Labor Monitoring Research Articles

899 Glucose Monitoring in Labor: Does the Frequency Matter?

899 Glucose Monitoring in Labor: Does the Frequency Matter?

Risk Factors for Birth Asphyxia in Hospital-Delivered Newborns in Dodoma, Tanzania: A Case-Control Study.

Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from country to country, early identification and treatment of risk factors can improve the situation. To determine the risk factors of birth asphyxia in hospital-delivered neonates in Dodoma, Tanzania. A matched case-control study was conducted from May to July 2017 at Dodoma Region Referral Hospital. Data were collected using a semistructured questionnaire and a standard antenatal care index card. Cases were neonates diagnosed with asphyxia at birth (N = 100), while controls were neonates not diagnosed with asphyxia at birth (N = 300). A binary logistic regression model was used to assess the independent variables associated with birth asphyxia and reported as crude and adjusted odds ratios along with their 95% confidence intervals. A total of 400 newborns and their birth mothers were involved in the study. The average age of the case mothers was 26.9 years (SD = 7.85) and that of the control mothers was 27.24 years (SD = 6.08). Place of residence, anemia, maternal age, prenatal visits attended, use of herbs during labor, previously complicated pregnancy, duration of labor, meconium-stained amniotic fluid, and mode of delivery were predictors of birth asphyxia. The study showed that most predictors of birth asphyxia can be prevented. The results suggest appropriate health education before conception, effective follow-up through prenatal care, early identification and treatment of high-risk pregnant women, and proper monitoring of labor and delivery.

Comparing labour induction outcomes using misoprostol and dinoprostone in term pregnancies: A retrospective study at Kiambu Level 5 Hospital between 2018 and 2020.

The Maternal and Perinatal Death Surveillance and Response (MPDSR) was introduced in Kenya in 2016 and implemented at Kiambu Level 5 Hospital (KL5H) three years later in 2019. During a routine MPDSR meeting at KL5H, committee members identified a possible link between the off-label use of 200mcg misoprostol tablets divided eight times to achieve the necessary dose for labour induction (25mcg) and maternal deaths. Following this, an administrative decision was made to switch from misoprostol to dinoprostone for the induction of labour in June of 2019. This study aimed to assess the overall impact of MPDSR as well as the effect of replacing misoprostol with dinoprostone on uterine rupture, maternal and neonatal deaths at KL5H. We conducted a retrospective cohort study of women who gave birth at KL5H between January 2018 and December 2020. We defined the pre-intervention period as January 2018-June 2019, and the intervention period as July 2019-December 2020. We randomly selected the records of 411 mothers, 167 from the pre-intervention period and 208 from the intervention period, all of whom were induced. We used Bayes-Poisson Generalised Linear Models to fit the risk of uterine rupture, maternal and perinatal death. 12 semi-structured key person questionnaires was used to describe staff perspectives regarding the switch from misoprostol to dinoprostone. Inductive and deductive data analysis was done to capture the salient emerging themes. We reviewed 411 patient records and carried out 12 key informant interviews. Mothers induced with misoprostol (IRR = 3.89; CI = 0.21-71.6) had an increased risk of death while mothers were less likely to die if they were induced with dinoprostone (IRR = 0.23; CI = 0.01-7.12) or had uterine rupture (IRR = 0.56; CI = 0.02-18.2). The risk of dying during childbearing increased during Jul 2019-Dec 2020 (IRR = 5.43, CI = 0.68-43.2) when the MPDSR activities were strengthened. Induction of labour (IRR = 1.01; CI = 0.06-17.1) had no effect on the risk of dying from childbirth in our setting. The qualitative results exposed that maternity unit staff preferred dinoprostone to misoprostol as it was thought to be more effective (fewer failed inductions) and safer, regardless of being more expensive compared to misoprostol. While the period immediately following the implementation of MPDSR at KL5H was associated with an increased risk of death, the switch to dinoprostone for labour induction was associated with a lower risk of maternal and perinatal death. The use of dinoprostone, however, was linked to an increased risk of uterine rupture, possibly attributed to reduced labour monitoring given that staff held the belief that it is inherently safer than misoprostol. Consequently, even though the changeover was warranted, further investigation is needed to determine the reasons behind the rise in maternal mortalities, even though the MPDSR framework appeared to have been put in place to quell such an increase.

Analysis of Cesarean Section using Robsons classification at Teaching Hospital of Eastern Nepal

Introduction: Cesarean section is an operative procedure for delivery of fetus and placenta by making an incision over abdomen and uterus after period of viability. Aims: The aim of study is to analyze rate of cesarean section and perform an analysis based on Robsons ten group classification. Methods: A cross sectional study was conducted at Department of Obstetrics and Gynecology of a teaching hospital of eastern Nepal, over a period of one year from October 2022 to September 2023. All details regarding demography, obstetric history, medical history, labor status, indication of cesarean section, etc. were collected. Then all pregnant ladies were assigned to one of Robsons ten group classification systems and recorded into labor confinement book. The statistical analysis was performed using Statistical Package for Social Sciences version 21. Descriptive statistical tools were used to express the results. All tests were done with a significance level of 5% (p-value <0.05) and 95% confidence Interval. Results: The overall rate of cesarean section was 1,829(46.93%). Majority 1323(72.30%) were in age group 20-30 years. Maximum 1,629(89.10%) delivered at>37 weeks of gestation. Majority 789(43.10%) of cases had lower segment cesarean section because of previous cesarean delivery. According to Robsons classification system, Group 5 has highest cesarean section rate 725 (39.60%) followed by Group 2(A+B), 334(18.21%). Conclusion: Implementing Robsons Ten Group Classification System at our setting has helped us to identify major contributor of overall cesarean section rate. Group 5 was at top followed by group 2. Thus with adequate trial of labor after cesarean, proper labor monitoring and judicious use of induction protocol can significantly reduce rate of cesarean section.

Implementing quality-of-care during labour, childbirth, and early postnatal care, northeast Namibia: a quasi-experimental study

Background Attention to quality-of-care is increasing in low- and-middle-income countries. Nevertheless, few studies exist on the impact of these approaches to caregiving. This paper presents results on the quality-of-care mothers and neonates receive during labour, childbirth, and early postnatal care, pre-and-post-implementation of the World Health Organization/United Nations Children’s Fund/United Population Fund (WHO/UNICEF/UNFPA) quality improvement interventions. Methods A quasi-experimental study design was used to assess the quality-of-care measures/interventions around childbirth and the immediate postnatal care period; we purposively sampled a high-volume hospital, northeast Namibia. Using the Every Mother Every Newborn (EMEN) childbirth quantitative survey questionnaire, we interviewed (pre=100; post=102) women who delivered prior to their discharge home and observed (pre=53; post=60) different women at admission, of which 19 of 53 and 50 of 60, respectively, progressed to deliver on the same day of data collection. Twenty (pre) and 24 (post) staff, and one facility manager (pre-and-post) were also interviewed. Descriptive statistics were used to present results. Results Postintervention, we found improvements in most assessed quality-of-care measures/interventions, e.g., thorough drying (94.7-100%), babies placed skin-to-skin with their mothers (89.5-98%) and assessed for resuscitation (69.8-98%) needs. Monitoring labour using partograph remained low (11.3-19.3%). During admission, women’s history taking (75.5-95%), blood pressure (98.1%-100%), urine testing (77.4-93.3%), foetal heart rate (94.3-100%), abdominal (86.8-100%) and vaginal examinations (96.2-100%) all improved. Yet, quality-of-care gaps were identified for labour monitoring, and routine postnatal care. Less 50% of women received counselling on family planning (5.3-42%), postnatal care (5.3-40%), maternal (0-38%) and newborn (0-40%) danger signs. Women’s satisfaction with information on breastfeeding and post-partum care and hygiene was 48-56.9% and 41-43.0% respectively. Conclusions This is the first study in Namibia to assess pre-and-post implementation of quality-of-care practices around childbirth, and postnatal period. Inconsistency and noteworthy quality-of-care gaps exist in the early postnatal care period. Postnatal care management and interpersonal communication skills trainings are likely to improve and sustain high evidence-based care beyond labour and delivery. The poor quality-of-care practices for labour and postnatal care requires further investigation.

UTILITY OF PAPERLESS PARTOGRAM IN LABOR MANAGEMENT

Objective: To compare WHO-modified partograph and paperless partogram in the effective management of labor. Methods: A prospective analytical study was carried out in the Department of Obstetrics and Gynecology, Pannadhay Zanana Hospital at RNT Medical College, Udaipur. A sample of 400 pregnant women was recruited by random sampling from the labor room, for 1 year (June 01, 2021, to May 31, 2022). Women fulfilling inclusion criteria were randomly assigned for monitoring of labor in an active phase of labor ≥ 4 cm of cervical dilatation. Results: The mean age was 26.46 ± 3.90 years with an age range of 18–37 years, 65% were rural. 11% crossed alert line and 1.5% crossed action line. 94.75% had a normal vaginal delivery and 21 (5.25%) cases had lower segment cesarean section (LSCS). As indication for LSCS 16 (76.19%) had fetal distress and 5 (23.81%) had secondary arrest of dilatation and descent head. 17 (4.25%) had APGAR <7 at 5 min and no stillbirth was reported. Conclusion: We concluded that the paperless partogram was effective and user-friendly in the management of labor and prevention of abnormal or prolonged labor when compared to the WHO partogram in low-risk cases.

Factors Associated with Maternal Near-Miss (MNM) Among Women in Eastern Province, Rwanda

The World Health Organization (WHO) defines Maternal Near-Miss (MNM) as a situation where a woman nearly dies but survives a life-threatening condition during pregnancy and childbirth. Maternal mortality rate, used to gauge obstetric care quality globally, can aid in achieving the SDG target 3.1, which aims to lower the global maternal mortality ratio below 70 per 100,000 live births. A retrospective cross-sectional design was employed to assess the prevalence and factors associated with MNM at Kirehe District Hospital in Rwanda. 350 women admitted to the hospital's maternity units from January to December 2020 were sampled. Data from patients' medical records was extracted, focusing on demographics, MNM characteristics based on WHO criteria, and clinical outcomes. Statistical analysis was performed with SPSS version 21. Women aged 20-29 constituted the majority, primarily with primary education and working in agriculture. From the 350, 6.3% encountered severe postpartum haemorrhage, 3.1% severe preeclampsia, and 2% uterine rupture. 53.7% underwent cesarean section, 38.9% had vaginal deliveries, and 4.9% experienced abortion. The MNM prevalence for 2020 was 10.2%. Age and marital status correlated with MNM; younger, married, or widowed women exhibited higher MNM rates. Among maternal factors, only labor duration significantly related to MNM. The MNM rate at Kirehe District Hospital remains a concern. Cesarean section was predominant. Age and marital status played pivotal roles in MNM occurrences. Access to enhanced maternal healthcare and improved labor monitoring can mitigate severe complications.

Monitoring of pregnancy and labour by cardiotocography: 155 cases from the maternity ward of the institut hygiène sociale Hospital in Dakar

Objectives: To determine the epidemiological and clinical profile of patients monitored by cardiotocography, to assess the performance of the device in detecting labour abnormalities and to identify factors influencing the results of cardiotocography. Patients and methods: We conducted a retrospective, descriptive and analytical study of labour monitoring and pathological pregnancies using the cardiotocograph at the Maternity Unit of the Institut Hygiène Sociale hospital in Dakar over a two-year period from 1 January 2019 to 31 December 2020. All cardiotocographic tracings were subject to a 2nd blind interpretation by a senior. The results were interpreted using the 2007 classification of the Collège National des Gynécologues et Obstétriciens Français (CNGOF). An APGAR score of less than 7 at 1 minute was defined as neonatal asphyxia. Data were collected from the patients' records and entered on a computerised form. Data analysis was performed using SPSS version 22 software. Results: During the study period, 208 patients were monitored with the cardiotocograph out of a total of 4123 deliveries, i.e. a frequency of use of 5%. Of these, 155 were included in the study (74.5%). These included 118 parturients (76.1%) and 37 pathological pregnancies (23.9%). The epidemiological profile of the patients was that of a woman aged 28 years on average, of low socio-economic status (83.2%), paucigest (48.4%), pauciparous (46.5%), carrying a full-term pregnancy (67.7%) and living outside the South District (72.3%). Ninety-seven FHR tracings contained abnormalities (62.2%). These included 47 pathological FHR tracings (30.1%) and 50 FHR tracings at intermediate risk of acidosis (32.1%). The basic rhythm was most often normal (87.2%). The abnormalities found were bradycardia (4.5%), tachycardia (7.7%) and absent rhythm (0.6%). Variability was mostly normal (78.9%). However, it was reduced in 12.2% of cases. Fifty tracings showed accelerations (32.1%) and decelerations were noted in 49 foetuses (31.4%). These were most often early (16%) or late (7.1%) decelerations. Tocography was mostly normal (60%). The abnormalities noted were dominated by hypertonia (11.7%) followed by hyperkinesia of intensity (7.7%). The majority of patients (54.8%) had given birth by caesarean section and the indications were dominated by the non-reassuring state of the foetus (69.4%). Most of the newborns had an APGAR score greater than 7 at 1 minute (82.7%) and 5 minutes (91.7%). Comparison of the results of the ERCF with the neonatal status revealed 20 true positives, 7 false negatives, 27 false positives and 102 true negatives, giving the ERCF a sensitivity of 74.1%, a specificity of 79.1%, a positive predictive value of 42.1% and a negative predictive value of 93.6% for the diagnosis of non-reassuring foetal status. A bivariate analysis enabled us to identify factors associated with the occurrence of perinatal asphyxia. Basic rhythm abnormalities (p = 0.001) and variability (p = 0.004), hypertension in the pregnant woman (p = 0.034), premature rupture of the membranes of more than 6 hours (p = 0.044) and intrauterine growth retardation (p = 0.013) were significantly associated with the risk of neonatal asphyxia. Conclusion: Cardiotocography is a powerful tool for monitoring labour, but its effectiveness is influenced by the conditions in which it is performed and the qualifications of the operator.

Outborn newborns drive birth asphyxia mortality rates—An 8 year analysis at a rural level two nursery in Uganda

Birth asphyxia is a leading cause of global neonatal mortality. Most cases occur in low- and middle- income countries and contribute to half of neonatal deaths in Uganda. Improved understanding of the risk factors associated with mortality among these patients is needed. We performed a retrospective cohort study of a clinical database and report maternal demographics, clinical characteristics and outcomes from neonates with birth asphyxia at a Ugandan level two unit from 2014 through 2021. “Inborn” patients were born at the hospital studied and “outborn” were born at another facility or home and then admitted to the hospital studied. Doctors assigned the patient’s primary diagnosis at death or discharge. We performed a Poisson model regression of factors associated with mortality among patients with asphyxia. The study included 1,565 patients with birth asphyxia and the proportion who were outborn rose from 26% to 71% over eight years. Mortality in asphyxiated patients increased over the same period from 9% to 27%. Factors independently associated with increased death included outborn birth location (ARR 2.1, p<0.001), admission in the year 2020 (ARR 2.4, p<0.05) and admission respiratory rate below 30bpm (RR 3.9, p<0.001), oxygen saturation <90% (ARR 2.0, p<0.001) and blood sugar >8.3 mmol/L (RR 1.7, p<0.05). Conversely, a respiratory rate >60bpm was protective against death (ARR 0.6, p<0.05). Increased birth asphyxia mortality at this referral unit was associated with increasing admission of outborn patients. Patients born at another facility and transferred face unique challenges. Increased capacity building at lower-level birth facilities could include improved staffing, training and equipment for labor monitoring and newborn resuscitation as well as training on the timely identification of newborns with birth asphyxia and resources for transfer. These changes may reduce incidence of birth asphyxia, improve outcomes among birth asphyxia patients and help meet global targets for newborn mortality.

“Normal in all the rush”: A phenomenological study analyzing midwifery students' views on obstetric violence

IntroductionIn recent years, obstetric violence, which undermines women's dignity and autonomy, has received increased attention worldwide. Considering the importance of midwives in combating violence in the obstetric field and the significance of the discussed issue, the following question arises: How do future midwives view obstetric violence? ObjectiveThis study aimed to investigate midwifery students' thoughts about obstetric violence. Design and methodThis study was conducted using a phenomenological qualitative research design. This study, which adopted a descriptive approach and used typical case sampling, was conducted in the midwifery department of the Kutahya Health Sciences University. Sixteen midwifery students studying fourth-year in the 2018–2019 academic year, who had participated in childbirth during their studies, and who agreed to participate in the study were included. All students had the experience of repeated monitoring and presence in labor. They had witnessed births in different institutions. Focus group interviews were conducted using an unstructured interview guide to obtain data for the study. Data were collected through four focus group interviews with groups of four students in the classroom environment. The data were evaluated separately by two researchers using the content analysis method in MAXQDA Analytics Pro 2020. The Consolidated Criteria for Reporting Qualitative Studies guidelines were used as a guide in reporting. ResultsAs a result of the analysis, four main themes emerged: defining violence, causes of violence, effects of witnessing violence, and whether can violence be prevented? ConclusionsMidwifery students have an awareness of all visible forms of obstetric violence. However, they were less aware of the invisible structural and policy drivers of obstetric violence. It is invaluable to raise awareness of obstetric violence among midwifery students, who will be the most important defenders of women in childbirth. Studies focused on education and policy will contribute to women receiving quality care at birth.

EP25.29: Place of ultrasound monitoring during labour monitoring

EP25.29: Place of ultrasound monitoring during labour monitoring

Post-Caesarean Bacterial Infections at the Reference Health Center of Commune I of Bamako, Mali Sylla Yacouba, Keita Mahamadou, Diarra Issaka, Diarra Salif, Dicko Modibo, Koné Diakaridia, Keita

Caesarean section is not a harmless procedure, as it can be complicated by infections. Postoperative caesarean section infections remain a public health problem because of their high frequency, the cost of treating them and their seriousness. Aim: The aim of this study was to determine the frequency, risk factors and germs responsible for post-caesarean section surgical site infections in the obstetrics and gynaecology department of the commune I referral health centre in Bamako. Materials and methods: We conducted a cross-sectional, descriptive and analytical study over a 12-month period from 1er January to 31 December 2019. All women who underwent caesarean delivery in the department during the study period were included. Results: Out of 9158 deliveries we recorded́1793 caesarean sections, i.e. 19.58%. Among the 1793 cases of caesarean section we recorded 50 cases of surgical site infection or 2.78%. Long labour was the most common infectious risk factor (46%). The germs found were Escherichia coli, staphylococcus aureus, streptococcus agalactiaes, proteus mirabilis and proteus vulgaris. Conclusion: Bacterial infections of the post-caesarean surgical site are frequent in our department. Better antenatal care and adequate monitoring of labour, combined with compliance with infection prevention rules, can help to significantly reduce these post-caesarean complications.

The Role of Multi National Cooperation (MNC) in Developing Countries Case Study : “Ferrero Group's Influence on Enhancement Cocoa Farms in Côte d'Ivoire”

This article will discuss Ferrero Group's influence on the enhancement of agricultural cocoa in Côte d'Ivoire. Using the objective qualitative method to know how far that influence has been awarded the Ferrero Group to the Côte d'Ivoire country in agriculture cocoa. Côte d'Ivoire is a developing country that can say it still lacks knowledge in agriculture even though 40% of world cocoa comes from Côte d'Ivoire. Respond matter this is the Ferrero Group initiative to empower farmers' existing chocolate with three main pillars, namely: 1). Increase the level of life for farmers and communities 2). Protect the right of children 3). Protect natural capital. Through the Cocoa Horizons program, Ferrero Farming Values return the right child, agroforestry, and against deforestation. Through its programs, the Ferrero Group is capable of pushing agriculture Côte d'Ivoire cocoa by providing knowledge transfer and technology transfer to optimize agriculture cocoa. Ferrero also delivers education for the public will haka children for learning and play through the Ferrero Hazelnut Company Child Labor Monitoring & Remediation System. As well as building sustainable agriculture without damage natural through agroforestry and against deforestation. Keywords: Cocoa Agroforestry, Cocoa Horizons, Deforestation, Ferrero Farming Values.

Determinants of Birth Asphyxia among Newborn in a Zonal Hospital

Background & Objective: Birth asphyxia is a leading cause of brain damage. Early identification and managing of its contributing factor would change the burden of birth asphyxia. Therefore, the objective of this study was to identify the determinants of birth asphyxia among newborn in a zonal hospital, Dhanusha, Nepal. Material and Methods: A case control study was carried out among 192 newborns where cases and controls were taken in the ratio of 1:1. Newborns with an APGAR score of less than 7 at 1 min and 5 min were taken as cases, and those with greater or equal to 7 were taken as controls. Case includes all asphyxiated newborns at time of data collection. There were total 96 birth asphyxiated newborn and equal number of non-asphyxiated newborn meeting the inclusion criteria were included as a control group. Data was collected by using structured interview schedule and chart review. The data was entered into SPSS version 16. The data were analyzed by frequency, percentage, mean, standard deviation, chi-square test and odd ratio. Those variables with a p-value <0.05 were identified as significant determinants of birth asphyxia. Results: Findings revealed that rural residency (79.2%), dalit ethnicity (69.6%) and joint family (92.7%) were socio-demographic determinants of birth asphyxia. Finding also revealed that primi-parity (OR:3.2,95%CI:1.7-8.2),problem during pregnancy(OR:3.1,95%CI:1.5-6.6), premature rupture of membrane (OR:23.4, 95%CI: 8.7-62.7), augmentation of labour with oxytocin (OR:12.3, 95%CI:6.1-24.4), sex of newborn (OR:5.0, 95%CI;2.7-9.4), meconium stained amniotic fluid (OR:0.22,95%CI:0.00-0.05), cord round the neck (OR:19.0,95%CI:2.4-24.6) and height of mother (OR:16.2,95% CI:2.0-126.0) were significantly associated with increase odds of birth asphyxia. Conclusion: Most of the identified determinants were common and familiar causes of birth asphyxia. Early detection can prevent and control birth asphyxia. Thus, every pregnant woman need for better maternal care, so creating awareness about determining factors of birth asphyxia to the midwives, careful monitoring of labour, and identifying and taking proper measures that would help in decreasing the occurrence of birth asphyxia.

Causes of Neonatal Morbidity and Mortality in Bingham University Teaching Hospital, Jos, Plateau State, Nigeria

Introduction: Neonatal morbidity and mortality continue to be serious public health issues in developing countries, where it also has a considerable impact on the under-five mortality rate.
 Aims: To determine the causes of morbidity and mortality in neonates admitted to the inborn Special Care Baby Unit (SCBU) at Bingham University Teaching Hospital (BHUTH), Jos.
 Study Design: Cross Sectional Descriptive study.
 Place and Duration of Study: Inborn Neonatology Unit of the Department of Paediatrics, Bingham University teaching Hospital, Jos, Plateau State, Nigeria.
 Methodology: A retrospective analysis of the records of all the babies admitted into the inborn SCBU of BHUTH over an 18-month period of January 2021 to June 2022 was done. We included 195 babies (99 males, 96 females)
 Results: A total of 196 patients were admitted into the inborn SCBU of BHUTH during the period reviewed and 195 (99.5%) had complete records. There were 99 (50.8%) males and 96 (49.2%) females with M: F of 1.03:1. The leading causes of admission were prematurity (51.3%), asphyxia (21.5%) and neonatal jaundice (10.8%). Nine (4.6%) infants had severe birth asphyxia, while 33 (16.9%) had moderate birth asphyxia. Twenty-eight deaths were recorded over the 18-month period giving a mortality rate of 14.4%. Prematurity (71.4%) and severe birth asphyxia (17.9%) were the leading causes of death. Of all the deaths that occurred, 9 (32.1%) occurred within the first 24 hours of hospitalization, while 3 (10.7%) of them died after 7 days of admission.
 Conclusion: In our community, the neonatal mortality rate is still very high. This death rate can be decreased with the support of concerted efforts to guarantee appropriate antenatal care, close monitoring of labour, and enhanced neonatal unit facilities for newborn care.

Establishment of a nomogram model to predict the risk of macrosomia in patients with gestational diabetes mellitus

Background To establish and verify a nomogram model that can predict the risk of macrosomia in patients with gestational diabetes mellitus (GDM). Methods Data of patients with GDM who delivered their babies in Shanxi Bethune Hospital between November 2020 and February 2022 were analyzed. Multifactor logistic regression analysis was used to screen the independent risk factors for macrosomia. The model was constructed by R software. The area under the receiver operating characteristic curve (AUC) and goodness-of-fit analysis were used to evaluate its efficiency and accuracy. The clinical application value was evaluated using the decision curve analysis (DCA). Results A total of 991 patients with GDM were enrolled for modeling. Multigravida, pre-pregnancy body mass index, family history of hypertension, abdominal circumference, and biparietal diameter were independent risk factors for macrosomia, and the prediction model was established. The AUC in the training and test set were 0.93 (0.89–0.97) and 0.90 (0.84–0.96), respectively, and the difference was not statistically significant. The DCA suggested that the model has a high clinical application value. Conclusion The nomogram model for predicting macrosomia in patients with GDM was established. The model has certain accuracy and is expected to be a quantitative tool to guide clinical decision of delivery timing, individualized labor monitoring, and delivery mode.

Heterogeneity in management of category II fetal tracings: data from a multihospital healthcare system

Electronic fetal monitoring is widely used to identify and intervene in suspected fetal hypoxia and/or acidemia. Category II fetal heart rate tracings are the most common class of fetal monitoring in labor, and intrauterine resuscitation is recommended given the association of category II fetal heart rate tracings with fetal acidemia. However, limited published data are available to guide intrauterine resuscitation technique selection, leading to heterogeneity in the response to category II fetal heart rate tracings. This study aimed to characterize approaches to intrauterine resuscitation in response to category II fetal heart rate tracings. This was a survey study administered to labor unit nurses and delivering clinicians (physicians and midwives) across 7 hospitals in a Midwestern healthcare system spanning 2 states. The survey posed 3 category II fetal heart rate tracing scenarios (recurrent late decelerations, minimal variability, and recurrent variable decelerations) and asked participants to select first- and second-line intrauterine resuscitation management strategies. The participants were asked to quantify the level of influence certain factors have on their choice using a scale from 1 to 5. Intrauterine resuscitation strategy selection was compared by clinical role and hospital type (nurses vs delivering clinicians and university-affiliated hospital vs non-university-affiliated hospital). Of 610 providers invited to take the survey, 163 participated (response rate of 27%): 37% of participants from university-affiliated hospitals, 62% of nurses, and 37% of physicians. Maternal repositioning was the most selected first-line strategy, regardless of the type of category II fetal heart rate tracing. First-line management varied by clinical role and hospital affiliation for each fetal heart rate tracing scenario, particularly for minimal variability, which was associated with the most heterogeneity in the first-line approach. Previous experience and recommendations from professional societies were the most influential factors in intrauterine resuscitation selection overall. Of note, 16.5% of participants reported that published evidence did not influence their choice at all. Participants from a university-affiliated hospital were more likely than participants from a non-university-affiliated hospital to consider patient preference when selecting an intrauterine resuscitation technique. Nurses and delivering clinicians differed significantly in the rationale for management choices: nurses were more often influenced by advice from other healthcare providers on the team (P<.001), whereas delivering clinicians were more influenced by literature (P=.02) and ease of technique (P=.02). There was significant heterogeneity in the management of category II fetal heart rate tracing. In addition, motivations for choice in intrauterine resuscitation technique varied by hospital type and clinical role. These factors should be considered when creating fetal monitoring and intrauterine resuscitation protocols.

Maternal heart rate artifact during electronic fetal monitoring (EFM) in labour and birth

Maternal heart rate artifact (MHRA) impacting interpretation of EFM is a well-recognised phenomenon in case reports. We assessed the proportion of birth asphyxia cases associated with delay in delivery (DD) secondary to MHRA.

Analysis of Cesarean Section Rates Based on ROBSON Classification System in a Tertiary Care Hospital in West Coast of Gujarat, India

Background with objectives: Because of growing concern over the increasing C-Section worldwide, WHO proposes the ROBSON classification system as a global standard for assessing, monitoring and comparing caesarean section rates. Objective of present study is to investigate CS rates according to ROBSON classification system and to determine area of concern to decrease overall C-section rates. Methods: This study is a retrospective descriptive cohort study done with all caesarean sections delivered in a tertiary teaching hospital in the west coast of Gujarat, India from January 2022 to December 2022. Results: In current study, total CS rate was 28.47%. The major contributor to total CS rate was ROBSON I group (34.09%) followed by ROBSON V (26.34%). Major indications for ROBSON I group include fetal distress due to meconium-stained liquor (25%), Cephalo-pelvic disproportion (CPD) stage1(18%). Major indications for ROBSON group V includes CPD 1(31%), scar tendereness(23%) and previous 2 LSCS(14%). Conclusion: ROBSON I and V being major contributors to total CS suggest to focus on these groups to reduce total CS rate. Art of proper labor monitoring is to be rejuvenated to reduce ROBSON I group, more trial of labor after cesarean should be performed to reduce ROBSON V group.

Outcomes of Pregnant Females Presented with Non-Reactive CTG

Objective: One of the objectives of this research was to determine the rate outcomes for patients who first presented with non-reactive cardiotocography. Study Design: Descriptive study Place and Duration: Sindh Government Qatar Hospital Orangi town Karachi. Jan 2022-Dec 2022 Methods: 133 women between the ages of 20 and 42 who presented to the OPD or ER with labor pains were included in the research. Abnormalities were seen on both the antepartum and intrapartum CTG. The manner of delivery was decided after a CTG and physical assessment. SPSS 24.0 was used to analyze and input the data. As a follow-up to the stratification process, Chi-square was employed. Values of p less than 0.05 were considered significant. Results: Mean age of the females was 27.14±12.88 years and had mean BMI 36.2±5.81 kg/m2. Mean gestational age of the females was 37.2±3.34 weeks. There were 80 (60.2%) cases had rural residency. Frequency of obesity and anemia was 13 (9.8%) and 18 (13.5%). We found C-section in 58 (43.6%) cases, induction of labor in 42 (31.6%) cases and prolong labor in 33 (24.8%) cases. Frequency of pre-eclampsia found in 46 (34.6%) cases, gestational diabetes in 55 (41.4%) cases and post-partum haemorrhage in 77 (57.9%) cases. Low apgar score found in 25 (18.8%) cases. Conclusion: Cardiotocography monitoring in labor is associated with a higher risk of caesarean sections because of its high false positive rate. Our research shows that pregnant women who are overweight have an increased risk of developing diabetes, premature labor, and preeclampsia and these are contributing factors for non-assuring CTG. Keywords: Non-reactive cardiotocography, C-section, Obesity, Anemia, PPH