Fetal Distress Research Articles

A Comparative Study on the Relationship Between Placental Weight and Neonatal Outcomes Among Anaemic Mothers and Non-Anaemic Mothers in Selected Hospital, Rajnandgaon, Chhattisgarh

Abstract: Maternal anemia is a common pregnancy complication that may impact placental function and fetal development. This study aims to compare placental weight and neonatal outcomes among anemic and non-anemic mothers to determine the potential effects of maternal anemia on fetal growth and neonatal health. A comparative cross-sectional study was conducted among 200 mothers (100 anemic, 100 non-anemic) who delivered at term in a tertiary care hospital. Placental weight, neonatal birth weight, Apgar scores, and neonatal complications were recorded. Statistical analysis, including independent t-tests, chisquare tests, and Pearson correlation, was performed to examine differences between the two groups. The average placental weight was slightly lower in anemic mothers (495 ± 55 g) compared to non-anemic mothers (510 ± 50 g), though not statistically significant (p = 0.16). Neonates of anemic mothers had significantly lower birth weights (2600 ± 500 g vs. 2700 ± 450 g, p = 0.03) and lower Apgar scores at 1 minute (7.4 vs. 8.2, p = 0.02) and 5 minutes (8.3 vs. 9.0, p = 0.01). Neonatal complications, including respiratory distress and NICU admissions, were more frequent among the anemic group, but the difference was not statistically significant (p = 0.08). A moderate positive correlation was found between placental weight and neonatal birth weight (r = 0.45 for anemic, r = 0.52 for non-anemic).Maternal anemia is associated with lower neonatal birth weight and reduced Apgar scores, indicating possible fetal distress. Although placental weight differences were not statistically significant, the findings highlight the importance of managing maternal anemia to improve neonatal health outcomes. Further studies with larger samples are recommended to confirm these findings and explore additional contributing factors

A retrospective analysis on maternal and neonatal outcomes in pSS/AITD pregnancies

The combined impact of concurrent primary Sjögren’s syndrome (pSS) and autoimmune thyroid disease (AITD) on pregnancy outcomes remains underreported. A retrospective analysis was conducted on 115 pregnant patients diagnosed with pSS and delivering at the Third Affiliated Hospital of Guangzhou Medical University from January 2009 to July 2023. The effects of AITD on maternal and neonatal outcomes were examined and compared to a control group without AITD. In the group with pSS and AITD, the pregnancy loss rate was significantly higher than in the non-AITD group (P = 0.015), primarily reflected in the increased rate of neonatal death (P = 0.029). The proportion of term births and vaginal deliveries in the AITD group was notably reduced compared to the non-AITD group (54% vs. 81.5%; 16.0% vs. 41.5%; P = 0.001 and P = 0.003, respectively). No significant differences were observed in other maternal pregnancy outcomes, including induced abortion, spontaneous abortion, therapeutic abortion, and premature delivery (P > 0.05). The average birth weight of newborns in the pSS with AITD group was significantly lower than in the pSS without AITD group (2587.70 ± 720.50 g vs. 2812.54 ± 495.30 g, P < 0.001). Additionally, the rate of low-birth-weight infants in the pSS with AITD group was higher than in the pSS without AITD group (39.0% vs. 19.7%, P = 0.032). However, no significant differences were found between the two groups in the rates of fetal death, neonatal live birth, and fetal distress (P > 0.05). These results emphasize the importance of monitoring and managing thyroid health during pregnancy to optimize maternal and neonatal outcomes. Further exploration is essential to unravel the precise mechanisms through which AITD impacts fetal growth and to identify potential interventions to mitigate these effects.

Association of epidural labor analgesia with maternal and neonatal outcomes in women with preeclampsia: a propensity score-matched single-center retrospective cohort study

BackgroundEpidural labor analgesia (ELA) is widely and safely used for labor pain relief. However, it remains unclear whether ELA affects maternal and neonatal outcomes in women suffering from preeclampsia.MethodsThis study reviewed the medical records of women with preeclampsia at ≥ 28 weeks of gestation between January 2015 and December 2020. The medical records of women were divided into ELA and no analgesia (NA) groups. The primary endpoint was the cesarean section (CS) rate. Secondary endpoints included hypotension, operative vaginal delivery, fetal distress, neonatal intensive care unit admission, and complications. Using multivariate logistic regression analysis and propensity score matching (PSM), the association between ELA and maternal and neonatal outcomes was examined.ResultsA total of medical records of 686 women were enrolled, with 242 (35.3%) receiving ELA. Of these, 126 (18.4%) had a higher incidence of CS in the ELA group than in the NA group (22.7% vs. 16.0%, P = 0.020). Multivariable analysis indicated greater risks of CS [adjusted Odds Ratio (aOR) = 1.71; 95% CI, 1.07–2.74; P = 0.025] and operative vaginal delivery (aOR = 2.810; 95% CI, 1.379–5.725; P = 0.004) in the ELA group than that of NA group. In the PSM, ELA did not increase the risk of CS (aOR = 1.56; 95% CI, 0.97–2.52; P = 0.067) and OVD (aOR = 2.048; 95% CI, 0.936–4.484; P = 0.073). The secondary endpoints showed no significant differences between the two groups.ConclusionThe study indicates an association between ELA and maternal and neonatal outcomes, supporting the safety of ELA in this population.

Novel Machine Learning Applications in Peripartum Care: A Scoping Review.

Machine learning (ML), a subtype of artificial intelligence (AI), presents predictive modeling and dynamic diagnostic tools to facilitate early interventions and improve decision-making. Considering the global challenges of maternal, fetal, and neonatal morbidity and mortality, ML holds the potential to enable significant improvements in maternal and neonatal health outcomes. We aimed to conduct a comprehensive review of ML applications in peripartum care, summarizing the potential of these tools to enhance clinical decision-making and identifying emerging trends and research gaps. We conducted a scoping review on MEDLINE, Cochrane Library, and EMBASE databases from inception to April 2024. We gathered additional relevant studies through snowball sampling. We meticulously screened titles and abstracts and chose full-text articles for further analysis. We included primary research articles and abstracts focusing on pregnant individuals, employing ML methods for peripartum care. No formal quality assessment was performed. Data were extracted using a custom template to capture study characteristics and ML models. Findings were synthesized using summary tables and figures to highlight key trends and results. Among 406 studies, 78% were published within the last five years. Most studies originated from high-income or well-resourced countries, with 27% from North America (including 24% from the United States) and 34% from Asia, predominantly China (18%). Studies from low- and middle-income regions were notably scarce, reflecting significant regional disparities. Predictive modeling tasks were the most prevalent (59%), followed by classification tasks (29%). Supervised learning dominated (90%), with algorithms such as Support Vector Machines, Random Forests, and Logistic Regression most commonly used. Key topics included fetal distress and acidemia (32%), preterm birth (22%), mode of delivery (13%), and birth weight (13%). Notably, Explainable AI methods were utilized in only 19% of studies, and external validation was performed in just 5%. Despite these advancements, only 1% of models resulted in accessible clinical tools, and none were fully integrated into healthcare systems. ML holds significant potential to enhance peripartum care by improving diagnostic accuracy and predictive capabilities. However, realizing this potential requires responsible AI practices, including robust validation with external datasets, prospective investigations across diverse populations, and the development of digital and data infrastructure for seamless integration into electronic health records. Additionally, transparent AI that provides insights into risk stratification logic is essential for clinician trust in ML tools. Future research should address understudied areas, prioritize neglected low-income settings, and explore advanced ML approaches to improve maternal and neonatal outcomes.

Maternal and neonatal outcomes of Group B Streptococcus colonization: a retrospective study

BackgroundGroup B Streptococcus (GBS) colonization is one of the major causes of severe neonatal infections. The study was intended to identify GBS colonization in pregnant women, explore its potential risk factors, and analyze the impact of GBS on outcomes for both mothers and newborns.Material and MethodsA retrospective research was carried out on pregnant women who had undergone GBS screening and delivered from June 2020 to December 2022. Pregnant women between 35 and 37 weeks of gestation had GBS screening using real-time polymerase chain reaction (RT-PCR). The clinical characteristics and outcomes of mothers and newborns were collected. The risk factors linked to maternal GBS colonization and its impact on adverse outcomes for mothers and neonates were assessed using chi-square and logistic regression analyses. The composite neonatal adverse outcomes included low Apgar scores, neonatal pneumonia, neonatal hyperbilirubinemia, neonatal sepsis, or low birth weight.ResultsOverall, the rate of GBS positivity was 10.63% (551/5183), and the rate of maternal GBS screening was 88.4%. Diabetic pregnant women were more likely to become colonized with GBS. Our research revealed that GBS carriers experienced higher rates of fetal distress and neonatal adverse outcomes than non-GBS carriers. Fetal distress (OR, 1.940; 95% CI, 1.355 to 2.778, P < 0.001), neonatal sepsis (OR, 5.063; 95% CI, 2.536–10.109, P < 0.001), low Apgar scores (OR, 2.097; 95% CI, 1.184–3.715, P = 0.011), neonatal pneumonia (OR, 1.638; 95% CI, 1.039 to 2.582, P = 0.034) and neonatal hyperbilirubinemia (OR, 1.438; 95% CI, 1.080 to 1.915, P = 0.013) were significantly related to maternal GBS colonization. When we used the composite adverse neonatal outcomes as the dependent variable and analyzed the influencing factors, the logistic regression analysis revealed that GBS colonization was still significantly related to an elevated risk of adverse neonatal outcomes (OR = 1.752, 95% CI, 1.389–2.208; P < 0.001).ConclusionsDiabetes may be a risk factor for maternal GBS colonization. Moreover, in this study, GBS colonization correlated with neonatal adverse outcomes but not with maternal outcomes.

The effect of maternal and fetal weight on the risk of emergency cesarean section in nulliparous women.

Although many studies based on different ethnic groups have analyzed the impact of maternal and infant weight on overall cesarean section rates in recent years, research on the impact of maternal and infant weight on emergency cesarean section (EmCS) rates is lacking, especially in the Chinese population. This study aimed to analyze whether maternal and fetal weight could influence the risk of EmCS. A total of 8427 nulliparous women who delivered vaginally (full-term, singleton, and cephalic presentation) were included in this study and divided into the normal vaginal delivery (VD) and EmCS groups. Of 8427 cases, 909 (10.8%) were delivered by EmCS because of failed VD. Compared with pregnant women with a normal body mass index, the risk of EmCS in overweight women increased significantly (P < .001). Birth weight > 3550 g was associated with an increased risk of EmCS. Subgroup analyses showed that among women with underweight and normal weight, old age, inadequate gestational weight gain, and large for gestational age were independent high-risk factors for EmCS (P < .05), whereas small for gestational age was the low-risk factor. Compared with the fetal distress group, the weight of newborns in the nonfetal distress group was significantly higher (P < .001), and the main cause of EmCS in women with macrosomia, large for gestational age, or birth weight ≥ 3550 g was fetal distress (P < .05). The prepregnancy maternal and fetal weights can affect the risk of EmCS. Weight management should be enhanced to control gestational weight gain according to the prepregnancy body mass index to reduce the risk of EmCS due to failed VD.

Prenatal diagnosis and treatment of fetal intestinal volvulus: A case report.

Fetal intestinal volvulus, a rare and severe disorder, poses significant diagnostic challenges prenatally and can lead to intrauterine death or adverse neonatal outcomes if untreated in a timely manner. This study reports a case of fetal intestinal volvulus confirmed postoperatively, providing insights into its clinical manifestations, diagnostic methods, and treatment outcomes, thereby enhancing understanding of this rare condition. A Chinese gravida 2, para 1 female presented at 32 weeks and 5 days of gestation with decreased fetal movements. Fetal ultrasound and MRI revealed small intestinal torsion and obstruction. Due to fetal distress, an emergency cesarean section was performed, followed by an urgent laparotomy on the neonate to untwist the intestinal volvulus and resect the necrotic bowel segment. Fetal intestinal volvulus. Following an emergency cesarean section, the neonate was promptly transferred to the surgical department for immediate surgical intervention. The procedure encompassed detorsion of the intestinal volvulus and resection of the necrotic bowel segment. The infant exhibited a satisfactory postoperative recovery, successfully transitioned to complete oral and gastrointestinal nutrition, and demonstrated normal physical growth and cognitive development during the ensuing follow-up period. Fetal intestinal volvulus requires multidisciplinary collaboration for diagnosis and treatment. Early recognition, prompt delivery, and urgent surgical intervention are crucial for optimizing neonatal outcomes. By sharing this case, we hope to enhance the diagnostic and therapeutic capabilities of healthcare providers in managing this rare but severe condition.

Intrauterine Contraction Monitoring in Chorioamnionitis: A Secondary, Blinded Analysis of a Randomised Controlled Trial Cohort.

To study the effects of chorioamnionitis on uterine activity and to investigate associations between external and intrauterine monitoring methods and neonatal outcomes. Secondary analysis of a randomised controlled trial cohort. Two labour wards, in a university tertiary hospital and a central hospital. Parturients with singleton pregnancies, gestational age ≥ 37 weeks and fetus in cephalic position. Clinical chorioamnionitis developed in 8.6% of cases (n = 130/1504). Analyses of uterine activity (contractions/10 min or intrauterine pressure in Montevideo units) during the 4 h before birth adjusted for maternal characteristics and intrapartum factors. Uterine activity with or without chorioamnionitis and the intervention of external versus intrauterine monitoring in relation to fetal distress (admission to neonatal intensive care with umbilical artery pH ≤ 7.10 or 5-min Apgar score < 7), stratified by chorioamnionitis status. Uterine contraction frequency/10 min decreased in labours with chorioamnionitis during the final hour preceding birth (4.2 [SD 1.1] vs. 3.9 [SD 1.2], adjusted regression coefficient -0.383, 95% CI -0.654 to -0.112, p = 0.006) compared to non-infected labors. In chorioamnionitis cases, mean frequency/10 min during last 4 h was higher with external versus intrauterine monitoring (4.2 [SD 0.8] vs. 3.8 [SD 0.9], MD 0.39, 95% CI 0.02-0.76, p = 0.038), and the intrauterine monitoring group had a lower incidence of fetal distress (6.7% vs. 23.1%, OR 0.24, 95% CI 0.07-0.79, p = 0.013). Chorioamnionitis impairs uterine activity. Intrauterine monitoring may provide more accurate contraction analysis than external tocodynamometry and help reduce fetal compromise during labours complicated by chorioamnionitis.

Implications of mechanical circulatory support devices in a pregnant woman with cardiogenic shock

Data on the use of mechanical circulatory support devices in pregnant women are limited. A 27-year-old woman at 27 weeks and 6 days of gestation was supported by three different mechanical circulatory support devices due to cardiogenic shock. She came into spontaneous labor, which was complicated by major hemorrhage at the cannulation site, fetal distress, and transverse position, requiring emergency cesarean section. The postpartum period was complicated by intra-abdominal bleeding and arterial occlusion of lower extremity. When using mechanical circulatory support devices in pregnant women, a multidisciplinary approach is recommended.

EFFECTS OF UDUMBARA JAL, MASANUMASIKA KALP, GARBHAPALA RASA, VASANT KALPA IN THE MANAGEMENT OF OLIGOHYDRAMNIOS - A CASE REPORT

Oligohydramnios frequently demands intensive foetal surveillance and proper antepartum and intrapartum care. Its incidence is 1:750. Oligohydramnios is associated with increased perinatal morbidity and mortality. Features include IUGR, PIH, Abortion, Prematurity, IUFD, Malpresentations, Foetal distress, and Low APGAR, which are very emerging and life-threatening conditions for both mother and foetus in which the production of amniotic fluid is reduced and require immediate treatment and care. In the modern medicine they have not any particular treatment instead of giving adequate rest which decreases dehydration, hydration – Oral/IV Hypotonic fluids (2 Lit/d) or directly infusion of fluids in amniotic cavity, serial USG – Monitor growth and AFI. All these complica-tions result in higher rates of obstetrician intervention like induction of labour and caesarean delivery, which in-crease maternal risks as well. In Ayurveda, oligohydramnios can be considered under Upavishtaka, Nagodara, which comes under Garbha vyapad. Here, Garbhakshaya, as stated by Acharya Sushruta, where Garbhaaspan-dana, i.e. Ksheena Spandana (low foetal moments) and anunatkukshitta (Less fundal height) mentioned which is mainly due to the reduced amniotic fluid. A case study of a 20-year-old patient, primigravida with 20 weeks ges-tation, presented in OPD with fundal height less than gestational age on abdominal examination and AFI 6 cm on ultrasonography is presented. She managed efficiently by administering her with Udumbara Jal, Masanu-masika Kalp, Garbhapala Ras, and Vasant Kalpa orally and eating a diet according to Ayurveda. AFI increased to 9.5 cm on the 24th week, 12.9 cm at 29 weeks &amp; 15.5 cm at 36 weeks and fundal height was increased and corresponded to the gestational ages. Foetal weight also increased from 300 gms to 657 gms, 1339 gms, &amp; 2821 gms, respectively. This very effective treatment modality increases the amniotic fluid and provides good nour-ishment for the foetus.

Analyzing trends in Cesarean Section by Action Oriented Classification (Robson Criteria) at Creek General Hospital, Karachi

Objectives: The objective of this study is to analyze Cesarean section trends using the Robson classification system and identify the cause of cesarean section in each group, in a tertiary care hospital Karachi. Study Design and Settings: This cross-sectional study was conducted in the obstetric department of Creek General Hospital Karachi, from 1 Jan 2021 to 31 Dec 2022. Methodology: Data collection utilized a non-probability consecutive sampling method. This study examined the sociodemographic characteristics, indications for cesarean section, and the Robson classification system in the women who underwent cesarean section in the hospital during specified duration. Inclusion criteria of study were all women who underwent for C-section procedure during the study timeline. Data was analyzed using IBM SPSS Statistics version 26. The study adhered to the Helsinki Declaration and ethical approval. Results: The Robson classification system was analyzed in this study, and group 5 was shown to be the primary contributor followed by group 2 and then group 1. Most frequently noted indication was previous CS (43.2%), followed by non-progress of labor (15.1%), and fetal distress (11.6%). Conclusion: Cesarean section rate can be reduced by encouraging vaginal birth after cesarean section in multiparous women who had one cesarean section, under supervision of senior obstetrician. Meanwhile, the Non-progress of labor can be targeted by improving antenatal and intrapartum care, birth preparation classes and presence of companion during labor. Through CTG interpretation and their standardized management protocols will be effective in preventing and curbing the rising cesarean rate due to fetal distress

Pregnancy Complications and Outcomes in Obese Women with Gestational Diabetes.

Background and Objectives: To assess pregnancy and delivery complications in obese women with gestational diabetes mellitus (GDM) and neonatal weight and condition after birth. Materials and Methods: A retrospective tertiary referral centre study included all cases of GDM in the Department of Obstetrics and Gynaecology of the Lithuanian University of Health Sciences (LUHS) Birth Registry from 1 January 2019 to 31 December 2019. We included 583 women with GDM and singleton pregnancies. Women were divided into two groups according to their pre-pregnancy weight: 202 were obese (BMI ≥ 30 kg/m2), and 381 were weight (BMI 18.5-24.9 kg/m2). Survey data were analysed using IBM SPSS Statistics 26.0 and MS Excel 2016 software. A value of p < 0.05 was considered significant. Results: Fasting glycaemia was significantly higher in obese women with GDM than in normal-weight women with GDM (p < 0.001). In addition, fasting glycaemia was higher in obese women with GDM requiring insulin correction than in normal-weight women (p = 0.006). OGTT 0-min glycaemia was higher in obese than in non-obese women with gestational diabetes (p < 0.001). Women with pre-pregnancy obesity had a higher incidence of primary hypertension (p < 0.001), hypertensive disorders in pregnancy (p < 0.001), gestational cholestasis (p = 0.002), polyhydramnios (p < 0.001), induced labour (p < 0.001), and caesarean section (p = 0.015), with emergency caesarean sections being more frequent than planned caesarean sections (p = 0.011) compared to normal-weight women with GDM. Labour dystocia (p = 0.003) and foetal distress (p = 0,019) were more common during labour in obese women. Neonates of these women more often had macrosomia (p < 0.001) and lower Apgar scores at 1 min (p = 0.024) and at 5 min (p = 0.024) compared to neonates of normal-weight women. Conclusions: Obese women with GDM experience more pregnancy complications than normal-weight women with GDM.

Effects of thalassemia minor on umbilical artery blood flow and perinatal outcomes in pregnancy: A retrospective cohort study.

The aim of the present study was to compare the fetal umbilical artery blood flow parameters in the third trimester and perinatal outcomes between pregnant women with and without thalassemia minorin South China. This was a retrospective cohort study. Doppler ultrasound was used to detect fetal umbilical artery hemodynamics in pregnant women with or without thalassemia minor during the third trimester. The main parameters assessed were umbilical artery peak systolic flow velocity/end-diastolic flow velocity (S/D), resistance index (RI), pulsation index (PI), and relevant perinatal outcomes. This study included 540 pregnant women, 180 with thalassemia minor and 360 being healthy controls. In the third trimester, the thalassemia minor group had higher umbilical artery S/D (P = 0.002), RI (P = 0.002), and PI (P = 0.012) than healthy pregnant women, as well as lower levels of hemoglobin (Hb) (P < 0.001) and higher ferritin levels (P < 0.001). Compared to the non-thalassemia group, neonatal body weight in the thalassemia minor group was significantly lower (P = 0.001). Additionally, the incidence of maternal anemia (odds ratio [OR] 3.92; 95% confidence interval [CI]: 2.57-5.99, P < 0.001), low birth weight (OR 15.35; 95% CI: 1.71-137.93, P = 0.015), fetal distress (OR 2.18; 95% CI: 1.12-4.26, P = 0.023), neonatal asphyxia (OR 12.81; 95% CI: 1.40-117.33, P = 0.024), oligohydramnios (OR 18.25; 95% CI: 2.21-150.36, P = 0.007) and Apgar score <7 at 1 min after birth (OR 7.97; 95% CI: 1.53-41.54, P = 0.014) was significantly higher in the thalassemia minor group. Pregnant women with thalassemia minor have higher umbilical artery S/D, RI and PI during the third trimester and a higher risk of adverse perinatal outcomes.

Similar Spatial Expression of Immune-Related Proteins in SARS-CoV-2 Placentitis and Chronic Histiocytic Intervillositis.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in the placenta can lead to fetal distress and demise, characterized by severe trophoblast necrosis, chronic histiocytic intervillositis (CHI), and massive perivillous fibrin deposition. We aimed to uncover spatial immune-related protein changes in SARS-CoV-2 placentitis compared with CHI placentas and uncomplicated pregnancies to gain insight into the underlying pathophysiological mechanisms. Placentas were retrospectively collected from cases with SARS-CoV-2 placentitis resulting in fetal distress/demise (n=9), CHI (n=9), and uncomplicated term controls (n=9). The expression of 53 immune-related proteins was quantified using GeoMx Digital Spatial Profiler in three separate compartments: villi (fetal compartment), intervillous space, and decidua (both maternal compartments). Compared with controls, SARS-CoV-2 placentitis and CHI both displayed differentially expressed proteins in the intervillous space only, including upregulation of myeloid markers (e.g., CD40, CD11c, CD68, CD163). Specifically, SARS-CoV-2 placentitis was associated with reduced expression of multiple apoptotic proteins (e.g., BAD, BIM, BLXL, BCL6). In conclusion, SARS-CoV-2 placentitis and CHI are associated with enhanced myeloid cell infiltration into the intervillous space, but not in the decidua and villi. The more prominently reduced apoptosis-related protein expression in SARS-CoV-2 placentitis may lead to an exaggerated immune response, causing acute placental dysfunction and fetal demise.

Prospective Applications of Artificial Intelligence In Fetal Medicine: A Scoping Review of Recent Updates.

With the incorporation of artificial intelligence (AI), significant advancements have occurred in the field of fetal medicine, holding the potential to transform prenatal care and diagnostics, promising to revolutionize prenatal care and diagnostics. This scoping review aims to explore the recent updates in the prospective application of AI in fetal medicine, evaluating its current uses, potential benefits, and limitations. Compiling literature concerning the utilization of AI in fetal medicinedoes not appear tomodify the subjector provide an exhaustive exploration of electronic databases. Relevant studies, reviews, and articles published in recent years were incorporated to ensure up-to-date data. The selected works were analyzed for common themes, AI methodologies applied, and the scope of AI's integration into fetal medicine practice. The review identified several key areas where AI applications are making strides in fetal medicine, including prenatal screening, diagnosis of congenital anomalies, and predicting pregnancy complications. AI-driven algorithms have been developed to analyze complex fetal ultrasound data, enhancing image quality and interpretative accuracy. The integration of AI in fetal monitoring has also been explored, with systems designed to identify patterns indicative of fetal distress. Despite these advancements, challenges related to the ethical use of AI, data privacy, and the need for extensive validation of AI tools in diverse populations were noted. The potential benefits of AI in fetal medicine are immense, offering a brighter future for our field. AI equips us with tools for enhanced diagnosis, monitoring, and prognostic capabilities, promising to revolutionize the way we approach prenatal care and diagnostics. This optimistic outlook underscores the need for further research and interdisciplinary partnerships to fully leverage AI's potential in driving forward the practice of fetal medicine.

Factors contributing to visual intrapartum cardiotocograph interpretation variation among healthcare professionals: An integrative review.

The reliability of cardiotocographs as diagnostic tools for fetal well-being is hampered by interpretational variations among healthcare professionals, contributing to high rates of cesarean sections and instrumental deliveries. While adjunct technologies may be used to confirm cases of fetal distress, those in resource constrained areas continue to rely on visual cardiotocograph interpretation to come up with the diagnosis of fetal hypoxia. This study investigated the factors contributing to variations in the visual interpretation of intrapartum cardiotocograph among healthcare professionals in the absence of adjunctive technologies. In this integrative literature review, we conducted a literature search of the following electronic databases: EBScohost, PubMed, Web of Science, and Scopus. The following search terms and Boolean operators were used: (Intrapartum OR Labor OR Labour OR Childbirth OR Birth OR Delivery) AND (Cardiotocography OR CTG OR "Electronic Fetal Monitoring" OR EFM) AND (Interpretation OR Analysis) AND (Variations OR Differences) AND ("Healthcare Workers" OR Nurses OR "Medical Workers" OR "Healthcare Professionals" OR Midwives OR Obstetricians). After removal of duplicates, a total of 1481 articles and titles were screened, 60 full-text articles were examined to verify whether they addressed the scope of the literature review. Nine articles addressed the factors contributing to variations in the visual interpretation of intrapartum cardiotocographs among healthcare professionals. The quality of the studies was appraised using the Quality Appraisal Tool for Studies of Diagnostic Reliability. Thematic analysis identified the following themes: 1) Interpretational variations in cardiotocograph characteristics among health professionals, and 2) factors leading to increased interpretational variation among healthcare professionals. Our results highlight the need for increased cardiotocograph training to improve consistency among health professionals, especially for suspicious and pathological traces, which often lead to cesarean section.

Consent for interventions during childbirth: A national population-based study.

To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.

Obstetric Factors Contributing to the Rising Trend of Cesarean Deliveries at Sheikh Khalifa Bin Zaid Hospital, Rawlakot

The study aimed to assess the rate of cesarean section and to analyse the risk factors contributing to C-sections to introduce measures to check unwanted, non-medical reasons to go for a C-section. The study was retrospectively conducted at Sheikh Khalifa Bin Zaid Hospital Rawlakot Azad Kashmir on 5226 normal deliveries and 1604 C-sections. The rate was found to be 30.6%, more than the recommended rate by WHO (10-15 %). The major contributing factor was the previous scar (41.6%). The most prevalent indications were foetal distress (14%), older age more than 35 years (6 %), obstructed labour (1.9 %), failed IOL (1.6 %), failure of progress of labour (1.8 %), multiple pregnancies (1.74 %), PIH (0.99 %), meconium aspiration (1.62 %), placental problems (1.8 %), only one patient (0.06 %) requested for elective caesarean and other risk factors were also seen (18 %) in aggregate. The study concluded that at SKBZ hospital C-sections were overused. The study was conducted with a limited sample size only in one high-standard hospital in Rawalakot Azad Jammu and Kashmir, where the demographic characteristics of the patients were almost similar. Yet, it will be better to repeat the same kind of study in other hospitals of the AJK with larger sample sizes and with varying population characteristics and facilities, including populations from both the urban as well as from rural areas to get a clear understanding based on these differences to and generalize the results. The findings of this study will contribute to theory and practice and will be helpful to the government functionaries in healthcare planning.

ACUTE POST HEMORRHAGIC ANEMIA AND SHOCK IN NEONATE DUE TO RUPTURE UMBILICAL CORD DURING DELIVERY

Umbilical cord rupture in utero is a very rare and critical emergency that can cause fetal death within minutes. Umbilical cords rupture can be associated with normal or adverse perinatal outcomes leading to stillbirth, asphyxia, fetal distress, and neurologic damage. When rupture does occur in utero signs of fetal distress appear and fetal mortality rate is approximately 50%. We present the rare case of severe anaemia and shock immediately after delivery related to severe neonatal blood loss due to intrapartum umbilical cord rupture where there was a tight nuchal cord and the placenta was bilobed with a Succenturiate lobe. The umbilical cord ruptures close to the babys side near the abdominal wall.This is an unusual site, as most cases tend to rupture from the weakest site at the insertion of the cord to the abnormal placenta.Following stabilization and resuscitation, the baby survived and recovered well.

A retrospective cross-sectional study on the prevalence of adverse perinatal outcomes and its associated factors in fetuses with late-onset fetal growth restriction

Late-onset fetal growth restriction (FGR) has a possibility of urgent fetal deterioration before labor, which contributes to late-pregnancy mortality, intrapartum fetal distress, and neonatal acidosis. This study was conducted to evaluate the prevalence of adverse perinatal outcomes (APO) and identify factors associated with APO in fetuses with late-onset FGR. This was a retrospective cross-sectional study of singleton pregnancies diagnosed with late-onset FGR, enrolled in Tu Du Hospital from 4/2022 to 12/2022. Late-onset FGR was defined according to the Delphi consensus. Databases of Doppler parameters and APO were recorded. Of 101 pregnancies in the study, APO occurred in 21 cases (20.8%). The need for admission to the neonatal intensive care unit, the mean overall length of hospital stay, neonatal resuscitation requiring mechanical ventilation, neonatal jaundice requiring phototherapy, and neonatal hypoglycemia were recorded, respectively, in 21 (20.8%), 6.67 days, 11 (10.9%), and 2 (2%) cases, while no case of perinatal death and 5-min Apgar score&lt;7 was reported in the study. In the prediction of APO, there was a significant contribution from cerebroplacental ratio (CPR)&lt;5 percentile (adjusted OR (aOR)=4.76, 95% confidence interval [CI] 1.07–21.11, p=0.04), EFW&lt;3 percentile (aOR=3.22, 95% CI 1.01–10.27, p=0.049) and gestational age at delivery (aOR=0.35, 95% CI 0.18–0.65, p=0.001). In our research, the prevalence of APO is 20.8%. CPR&lt;5 percentile, severe late-onset FGR, and gestational age at delivery are independently statistically associated with APO in pregnancies with late-onset FGR.