashore Medical College hospital, Jashore Bangladesh, on 115 pregnant PCOS patients. SPSS version 20 was used for data analysis on the recent pregnancy, PCOS, and maternal and perinatal outcomes. Parity and others perinatal and maternal outcomes were examined as categorical variables. Result: The average age was 25.07 years, 82% had a history of primary infertility, and 66% had a high BMI. The percentage of pregnant women with hypertensive problems was 18.26%, PROM was 33.91%, and the low APGAR score at five minutes was 12.17%. gestational diabetes (23.47%), miscarriage (2.1%), preterm delivery (13.91%), caesarean delivery (37.39%), low birth weight babies (2.6%), macrosomia (0.7%), PPROM (19.52%), perinatal mortality (1.73%) and NICU admission (21.74%). Conclusion: Pregnant women with PCOS were identified with either similar or lower rates of GDM, miscarriage, preterm delivery, meconium-stained liquor, caesarean delivery, small for gestational age/IUGR, macrosomia, PPROM, perinatal mortality, NICU admission, and congenital anomalies, but higher rates of hypertensive conditions of pregnancy, PROM, low birth weight babies, and low five-minute APGAR scores.

Five-minute Apgar score and risk of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity in term infants – an Australian population-based cohort study

The aim of this study was to ascertain risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity related to the 5-min Apgar score in early term (37+0-38+6 weeks), full term (39+0-40+6 weeks), late term (41+0-41+6 weeks), and post term (≥42+0 weeks) infants. This was a retrospective cohort study of 941,221 term singleton births between 2000 and 2018 in Queensland, Australia. Apgar scores at 5-min were categorized into five groups: Apgar 0 or 1, 2 or 3, 4-6, 7 or 8 and 9 or 10. Gestational age was stratified into 4 groups: Early term, full term, late term and post term. Three specific neonatal study outcomes were considered: 1) Neonatal mortality 2) Severe neurological morbidity and 3) Severe non-neurological morbidity. Poisson multivariable regression models were used to determine relative risk ratios for the effect of gestational age and Apgar scores on these severe neonatal outcomes. We hypothesized that a low Apgar score of <4 was significantly associated with increased risks of neonatal mortality, severe neurological morbidity and severe non-neurological morbidity. Of the study cohort, 0.04% (345/941,221) were neonatal deaths, 0.70% (6627/941,221) were infants with severe neurological morbidity and 4.3% (40,693/941,221) had severe non-neurological morbidity. Infants with Apgar score <4 were more likely to birth at late term and post term gestations and have birthweights <3rd and <10th percentiles. The adjusted relative risk ratios (aRRR) for neonatal mortality and severe neurological morbidity were highest in the Apgar 0 or 1 cohort. For infants in the Apgar 0 or 1 group, neonatal mortality increased incrementally with advancing term gestation: early term (aRRR 860.16, 95% CI 560.96, 1318.94, p<0.001); full term (aRRR 1835.77, 95% CI 1279.48, 2633.91, p<0.001); late term (aRRR 1693.61, 95% CI 859.65, 3336.6, p<0.001) and post term (aRRR 2231.59, 95% CI 272.23, 18293.07, p<0.001) whilst severe neurological morbidity decreased as gestation progressed: early term (aRRR 158.48, 95% CI 118.74, 211.51, p<0.001); full term (aRRR 112.99, 95% CI 90.56, 140.98, p<0.001); late term (aRRR 87.94, 95% CI 67.09, 115.27, p<0.001) and post term (aRRR 52.07, 95% CI 15.17, 178.70, p<0.001). Severe non-neurological morbidity was greatest in the full term, Apgar 2-3 cohort (aRRR 7.36, 95% CI 6.2, 8.74, p<0.001). A 5-min Apgar score of <4 was prognostic of neonatal mortality, severe neurological morbidity, and severe non-neurological morbidity in infants born >37 weeks' gestation with the risk greatest in the early term cohort. National Health and Medical Research Council and Mater Foundation.

The comparison of umbilical cord artery pH in newborns with and without thick meconium stained amniotic fluid

Meconium-stained amniotic fluid (MSAF) affects 15-20% of term pregnancies. Recent studies have shown that MSAF has adverse effects on neonatal outcomes. There is no scientific consensus on the incidence of fetal distress in MSAF neonates, and most cesarean sections due to MSAF are unnecessary. The present study was conducted to assess umbilical artery blood pH in neonates with MSAF and to examine whether there is a relationship between MSAF and fetal distress. A clinical survey case-control was conducted on the neonates of 200 pregnant women admitted to a delivery unit of the obstetrics and Gynecology center in Amir al-Momenin Hospital, Zabol in 2014. Neonates born with MSAF made up the case group, and the control group consisted of neonates born with clear amniotic fluid. Umbilical cord arterial pH, gestational age, gender, mode of delivery, and one and five-minute Apgar scores were considered in both groups. The mean pH of the umbilical cord artery blood in the infants of the case group was 7.25, and the mean pH of the umbilical cord artery in the infants of the control group was 7.29 (P = 0.93). The mean gestational age in the case and control groups was 40.08 weeks and 38.32 weeks, respectively (P= 0.03). In this study, a cesarean delivery (P=0.001) and female gender (P= 0.016) were higher in the case group than in the control group. MSAF does not necessarily imply fetal distress, so urgent cesarean sections are unnecessary. This study showed that based on the acidity variables of the umbilical cord artery, there is no statistically significant correlation between the Apgar score at the 1st and 5th minute. While a significant difference has been observed between the type of delivery, gestational age and baby's gender.

Nifedipine versus magnesium sulfate in the management of preterm labour- A randomised controlled trial

Preterm labour is the leading cause of perinatal morbidity and mortality worldwide. Preterm birth accounts for 75% of neonatal deaths and 50% of long-term morbidity including respiratory disease and neuro-developmental impairment. The use of tocolysis in women in preterm labour aims to inhibit uterine contractions and reduce perinatal morbidity and mortality associated with early delivery.To study the effect and compare the efficacy of Nifedipine and Magnesium sulphate in management of preterm labour.: This randomized controlled trial was performed on 80 women with preterm labor between 28 and 37 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. All patients were checked for successful prolongation of pregnancy who had not been delivered at 48 hours [primary tocolytics effects] and more than 7 days [secondary tocolytics effects] after beginning the treatment and side effects of tocolysis.: From 80 patients, 40 received nifedipine and 40 received MgSO4. There were no differences in suppression of labor pain in 24 hours, 48 hours and 7 days between the two groups. Even though there were no statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome between the groups neonates of MgSO4 group had more NICU admission which is significant (p value 0.049).: Oral nifedipine is as effective as magnesium sulfate with regard to inhibition of preterm labor.

Effects of Single-Course Betamethasone on the Outcomes of Late Preterm Neonates.

Background Prenatal glucocorticoids are commonly used in pregnancies before 34 weeks of gestation in women at risk of preterm delivery; however, the effects of these drugs on late preterm infants (those born after the 34th week of pregnancy) are controversial. As a result, we aimed to investigate the effect of a single course of betamethasone (two doses of betamethasone every 24 hours) on the neonatal outcome of late preterm births. Methods We retrospectively assessed all spontaneous late preterm births (34-36+6 weeks of gestation) at a tertiary hospital in Iran over a period of two and a half years. Exclusion criteria included multiple pregnancies, induced labor, and fetal malformations identified in sonograms. Neonatal outcome measures encompassed first and five-minute Apgar scores, respiratory distress syndrome, neonatal death, birth asphyxia, and the need for positive pressure ventilation, continuous positive airway pressure, tracheal intubation, and surfactant. Baseline characteristics, such as maternal age, parity, fetal gender, and high-risk pregnancy, were considered confounding variables. High-risk pregnancies were defined as any cases involving prolonged rupture of membranes or maternal comorbidities such as severe anemia, preeclampsia, diabetes, or COVID-19. Results During the study period, there were 830 spontaneous preterm births at our center. Of these, only 195 (23.5%) received complete doses of betamethasone. Low birth weight was more common in mothers who did not receive betamethasone compared to those who did (63.6% vs. 41.2%). The mean gestational age was lower in mothers who received betamethasone than in those who did not. Respiratory distress syndrome was more common in mothers who received betamethasone (P<0.001, RR 2.11, 95% CI (0.98-4.18)). However, after adjusting for confounding factors, such as gestational age and birth weight, betamethasone did not increase the risk of respiratory distress syndrome. Other adverse neonatal outcomes did not differ significantly. Conclusions There were no differences in neonatal outcomes between those who received betamethasone and those who did not.

Association Of Maternal Age And Hemoglobin Level With Apgar Score Of Newborns In A Tertiary Care Hospital Of Suburbs Of Islamabad

Objectives: To determine the association of Apgar score with maternal age and hemoglobin.&#x0D; Methods&#x0D; A cross-sectional study was conducted on mothers (n=306) delivering live, full-term, singleton babies by spontaneous vertex delivery. Women who suffered stillbirths had babies of unknown gestational age or showed co-morbidities were excluded.&#x0D; SPSS version 26 was used for data analysis. Mean + standard deviation, and percentages were calculated. Cross-tabulation and logistic regression were done to see the association between dependent and independent variables. A p-value of &lt;0.05 was statistically significant.&#x0D; Results&#x0D; The ages of women ranged from 20 to 40 years (mean= 25+1.9). The number of patients aged 24 years with Hb &lt;7g/dl was 6 (37.5%). Out of all, 90 (29.4%) patients had Hb &gt;11g/dl, and their ages were 30 years which was significant (p = 0.000). Apgar score for the neonates showed that 258 (84.3%) had an Apgar score &gt;7 while 48 (15.7%) had a score &lt; 7. Babies of mothers whose age was 26 years had Apgar score &lt; 7(25%) (p = 0.001). Neonatal birth weight, of &lt;2kg was observed in infants born to young mothers of 26 years of age (20%) (p = 0.001), and a weight &gt;3.5kg was recorded in 20 infants (6.5%). The younger mothers had lower Hb, and their babies had low Apgar scores &lt;7 at the time of birth (p = 0.001).&#x0D; Conclusion&#x0D; Women of younger age and lower hemoglobin levels give birth to infants with low Apgar scores and birth weight. Low birth weight in neonates is significantly associated with a low five-minute Apgar score.

Neonatal Depression Is Associated With 1-Year Mortality in Critical Congenital Heart Disease.

Background Low 5-minute Apgar scores (AS) are predictive of term and preterm neonatal mortality but have not been well studied in the critical congenital heart disease (CCHD) population. We analyzed US national vital statistics data to evaluate the association between neonatal depression (AS 0-3) and 1-year mortality in CCHD. Methods and Results We performed a retrospective cohort study using 2014 to 2018 Centers for Disease Control and Prevention cohort-linked birth certificate and infant death records. Five-minute AS were categorized as ≤3, 4 to 6, or ≥7. We calculated birth rates and associated mortality rates by AS group in infants with and without CCHD. Multivariable logistic regression analyzed neonatal, maternal, and pregnancy-related risk factors for neonatal depression and 1-year mortality. Of 11 642 neonates with CCHD (0.06% of all births), the 5.8% with AS 0 to 3 accounted for 23.3% of all 1-year CCHD mortality, with 69.9% of deaths occurring within 1 month of life. Gestational age at birth, growth restriction, extracardiac defects, race, and low maternal education were associated with an increased odds of AS 0 to 3 in neonates with CCHD relative to those with AS 7 to 10 on multivariable analysis. AS 0 to 3 was associated with 1-year CCHD mortality after adjusting for these factors, prenatal care, and delivery location (adjusted odds ratio, 14.57 [95% CI, 11.73-18.10]). Conclusions The AS is a routine clinical measure providing important prognostic information in CCHD. These findings suggest that prenatal and perinatal factors, beyond those included in current risk stratification tools, are important for CCHD outcomes. Multidisciplinary collaboration to understand the pathophysiology underlying neonatal depression may help identify interventions to improve CCHD mortality rates.

Impact of Birth Companionship on Maternal and Fetal Outcomes in Primigravida Women in a Government Tertiary Care Center.

Studies have shown that the support provided by birth companions during labour and childbirth improves maternal and neonatal outcomes and helps women in having a positive childbirth experience. To study the role of birth companionship on maternal and foetal outcomesalong with their satisfaction rates in primigravidas supported by birth companions compared to those receiving routine care in the labour room. The study was a prospective comparative observational study. One hundred fifty primigravida women were randomly divided into two groups, one group (n = 75) who were allowed a female companion of their choice (A) and the other group (n = 75) who did not have a birth companion receiving routine standard care as routinely practised in our hospital. The data was entered in MS Excel Sheet and analysis was done using the statistical package for social sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY). A p-value of <0.05 was considered statistically significant. Spontaneous vaginal births were significantly higher in group A (Group A: mean = 67; SD = 89.3%, Group B: mean = 57; SD = 76 %; p = 0.03) along with a favourable trend in a shorter duration of the first stage of labour (9.96±1.09 vs 11.95±3.11 hours) and decreased need of augmentation (Group A; mean = 10; SD = 13.3, Group B:mean = 23; SD = 30.7; p = 0.01). Maternal satisfaction was significantly higher in group A (Group A: mean = 60; SD = 80, Group B: mean = 44; SD = 58.7; p <0.01) and in the early initiation of breastfeeding (Group A: mean = 70; SD = 93.3, Group B: mean = 55; SD = 73.3; p <0.01). No statistical difference was observed between the mean duration of labour, mode of delivery, and NICU stay of the baby. Companionship during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter labour duration, a low five-minute Apgar score, and higher satisfaction rates with childbirth experiences.

Mechanical methods for induction of labour.

Mechanical methods for induction of labour.

Comparison of pregnancy outcomes and neonatal complications between COVID–19-vaccinated and unvaccinated pregnant women in Tabriz, Iran

Introduction: Insufficient information exists regarding the coronavirus disease 2019 (COVID-19) vaccination safety in pregnant women. Objectives: The present study compared the pregnancy and fetal outcomes among COVID-19-vaccinated and unvaccinated pregnant women. Patients and Methods: This cross-sectional study was conducted at Tabriz University of Medical Sciences (Tabriz, Iran) on 117 pregnant women (55 vaccinated women as the case group and 62 unvaccinated women as the control group) using census sampling in 2022. The maternal outcomes (death, admission to intensive care unit [ICU], premature birth, gestational hypertension, preeclampsia, oligohydramnios, and polyhydramnios) and neonatal outcomes (neonatal death, congenital disabilities, neonatal weight loss, admission to ICU, neonatal infection, neonatal fever, need for mechanical ventilation of the newborn, and one- and five-minute Apgar scores) were recorded. Then the two groups were compared using independent t-test, along with ANOVA and chi-square tests. Results: The number of women without pregnancy outcomes was marginally lower in the case group than in the control group (P=0.099). Gestational hypertension (P=0.312) and preterm birth were lower among unvaccinated women than among vaccinated women but this difference was not significant (P=0.089). Hospitalization in the neonatal intensive care unit (P=0.361), neonatal fever (P=0.259), and neonatal infection (P=0.079) were more common in infants born to vaccinated mothers than in infants born to unvaccinated women, although the difference not significant. Conclusion: Vaccination against COVID-19 appears to not be associated with an increased probability of maternal and neonatal complications.

Impact of Aspirin Supplementation for Pre-Eclampsia Prevention on Neonatal Outcomes.

Pre-eclampsia negatively affects pregnancy. In 2018, the American College of Obstetricians and Gynecologists (ACOG) updated their low dose aspirin (LDA) supplementation recommendation to include pregnant women at moderate risk for pre-eclampsia. In addition to the potential benefit of LDA supplementation for delaying or preventing pre-eclampsia, LDA supplementation can affect neonatal outcomes. The association of LDA supplementation was studied with six neonatal outcomes in a sample of mostly minority pregnant women from Hispanic and Black race/ethnicities that included those of low, moderate, and high-risk designation for pre-eclampsia. This was a retrospective study of 634 patients. The main predictor variable was maternal LDA supplementation for six neonatal outcomes: NICU admission, neonatal readmission, one- and five-minute Apgar scores, neonatal birth weight (BW), and hospital length of stay (LOS). Demographics, comorbidities, and maternal high-or moderate-risk designation were adjusted for per ACOG guidelines. High-risk designation was associated with neonatal increased rate of NICU admission (OR: 3.80, 95% CI: 2.02, 7.13, p < 0.001), LOS (B = 0.15, SE = 0.04, p < 0.001), and decreased BW (B = -442.10, SE = 75.07, p < 0.001). No significant associations were found with LDA supplementation or moderate-risk designation for NICU admission, readmission, low one- and five-minute Apgar scores, BW, and LOS. Clinicians recommending maternal LDA supplementation should be aware that LDA supplementation did not appear to provide any benefits for the above neonatal outcomes.

Decision Delivery Interval for Emergency Caesarean Section and Associated Maternal and Neonatal Outcomes in a Tertiary Hospital in South- South Nigeria

Standard guidelines recommend that delivery by caesarean section should be initiated within 30 minutes of decision to operate to avoid adverse maternal and fetal outcome. Patient however encounter delays despite recommended time frames. The aim of the study was to determine the average decision delivery interval and its effect on perinatal outcomes in emergency caesarean sections. The study was a descriptive cross-sectional study. The study population consisted of 120 consecutive pregnant women who had emergency caesarean section who met the inclusion criteria. Data was collected using a structured questionnaire and analyzed with SPSS version 20. Sixty – two (51.7%) of the study participants were booked. The commonest indication for CS was cephalo-pelvic disproportion (35%). The mean DDI was 209.5± 98.9 minutes. Patient factor was the leading cause of delay due to lack of funds and non-provision of surgical materials (55%). Only delay in obtaining consent was statistically significant in prolonging DDI interval. Five-minute APGAR score was normal in 91.7%. Indication for emergency CS was significantly related to fetal outcomes; asphyxia and mortality. There was lack of association between DDI, perinatal and maternal outcome, which may indicate decision delivery interval of 30 minutes or less may not be applicable to all emergency CS, especially in developing countries with infrastructural challenges. However, decision- delivery interval should be considered as an important contributing factor for adverse neonatal outcomes. Therefore, clinical judgment is required to assess the urgency of caesarean section to prevent neonatal morbidity and mortality.

Mechanical ventilation and death in pregnant patients admitted for COVID-19: a prognostic analysis from the Brazilian COVID-19 registry score

BackgroundThe assessment of clinical prognosis of pregnant COVID-19 patients at hospital presentation is challenging, due to physiological adaptations during pregnancy. Our aim was to assess the performance of the ABC2-SPH score to predict in-hospital mortality and mechanical ventilation support in pregnant patients with COVID-19, to assess the frequency of adverse pregnancy outcomes, and characteristics of pregnant women who died.MethodsThis multicenter cohort included consecutive pregnant patients with COVID-19 admitted to the participating hospitals, from April/2020 to March/2022. Primary outcomes were in-hospital mortality and the composite outcome of mechanical ventilation support and in-hospital mortality. Secondary endpoints were pregnancy outcomes. The overall discrimination of the model was presented as the area under the receiver operating characteristic curve (AUROC). Overall performance was assessed using the Brier score.ResultsFrom 350 pregnant patients (median age 30 [interquartile range (25.2, 35.0)] years-old]), 11.1% had hypertensive disorders, 19.7% required mechanical ventilation support and 6.0% died. The AUROC for in-hospital mortality and for the composite outcome were 0.809 (95% IC: 0.641–0.944) and 0.704 (95% IC: 0.617–0.792), respectively, with good overall performance (Brier = 0.0384 and 0.1610, respectively). Calibration was good for the prediction of in-hospital mortality, but poor for the composite outcome. Women who died had a median age 4 years-old higher, higher frequency of hypertensive disorders (38.1% vs. 9.4%, p < 0.001) and obesity (28.6% vs. 10.6%, p = 0.025) than those who were discharged alive, and their newborns had lower birth weight (2000 vs. 2813, p = 0.001) and five-minute Apgar score (3.0 vs. 8.0, p < 0.001).ConclusionsThe ABC2-SPH score had good overall performance for in-hospital mortality and the composite outcome mechanical ventilation and in-hospital mortality. Calibration was good for the prediction of in-hospital mortality, but it was poor for the composite outcome. Therefore, the score may be useful to predict in-hospital mortality in pregnant patients with COVID-19, in addition to clinical judgment. Newborns from women who died had lower birth weight and Apgar score than those who were discharged alive.

Impact of Obstetric Nutritional Risk on Perinatal Morbidity: A Case-Control Study

Objective. Malnutrition is among the most relevant problems in pregnant women, which affects nutritional status of the fetus and newborn outcome. The impact of obstetric nutritional risk (ONR) on neonatal morbidity has not been investigated. The purpose of this work was to identify a possible association between ONR, on high-risk pregnancy (HRP) patients and perinatal morbidity. Methods. This Case Control study included 118 neonates of HRP patients who were either (Cases, n =66) or not (Controls, n =52) with ONR. Groups were then compared to identify associated Neonatal Morbidity. Study variables included: neonatal morbidity, one and five-minute APGAR scores, birth weight, gestation weeks, preterm births, newborn gender and neonatal complications. Results. Morbidity and preterm births were identified in 40 (60.6%) and 11 (21.1%) neonates (p &lt;0.001); and 40 (60.6%) and 14 (26.9%) neonates (p &lt;0.001), for cases and controls, respectively. Average one-minute and five-minute APGAR scores was 6 ± 1 and 8 ± 1 (p &lt;0.05); and 8 ± 1 and 9 ± 1 (p &gt;0.05) for cases and controls, respectively. Average birth weight and gestation weeks was 2,272.5 and 2,548.5 grams (p &lt;0.05); and 34 ± 3.7 and 37 ± 3 weeks (p &lt;0.05) for cases and controls, respectively. There were 34 (51.51%) and 24 (46.15%) female neonates (p &lt; 0.05); and 32 (48.48%) and 28 (53.85%) male neonates (p &gt;0.05) for cases and control, respectively. Conclusion. Morbidity was significantly higher in neonates of HRP patients with ONR. Therefore, Obstetric Nutritional Risk had a negative impact on perinatal morbidity and newborn outcome.

Neonatal near miss and mortality and associated factors: cohort study of births in the city of Rio de Janeiro, RJ, Brazil.

The aim of this study was to investigate factors associated with neonatal near miss and mortality of the live birth cohort in the city of Rio de Janeiro, Brazil, in 2015. Population-based retrospective cohort of live births (LB) of single pregnancy with 0-27 days of follow-up. Data were obtained from the Brazilian Live Birth and Mortality Information Systems. Logistic regressions with the analytical strategy of hierarchical determination were used for cases of near miss and deaths separately. The cohort was composed of 85,850 LB. For every one thousand LB, about 16 were cases of near miss and six died. Maternal level of education, skin color, and age and adequacy of prenatal care were associated with neonatal near miss; for deaths, presentation of LB at delivery, birth weight, gestational age, and five-minute Apgar score are added. Besides confirming the effect of low birth weight, prematurity, and asphyxia on neonatal death, socioeconomic vulnerability markers - low education level and brown or black skin colors - were associated with neonatal death and near miss. Absent or inadequate prenatal care showed a strong association with both outcomes, being stronger for neonatal death. Investments in the quality of prenatal care and reduction of disparities in health care are necessary in Rio de Janeiro.