Incidence Of Neonatal Complications Research Articles

Feasibility study of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester

Objective: To investigate the feasibility of expectant management of different degrees of vaginal fluid in pregnant women with premature rupture of membranes in the second trimester. Methods: A retrospective cohort study was conducted to collect 103 pregnant women who were diagnosed with premature rupture of membranes in the second trimester of pregnancy and insisted on continuing the pregnancy in Shanxi Bethune Hospital from July 2012 to July 2022. According to the degree of vaginal fluid, pregnant women were divided into rupture group (with typical vaginal fluid, 48 cases) and leakage group (without typical vaginal fluid, 55 cases). The rupture latency (the time from rupture of membranes to termination of pregnancy), gestational weeks of termination, indications and methods of termination of pregnancy, maternal infection related indicators and perinatal outcomes were compared between the two groups. Univariate regression model was used to analyze the correlation between different degrees of vaginal fluid in pregnant women with premature rupture of membranes and maternal and neonatal outcomes. Results: (1) Obstetric indicators: there was no significant difference in the gestational age of rupture of membranes between the two groups (P>0.05). However, the proportion of rupture latency >28 days in the leakage group was significantly higher than that in the rupture group [42% (23/55) vs 13% (6/48); χ2=33.673, P<0.001], and the incidence of pregnancy termination ≥28 weeks was significantly higher [47% (26/55) vs 19% (9/48); χ2=9.295, P=0.002]. (2) Indications and methods of termination: the incidence of progressive reduction of amniotic fluid as the indication for termination in the leakage group was significantly lower than that in the rupture group [22% (12/55) vs 42% (20/48); χ2=4.715, P=0.030], and the incidence of full-term termination in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 12% (6/48); χ2=5.008, P=0.025], while there were no significant differences in the indications of termination of pregnancy, including amniotic cavity infection, uterine contraction failure and fetal distress between the two groups (all P>0.05). The incidence of induced labor or spontaneous contraction in the leakage group was significantly lower than that in the rupture group [53% (29/55) vs 81% (39/48); χ2=9.295, P=0.002], while the cesarean section rate and vaginal delivery rate were similar between the two groups (both P>0.05). (3) Infection related indicators: the incidence of amniotic cavity infection in the leakage group was significantly higher than that in the rupture group [31% (17/55) vs 13% (6/48); χ2=4.003, P=0.045]. However, there were no significant differences in the elevation of inflammatory indicators, the positive rate of cervical secretion bacterial culture and the incidence of tissue chorioamnionitis between the two groups (all P>0.05). (4) Perinatal outcomes: the live birth rate in the leakage group was significantly higher than that in the rupture group [51% (28/55) vs 27% (13/48); χ2=5.119, P=0.024]. The proportion of live births with 1-minute Apgar score >7 in the leakage group was significantly higher than that in the rupture group [38% (21/55) vs 17% (8/48); χ2=4.850, P=0.028]. However, there were no significant differences in the birth weight of live births and the incidence of neonatal complications between the two groups (all P>0.05). (5) Univariate regression analysis showed that compared with the rupture group, the leakage group had a higher risk of pregnancy termination at ≥28 gestational weeks (RR=2.521, 95%CI: 1.314-4.838; P=0.002), amniotic infection (RR=2.473, 95%CI: 1.061-5.764; P=0.025), perinatal survival (RR=1.880, 95%CI: 1.104-3.199; P=0.014). Conclusion: Compared with pregnant women with typical vaginal fluid in the second trimester of premature rupture of membranes, expectant treatment for pregnant women with atypical vaginal fluid is more feasible, which could effectively prolong the gestational weeks and improve the perinatal live birth rate.

Early neonatal complications in pregnant women with gestational diabetes mellitus and the effects of glycemic control on neonatal infection.

Gestational diabetes mellitus (GDM) has become increasingly prevalent globally. Glycemic control in pregnant women with GDM has a critical role in neonatal complications. To analyze the early neonatal complications in GDM, and examine the effect of blood glucose control level on neonatal infection. The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed, and the early complications in newborns in the two groups were compared. The patients were divided into the conforming glycemic control group (CGC group) and the non-conforming glycemic control group (NCGC group) based on whether glycemic control in the pregnant women with GDM conformed to standards. Baseline data, immune function, infection-related markers, and infection rates in neonates were compared between the two groups. The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group (P < 0.05). Pregnant women with GDM in the NCGC group (n = 178) had significantly higher fasting plasma glucose, 2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group (n = 58) (P < 0.05). There were no differences in baseline data between the two groups (P > 0.05). Additionally, the NCGC group had significantly decreased peripheral blood CD3+, CD4+, CD8+ T cell ratios, CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group (P < 0.05), while white blood cells, serum procalcitonin and C-reactive protein levels increased significantly. The neonatal infection rate was also significantly increased in the NCGC group (P < 0.05). The risk of neonatal complications increased in pregnant women with GDM. Poor glycemic control decreased neonatal immune function, and increased the incidence of neonatal infections.

Intervention Strategy for the Development of Specific Competencies in the Care of the Pathological Neonate

<i>Introduction:</i> Neonatology experts affirm that neonatal complications are closely related to the performance of nurses, in such a sense the factual reasons that motivate the present study denoted a high incidence of complications in neonates assisted at the NICU of the National Hospital "Edward Francis Small Teaching Hospital in The Gambia in the period of julio-december 2021, revealed an increase in complications and the number of neonatal deaths. The solution of this assignment has as <i>objective</i>: Implement an intervention strategy for the development of specific competencies in the care of the pathological newborn that contributes to the prevention of complications and impacts on the quality of life of the child population in The Gambia. The intervention strategy implemented is based on the philosophical, sociological, psychological and epistemological ones that, from their contextualization, improvement the <i>development</i> of competencies in the care of the pathological neonate in 26 nurses who participated in the study. As a <i>result</i> of the implementation, it was possible to verify the level of promotion of the competencies to an average of 4.03, which corresponds to high levels of development and its impact on neonatal morbidity and mortality in the NICU. <i>Conclusions:</i> the intervention Strategy is the theoretical methodological concretion that from the scientific point of view emanates from the work in the training of personnel competencies in the NICU, is in correspondence with the social demands and the requirements of the Health System in the Cuban medical mission. The Gambia.

Establishing the Optimal Time for Induction of Labor in Women with Diet-Controlled Gestational Diabetes Mellitus: A Single-Center Observational Study.

To determine the optimal week for labor induction in women with diet-controlled gestational diabetes mellitus by comparing differences in perinatal and neonatal outcomes of labor induction to expectant management at different gestational weeks. Methods: This was a retrospective analysis of a prospectively recruited cohort of 797 singleton pregnancies complicated by diet-controlled gestational diabetes mellitus that were diagnosed, treated, and delivered after 37 weeks in a tertiary, university-affiliated perinatal center between January 2016 and December 2021. Results: The incidence of neonatal complications was highest when delivery occurred at 37 weeks, whereas fetal macrosomia occurred mostly at 41 weeks (20.7%); the frequency of large for gestational age infants did not differ between the groups. Conversely, the best neonatal outcomes were observed at 40 weeks due to the lowest number of neonates requiring phototherapy for neonatal jaundice (1.7%) and the smallest proportion of neonates experiencing composite adverse neonatal outcomes defined as neonatal hypoglycemia, phototherapy, clavicle fracture, or umbilical artery pH &lt; 7.15 (10.4%). Compared with expectant management, the risk for neonatal hypoglycemia was increased for induction at 39 weeks (adjusted odds ratio 12.29, 95% confidence interval 1.35-111.75, p = 0.026) and that for fetal macrosomia was decreased for induction at 40 weeks (adjusted odds ratio 0.11, 95% confidence interval 0.01-0.92, p = 0.041), after adjusting for maternal pre-pregnancy body mass index, nulliparity, and mean pregnancy A1c. Conclusions: The lowest rate of neonatal complications was observed at 40 weeks. Labor induction at 40 weeks prevented fetal macrosomia.

Changes of dendritic cell and natural killer cell on the cord blood with idiopathic fetal growth restriction

Objective To investigate the characteristics of dendritic cells (DC) and natural killer cells (NK) in umbilical cord blood of pregnant patients diagnosed with idiopathic fetal growth restriction (IFGR). Methods A prospective study cohort of IFGR patients was established who were in the third trimester (28–36 weeks), with a healthy, pregnant woman cohort selected as controls. Umbilical cord blood was collected. Results The study included 50 pregnant women in the IFGR group and 50 pregnant women in the healthy, control group. The incidence of SGA in the IFGR group was 52.0%, and the incidence of preterm birth was 18.0%. The incidence of neonatal complications in neonates with live birth in the IFGR group was 12.0%. The birth weight, body length and placental weight of the newborns in the IFGR group were significantly lower than those in the control group (p < .05). Flow cytometry revealed no significant difference in the proportion or maturity of DC in umbilical cord blood between IFGR group and control group (p > .05). The proportion of NK cells in umbilical cord blood of IFGR group was significantly higher than that of normal control group. The proportion of CD56dimCD16+ NK cells was also significantly higher than that of the normal control group (p < .05), but the expression of NK cell surface killing activator receptor NKG2D and inhibitory receptor NKG2A was not statistically significant (p > .05). Conclusion The number and proportion of DC cells in cord blood may not be the key factors affecting the outcomes observed during FGR pregnancies. However, we found the proportion of NK cells in cord blood to be significantly increased, as well as the ratio of CD56dimCD16 + NK to CD56highCD16-NK to be imbalanced, which may be one of the pathogenesis of the pathological pregnancy leading to IFGR.

PECULIARITY OF ADAPTATION OF BABIES ARE BORN PREMATURELY FROM MOTHERS WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA

The aim: To evaluate the peculiarity of clinical manifestations of neonatal respiratory distress syndrome (NRDS) in deeply premature infants from mothers with phenotypic markers of undifferentiated connective tissue dysplasia (UCTD). Materials and methods: The study represent the results of a retrospective clinical and statistical analysis of 268 premature birth report card and newborn report sheet. .The main (1 group) included 50 pregnants with obvious phenotypic markers of UCTD, the comparison group (group 2) consisted of 50 pregnant women without phenotypic markers of UDCTD. Results: According to the study, in 12 (24%) pregnant women of the main group at the time of admission to the clinic had contractions,which required specific therapy. Cervical cerclage was performed in 38 (76%) patients of the main group due to the presence of cervical insufficiency (CI). In these cases, the severity of the CI on the Steinber scale was 7.2 &amp;#177; 0.4 points in the main group against 4.4 &amp;#177; 0.2 points in the comparison group (p &amp;#60;0.05). Group I patients were more likely to have complications of labor such as:premature rupture of membranes, uterine contraction abnormalities and fetal distress, which required in most cases cesarean delivery (7% and 2%), respectively (p &amp;#60;0.05). The incidence of neonatal complications requiring respiratory support was 67% in group I and 48% in group II. According to our observations, the clinical manifestations of bronchopulmonary dysplasia were twice as high in infants of the main group (66%) against (44%) of the comparison group (p &amp;#60;0.05). Conclusions:1.Neonatal respiratory distress syndrome in premature infants is more often associated from mothers with UDCTD. 2. The high importance of steroid prophylaxis of NRDS and antioxidant therapy in reducing the frequency of mechanical ventilation and the development of bronchopulmonary pathology, especially in infants from mothers with UDCTD syndrome, has been proven. 3. The possibility of diagnosing disorders of functional maturation of the lungs in the fetal period using a non-invasive method of ultrasonography has been confirmed.

Comparison of Fetomaternal Outcomes in Patients With Gestational Diabetes Mellitus Treated With Insulin Versus Acarbose: Results of a Prospective, Open Label, Controlled Study.

ObjectiveTo evaluate fetomaternal outcomes in patients with gestational diabetes mellitus (GDM) treated with insulin versus acarbose.Material and methodsIn this prospective, open label, controlled study, GDM patients treated with insulin or acarbose were observed till six weeks after delivery. Maternal outcomes, fetal outcomes and glycemic control were compared between two groups. ResultsFifty patients in each group (insulin group-mean age 28.52 years; acarbose group-mean age 26.26 years; p=0.020) were included. There was no difference in body mass index (p=0.157), family history of diabetes (p=0.648), history of GDM (p=0.50) or mean gestational age at diagnosis (p=0.245) between the two groups. There was no significant difference in the incidence of recurrent infections (p=0.64), pre-eclampsia (p=0.64) or premature rupture of membranes (p=0.40) between the two groups. Mean duration of gestational weeks at the time of delivery in the insulin and acarbose group was 36.93 and 38.36 weeks respectively (p=0.002). There was no difference in the modes of delivery, mean post-operative random blood glucose (p=0.96), fasting blood glucose level at day seven (p=0.15) and after six weeks (p=0.83) between the insulin and acarbose groups. There was no difference in reduction in the postprandial blood glucose level at day seven (p=0.48) and after six weeks (p=0.23). There was no significant difference in the mean birth weight of babies born to mothers treated with the two drugs (p=0.21). There was no difference in the incidence of neonatal complications between the two groups.ConclusionAcarbose can be an effective and well tolerated option for treatment of gestational diabetes mellitus.

Outcomes of twin neonates and association with chorionicity and modes of conception

Objective To investigate the pregnancy and neonatal outcomes in twin pregnancies and the association with chorionicity and modes of conception in order to provide evidence for early prevention and reduction of complications and life quality improvement of twin neonates. Methods This study retrospectively enrolled 756 women with twin pregnancies who gave birth at Peking University Third Hospital from January 1, 2014 to December 31, 2015. Clinical features of the mothers and newborns were collected, the pregnancy and neonatal outcomes were analyzed. Impacts of chorionicity and different modes of conception on the outcomes were also evaluated. Two independent-sample t test and Chi-square test were used as statistical methods. Results Twin pregnancies accounted for 6.7% (756/11 169) of all deliveries in the hospital during the study period and the preterm birth rate was 59.4% (449/756). Twenty five women underwent fetal reduction (3.3%, 25/756) and intrauterine death occurred in 85 pregnancies (11.2%, 85/756). Eventually 1 400 babies were born alive (92.6%, 1 400/1 512). Subgroup analysis suggested that compared with dichorionic diamniotic (DCDA) pregnancies, monochorionic diamniotic (MCDA) cases showed younger maternal age at conception [(30.5±4.2) vs (32.9±4.0) years, t=-7.412], smaller gestational age at delivery [(34.1±3.1) vs (35.7±2.2) weeks, t=-7.325] and higher preterm birth rate [78.4% (174/222) vs 51.5% (263/511), χ2=46.554], all P<0.05. Moreover, the incidence of neonatal complications, including respiratory distress syndrome [18.3% (40/219) vs 8.0% (21/261), χ2=11.210], neonatal pneumonia [18.3% (40/219) vs 8.8% (23/261), χ2=9.331] and sepsis [6.8% (15/219) vs 1.5% (4/261), χ2=8.854], etc. was higher in the MCDA group than those in the DCDA group, resulting in a higher mortality rate [7.8% (17/219) vs 1.1% (3/261), χ2=13.042] in the MCDA pregnancies, all P<0.05. Compared with spontaneously conceived twin pregnancies, women underwent in vitro fertilization-embryo transfer were older at conception [(33.4±3.8) vs (30.6±4.4) years, t=-6.095], delivered at a greater gestational age [(35.8±2.1) vs (35.2±2.6) weeks, t=-2.452] and had a lower preterm birth rate [49.2% (206/419) vs 63.5% (54/85), χ2=5.838] in the DCDA group, all P<0.05. No significant differences in the incidence of neonatal diseases were observed between the two subgroups. Conclusions The incidence of preterm birth is high in twin pregnancies. Compared with DCDA twin pregnancies, MCDA twin pregnancies are associated with more adverse outcomes due to higher incidence of neonatal diseases. In vitro fertilization-embryo transfer does not increase the incidence of preterm birth and the neonatal outcomes were comparable to those of spontaneously conceived ones. Key words: Pregnancy, twin; Pregnancy outcome; Premature birth; Infant, newborn, diseases; Incidence; Fertilization in vitro; Embryo transfer

Study of the Consequences of Mothers’ Hypothyroidism in Children: A Systematic Review

Introduction: Hypothyroidism is a common endocrine disorder that, occurs in 2% to 5% of pregnancies. During pregnancy, the body’s demand for thyroid hormones increases, which affects the growth of the fetus. In case of inadequate and defective production of thyroid hormones, adverse effects on the development of the fetus will appear. Lack of symptoms of hypothyroidism during pregnancy causes late diagnosis, resulting in a lack of timely treatment and impaired fetal development. The purpose of this review is to investigate the effects of mothers’ hypothyroidism on children. Methods: This systematic review study was performed by searching the Google Scholar, PubMed, and Science Direct databases for the period between 2018 and 2008 by including the keywords for hypothyroidism, thyroid hormones, growth in the uterus. A number of papers related to the use of the Cochran seven-step model were obtained and analyzed for the final analysis. Results: Thyroid hormones play a vital role in fetal development for ectopic life, through direct and indirect mechanisms that, act on the development of the fetus. Thyroid hormones help in the synthesis of surfactant and lung evolution, stimulation of secretion of catecholamine, increased beta-adrenergic receptors of the lung and stimulation: the activity of sodium and potassium pumps in the alveolar cell surface, the effect on the transmission of brain neurotransmitters and growth hormone, and nervous function. Conclusions: Thyroid hormones play a key role in fetal development. Therefore, in women with hypothyroidism, especially when not treated, it affects the development of the fetus and increases the incidence of complications in neonates. So early diagnosis of hypothyroidism and adequate and timely treatment during pregnancy is cornerstone in preventing impaired growth and development of the fetus and the occurrence of defects in childhood.

Analysis of outcomes in neonates of mothers with gestational diabetes mellitus at a tertiary care hospital in Goa

Background: Diabetes is a common metabolic disorder complicating pregnancy in India. Babies born to diabetic mothers are at increased risk of neonatal complications as well as long term complications with potential of developing type 2 DM in future. Methods: A large prospective study was conducted at a tertiary care hospital in Goa for a period of 18 months (2014-2016) to study the outcomes among neonates born to mothers with Gestational Diabetes Mellitus (GDM).Results: Clinical outcomes of neonates born to 424 mothers with GDM were studied and compared with 424 neonates born to mothers without GDM during the same time period. The mean birth weight of neonates born to GDM mothers was 3.17 kg. Macrosomia was found among 1.2% neonates born to GDM mothers. There was no significant difference in Apgar scores at 5 minutes of birth in GDM and non-GDM groups. The rate of admissions to Neonatal Care Unit was significantly higher (32.1%) in neonates born to GDM mother as compared to non-GDM group. Incidence of neonatal complications like respiratory distress syndrome (4.2%) and hypoglycaemia (11%) was significantly higher in neonates born to GDM mothers. There was a significant increase noted in neonatal mortality (3.3%) in the GDM group.Conclusion: Numerous complications are reported among neonates born to mothers with GDM. Hence these mothers with GDM should be delivered in tertiary care centre or district hospitals where fully staffed and well equipped neonatal intensive care units are available for management of these complications.

Effect of delivery management on first-week neonatal outcome: How to improve it in Great Danes

A different incidence of neonatal complications has been reported in several species according to the duration of the various labour stages and the type of delivery. Trauma associated with dystocia may result in the release of neonatal catecholamines and cortisol that negatively affect neonatal metabolism, thus survival. Aim of the present study was to assess how the first-week neonatal outcome is affected by a different management of parturition.Clinical records of 46 Great Dane litters from 8 different kennels were evaluated retrospectively. Data were grouped in 3 categories: vaginal delivery (VD), emergency C-section (ES), planned C-section (PS). The risk of stillbirth, early neonatal mortality and perinatal mortality was calculated at puppy and at litter level in each group. Data were statistically compared by the ANOVA and Chi-Square test (p < 0.05).Seventy-eight puppies were naturally delivered (VD), 120 experienced dystocia at birth that required emergency C-section (ES) and 105 came from planned C-section (PS). No statistical difference in neonatal bodyweight and litter size was observed among groups. In PS, both stillbirth and neonatal mortality resulted significantly lower than in VD and ES, resulting in the lowest observed perinatal mortality. The number of litters with stillbirth was significantly higher in ES than VD and PS. The number of litters with neonatal mortality resulted significantly lower in PS than VD and ES. The overall perinatal mortality in VD resulted statistically influenced from both stillbirth and neonatal mortality, while it resulted strongly affected by the high stillbirth in ES. No difference was observed for PS perinatal mortality.Present results, reporting a high incidence of dystocia as well as high perinatal and neonatal mortality, lead us to evaluate the opportunity to plan an elective C-section in Great Dane bitches, in order to minimize perinatal mortality.

Pregnancy management in prognosis for pregnant patients with systemic lupus erythematosus

Objective: To study the effects of pregnancy management in prognosis for pregnant patients with systemic lupus erythematosus (SLE). Methods: 217 pregnant patients who were diagnosed with SLE were divided into two groups, the control group and the intervention group. The intervention group was treated with routine treatment and nursing with additional pregnancy management, while the control group was treated with only routine treatment and nursing. Additionally, 195 normal pregnant women in the same period were selected as the healthy control. Regular laboratory tests were conducted for all subjects. Statistical analysis on changes of related disease indexes in each group was also performed. All information of maternal and neonatal outcomes was collected to record SLE activity rate, incidence of pregnancy induced hypertension (PIH), premature and fetal loss, neonatal weight and incidence of neonatal complications. Results: Increased ANA titer and dsDNA, lower immunoglobulin complement, renal damage, blood system damage, increased SLEDAI score and BILAG score were observed in the control group and the invention group compared with the healthy control. Both the control group and the intervention group showed significant increase in the incidences of PIH, premature delivery, fetal loss and neonatal complications as well as significant decrease in neonatal weight compared with the healthy control. SLE activity rate and incidences of PIH, premature delivery and neonatal complications were significantly decreased while neonatal weight was greatly increased in the intervention group compared with the control group. Results of logistic analysis showed that low immunoglobulin complement, renal damage, increased dsDNA, increased dsDNA and low immunoglobulin complement were independent risk factors for increased SLE activity rate, fetal loss, premature delivery and neonatal complications, respectively. Conclusion: The present study indicates that pregnancy management for pregnant SLE patients can significantly improve maternal and neonatal outcomes.

Short cervix in twin pregnancies: current state of knowledge and the proposed scheme of treatment.

Short cervical length (SCL) should be defined as cervical length (CL) less than 25 mm between 18 and 22 weeks of gestation. This definition of SCL is fully applicable for singleton pregnancies but is not entirely correct for twin pregnancies. So far there are no explicit guidelines on the treatment of twin pregnancy with SCL. The use of progesterone in the treatment of SCL and preterm birth (PTB) prophylaxis is one of the interventions recommended by the Polish Ministry of Health for cervical shortening in singleton pregnancies. In twin pregnancies attention should be paid to the potential benefits of using vaginal progesterone in reduction of neonatal mortality and incidence of neonatal complications in a group of patients with twin pregnancies and CL less than 25 mm or below the 10th percentile for the gestational age, measured between 18 and 22 weeks of gestation. It is still difficult to identify the benefits of using pessaries in the prevention of PTB in twin pregnancies. The usage of pessaries appears to be beneficial only in selected subpopulations of patients with asymptomatic CL less than 25 mm or 10th percentile for gestational age. The use of cervical cerclage in PTB prevention in twin pregnancies is limited to cases where the external cervical dilation is >1 cm and.

The effects of multi mineral-vitamin D and vitamins (C+E) supplementation in the prevention of preeclampsia: An RCT

Several studies have reported the uncertain role of multi-minerals and vitamins in the prevention of preeclampsia. The present study aims to investigate the effect of multimineral-vitamin D supplements (calcium, magnesium, zinc and Vitamin D) and vitamins (C+ E) in the prevention of preeclampsia. In this randomized clinical trial, 90 pregnant women were divided into three groups: group A received Ferrous sulfate (1 tablet/day) + one tablet of Claci-care multimineral-vitamin D containing 800mg calcium, 200mg magnesium, 8mg zinc and 400 IU Vitamin D3 per day; group B received Ferrous sulfate (1 tablet/day) + 250 mg vitamin C + 55 mg vitamin E; and the controls received only one Ferrous sulfate tablet daily. The incidence of preeclampsia in group A was significantly lower than the control group (p=0.03), while there was no significant difference between group B and controls (p=0.50), as well as groups A and B (p=0.063). The incidence of neonatal complications in the group A was significantly lower than the control group (p=0.01), while there was no significant difference between group B and control (p=0.48). According to the results, calcium, magnesium, and zinc supplements have a significant effect on the prevention of preeclampsia. In addition, prescription of multimineral-vitamin D during pregnancy can be a low-cost and affordable way to reduce the incidence of preeclampsia in women who are at high risk of preeclampsia.

Analysis on perinatal risk factors and clinical characteristics of complications in early term infants

Objective To explore the perinatal risk factors and clinical characteristics of complications of early term neonates. Methods Data of 5 468 live term newborns and their mothers hospitalized in the Third Affiliated Hospital of Zhengzhou University from January 2013 to December 2013 were analyzed. Background information, morbidity and complications of the mothers were compared among early, full and late term groups (n=1 933, 3 013, 412, respectively). And background information and incidence of complications were also investigated among neonates of early, full and late term groups (n=2 033, 3 023, 412, respectively), and neonates born between 37-37+6 (n=695) and 38-38+6 weeks (n=1 338). One-way analysis of variance, LSD-t test, logistic regression analysis, Chi-square or Fisher exact test, Pearson Chi-square test, corrected Chi-square test were used for statistical analysis. Results 1. Comparison among the early, full and late term group showed that higher proportions of elder gravida [21.1%(407/1 933), 10.5%(317/3 013), 6.8%(28/412), χ2=127.690], multipara [43.7%(844/1 933), 23.1%(697/3 013), 15.0%(62/412), χ2=287.765], scarred uterus [27.9%(539/1 933), 8.9%(267/3013), 1.5%(6/412), χ2=396.521], higher incidence of cesarean section [75.2%(1 453/1 933), 56.2%(1 693/3 013), 54.1%(223/412), χ2=196.348], hypertensive disorder complicating pregnancy [9.2%(178/1 933), 3.5%(105/3 013), 2.9%(12/412), χ2=79.915], multiple pregnancy[5.1%(99/1 933), 0.3%(9/3 013), 0.0%(0/412), χ2=147.860], gravidity>1[63.1%(1 220/1 933), 47.3%(1 425/3 013), 39.6%(163/412), χ2=147.668], premature rupture of fetal membranes[20.6%(398/1 933), 14.2%(428/3 013), 10.2%(42/412), χ2=47.217], abnormal amniotic fluid[17.8%(344/1 933), 12.3%(370/3 013), 11.2%(46/412), χ2=32.777], gestational diabetes mellitus[11.5%(223/1 933), 5.9%(178/3 013), 5.1%(21/412), χ2=56.169], abnormal presentation [9.5%(184/1 933), 5.1%(155/3 013), 2.9%(12/412), χ2=43.511], abnormal placenta [7.6%(146/1 933), 3.1%(92/3 013), 2.7%(11/412), χ2=57.739], hysteromyoma[4.9%(94/1 933), 2.3%(68/3 013), 0.7%(3/412), χ2=35.062] in the early term group than in the full and late term group, respectively ( all P<0.016). Multivariate logistic analysis showed that multiple pregnancy (OR=21.736, 95%CI: 10.785-43.806),scarred uterus (OR=3.302, 95%CI: 2.679-4.071) and hypertensive disorder complicating pregnancy(OR=2.658, 95%CI: 2.040-3.465) were the leading three perinatal risk factors for early term delivery. 2. The incidence of the following neonatal conditions were different among early, full and late term infants (all P<0.05): hyperbilirubinemia [12.5%(255/2 033), 3.9%(119/3 023), 4.9%(20/412), χ2=138.343], infectious diseases [4.3%(88/2 033), 2.0%(59/3 023), 1.7%(7/412), χ2=27.122], asphyxia[3.0%(60/2 033, 1.4%(42/3 023), 1.0%(4/412), χ2=17.795], brain damage [2.3%(46/2 033), 0.5%(15/3,023), 10.%(4/412)], respiratory distress syndrome [1.1%(23/2 033), 0.2%(7/3 023), 0.0%(0/412)], feeding problems [2.0%(41/2 033), 0.3%(10/3 023), 1.0% (4/412) ], surgical diseases[2.0%(41/2 033), 0.9%(28/3 023), 1.5%(6/412), χ2=0.709], intracranial hemorrhage [1.9%(39/2 033), 0.9%(26/3 023), 0.5%(2/412) , χ2=13.263], wet lung [0.9%(19/2 033), 0.4%(11/3 023), 0.5%(2/412)]. Incidences of the above complications in the early term infants were all higher than in the full term infants, but when compared with the later term infants, only that of hyperbilirubinemia and infectious diseases was higher (all P<0.016). Incidence of admission ot NICU [24.5%(170/695) vs 11.5%(153/1 338), χ2=57.729], hyperbilirubinemia [19.0%(132/695) vs 9.2%(123/1 338), χ2=40.046], infectious diseases[6.2%(43/695) vs 3.4%(45/1 338), χ2=8.807], brain damage[4.0%(28/695) vs 1.3%(18/1 338), χ2=14.828], and NRDS[2.0%(14/695) vs 0.5%(9/1 338), χ2=7.329], feeding problems [3.2%(22/695) vs 1.5%(20/1 338), χ2=6.271], intracranial hemorrhage [3.2%(22/695) vs 1.3%(17/1 338), χ2=8.684], wet lung [1.7%(12/695) vs 0.5%(7/1 338), χ2=7.049] of the early term infants born at 37-37+6 weeks were all higher than those born at 38-38+6 weeks(all P<0.05). Conclusions Multiple pregnancy, scarred uterus and hypertensive disorder of pregnancy are the three leading perinatal risk factors of early term delivery. The incidence of neonatal complications among early term infants are higher than those among full term infants, and early term infants are more likely to stay in NICU. We should take preventive measures to decrease the rate of early term delivery and improve the follow-up management of early term infants. Key words: Infant, newborn; Infant, premature; Peripartum period; Risk factors; Intensive care units, neonatal; Infant mortality

Effects of comprehensive nursing care on the maternal and neonatal health status of puerperal period

Objective To investigate the effects of comprehensive nursing care on the maternal and neonatal health status ofpuerperal period. Methods 134 cases of maternal accepted comprehensive care which called comprehensive care group; 167 cases received the routine nursing care which called the routine care group. The maternal and neonatal health status of the two groups was compared, and using the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) to evaluate psychological situation of the mothers. The psychological situation was compared. Results The incidence of maternal complications of comprehensive nursing group was 23.13%, which was significantly lower than 40.12% of the routine care group (χ2=9.768, P<0.01). The incidence of neonatal complications of comprehensive nursing group was 31.35%, which was significantly lower than49.71% of the routine care group (χ2=10.318, P<0.01). There was no difference in psychological evaluation of the two groups before hospital. The score of SAS and SDS of the comprehensive nursing group were (40.01±2.33) and (43.17±1.93), which were significantly lower than(47.31±4.33) and (51.63±2.49) of the routine care group (t=8.093, 5.681; P<0.01). Conclusions The comprehensive nursing can reduce maternal and neonatal complications, and can obviously improve the psychological status of patients, which make the comprehensive nursing care a better obstetric nursing mode. Key words: Nursing; Maternal puerperal period; Maternal and neonatal; Complication

Maternal and Fetal Outcomes in Placenta Accreta After Institution of Team-Managed Care

Placenta accreta significantly contributes to maternal morbidity and mortality. We evaluated whether planned delivery and experienced, team-managed surgical intervention results in improved outcomes. We also examined whether risk factors differed for accreta, increta, and percreta and evaluated whether excess lower segment uterine vascularity correlates with disease severity. We retrospectively analyzed patients before versus after institution of a management protocol. Of the 58 044 deliveries over 10 years, there were 67 women whose pregnancies were histopathologically confirmed as placenta accreta, increta, or percreta (1/866). Clinical outcome measures were estimated blood loss (EBL), packed red blood cells (pRBCs) transfused, maternal and fetal complications, intensive care unit admission, and length of stay. There were no maternal or infant deaths. In the managed cohort, EBL was reduced by 48% (P < .001), intraoperative pRBCs transfused by 40% (P < .01), total transfused pRBCs per case by 50% (P < .01), and surgical intensive care unit admissions by >50% (P < .01). Assessment of maternal risk factors by diagnosis revealed marked differences between accreta versus increta and percreta. Clinically assessed excess vascularity of the lower uterine segment correlated with disease severity. The incidence of neonatal complications was similar in both cohorts. Targeted delivery at 34 weeks and team-managed diagnosis, treatment, and care of patients with placenta accreta were associated with improved maternal, but not neonatal outcomes.

Elective Cesarean section at 37 weeks is associated with the higher risk of neonatal complications.

Elective Cesarean section performed before 39 weeks of gestation may be associated with increased risk of neonatal complications. We retrospectively investigated differences in the neonatal complication rate between 684 newborns delivered by elective Cesarean section at 37 weeks of gestation (n = 390) and those delivered by the same procedure at 38 weeks (n = 294) between 2006 and 2012 at our hospital in order to ascertain whether adverse outcomes differ between the groups. Newborns delivered at 37 weeks had a significantly higher incidence of neonatal intensive care unit admission (p = 0.03), adverse respiratory complications (p < 0.01), low birth weight (p < 0.001), and hypoglycemia (p < 0.005) than those delivered at 38 weeks. Compared with normal weight neonates, low birth weight neonates were more likely to have hypoglycemia (p < 0.001). Multivariate logistic regression analysis revealed that an adverse respiratory outcome was independently associated with gestational age (p < 0.01; odds ratio [OR], 3.26; 95% confidence interval [CI], 1.36-7.81), while hypoglycemia was independently associated with birth weight (p < 0.01; OR, 16.34; 95% CI, 7.72-34.56). Respiratory disorders were significantly associated with gestational age even in normal birth weight newborns without any other complications such as hyperbirilubinemia, hypoglycemia or bacterial infections. In conclusion, the incidence of neonatal complications was higher in newborns delivered at 37 weeks of gestation than in those delivered at 38 weeks via elective Cesarean section. Thus, the procedure should be scheduled at 38 weeks to improve neonatal outcomes.

Perinatal Outcomes of Failed Vacuum Extraction

The aims of this study were to compare the perinatal outcomes of successful vacuum extraction (VE) or failed VE and to compare the perinatal outcomes of failed VE followed by forceps delivery (FD) or Cesarean section (CS) from 2000 through 2007. Compared with cases of successful VE, cases of failed VE followed by CS had a significantly higher incidence of neonatal complications, whereas cases of failed VE followed by FD had a significantly higher incidence of maternal injury. Both CS and FD remain important yet distinct treatments for emergency cases of failed VE. Therefore, the decision to use a second instrument (FD) or to proceed to CS should be made in each case on the basis of these differences.

647: Neonatal morbidity and mortality of operative vaginal delivery: a 10-year study of 82,000 infants

vaginal delivery: a 10-year study of 82,000 infants Colin Walsh, Michael Robson, Fionnuala McAuliffe National Maternity Hospital, Maternal-Fetal Medicine, Dublin, Ireland, National Maternity Hospital, Obstetrics and Gynaecology, Dublin, Ireland, UCD Obstetrics and Gynaecology, School of Medicine and Medical Science, Dublin, Ireland OBJECTIVE: To examine the relationship between operative vaginal delivery and early neonatal mortality and morbidity, in a single tertiary maternity unit over a 10-year period. STUDY DESIGN: This is a retrospective analysis of hospital clinical records for the period 2000-2009. All cases of intrapartum fetal and early neonatal ( 7 days) death, and neonatal encephalopathy (NE) occurring in our institution were evaluated. The primary outcome was fetal/ neonatal death secondary to traumatic intracranial hemorrhage (TICH). Secondary outcomes were total peripartum (intrapartum and early neonatal) deaths and rates of NE. RESULTS: Between 2000 and 2009, 82,327 infants 500g were delivered. The overall rate of Cesarean birth was 17% during the study period. Thus, 69,094 infants delivered vaginally, of which 16% (n 10,913) had an operative vaginal delivery (Table 1). We found no difference in the incidence of neonatal complications in forcepsversus vacuum-assisted births (p 0.05 for all outcome measures). The incidence of TICH in infants born by operative vaginal birth (0.27 per 1,000) was not different from those born by Cesarean birth (p 0.20) but was higher than for infants born by spontaneous vaginal birth (p 0.02 Table 1). Infants born by operative vaginal birth had a similar rate of peripartum death (p 0.30), but a higher rate of neonatal encephalopathy (p 0.0001), compared to those born by spontaneous vaginal birth. We found no difference in the incidence of NE in infants born by operative vaginal birth compared to those born by Cesarean birth(p 0.12). CONCLUSION: The incidence of peripartum neonatal death from TICH is low (approximately 3 per 10,000 operative vaginal deliveries) for both forcepsand vacuum-assisted births. Rates of both TICH-related death and total peripartum deaths are similar for both instruments. Although rates of NE were higher in operative versus spontaneous vaginal births, this was mostly related to the indication for delivery rather than the mode of delivery. This is substantiated by a finding of similar rates of NE in operative vaginal and Cesarean births.