Labor Monitoring Research Articles

Incidence and determinants of neonatal mortality in the first three days of delivery in northwestern Ethiopia: a prospective cohort study

BackgroundAddressing sustainable development goals to reduce neonatal mortality remains a global challenge, and it is a concern in Ethiopia. As a result, the goal of this study was to assess the incidence and determinants of neonatal mortality in the first 3 days among babies delivered in the referral hospitals of the Amhara National Regional State.MethodsA hospital-based prospective cohort study was conducted among 810 neonates in the first 3 days of delivery between March 1 and August 30, 2018. The neonates were followed up from the time of admission to 72 h. Interviewer-administered questionnaires and medical record reviews were conducted for data collection. Data were entered into Epi-data manager version 4.4 and analysed using STATA™ version 16.0. The neonate’s survival time was calculated using the Cox-Proportional hazards model.ResultsThe overall incidence of neonatal mortality in this study was 151/1000 births. Neonatal mortality was significantly higher among neonates whose mothers came between 17 and 28 weeks of gestation for the first visit; among those whose mothers labour was not monitored with a partograph, mothers experienced postpartum haemorrhage and developed a fistula first 24 h, and experienced obstructed labour. However, 39% were less risky among neonates whose mothers were directly admitted and whose mothers had visited health facilities in less than 1-h, both.ConclusionsThis study revealed that approximately 1 in 7 neonates died within the first 3 days of life. The determinants were the timing of the first antenatal visit, quality of labour monitoring, maternal complications, and delay in seeking care. Thus, scaling up evidence-based interventions and harmonising efforts to improve antenatal care quality, promote institutional deliveries, provide optimal essential and emergency obstetric care, and ensure immediate postnatal care may improve neonatal survival.

A Comparative Study of Associated Factors for Intrapartum Meconium Staining of Amniotic Fluid in a Tertiary Care Hospital

Aims and Objectives: • To study factors associated with intra-partum meconium stained liquor &feto maternal outcome. • To compare the fetal outcome in relation to MSAF and clear amniotic fluid also in thick v/s thin meconium. Material and methods: This study prospective of 100 subjects was done in a tertiary care hospital over six months. Fifty with MSAF detected at any time during the course of labour or prior to it were enrolled in the study group. The inclusion criteria were, a singleton, cephalic, term pregnancy without anomalies. For control, the next woman giving birth following the index patient who satisfied similar inclusion criteria and had clear amniotic fluid was selected. Result: Among risk factors, preeclampsia p=0.04, fetal growth restriction p=0.05, fetal distress p=0.0002 and labour dystocia p=0.0009 were found to be statically significant. Caesarean section was considerably higher in patients with MSAF, p=<0.001. 66% patients with MSAF had FHR abnormalities as compared to 2% controls. 47.6% babies with thin MSAF and 75.8% of babies with thick MSAF had nonreassuring CTG. 42% patients had thin meconium and 58% patient had thick meconium. Conclusion: Women with prelabour or early labour rupture of membranes were noted to have a higher association with MSAF. Presence of thick MSAF, necessitates intensive monitoring of labour including surveillance of fetal wellbeing to optimise the neonatal outcome. Vigilance during labour and timely referral to higher centre/ availability of trained staff for neonatal resuscitation and management is the key to reducing neonatal morbidity and mortality associated with MSAF.

Evaluation of the use of the partogram in the obstetric gynecology department of the National Hospital Donka University Teaching Hospital Conakry Guinea

Objectives: To calculate the proportion of partogram use in the department, to describe the epidemiological profile of parturients, to identify the main reasons for not filling out the partogram and to establish the maternal and fetal prognosis in the gynaecology-obstetrics department of the Donka National Hospital, University Teaching Hospital of Conakry. Methodology: This was a prospective analytical cross-sectional study lasting six (6) months. All patients admitted to the department during the study period with a longitudinal presentation (cephalic, breech), permeable pelvis with a minimum of 28 weeks of gestational age with a live fetus were included in the study. The following were not included in this study: patients admitted for extreme obstetric emergencies (haemorrhagic placenta previa, retro-placental haematoma, uterine rupture, eclampsia....), patients admitted for prophylactic caesarean section; patients with a gestational age of less than 28 weeks of amenorrhoea and all contraindications to vaginal delivery with a live foetus. Word software from the 2007 office pack, Epi DATA3.1 was used for data entry, SSPS 20.0 was used for data analysis and Power Point software for presentation. The Chi-square test was used for the variables and a probability of p<0.05 was obtained in favour of an association between the variables compared. Results: Out of a total of 402 patients, the partogram was opened in only 269 patients, i.e. 67%, while 133 patients, i.e. 33%, did not receive a partogram. The epidemiological profile of the patients was that of women aged 20-24 years (31.3%), a housewife (34.1%), primiparous women (64.2%) and women who had not attended school (39.1%). 13.02% of the partograms were filled in correctly and 86.98% were filled in inadequately. 60% of the partograms were filled in correctly when they were carried out by a doctor, and only 12.8% were carried out by a midwife. Hypokinesia was found to be the most common anomaly, 60.59%, and the majority of patients (96.3%) did not cross the alert line. The reasons given by the staff interviewed for not filling out the patients were: lack of motivation on the part of the providers (25.56%), emergencies and overflowing activities in the delivery room (15.03%). Half of the staff interviewed did not give any reason for not filling out the partogram (50.37%). A previous caesarean section at the last delivery was found in 2.7% of the patients. The proportion of newborns without labour monitoring with a partogram with an APGAR score of less than 7 was 30.8%, compared with 11.2% with labour monitoring with a partogram. More than 2/3 of the births, 79.56%, that took place before the alert line was crossed, against 20.44% of the alert line. The morbidity is 3.7% for births before crossing the alert line against 20% after crossing it. The overall maternal morbidity is 6.5%: It is 5.57% under partogram, and 8.3% without partogram. Fetal mortality is 2.6% for those who gave birth under labour monitoring with partogram, and 3% for those who did not give birth under labour monitoring with partogram. We did not record any maternal deaths. Conclusion: The partogram is an indispensable tool in labour monitoring. We note a better maternal-fetal prognosis in patients who have given birth under partogram monitoring. The improvement of the quality of filling in the partogram would be achieved through the motivation of medical staff and supervision.

Continuous physical activity recognition for intelligent labour monitoring

Continuous physical activity recognition for intelligent labour monitoring

Hypoglycemia as a cause of sudden cardiac arrest during cesarean delivery under spinal anesthesia: a\xa0case report and review of the\xa0literature

BackgroundSudden cardiac arrest during spinal anesthesia is a rare event. However, its management by an unprepared team is difficult and carries poor outcomes. Hypoglycemia as the cause of sudden cardiac arrest is rarely reported. This case illustrates lifesaving procedures for sudden cardiac arrest secondary to hypoglycemia during cesarean delivery under spinal anesthesia.Case summaryWe report a case, from rural Ethiopia of sudden cardiac arrest secondary to hypoglycemia during cesarean delivery under spinal anesthesia. The case was successfully managed by a team of anesthetists and other operating teams. The mother and newborn were discharged from the hospital on the 7th postoperative day.ConclusionHypoglycemia during cesarean delivery under spinal anesthesia can cause sudden cardiac arrest. Therefore, identifying patients at risk of developing hypoglycemia, monitoring the patient’s condition, and initiating prompt intervention at the first sign of cardiovascular instability is advisable. Determining serum blood glucose levels at admission to the labor ward and monitoring blood glucose levels during spinal anesthesia should be routine practices.

Do Blood-Borne Viruses Affect the Progression of Labor: A Hospital-Based Pilot Study.

BackgroundBlood-borne viruses form the basis of enormous research on universal precautions. A paucity of research is noted regarding labor progression in seropositive women. Women testing positive for human immunodeficiency virus (HIV)/hepatitis B surface antigen (HBsAg)/hepatitis C virus (HCV) are often denied obstetric care and referred. Their need for safe delivery conditions propelled us to undertake this study to establish whether seropositive status affects labor progression or not.MethodsWomen in early labor (<4 cm cervical dilation) testing positive for HIV/HBV/HCV and delivering vaginally during the study period at All India Institute of Medical Sciences (AIIMS), Rishikesh, India, were included as Group A (n=36). The authors recruited an equal number of women with seronegative status with comparable age, parity, admission at or before 4 cm, body mass index (BMI) characteristics as Group B. They were compared in terms of effacement at 4 cm dilatation and time from 4 cm dilatation till delivery.ResultsThe authors report a significant difference (p <0.05) between time to delivery between the two groups (2 hours vs. 2.43 hours in nulligravidas and multigravidas, respectively). Thirty-two (32) of 36 cases were already 70%-80% effaced at 4 cm dilation while only 25% of controls had similar findings. The present study suggests that seropositive women progress significantly faster in labor and need vigilant monitoring. We report such findings for the first time and aim to encourage similar research worldwide.

Relationship Between Premature Rupture Of Membranes And The Incidence Of Asphyxia In Newborns At RSUD Dr. Soegiri Lamongan

Neonatal mortality rate is one indicator to assess health in the community. According to WHO, the main causes of neonatal death include prematurity, neonatal asphyxia, and neonatal sepsis. The purpose of this study was to analyze the relationship between premature rupture of membranes and asphyxia in newborns at RSUD Dr. Soegiri Lamongan. This study used an analytical method with a cross sectional approach. The total sample was 240 newborns, consisting of babies with asphyxia and normal babies. Sampling with simple random sampling. Collecting data using a check list. Data taken from patient medical records (secondary data). Data analysis used the Chi Square test with a significance level of α &lt;0.05. The results of the analysis with the Chi square test showed that the value of Asympt.Sig. (2-sided) on the Pearson Chi square test is 0.000 less than 0.05. So it can be concluded that there is a significant relationship between PROM/KPD and the incidence of neonatal asphyxia in the delivery room of dr. Soegiri Lamongan. Asphyschia neonatorum is a complication of newborns which one of the contributing factors is PROM. Therefore, emergency obstetric and newborn care efforts should be strengthened to prevent neonatal asphyxia. It is hoped that health workers in the delivery room will carry out careful monitoring of labor, and identify and take appropriate measures to help reduce the occurrence of neonatal asphyxia

Does training in intrapartum fetal monitoring actually work?

Intrapartum cardiotocograph (CTG) monitoring is widely used in the provision of maternity care in high-income countries. First introducedintoclinicalpractice in the 1960s, it was anticipated thattheuse ofCTG monitoring in labour would dramatically reduce theperinatal mortalityrate and prevent long term neurological injury, whilealsoreducing the caesarean section rate(Paul & Hon, 1970, Obstetrics & Gynaecology 35(2), 161-9).

Internet of things in manufacturing: A review

Internet of things (IoT) make a major contribution in the manufacturing industries by connecting the objects with the help of network and remotely controlled the existing network infrastructure, initiation of opportunities for integration of the manufacturing world to the computer-based systems, this results the enhanced production efficiency, product accuracy and economic growth in addition to minimum human intervention. In this review we have discussed about the modern technologies for the accomplishment of the smart manufacturing. The aim of this paper is to fulfill the objective of developing the discrete event-based system for Men, Materials and Plant & Equipment (MMP) on the manufacturing site, for that the primary focus on reviews the different ways to implement the Internet of Things (IoT) at the project site and improve the material handling, labor monitoring and tracking the plant and equipment for better productivity and efficiency of the overall project.

Management of prolonged first stage of labour in a low-resource setting: lessons learnt from rural Malawi

BackgroundCaesarean sections without medical indication cause substantial maternal and perinatal ill-health, particularly in low-income countries where surgery is often less safe. In presence of adequate labour monitoring and by appropriate use of evidence-based interventions for prolonged first stage of labour, unnecessary caesarean sections can be avoided. We aim to describe the incidence of prolonged first stage of labour and the use of amniotomy and augmentation with oxytocin in a low-resource setting in Malawi.MethodsRetrospective analysis of medical records and partographs of all women who gave birth in 2015 and 2016 in a rural mission hospital in Malawi. Primary outcomes were incidence of prolonged first stage of labour based on partograph tracings, caesarean section indications and utilization of amniotomy and oxytocin augmentation.ResultsOut of 3246 women who gave birth in the study period, 178 (5.2%) crossed the action line in the first stage of labour, of whom 21 (11.8%) received oxytocin to augment labour. In total, 645 women gave birth by caesarean section, of whom 241 (37.4%) with an indication ‘prolonged first stage of labour’. Only 113 (46.9%) of them crossed the action line and in 71/241 (29.5%) membranes were still intact at the start of caesarean section. Excluding the 60 women with prior caesarean sections, 14/181 (7.7%) received oxytocin prior to caesarean section for augmentation of labour.ConclusionThe diagnosis prolonged first stage of labour was often made without being evident from labour tracings and two basic obstetric interventions to prevent caesarean section, amniotomy and labour augmentation with oxytocin, were underused.

Rupture Uterus in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Rupture uterus is an obstetric catastrophe with poor maternal and fetal outcome. The objective of the study is to determine the prevalence of rupture uterus in pregnancy. This was a descriptive cross sectional study conducted in a tertiary care centre from January 2016 to December 2016 after taking ethical approval (Approval No. F-NMC-510/76/77) from Institutional Review Committee. Convenience sampling method was used. Data were entered in the Microsoft Excel sheet and obtained data was analysed using Statistical Package for Social Sciences version 18 software for central tendency and frequencies. Out of total 1559 deliveries, prevalence of rupture uterus was found to be 12 (0.0077%). Previous lower segment caesarean scar rupture was the most common risk factor noted in 7 (58.3%) cases. A total of seven patients (58.3%) required intensive care unit admission and blood transfusion. Other maternal complications were surgical site infection 2 (16.67%), sepsis 2 (16.67%), paralytic ileus 1 (8.3%), pelvic collection 1 (8.3%) and vesico vaginal fistula 1 (8.3%). Two maternal deaths (16.67%) and perinatal death was noted in 8 (66.66 % ) cases. Rupture uterus most commonly occurred in scarred uterus. Identification of high risk pregnancy, judicious caesarean section, proper labor monitoring, early diagnosis and prompt management are essential in reducing its occurrences.

The development of the WHO Labour Care Guide: an international survey of maternity care providers

BackgroundThe partograph is the most commonly used labour monitoring tool in the world. However, it has been used incorrectly or inconsistently in many settings. In 2018, a WHO expert group reviewed and revised the design of the partograph in light of emerging evidence, and they developed the first version of the Labour Care Guide (LCG). The objective of this study was to explore opinions of skilled health personnel on the first version of the WHO Labour Care Guide.MethodsSkilled health personnel (including obstetricians, midwives and general practitioners) of any gender from Africa, Asia, Europe and Latin America were identified through a large global research network. Country coordinators from the network invited 5 to 10 mid-level and senior skilled health personnel who had worked in labour wards anytime in the last 5 years. A self-administered, anonymous, structured, online questionnaire including closed and open-ended questions was designed to assess the clarity, relevance, appropriateness of the frequency of recording, and the completeness of the sections and variables on the LCG.ResultsA total of 110 participants from 23 countries completed the survey between December 2018 and January 2019. Variables included in the LCG were generally considered clear, relevant and to have been recorded at the appropriate frequency. Most sections of the LCG were considered complete. Participants agreed or strongly agreed with the overall design, structure of the LCG, and the usefulness of reference thresholds to trigger further assessment and actions. They also agreed that LCG could potentially have a positive impact on clinical decision-making and respectful maternity care. Participants disagreed with the value of some variables, including coping, urine, and neonatal status.ConclusionsFuture end-users of WHO Labour Care Guide considered the variables to be clear, relevant and appropriate, and, with minor improvements, to have the potential to positively impact clinical decision-making and respectful maternity care.

The problem of labor protection and monitoring of emergencies in the conditions of the spread of graphite dust

The article deals with the issues of labor protection and monitoring of emergencies in workshops for the production of carbon electrodes. A numerical study of the problem of the spread of coal dust in the production room is carried out. The possible height of dust rise and the distance of movement of the most probable particle size are estimated. The data obtained indicate that in order to prevent coal dust from sticking to clothing and spreading it around the room, it is necessary to provide for labor protection measures. Based on the results obtained, recommendations can be formulated to improve safe working conditions in production associated with the formation of graphite dust: first of all, attention should be directed to the removal of a loose dust layer.

Usability evaluation of assignment and monitoring information learning system of internship students based on SMS Gateway with Raspberry Pi

There are obstacles in the delivery of information during pre-engineering activities at the Vocational High School. There needs to be a system that makes it easy to deliver information from schools to students who carry out internship. The purpose of this study was to evaluate the usefulness of the evaluation of the usefulness of the task information learning system and the monitoring of student labor based on the SMS gateway with raspberry pi. The instrument used in usability testing is the Computer Usability Satisfaction Questionnaires: Psychometric Evaluation and Instructions for Use questionnaire developed by IBM for software usability measurement standards. The instrument for testing usability aspects with the Computer System Usability Questionnaires (CSUQ) questionnaire developed by IBM uses a Likert scale as a measurement scale. The data for the trial were 20 respondents consisting of adaptive normative subject teachers, internal engineering committee and smartschool developers. Based on the results of testing the quality of software developed on the usability aspect has a percentage of 85% or has a high quality scale and based on alpha cronbach calculations has a calculation result of 0.851 or has a “good” category. The SMS Gateway system with Raspberry Pi for Internship Assignment and Monitoring meets the usability aspect and is suitable for use.

642 How does elevated intrauterine resting tone affect the fetus?

More than a third of laboring patients receive an intrauterine pressure catheter (IUPC) for contraction monitoring in labor. Elevated resting intrauterine tone has been hypothesized to decrease uterine perfusion with unknown fetal affect. We assessed the effect of elevated uterine resting tone on neonatal outcomes. This was a secondary analysis of a prospective cohort study of singleton term deliveries between 2010-2014. We included patients with at least 30 minutes of IUPC data prior to delivery. The primary outcome was composite neonatal morbidity (hypoxic ischemic encephalopathy, hypothermia treatment, meconium aspiration syndrome, intubation, mechanical ventilation, seizures, or death). The secondary outcome was umbilical arterial (UA) pH<7.2, lactate ≥ 4 mmol/l, NICU admission, and 5 min APGAR <7. We defined resting tone as the average baseline tone between contractions. Elevated intrauterine tone was ≥ 75th percentile. Multivariable logistic regression and the Zhang method was used to estimate relative risk while adjusting for potential confounders. Of the 8580 patients in the cohort, 2210 (25.8%) had an IUPC and at least 30 mins of pressure data prior to delivery. The majority (98%) of IUPC data were from the second stage. 567 patients had resting intrauterine tone ≥ 12.3 mmHg (≥75th percentile). After adjusting for obesity and chorioamnionitis, elevated resting tone was not associated with increased risk of composite neonatal morbidity (3.5% vs 2.0%, [aRR 1.71 (0.98-2.94)]. However, in a sensitivity analysis of patients in the second stage, elevated resting tone was significantly associated with composite neonatal morbidity [aRR 1.83 (95% CI 1.03-3.15)]. Elevated resting tone was associated with an increased risk of UA pH < 7.2 and UA lactate ≥ 4 [aRR 1.66 (95% CI 1.32-2.07) and 1.32 (95% CI 1.13-1.52)]. Low APGAR scores and NICU admission was similar between groups. The risk of composite neonatal morbidity and acidosis was increased among patients with higher uterine resting tone in the second stage, though the absolute risk was low.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

670 Neonatal outcomes after cesarean for non-reassuring fetal status in the first stage of labor

Non-reassuring fetal status (NRFS) is the second most common indication for cesarean delivery (CD) accounting for 1 in 4 cesareans. We sought to evaluate neonatal outcomes following CD for NRFS. This was a secondary analysis of a prospective cohort study. We included singleton term pregnancies admitted for labor or induction of labor between 2010-2014. The primary outcome was fetal acidemia defined as umbilical artery (UA) pH < 7.1. Secondary outcomes were UA base excess, lactate, and neonatal composite morbidity (hypoxic-ischemic encephalopathy, meconium aspiration syndrome, hypothermia treatment, intubation, mechanical ventilation, neonatal seizure, death). The exposure was first stage CD for any indication that included NRFS and the control group was all other deliveries. Multivariable logistic regression and the Zhang method was used to estimate relative risk and adjust for confounders. We also performed a sensitivity analysis of patients who underwent CD for the sole indication of NRFS. Of the 8580 patients in the cohort, 721 (8.4%) had a first stage CD for NRFS. Among these, 476 (66.0%) were for the sole indication of NRFS. The risk of fetal acidemia was 5 times higher among patients undergoing CD for NRFS compared to all other deliveries (7.3% vs 1.2%, aRR 5.45[95% CI 3.35-8.68]). UA base excess and lactate were higher among patients with CD for NRFS. CD for NRFS was associated with an increased risk of composite neonatal morbidity (4.0% vs 1.0%, aRR 2.52 [95% CI 1.30-4.78]). After restricting the analysis to patients who had CD for the sole indication of NRFS, the risk of fetal acidemia and neonatal morbidity remained significantly higher in the CD for NRFS group than control deliveries. CD for NRFS is associated with an increased risk of fetal acidemia and composite neonatal morbidity. Although the vast majority of infants delivered for NRFS have normal outcomes, these results suggest that the diagnosis of NRFS using continuous fetal monitoring in labor is predictive of adverse outcomes.

Quantification of Posterior Risk Related to Intrapartum FIGO 2015 Criteria for Cardiotocography in the Second Stage of Labor

Introduction: Intrapartum cardiotocography (CTG) was used for several decades to detect a stressed fetus so that delivery can be expedited to prevent birth asphyxia. The main aim of the study was to calculate the risk of neonatal acidemia (pH ≤ 7.10) according to duration of the 2nd stage of labor and occurrence of the International Federation of Gynecology and Obstetrics (FIGO) 2015 CTG classification parameters. Materials and Methods: This was a retrospective case-control study on 552 pregnancies receiving continuous CTG monitoring in labor and immediate hemogasanalysis at birth. Cases with umbilical artery (UA) pH ≤ 7.10 and controls with UA pH ≥ 7.10 were matched for parity and gestational age at delivery, with ratio 1:5. Logistic regression analysis, adjusted for the expected risk in the general population, was used to calculate the baseline risk of UA pH ≤ 7.10 in the absence of any CTG pathological feature and those associated with pathological CTG patterns occurring in the 2nd stage according to FIGO 2015. Results: Seventy-three cases and 387 controls reached 2nd stage and were included in the analysis. For those reaching 2nd stage, the mean adjusted risk of acidemia associated with nonpathological CTG was 1.6%. Stratification of risk according to duration of the 2nd stage yielded risks of neonatal acidemia of 1.23, 2.08, 5.81, and 15.22% at 30, 60, 120, and 180 min, respectively. Bradycardia >10 min was associated with risk of neonatal acidemia of 9.9 and 15.8% for 2nd-stage durations of 30 and 60 min, respectively. Risks associated with 1 prolonged deceleration >5 min were 6.80, 11.08, 27.0, and 51.0% at 30, 60, 120, and 180 min, respectively. Repetitive late or prolonged decelerations >30 min were associated with risk of neonatal acidemia of 2.43, 4.14, 11.17, and 26.45% at 30, 60, 120, and 180 min, respectively. Conclusion: The risk of neonatal acidemia is directly proportional to duration of the 2nd stage, irrespective of the presence of CTG abnormalities, increasing 12-fold (1.2–15.3%) from 30 to 180 min. Occurrence of FIGO 2015 pathological CTG patterns showed a decreasing impact from bradycardia >10 min to decelerations >5 min, recurrent later or prolonged decelerations >30 min, and nonpathological CTG.

Knowledge and correlates of using a partograph for labour monitoring among primary healthcare workers in Ibadan, Nigeria

Background The partograph is a graphic record of labour progress, and maternal and fetal condition, which was introduced to detect preventable maternal complications during parturition. It is plotted against time for intrapartum monitoring. There is a difference in how widely the modified partograph is used to monitor labour among health workers in primary healthcare across different countries, according to the World Health Organization. This study assessed primary healthcare workers' knowledge of how to use the partograph for labour monitoring in Ibadan, Nigeria. Methods The study used a cross-sectional descriptive survey to recruit 136 purposively selected respondents. A semi-structured questionnaire was administered for data collection. Data were analysed using the Statistical Package for Social Sciences version 23. Hypotheses were tested using the Chi-square test and logistic regression at P&lt;0.05 significance. Results The majority of respondents reportedly had good knowledge of how to use the partograph (72%) but did not use it when monitoring labour (82.4%). The odds of using a partograph was four times more likely in participants with good knowledge (odds ratio=3.61, P&lt;0.000). Conclusions There is a need for collaboration across all tiers of government with the National Primary Health Development Agency to develop and implement health policies that will encourage the utilisation of a partograph for monitoring labour.

Pregnancy outcome in patients with prolonged deceleration in intrapartum fetal heart rate monitoring: A case series report

Background: Diagnostic criteria for intrapartum fetal distress are still inconsistent. Currently, widely used tool in clinical practice is intrapartum fetal heart rate (FHR) monitoring in labor because of its convenience, non-invasiveness. Intrapartum. In contrast, the presence of prolonged deceleration in intrapartum FHR monitoring has a high predictive value of fetal distress compared with the absence of a deceleration. To evaluate the significance of prolonged deceleration intrapartum, it is necessary to combine the clinical context with features of fetal heart rate monitoring, that forms reasons and outcomes of prolonged deceleration – a “dangerous” type of deceleration in labor. Objectives: To describe the clinical characteristics and pregnancy outcomes of patients with prolonged deceleration in intrapartum FHR monitoring. Methods: A retrospective review of the medical records of four patients have at least an appeared prolonged deceleration in intrapartum FHR monitoring at Tu Du Hospital. Results: The present study consisted of four patients with prolonged deceleration in intrapartum FHR monitoring, in which 1 case was recorded placental abruption and 1 case had umbilical cord prolapse. All cases with prolonged deceleration were actively managed by emergency cesarean section or operative vaginal delivery, and there were no cases of postpartum asphyxia, 4 cases had APGAR 5 min ≥ 7. Conclusion: Prolonged deceleration in intrapartum FHR monitoring is a manifestation of acute hypoxia due to many dangerous causes such as placental abruption, umbilical cord prolapse, hypertonic uterine contraction. When there is a prolonged deceleration in fetal heart rate, it is necessary to combine it with the clinical characteristics and risk factors in pregnancy to diagnose the cause of the deceleration and promptly give appropriate treatment.

Pregnancy and delivery outcomes in the women who have received adenomyomectomy: Performed by a single surgeon by a uniform surgical technique

ObjectiveAlthough adenomyomectomy for fertility-sparing is an expanding procedure worldwide, there is no guideline or consensus about how to manage the pregnant women who have previously received conservative surgery for adenomyosis. The aim of this study is to evaluate antenatal care and delivery outcomes in pregnant women after adenomyomectomy. Materials and methodsBetween May 2011 and May 2019, the medical record was reviewed in all delivery of pregnant women received adenomyomectomy performed by a single surgeon by a uniform surgical technique. The evaluating parameters consisted of antenatal care outcomes, delivery outcomes, intrapartum outcome, and neonatal outcomes. ResultsTwenty-two patients were evaluated to monitor pregnancy and delivery outcomes after the adenomyomectomy. Mean age of delivery was 37.0 years old (SD = 3.1, range 32–45, median 37). All were delivered by cesarean section. Mean gestational age was 36.2 weeks (SD = 3.6, range 27.4–39.4, median 37.3). The mean birth weight was 2560.9 g (SD = 771.8, range 1100–3920, median 2550) and the number of preterm births admitted for prematurity care was seven (31.8%, 7/22). Placental abnormality was found in the four cases, which included two placenta accreta and two previa. However, there were no cases of hysterectomy or intervention. We identified one case of uterine rupture during pregnancy (4.5%, 1/22) at 27 weeks of gestation. Except for preterm birth, adverse neonatal outcomes were not found in this study. ConclusionDelivery of pregnant women who received adenomyomectomy can obtain safe perinatal outcomes under close monitoring of preterm labor and surveillance of catastrophic pregnancy related complications.