Incidence Of Low Apgar Scores Research Articles

Gestational Diabetes Mellitus Does Not Worsen Obstetrical and Neonatal Outcomes of Twin Pregnancy.

The specific effects of gestational diabetes mellitus (GDM) on twin pregnancy outcomes, which are at high risk per se, are unclear. The present study analyzes outcomes of twin pregnancies complicated by GDM (n = 227) by comparing them with GDM singleton pregnancies (n = 1060) and with twin pregnancies without GDM (n = 1008), all followed up at Sant'Anna Hospital, Turin (Italy), between January 2010 and March 2020. The prevalence of GDM among twin pregnancies (n = 1235) was 18.4%. Compared to GDM singletons, GDM twins had higher rates of preeclampsia (aOR 2.0; 95% CI 1.2-3.8), cesarean section (aOR 7.5; 95% CI 5.2-10.8), and neonatal hypoglycemia (aOR 2.5; 95% CI 1.1-5.3). They had a higher incidence of abnormal 2 h OGTT values (aOR 7.1; 95% CI: 3.2-15.7) and were less likely to require insulin therapy (aOR 0.5; 95% CI: 0.3-0.7). In comparison with twin pregnancies without GDM, women with GDM twins were significantly older (35.0 vs. 33.0 years; p < 0.001) and had higher BMI (23.0 versus 22.0 kg/m2; p < 0.001); they had a higher incidence of LGA newborns (aOR 5.3; 95% CI 1.7-14.8), and lower incidence of low APGAR scores (0.5; 95% CI 0.3-0.9). Overall, GDM does not worsen outcomes of twin pregnancy, which is per se at high risk for adverse outcomes.

Risk factors for low Apgar score at 1 minute after birth in very low/extremely low birth weight infants: a retrospective multicenter study

To investigate the risk factors for low Apgar score (≤7) at 1 minute after birth in very low/extremely low birth weight infants. Clinical data of very low/extremely low birth weight infants were retrospectively collected from January 2018 to December 2019 in the multicenter clinical database of the Jiangsu Multicenter Study Collaborative Group for Breastmilk Feeding in Neonatal Intensive Care Units. The infants were divided into two groups: low Apgar score group (Apgar score ≤7) and normal Apgar score group (Apgar score >7) based on the Apgar score at 1 minute after birth. Multivariable logistic regression analysis was used to identify factors associated with low Apgar score at 1 minute after birth. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of relevant indicators for low Apgar score at 1 minute after birth. A total of 1 809 very low/extremely low birth weight infants were included. The incidence of low Apgar score at 1 minute was 52.90% (957/1 809). Multivariable logistic regression analysis showed that older gestational age (OR=0.853, P<0.05) and higher birth weight (OR=0.999, P<0.05) were associated with a lower risk of low Apgar score at 1 minute, while the presence of abnormal amniotic fluid (OR=1.646, P<0.05) and antenatal use of glucocorticoids (OR=0.502, P<0.05) were associated with a higher and lower risk, respectively. ROC curve analysis showed that the combination of gestational age, birth weight, abnormal amniotic fluid, and antenatal use of glucocorticoids had a sensitivity of 0.554 and specificity of 0.680 in predicting low Apgar score at 1 minute. Younger gestational age, lower birth weight, and abnormal amniotic fluid increase the risk of low Apgar score at 1 minute after birth in very low/extremely low birth weight infants, while antenatal use of glucocorticoids can reduce this risk.

Induction of labour with misoprostol in premature rupture of membranes after 34 weeks: Which route is better and at what dose a randomized control trial in a tertiary care hospital

Background: The idea of this study was to evaluate the efficacy and safety of different routes of administration of misoprostol - 50µg oral, 25µg vaginal and 50µg sublingual for induction of labour in women with premature rupture of membranes after 34 weeks of gestation.Design: Randomized controlled trial.Sample: A total of 252 women with premature rupture of membranes after 34 weeks of gestation with indications of induction of labour.Methods: Study was conducted from 01/02/2022 to 31/11/2022, Women admitted to ward with premature rupture of membranes (PROM) after 34 weeks of gestation and requiring induction of labour were randomized into three groups. A total of 252 women participated in the study and were assigned to three groups to receive either 50µg oral misoprostol (n=82) or 25µg vaginal misoprostol (n=85) or 50µg sublingual misoprostol (n=85). The doses were repeated 4 hourly till active labour was established or up to a maximum of 4 doses.Major outcomes: 1.Induction to active labour 2.induction to delivery intervals 3.Delivery modes and 4.fetal outcomes were noted.Results: The mean induction to active labour interval was not significantly different in the three groups (oral vs vaginal vs sublingual- 7.54±4.8 vs 7.77±4.1 h vs 7.68±5.1 h; p=0.92). There was no significant difference in the induction to delivery time interval among the three misoprostol groups (oral vs vaginal vs sublingual – 10.7± 5.5 h vs 11.2±5.0 h vs 11.2±6.4 h; p= 0.88). Spontaneous vaginal delivery rate, instrumental delivery rate and lower segment caesarean section rates were comparable among the three groups. The spontaneous vaginal delivery is more in vaginal group and least in the sublingual group. The oral group is almost equal to the sublingual group in spontaneous delivery. The number of neonates with APGAR score <7 (low APGAR) at 1 minute of birth was highest in sublingual group and lowest in vaginal group which was statistically significant (oral vs vaginal vs sublingual, 16.8% vs 9.4% vs 20%; p= 0. 04). APGAR score <7 at 5 minutes was not significantly different among the three groups (oral vs vaginal vs sublingual, 6.02% vs 3.5% vs 7.05%; p=0.2). This implies that the need for immediate resuscitation was more in the sublingual group. Neonatal intensive care admission was least in the vaginal group although the difference was not statistically significant.Conclusion: 50µg oral misoprostol, 25µg vaginal misoprostol or 50µg sublingual misoprostol for induction of labour after 34 weeks of gestation have equal efficacy for induction of labour in women with spontaneous vaginal delivery is highest in vaginal route. The spontaneous vaginal delivery is more in vaginal route. The sublingual route having slightly higher incidence of low APGAR scores at one minute for the neonate.

Epidemiology and region-specific risk factors for low Apgar scores in China: a nationwide study.

Neonatal asphyxia is a serious public health issue. This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores, an important proxy for neonatal asphyxia, in China from 2015 to 2016. The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24 (out of 34) provinces. Logistic regression analysis was performed to examine the risk factors for a low Apgar score (< 7). Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions. The population attributable risk percentage (PAR%) was calculated for each region-specific risk factor. A total of 72,073 live births, including 320 births with low Apgar scores, were used for the analysis, giving a weighted rate of 3.9/1000 live births. There was a substantial difference in the incidence of low Apgar scores by geographic region, from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China. Maternal and obstetric factors are the major region-specific risk factors. In Southwest China, hypertensive disorders in pregnancy were more important contributors, with PAR% being 74.47%; in North and Northwest China, pre-pregnancy underweight was a more significant factor, with PAR% of 62.92%; in East China, infants born between 0:00 a.m. and 7:59 a.m. were a key factor, with PAR% of 80.44%. Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.

Instruments for assisted vaginal birth.

Instruments for assisted vaginal birth.

Fetal and Maternal Outcome in Preterm Premature Rupture of Membranes (PPROM) at Ain Shams Maternity Hospital: A Retrospective Analysis of Last Five Years Admissions

Abstract Background PPROM is defined as spontaneous rupture of the membranes before the onset of labour prior to 37 weeks gestation. It complicates 2-4% of all singletons and 7-20% of twin pregnancies and is associated with over 60% of preterm births. Aim of the Work to retrospectively compare the neonatal and maternal outcomes in women with preterm prelabor rupture of the membranes (PPROM) who delivered before versus who delivered after 34 weeks of gestation over a 5-year period (between January 2011 and December 2015). Patients and Methods This retrospective case-control study was conducted at Ain Shams University Maternity Hospital. The analysis covered the period between January 2011 and December 2015. The study included all women admitted to Ain Shams University Maternity Hospital during the period between January 2011 and December 2015 with a diagnosis of preterm prelabor rupture of the membranes (PPROM). Results The incidence of chorioamnionitis (p-value &amp;lt;0.001) and maternal sepsis (p-value = 0.001) were both significantly higher in those delivering before 34 weeks. The gestational age at ROM was significantly lower and the latent period was significantly shorter in patients delivering before 34 weeks of gestation (p-values &amp;lt;0.001). The Apgar score at 1 and 5 minutes as well as the birth weight were significantly lower in the group delivering before 34 weeks of gestation (p-values &amp;lt;0.001). The incidence of low Apgar score at 1 and 5 minutes (p-value &amp;lt;0.001 and 0.002, respectively), NEC (p-value = 0.006), IVH (p-value &amp;lt;0.001), RDS (p-value = 0.005) and neonatal death (p-value &amp;lt;0.001) were all significantly higher in patients delivering before 34 weeks of gestation. Conclusion In women with premature preterm rupture of membrane neonatal and maternal outcomes is better in those who delivered after 34 weeks of gestation when compared to those who delivered before 34 weeks of gestation.

The Effects of Incomplete Antenatal Corticosteroid Therapy Prior to Delivery on Clinical Outcomes of Preterm Infants

Objective: To investigate the effect of incomplete antenatal corticosteroid therapy (ACST) prior to delivery on clinical outcomes of preterm infants. Methods: Preterm infants born between 24 0/7 and 33 6/7 weeks of gestation from 2010 through 2016 were included and divided into the three groups according to the ACST; the no ACST group, the incomplete ACST group (inadequate dose of antenatal corticosteroid in pregnancy), and the complete ACST group (recommended dose of antenatal corticosteroid in pregnancy). The effect of risk factors including ACST on clinical outcomes of preterm infants was further explored using logistic regression analysis. Results: Among 198 infants who fulfilled the study criteria, 32 (16.2%) were classified as the no ACST group, 71 (35.9%) as the incomplete ACST group, and 95 (48.0%) as the complete ACST group. The incidence of low Apgar score at 5-minutes (≤4) was significantly higher in the no ACST group than in the complete ACST group (adjusted odds ratio [OR] 4.49; 95% confidence interval [CI] 1.41-14.32; P=0.011). The incidence of necrotizing enterocolitis (NEC, stage ≥2a) was not different between the no ACST group and the incomplete/the complete group, but significantly higher in the incomplete ACST group than in the complete ACST group (adjusted OR 10.49; 95% CI 1.13-97.28; P=0.039). Conclusion: Incomplete ACST within 24 hours prior to delivery appears to significantly increase NEC (stage ≥2a) in preterm infants born between 24 0/7 and 33 6/7 weeks gestation.

Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis

The effects of delayed cord clamping of the umbilical cord in preterm infants are unclear. We sought to compare the effects of delayed vs early cord clamping on hospital mortality (primary outcome) and morbidity in preterm infants using Cochrane Collaboration neonatal review group methodology. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Chinese articles, cross-referencing citations, expert informants, and trial registries to July 31, 2017, for randomized controlled trials of delayed (≥30 seconds) vs early (<30seconds) clamping in infants born <37 weeks' gestation. Before searching the literature, we specified that trials estimated to have cord milking in >20% of infants in any arm would be ineligible. Two reviewers independently selected studies, assessed bias, and extracted data. Relative risk (ie, risk ratio), risk difference, and mean difference with 95% confidence intervals were assessed by fixed effects models, heterogeneity by I2 statistics, and the quality of evidence by Grading of Recommendations, Assessment, Development, and Evaluations. Eighteen randomized controlled trials compared delayed vs early clamping in 2834 infants. Most infants allocated to have delayed clamping were assigned a delay of ≥60 seconds. Delayed clamping reduced hospital mortality (risk ratio, 0.68; 95% confidence interval, 0.52-0.90; risk difference, -0.03; 95% confidence interval, -0.05 to -0.01; P= .005; number needed to benefit, 33; 95% confidence interval, 20-100; Grading of Recommendations, Assessment, Development, and Evaluations= high, with I2= 0 indicating no heterogeneity). In 3 trials in 996 infants ≤28 weeks' gestation, delayed clamping reduced hospital mortality (risk ratio, 0.70; 95% confidence interval, 0.51-0.95; risk difference, -0.05; 95% confidence interval, -0.09 to -0.01; P=.02, number needed to benefit, 20; 95% confidence interval, 11-100; I2= 0). In subgroup analyses, delayed clamping reduced the incidence of low Apgar score at 1 minute, but not at 5 minutes, and did not reduce the incidence of intubation for resuscitation, admission temperature, mechanical ventilation, intraventricular hemorrhage, brain injury, chronic lung disease, patent ductus arteriosus, necrotizing enterocolitis, late onset sepsis or retinopathy of prematurity. Delayed clamping increased peak hematocrit by 2.73 percentage points (95% confidence interval, 1.94-3.52; P < .00001) and reduced the proportion of infants having blood transfusion by 10% (95% confidence interval, 6-13%; P < .00001). Potential harms of delayed clamping included polycythemia and hyperbilirubinemia. This systematic review provides high-quality evidence that delayed clamping reduced hospital mortality, which supports current guidelines recommending delayed clamping in preterm infants. This review does not evaluate cord milking, which may also be of benefit. Analyses of individual patient data in these and other randomized controlled trials will be critically important in reliably evaluating important secondary outcomes.

Adverse perinatal outcomes in borderline amniotic fluid index

Normal amniotic fluid predicts normal placental function, fetal growth and fetal well-being. To determine adverse pregnancy outcomes in borderline amniotic fluid index (AFI). Pregnant women (37-40 wks) with diagnosis of borderline AFI between December 2012 and August 2014 were identified. Antepartum, intrapartum and neonatal data were collected and compared with those of pregnant women with normal AFI. An AFI less than 8 and more than 5 cm was defined for borderline AFI. Pregnancy outcomes included Cesarean section for non-reassuring fetal heart rate, meconium stained amniotic fluid, 5-min Apgar score <7, low birth weight, umbilical cord blood pH at term and NICU admission. Gestational age at delivery in pregnancies with borderline AFI was significantly lower than normal AFI. Cesarean section rate for non-reassuring fetal heart rate in women of borderline AFI was significantly higher and there was an increased incidence of birth weight less than 10th percentile for gestation age in borderline AFI group. Incidence of low Apgar score and low umbilical artery pH in pregnancies with borderline AFI was significantly higher than women with normal AFI. There were no significant difference in the rate of NICU admission and meconium staining in both groups. There are significant differences for adverse pregnancy outcomes , such as Cesarean section due to non-reassuring fetal heart rate, birth weight less than 10th percentile for gestation age, low 5 min Apgar score and low umbilical artery pH between pregnancies with borderline and normal AFI.

Results from the National Perinatal Patient Safety Program in Sweden: the challenge of evaluation.

We studied the effects of the national Perinatal Patient Safety Program in Sweden, addressing local improvement measures, changes in the proportion of low Apgar score and the number of settled injury claims due to asphyxia. Final reports on achieved improvements from all Swedish obstetric units were analyzed and categories of the improvement measures taken in perinatal risk areas were established. Data on all term newborns during 2006-12 were obtained from the Medical Birth Registry. Incidence of 5-min Apgar score <7 was analyzed before, during and after the intervention. The odds ratio for low Apgar score in period ÍII vs. period I was calculated. Patient injury claims from The Swedish National Patient Insurance Company (LÖF) were analyzed. Numerous local improvement initiatives were reported. The incidence of 5-min Apgar score <7 on a national level remained unchanged during the study periods. The units with the highest rate of Apgar score <7 showed a significant decrease in Apgar score of 4-6 after the intervention, whereas units with the lowest rate of Apgar score <7 showed a significant increase in Apgar score <7 after the intervention. A decline in settled claims due to substandard care was observed (7.5%, 2012-14; p for trend 0.049). The national incidence of low Apgar score remained unchanged but a reduction of settled claims of severely asphyxiated neonates was observed. The study highlights the need for robust designs when evaluating large-scale initiatives for improving patient safety at delivery, along with the difficulties in performing them.

Accelerated acidosis in response to variable fetal heart rate decelerations in chronically hypoxic ovine fetuses

Due to limitations of technology, clinicians are typically unable to determine if human fetuses are normoxic or moderately, chronically hypoxic. Risk factors for chronic hypoxia include fetal growth restriction, which is associated with an increased incidence of oligohydramnios and thus a risk for umbilical cord occlusion (UCO) and variable fetal heart rate (FHR) decelerations. At delivery, fetal growth restriction infants (<3rd percentile) have nearly twice the incidence of low Apgar scores and umbilical pH <7.0. Despite the risks of oligohydramnios and intermittent UCO, there is little understanding of the acid/base responses rates of chronically hypoxic fetuses to variable FHR decelerations as might occur during human labor. We sought to compare the increase in base deficit (BD) among chronically hypoxic as compared to normoxic ovine fetuses in response to simulated mild, moderate, and severe variable FHR decelerations. Near-term ovine fetuses were chronically prepared with brachial artery catheters and an inflatable umbilical cuff occluder. Following a recovery period, normoxic (n = 9) and spontaneously hypoxic (n = 5) fetuses were identified (arterial O2 saturation ≤55%). Both animal groups underwent graded, 1-minute occlusions every 2.5 minutes with 1 hour of mild (∼30 beats/min [bpm] decrease from baseline), 1 hour of moderate (∼60 bpm decrease from baseline), and up to 2 hours of severe (∼90 bpm decrease from baseline) variable FHR decelerations until fetal arterial pH reached 7.00, when occlusions were stopped. Repetitive UCO resulted in development of acidosis (pH <7.0) in both groups. Hypoxic and normoxic fetuses demonstrated similar BD increases in response to both mild (0.39, interquartile range [IQR] 0.28-0.45 vs 0.26, IQR 0.01-0.30 mEq/L/10 min, P = .25) and severe (1.97, IQR 1.50-2.43 vs 1.51, IQR 0.97-2.45 mEq/L/10 min, P = .63) variable decelerations. However, moderate variable decelerations increased BD in hypoxic fetuses at 2.5 times the rate of normoxic fetuses (0.97, IQR 0.52-1.72 vs 0.39, IQR 0.23-0.47 mEq/L/10 min, P = .03). During the recovery period, hypoxic fetuses cleared BD slower than normoxic fetuses (0.08 ± 0.02 vs 0.12 ± 0.03 mEq/L/min, P = .02). In comparison to normoxic fetuses, hypoxic fetuses can more rapidly progress to significant metabolic acidosis in response to moderate FHR variable decelerations, and more slowly recover with in utero resuscitation, likely a consequence of impaired placental function and fetal physiologic responses.

Maternal and Neonatal outcomes in mothers who undergo caesarean section under General and spinal Anesthesia in Gandhi Memorial Hospital, Addis Ababa

Background: Types of anesthesia and perioperative patient cares are the main determinants of maternal and neonatal outcomes in mothers undergo caesarean section. Body of evidence revealed that maternal and neonatal outcomes were better in mothers who gave birth under spinal anesthesia than general anesthesia. However evidences are lacking locally, hence, this study aimed to compare maternal and neonatal outcomes in mothers who undergo caesarean section under general anesthesia and spinal anesthesia. Methods: A prospective Cohort study was conducted in Gandhi Memorial Hospital among mothers, who undergo cesarean section under spinal and general anesthesia from March to July, 2014. One hundred and twenty Mothers were followed for twenty four hours period. Statistical Package for Social Sciences version 16 was used to perform descriptive and logistic regression analyses. Statistical significance was set at P-value <0.05 to judge the association. Results: The total response rate of the study was 120 (100 %). The study revealed that types of anesthesia were independent predictor of maternal and neonatal outcomes. Mothers who underwent caesarean section under spinal were more likely to have postoperative nausea and vomiting (COR=38.5, 95% CI=(12,123). Incidence of low Apgar score in first minute was two and half times more likely to occur in general anesthesia, (AOR=2.54, 95% CI=(1.26, 25.4). The first analgesic request in mothers underwent caesarean section under spinal anesthesia was three times more than mothers underwent caesarean section under general anesthesia (AOR=3.4, 95%CI=(1.4, 6.7) Conclusion: Spinal anesthesia was associated with high incidence of postoperative nausea and vomiting and hypotension. But first minute Apgar score and first time analgesic request were better in spinal analgesia. General anesthesia was associated with high estimated blood loss, shorter time to first analgesic request and lower first minute Apgar score. Appropriate perioperative patient care by anesthetist and provision of drugs for treatment of hypotension were recommended.

Consequences of the Term Breech Trial in Denmark

To analyze the consequences of the handling of breech presentation in Denmark after publication of the Term Breech Trial (TBT). Population-based retrospective cohort study. Data from the National Birth Registry and discharge letters from cases with perinatal death. Population. Singleton breech fetuses at term and alive at onset of labor delivered between 1997 and 2008 (n=23 789). Outcomes before and after publication of TBT were compared and analyzed by planned mode of delivery. Cesarean section, intrapartum or early neonatal mortality in infants without lethal congenital malformations, Apgar score ≤ 6 at five minutes and admittance to neonatal intensive care unit (NICU) for four days or more. The rate of cesarean section increased from 79.6 to 94.2%. Intrapartum or early neonatal mortality was reduced from 0.13 to 0.05%[relative risk (RR) 0.38 (95% confidence intervals (CI) 0.15-0.98)]. The incidence of low Apgar scores declined from 1.0 to 0.6%[RR 0.83 (95%CI 0.73-0.95)] and admission to NICU from 4.2 to 3.2%[RR 0.92 (95%CI 0.87-0.97)]. Planned vaginal delivery was associated with an increased risk of mortality, low Apgar score and admission to NICU throughout the period. Reduction in the rate of vaginal delivery was correlated with a significant reduction in rates of intrapartum or early neonatal mortality and morbidity, but at a much lower level than reported in the Term Breech Trial. The lower rate of vaginal delivery, indicating a strict selection of women, did not reduce the relative risks of complications during a planned vaginal delivery.

Trends in live births in the past 20 years in Zhengzhou, China

To evaluate changing trends in neonatal births and deaths in a provincial women's and children's hospital over the past 20 years. Retrospective longitudinal study. Henan Provincial Women's and Children's Hospital, China. Live births in Henan Provincial Women's and Children's Hospital from January 1987 to December 2006. Data was stratified by sex, birth weight, delivery type, maternal age, gestational age, and single or multiple births. The incidence of low Apgar scores and neonatal death was calculated for each fiscal year. Trends in the fundamental status of hospital-born live births and risk factors for neonatal death. 26 760 hospital live births were included. The ratio of males to females was 1.16:1. The mean gestational age decreased from 39.5±1.4 weeks to 38.4±2.5 weeks (p <0.001) and multiple births increased from 1.5 to 7.3% (p<0.001). The proportion of preterm births increased from 4.7 to 18.9% (p<0.001), maternal age increased from 25.9±3.7 years to 29.0±4.4 years (p<0.001), and cesarean deliveries increased from 23.7 to 65.5% (p<0.001). The incidence of low Apgar scores decreased from 12.9 to 1.1% (p<0.001). The incidence of neonatal death was 8.5/1 000 live births, with preterm births and low Apgar scores accounting for 72.8 and 16.2% of all neonatal deaths, respectively. Preterm births, multiple births, and cesarean deliveries increased dramatically. Preterm birth is the leading cause of neonatal death.

Risk Factors for Hearing Loss in Very Low Birth Weight Infants: Results of Hearing Test in Infants

Purpose: An association between very low birth weight infants(VLBWI) and hearing loss has long been recognized. Early identification and intervention for hearing loss benefits language and speech/cognitive development. We investigated the risk factors and clinical outcomes of hearing loss among VLBWI. Methods: We analyzed the results of auditory brainstem response (ABR) testing of VLBWI. These infants were admitted to the neonatal intensive care unit (NICU) of Pusan National University Yangsan Hospital between December 2008 and February 2011. A follow-up was conducted subsequently. Results: ABR evaluations were performed on 65 infants, and 31 showed abnormal results (47.7%). Among the 31 infants, 10 were classified with moderate/severe/profound hearing loss (15.4%). The infants with abnormal ABR had a higher incidence of low birth weight, prolonged ventilator care, cumulative dose of furosemide, and the lowest PaO2 (P<0.05). Those with moderate/severe/profound hearing loss had a higher incidence of low Apgar scores at 5 minutes (odds ratio[OR],0.34; 95% confidence interval[CI],0.13-0.89), prolonged ventilator care (OR,1.06; 95% CI,1.01-1.12), and mild hearing loss compared to those without profound hearing loss. Follow-up evaluations on eight infants with ABR reveled improvements 5.6±3.9 months later. One infant, who had profound hearing loss in both ears, used a hearing aid. Conclusion: Factors influencing hearing loss at the first VLBWI hearing screening test included lower Apgar scores at 5 min and prolonged use of a ventilator. Most VLBWI with hearing losses were expected to recover after several months of follow-up.

Singleton preterm births in Korle bu teaching hospital, Accra, Ghana – origins and outcomes

To determine the singleton preterm birth rate, the relative proportions of the clinical categories of preterm births and to compare the outcomes in these categories. Department of Obstetrics & Gynaecology, Korle Bu Teaching Hospital. Preterm births from 1(st) July to 31(st) December 2003. Out of a total of 4731 singleton births 440 were preterm, giving a preterm birth rate of 9.3%. One hundred and eighty-five (42%, [95% Confidence Interval (CI) 37.4%, 46.8%]) preterm births followed spontaneous onset of preterm labour (group A), 82 (18.6%, [95% CI 15.2%, 22.7%]) followed preterm premature rupture of membranes, PPROM (group B) and 173 (39.3%, [95% CI 34.8%, 44.1%]) were medically indicated (group C). The commonest indication for delivery in group C was severe pre-eclampsia/eclampsia. Although there was no significant difference in the mean gestational ages at delivery between the groups, babies in group C had significantly lower birth weights. No differences in sex ratios, still-birth rates, or incidence of low Apgar scores were found. Babies in group C were significantly more likely to be admitted to the neonatal intensive care unit (NICU) and had a significantly higher perinatal death rate. Survivors of NICU admission among group C babies spent significantly longer periods in hospital before discharge. Outcomes of preterm births in Korle Bu Teaching Hospital are less favourable among indicated preterm births than among spontaneous or PPROM-related preterm births. A detailed study of the causes of neonatal morbidity and mortality is suggested to determine any differences between the three groups.

Obstetric outcomes of low-risk labors at ‘Japanese tatami’ mat delivery room: a preliminary study

We examined the obstetric outcomes of low-risk labors at the 'Japanese tatami' mat compared with Western-style delivery room. A retrospective cohort study was performed on 201 deliveries at the 'Japanese tatami' delivery room and 360 deliveries at the standard Western-style delivery room. There were no measurable differences in the duration of labor, the incidence of perineal laceration, total maternal blood loss and the incidence of low Apgar score and umbilical artery pH between the two groups. We found no evidence that the Japanese room is unsafe for low-risk infants and mothers in comparison with the standard Western-style delivery room.

Maternal and fetal outcomes in grand multiparous women

The goal was to examine the influence of grand multiparity on the fetal and maternal outcome. The medical records of women delivered in Clinical Hospital Rijeka during seven years period were analyzed and divided into two study groups: grand multiparous women, (five or more infants), and women having given birth to three to four infants. The socio-economic parameters, frequency of pregnancy and labor complications as fetal outcome were compared between groups. The statistical analysis was done by chi square test, p<0.05. There were 22504 deliveries and 107 (0.47%) were in the grand multiparas group and 2745 (12.19%) in the control group. Cesarean section rate was significantly higher in the grand multiparas group (13.08 % vs 8.19 %). The neonatal outcome in the grand multiparas group indicated a significantly higher incidence of low Apgar score, and higher fetal mortality rate. Grand multiparity is linked with low socioeconomic status. Higher fetal mortality rate is a result of parity's interrelationship with social class factors and not parity per se.

Pregnancy Outcomes Among HIV-Infected Women Undergoing Antiretroviral Therapy

Background:The use of antiretroviral drugs (ARV) to prevent mother-to-child HIV transmission (PMTCT) promises to be effective. However, limited data on the adverse effects of ARV among pregnant women and pregnancy outcomes have been reported in clinical practice.Objectives:This study aimed to assess adverse effects and outcomes among pregnant HIV-infected women receiving antiretroviral drugs for either antiretroviral therapy (ART) or PMTCT.Study Design:This cohort study was at Chonburi Hospital, Thailand, in 2002-2006.Results:A total of 246 pregnant HIV-infected women with the median age (range) of 27 (16-41) years were included in this study. ART was initiated in 16.3% for treatment during ANC, 66.7% for PMTCT during ANC, and 17.1% for PMTCT in labor. Adverse effects, especially anemia, were significantly associated with continuing combined ART in pregnancy (p<0.001). 88.9% delivered normal-term neonates. The prevalence of pre-term delivery was 10.2%. Overall, 24 adverse events from 21 pregnant women (8.5%) were noted. A significantly higher prevalence of pre-term delivery was noted in the groups continuing combined ART, or initiating of PMTCT during labor rather than ANC (p=0.02). The incidence of low Apgar scores was 3.6%, and these were associated with initiation of PMTCT during labor (p=0.004).Conclusion:Adverse ARV events were more numerous among the pregnant women who needed ART than PMTCT. ANC is beneficial and strongly recommended for all pregnant HIV-infected women for better pregnancy outcomes.

Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid

Objective To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care. Materials and methods In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter. Results Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (< 7) at 1 min (12% vs. 47%; relative risk [RR], 0.26; 95% confidence interval [CI], 0.12–0.56); low Apgar score at 5 min (4% vs. 23%; RR, 0.17; 95% CI, 0.04–0.71); and meconium aspiration syndrome (4% vs. 18%; RR, 0.22; 95% CI, 0.05–0.92). There was also a trend towards a lesser incidence of cesarean deliveries (18% vs. 30%; RR, 0.6; 95% CI, 0.31–1.16) and perinatal deaths (4% vs. 13%; RR, 0.31; 95% CI, 0.07–1.31). The incidence of maternal hospital stays longer than 3 days was significantly lower in the amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29–0.85). There were no major complications related to amnioinfusion. Conclusions Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.