Late-term Pregnancy Research Articles

A rare case of peritoneal coccidioidomycosis.

Coccidioidomycosis, also known as valley fever, is a fungal infection that can develop after inhalation of arthroconidia from soil. Coccidioidomycosis infections are most common in the southwestern United States and typically involve the lungs. Risk factors for extrapulmonary spread, which can be life-threatening, include older age, diabetes, HIV and AIDS, late-term pregnancy, immunosuppressant drug use and African or Filipino ancestry. This article describes incidental identification of coccidioidomycosis of the peritoneum, an extremely rare site for dissemination, during bariatric surgery in a patient without known risk factors.

Transperineal sonographic assessment of the angle of progression before the onset of labour: how well does it predict the mode of delivery in late-term pregnancy.

Predicting the success of vaginal delivery is an important issue in preventing adverse maternal and neonatal outcomes. This study sought to examine whether measurement of the angle of progression (AoP) can predict asuccessful vaginal delivery following induction of labour (IoL) among late term nulliparous women with a low (4>) Bishop score. This prospective study included consecutive nulliparous pregnant women whose gestational age was 41weeks and 1-6days (late-term). The AoP was measured atleast three times and their means were calculated. During the study period, data of 150 women wereincluded in the final analysis. Thirty-eight women underwent CS due to failure to progress (n=30) or NRGHR (n=8), while the remaining 112 women underwent NVD, with four women requiring vacuum extraction. The two groups were similar with respect to age, gestational age, BMI, estimated foetal weight, and birth weight. Women undergoing NVD differed significantly from those undergoing CS with respect to a greater ultrasonographic AoP (113.8±11.9° vs. 98.1±10.9°, p=0.0001), a shorter duration of dinoprostone use, shorter time to labour contraction, and a shorter duration oflabour. In ROC analysis, the cut-off value for AoP was 100° for the prediction of successful IoL for NVD, with a sensitivity of 96 % and a specificity of 63 %. AoP may be a useful sonographic parameter for predicting successful vaginal delivery among nulliparous women at late term undergoing IoL; an AOP wider than 100°is associated with a high rate of vaginal delivery.

Assessment of fetal development during mid and late term pregnancies by standard B-Mode ultrasonography in Shetland ponies

Transrectal and transabdominal ultrasonography is an established method to monitor pregnancy, fetal growth and wellbeing in different species. Growth charts with multiple bio-morphometric parameters to estimate days of gestation and days before parturition exist in small companion animals, sheep and goats, riding type horses and large ponies but not in small horse breeds like Shetland ponies. The aim of this study was to apply fetal biometric assessment and detailed description of physiologic fetal development to mid and late term pregnancies in Shetland mares and to generate reference data for clinical practice and for future research. Fetal parameters were collected starting on day 101 of pregnancy in five Shetland mares. The fetal biometric parameters determined consisted of aortic diameter, eye diameter, combined rib and intercostal distance (CRID), stomach length and width and different heart morphology parameters in sagittal and frontal plane. Additionally, fetal activity and organ development in terms of differentiation and changes in echogenicity were recorded. Considering reliably assessable parameters, fetal CRID was the best predictor for gestational age with ± 13.6 days and fetal aortic diameter the most accurate for prediction of days until parturition with ± 16.2 days.

Application of blood parameters for the early diagnosis of natural ascending placentitis in pregnant mares

Placental infection is an important cause of late-term pregnancy loss and neonatal diseases in horses. Detection of changes in blood parameters especially during early placentitis could improve the diagnostic accuracy, treatment decision, and potential outcomes. The objectives of this 2-part study were to identify differences in circulating immunological, inflammatory, and hormonal parameters between mares with natural ascending placentitis and control mares; evaluate each and combination of parameters as predictors of placentitis; and determine how these parameters indicate severity of placentitis. Reproductive examination and blood sampling were prospectively performed on pregnant mares in a natural setting. Study 1 enrolled mares diagnosed with early stage of ascending placentitis based on ultrasonographic findings (n = 12), and gestationally age-matched mares with healthy pregnancies as controls (n = 12). Blood samples were classified as pre-onset (before) and early onset (at the time of ultrasonographic changes) of placentitis. There were no detected statistically significant differences between groups and timepoints in immunological and inflammatory parameters, including peripheral lymphocyte subpopulations, cytokine, and serum amyloid A concentrations. The placentitis group showed a reduced (P = 0.01) DHP/20α-DHP ratio when compared to the control group at the early onset timepoint. Plasma estradiol-17β concentration <359 pg/mL predicted ascending placentitis with acceptable accuracy (area under the curve, AUC = 0.71). Combined albumin <3.7 g/dL, estradiol-17β < 499 ng/mL, and DHP <33 ng/mL predicted 100 % of cases of ascending placentitis. In study 2, samples were classified according to the presence and severity of the abnormal ultrasonographic findings as mild (n = 11) and moderate-severe (n = 23), and gestationally age-matched with samples from control mares (n = 34). Mares with moderate-severe ascending placentitis had increased (P = 0.03) plasma 20α-DHP concentration and reduced (P = 0.03) DHP/20α-DHP ratio when compared to control mares. Our results suggest that the early events of ascending placentitis detected by ultrasonographic findings include hormonal alterations of feto-placental metabolism measurable in the mare's circulation, yet without obvious systemic immunological and inflammatory changes. Additional studies are warranted to further assess how hormonal markers and cutoff values could guide decisions for timely therapeutic intervention.

Analysis of adverse late-term pregnancy outcomes after cervical cold knife conization

Objective: To investigate the effects of cervical cold knife conization (CKC) on preterm delivery, other pregnancy complications and neonatal outcomes, and explore the relationship between preterm delivery risk and the depth and volume of conization. Methods: The clinical data and pregnancy outcomes of 272 women who underwent CKC in Peking Union Medical College Hospital from January 2002 to March 2018 (conization group) and 1 647 pregnant women who gave birth in Peking Union Medical College Hospital during January to December 2019 (control group) were collected. The preterm delivery, premature rupture of membranes, other pregnancy complications and neonatal outcomes of the two groups were compared, and the relationship between the depth and volume of conization and the risk of preterm delivery in postoperative singleton pregnancy was analyzed. Results: (1) There were no significant differences between the two groups in delivery age, parity, proportion of singleton pregnancy, proportion of assisted reproductive technology (all P>0.05). (2) The rate of preterm delivery in the conization group was significantly higher than that in the control group [14.8% (39/264) vs 5.7% (91/1 589); χ2=28.397, P<0.001]. There were still significant differences in preterm delivery rates between the two groups at <34 weeks and 34-37 weeks (all P<0.01). There was no significant difference in the incidence of premature rupture of membrane between the two groups [23.5% (62/264) vs 23.4% (372/1 589); χ2=0.001, P=0.979], but the incidence of preterm premature rupture of membrane in the conization group was significantly higher than that in the control group [11.4% (30/264) vs 2.2% (35/1 589); χ2=56.132, P<0.001]. (3) The rate of cesarean section in the conization group was higher than that in the control group [59.6% (162/272) vs 38.8% (639/1 647); χ2=41.377, P<0.001]. The birth weight of preterm infants in the conization group was significantly higher than that in the control group [(2 409±680) vs (2 150±684) g; t=2.184, P=0.030]. However, there were no statistically significant differences in the incidence of gestational diabetes mellitus, hypertensive disorders in pregnancy, the birth weight of full-term infants, incidence of small for gestational age infant and neonatal intensive care unit admission rate between the two groups (all P>0.05). (4) The preterm delivery rates of coning depth >15 mm, cone size ≥2 cm3 and cone size <2 cm3 were higher than that in the control group (all P<0.05). When the coning depth ≤15 mm, the preterm delivery rate in the conization group was higher than that in the control group, but there was no significant difference (P=0.620). The rate of preterm delivery of pregnant women with coning depth >15 mm was significantly higher than those with coning depth ≤15 mm (RR=3.084, 95%CI: 1.474-6.453; P=0.001). There was no significant difference in the preterm delivery rate between pregnant women with cone size >2 cm3 and those with cone size ≥2 cm3 (RR=1.700, 95%CI: 0.935-3.092; P=0.077). Conclusion: The risk of preterm delivery and preterm premature rupture of membranes in subsequent pregnancies are increased after cervical CKC, and the risk of preterm delivery is positively correlated with the depth of cervical coning.

Neonatal and maternal upregulation of antileukoproteinase in horses.

The end of gestation, ensuing parturition, and the neonatal period represent highly dynamic phases for immunological changes in both mother and offspring. The regulation of innate immune cells at the maternal-fetal interface during late term pregnancy, after birth, and during microbial colonization of the neonatal gut and other mucosal surfaces, is crucial for controlling inflammation and maintaining homeostasis. Innate immune cells and mucosal epithelial cells express antileukoproteinase (SLPI), which has anti-inflammatory and anti-protease activity that can regulate cellular activation. Here, we developed and validated new monoclonal antibodies (mAbs) to characterize SLPI for the first time in horses. Peripheral blood and mucosal samples were collected from healthy adults horses and a cohort of mares and their foals directly following parturition to assess this crucial stage. First, we defined the cell types producing SLPI in peripheral blood by flow cytometry, highlighting the neutrophils and a subset of the CD14+ monocytes as SLPI secreting immune cells. A fluorescent bead-based assay was developed with the new SLPI mAbs and used to establish baseline concentrations for secreted SLPI in serum and secretion samples from mucosal surfaces, including saliva, nasal secretion, colostrum, and milk. This demonstrated constitutive secretion of SLPI in a variety of equine tissues, including high colostrum concentrations. Using immunofluorescence, we identified production of SLPI in mucosal tissue. Finally, longitudinal sampling of clinically healthy mares and foals allowed monitoring of serum SLPI concentrations. In neonates and postpartum mares, SLPI peaked on the day of parturition, with mares returning to the adult normal within a week and foals maintaining significantly higher SLPI secretion until three months of age. This demonstrated a physiological systemic change in SLPI in both mares and their foals, particularly at the time around birth, likely contributing to the regulation of innate immune responses during this critical period.

Effect of Maternal Age and Body Mass Index on Induction of Labor Using Oral Misoprostol in Late-Term Pregnancies: A Retrospective Cross-Sectional Study

Introduction: Several studies have shown that late- and post-term pregnancies are associated with an increased risk of perinatal morbidity and mortality. In this case, induction of labor is the recommended approach. For full-term pregnancies, various methods exist to prepare the cervix and/or commence labor. Prostaglandins serve the dual purpose of cervical ripening and labor induction, blurring the distinction between the two processes. The aim of this research was to evaluate the effect of maternal age and body mass index (BMI) on oral misoprostol induction of labor for late-term pregnancies. Methods: This was a retrospective cross-sectional study (ClinicalTrial ID: NCT06184139), including only late-term pregnancies in healthy nulliparous women carrying a single cephalic fetus with normal birthweight who underwent induction of labor with oral misoprostol. We used the oral misoprostol regimen proposed by the World Health Organization (WHO) for induction of labor in term singleton pregnancies in women who have not had a previous cesarean delivery and a Bishop score <7. The regimen was oral misoprostol in aqueous solution at the low dose of 25 μg every 2 h until a Bishop score ≥7, labor, or for a maximum of 8 doses. Results: One hundred and four pregnant women underwent induction of labor with oral misoprostol for late-term pregnancy on the 290th day of gestation. Study population was divided in two groups based on age (<35 and ≥35 years) and obesity (BMI <30 and ≥30). No statistically significant differences were recorded between younger and older women. Obese women reported a longer time between the last dose of misoprostol and cervical dilation of 6 cm (p = 0.01), a longer time between the last dose of misoprostol and delivery (p = 0.04), and a higher rate of grade II vaginal lacerations (p = 0.02). Conclusions: Maternal BMI is a factor negatively influencing the efficacy of oral misoprostol for induction of labor in late-term pregnancy.

Maternal and perinatal outcomes of oligohydramnios in late term and post term pregnancies at public hospitals in Ethiopia: a cross-sectional study

BackgroundThe prevalence of oligohydramnios ranges from 12 to 14% after 41 weeks to as high as 30% in post term pregnancies. Oligohydramnios poses a dilemma in the choice of mode of labor and delivery in a setup where there is lack of continuous electronic fetal monitoring during labor. The condition also puts the mother at risks of operative interventions and cesarean delivery. We aimed to asses the maternal and perinatal outcomes in pregnancies with oligohydramnios in late term and post term pregnancy in this study.MethodsA cross-sectional study was conducted among mothers with diagnosis of oligohydramnios after 40+ 6 weeks of gestation at four hospitals at four public hospitals in Addis Ababa, Ethiopia from May 1, 2021 to September 30, 2021. Data were collected using structured questionnaire. Logistic regression were performed to assess factors associated with the adverse maternal and perinatal outcomes.ResultsFrom a total of 142 mothers with oligohydramnios in late term and post tem pregnancies, 40.8% delivered through cesarean section. Spontaneous labor and elective cesarean section were more likely to occurr in parous women (AOR 2.5, 95% CI 1.06–6.04, p = 0.04), but with less likely in those with secondary level education (AOR 0.13, 95% CI 0.02–0.74, p = 0.02). There was no statistically significant difference in adverse outcomes between those who had induction of labor and those who had either spontaneous labor or had elective cesarean section.ConclusionsThe adverse maternal and perinatal outcomes in late term and post term pregnancies with oligohydramnios may not be different among different modes of delivery. Induction of labor can be safe in these particular group of women with intermittent auscultation with fetoscope in a setup where continuous electronic fetal monitoring is not readily available.

Does inbreeding contribute to pregnancy loss in Thoroughbred horses?

Excessive inbreeding increases the probability of uncovering homozygous recessive genotypes and has been associated with an increased risk of retained placenta and lower semen quality. No genomic analysis has investigated the association between inbreeding levels and pregnancy loss. To compare genetic inbreeding coefficients (F) of naturally occurring Thoroughbred Early Pregnancy Loss (EPLs), Mid and Late term Pregnancy Loss (MLPL) and Controls. The F value was hypothesised to be higher in cases of pregnancy loss (EPLs and MLPLs) than Controls. Observational case-control study. Allantochorion and fetal DNA from EPL (n = 37, gestation age 14-65 days), MLPL (n = 94, gestational age 70 days-24 h post parturition) and Controls (n = 58) were genotyped on the Axiom Equine 670K SNP Genotyping Array. Inbreeding coefficients using Runs of Homozygosity (FROH) were calculated using PLINK software. ROHs were split into size categories to investigate the recency of inbreeding. MLPLs had significantly higher median number of ROH (188 interquartile range [IQR], 180.8-197.3), length of ROH (3.10, IQR 2.93-3.33), and total number of ROH (590.8, IQR 537.3-632.3), and FROH (0.26, IQR 0.24-0.28) when compared with the Controls and the EPLs (p < 0.05). There was no significant difference in any of the inbreeding indices between the EPLs and Controls. The MLPLs had a significantly higher proportion of long (>10 Mb) ROH (2.5%, IQR 1.6-3.6) than the Controls (1.7%, IQR 0.6-2.5), p = 0.001. No unique ROHs were found in the EPL or MLPL populations. SNP-array data does not allow analysis of every base in the sequence. This first study of the effect of genomic inbreeding levels on pregnancy loss showed that inbreeding is a contributor to MLPL, but not EPL in the UK Thoroughbred population. Mating choices remain critical, because inbreeding may predispose to MLPL by increasing the risk of homozygosity for specific lethal allele(s).

Gebeliğin Term ve Geç-Term Dönemlerinde Oksidatif Stresin ve Eser Elementlerin Değerlendirilmesi

Amaç: Gebelik, yüksek metabolik turnover (yapım-yıkım) ve doku oksijen kullanımı nedeniyle oksidatif stresin hakim olduğu fizyolojik bir durumdur. Çalışmamızda, gebeliğin term ve geç-term dönemlerinde oksidatif hasar belirteci olan malondialdehit (MDA) ve iskemi-modifiye albümin (IMA) ve bazı eser element düzeylerindeki değişiklikleri araştırmak amaçlandı. Yöntem: Çalışmada, sefalik prezentasyonlu ve anne yaşı 18-40 arasında olan term (n=80) ve geç-term (n=64) dönemlerinde olan toplam 144 tekil gebenin olduğu bireyler değerlendirildi. Serum IMA düzeyleri albumin kobalt bağlama (CAB) testi ve MDA düzeyleri tiyobarbitürik asit reaktif maddeler (TBARS) yöntemi ile ölçüldü. Selenyum (Se), demir (Fe), bakır (Cu), mangan (Mn) ve çinko (Zn) düzeyleri indüktif eşleşmiş plazma optik emisyon spektrofotometresi (ICP-OES, Thermo iCAP-6000) ile ölçüldü. Bulgular: Serum MDA ve IMA düzeylerinin geç-term grupta term grubundan yüksek olduğu, fakat serum Zn, Cu ve Se düzeyleri geç-term gebelerde term gebelere göre daha düşük olduğu bulunmuştur. Fe ve Mn değerlerinde anlamlı bir değişim bulunmamaktadır. Sonuç: Çalışmamızda, gebeliğin geç-term dönemlerinde oksidatif stres belirteçleri olarak IMA ve MDA düzeylerinin yükseldiği yani oksidatif stresin arttığı belirlenmiştir. Bu bulgular, gebeliğin geç-term dönemlerinde bu oksidatif stresin kaynağı ve etkilerinin araştırılmasına ışık tutacak öncül sonuçlardır.

Correlation between Pulmonary Artery Doppler with Neonatal Outcome in Patients with Placenta Accreta Spectrum Disorders

Objective: The purpose of this study was to correlate fetal main pulmonary artery (PA) Doppler indices with the neonatal outcome in the late preterm and early term pregnancies in placenta accreta spectrum (PAS) patients Methods: A prospective cross-sectional study was conducted on 71 patients with PAS disorders singleton pregnancies undergoing elective or emergency termination of pregnancy under general anesthesia at or after 34 weeks. A full obstetrics ultrasound scan was performed within 24 hours before delivery and after corticosteroids administration to confirm the eligibility criteria and to measure PA Doppler indices in the main PA (pulsatility index (PI), resistance index (RI), systolic to diastolic (S/D) ratio, peak systolic velocity (PSV) and acceleration to ejection time (At/Et) ratio). Results: Twenty-three neonates needed respiratory support and neonatal intensive care unit (NICU) admission. Fetuses that needed respiratory support had a significantly lower gestational age at delivery (36±1.2 versus 36.8±0.5), lower estimated fetal weight (EFW) (2770±475 versus 3096±328), lower birth weight (2782±595 versus 3152±337) and also lower Apgar score than those who did not need. None of the PA Doppler parameters correlated with the neonatal need for respiratory support. The need for respiratory support was more in the neonates who were terminated on emergency basis (39.1% versus 60.9%). The depth of placental invasion correlated with maternal morbidity. Conclusions: PA Doppler parameters do not correlate with the need for respiratory support in patient with PAS disorders.

Anterior uterocervical angle: is it an ultrasonographic screening tool that estimates the latent phase duration in post term pregnancies?

In recent years, in addition to cervical length measurement, a new ultrasonographic parameter has been defined as uterocervical angle (UCA), which can be used in the prediction of preterm labor. In this study,we evaluated the place of uterocervical angle in predicting the latent phase duration in postterm pregnancies. This prospective study consists of 90 pregnant women aged between 18 to 40 years who were hospitalized with a diagnose of late term pregnancy. Pregnant women with a latent phase duration of 1200 minutes or less were defined as Group 1. Patients with latent phase duration over 1200 minutes were defined as Group 2. All patients' age, BMI, smoke, cervical length measurements, uterocervical angle, latent and active phase of labor durations, length of the third stage and delivery types were compared. The UCA median value of group 1 was 120 (94-147), and group 2 was 99 (94-105) (p < 0.001). CL medians of Groups 1 and 2 were 29 (17-43) and 28 (27-41) respectively (p: 0.871). UCA (AUC: 0.917, p < 0.0001) significantly predicted prolonged latent phase duration. Optimal cut off value was obtained at the value of 105 degree (100% sensitivity, 75% specificity) for UCA. Kaplan-Meier survival analysis showed that duration of labor was significantly higher in a group with low UCA (p: 0.013). UCA can be a successful tool that can be used to predict duration of labor in cases of postterm pregnancies with medical induction.

A Retrospective Comparative Study of the Effect of Controlled-Release Dinoprostone Vaginal Delivery System (Propess®) and Mechanical Methods for Cervical Ripening in Nulliparous Women in Late-Term Pregnancy.

The effects of the controlled-release dinoprostone vaginal delivery system (Propess®) and mechanical methods for cervical ripening in nulliparous women in late-term pregnancy were compared retrospectively. This retrospective comparative study included 46 nulliparous pregnant women (24 in the Propess®group and 22 in the mechanical methods groups) with a low Bishop score (≤1) who needed labor induction at 41 weeks of gestation. The primary outcome was the success rate of cervical ripening (= Bishop score >6 or vaginal delivery) by the next day following the insertion of Propess®only or mechanical cervical dilation only. In the cases in which cervical ripening was unsuccessful, other methods were performed, and the success rate of cervical ripening the day after was compared as the secondary outcome. As the primary outcome, there was not a significant difference in the success rate of cervical ripening between the Propess®and mechanical methods groups (21 vs. 22%, p = 0.88). As for the secondary outcomes, there was not a significant difference in the total success rate of cervical ripening between the two groups (75 (5+13/24) vs. 73 (5+11/22)%, p = 0.86)). Of the unsuccessful cervical ripening cases as secondary outcomes, the Bishop score of all was ≤2 on the second day of hospitalization. The combined use of Propess®and mechanical methods was effective for cervical ripening in nulliparous women with a low Bishop score in late-term pregnancy, regardless of order.

Determination of Prenatal Attachment and Anxiety Levels in Postterm Pregnancy

Introduction and Aim: To compare anxiety and attachment levels besides obstetric and sociodemographic characteristics between late term and non-late term pregnants. &#x0D; Methods: This cross-sectional descriptive study was conducted on 49 pregnant women who were over 41 weeks of pregnancy as late-term pregnancy group and 67 pregnant women who were 37-41 weeks of pregnancy were included in the study as control group. Data were collected using demographic and obstetrics data form, Pregnancy-Related Anxiety Questionnaire-Revised-2, and prenatal attachment scale. &#x0D; Results: The prenatal attachment scale median score of late term pregnant women was 68 (39-81) and the anxiety scale median score was 28 (13-55). The median score of the prenatal attachment scale for may not affect the non-late term pregnant women was 64 (30-84), and the median score of the anxiety scale was 26 (11-43). There was no statistically significant difference between the two groups in terms of scale scores (p&gt;0.05). &#x0D; Conclusions: It was found that prenatal attachment and anxiety levels were not affected by the late term state of pregnant women in our study. In the presence of other conditions that positively affect attachment, although late term pregnancy is risky, it did not have an effect on attachment and anxiety.

Ruptured Aortic Dissection in an Unrecognized, Late-Term Intrauterine Pregnancy.

Ruptured Aortic Dissection in an Unrecognized, Late-Term Intrauterine Pregnancy.

Efficiency of the Cerebroplacental Ratio in Identifying High-Risk Late-Term Pregnancies.

Background and Objectives: Over the last few years, great interest has arisen in the role of the cerebroplacental ratio (CPR) to identify low-risk pregnancies at higher risk of adverse pregnancy outcomes. This study aimed to assess the predictive capacity of the CPR for adverse perinatal outcomes in all uncomplicated singleton pregnancies attending an appointment at 40-42 weeks. Materials and Methods: This is a retrospective cohort study including all consecutive singleton pregnancies undergoing a routine prenatal care appointment after 40 weeks in three maternity units in Spain and the United Kingdom from January 2017 to December 2019. The primary outcome was adverse perinatal outcomes defined as stillbirth or neonatal death, cesarean section or instrumental delivery due to fetal distress during labor, umbilical arterial cord blood pH < 7.0, umbilical venous cord blood pH < 7.1, Apgar score at 5 min < 7, and admission to the neonatal unit. Logistic mixed models and ROC curve analyses were used to analyze the data. Results: A total of 3143 pregnancies were analyzed, including 537 (17.1%) with an adverse perinatal outcome. Maternal age (odds ratio (OR) 1.03, 95% confidence interval (CI) 1.01 to 1.04), body mass index (OR 1.04, 95% CI 1.03 to 1.06), racial origin (OR 2.80, 95% CI 1.90 to 4.12), parity (OR 0.36, 95% CI 0.29 to 0.45), and labor induction (OR 1.79, 95% CI 1.36 to 2.35) were significant predictors of adverse perinatal outcomes with an area under the ROC curve of 0.743 (95% CI 0.720 to 0.766). The addition of the CPR to the previous model did not improve performance. Additionally, the CPR alone achieved a detection rate of only 11.9% (95% CI 9.3 to 15) when using the 10th centile as the screen-positive cutoff. Conclusions: Our data on late-term unselected pregnancies suggest that the CPR is a poor predictor of adverse perinatal outcomes.

Contributing factors of birth asphyxia in Thailand: a case–control study

BackgroundBirth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia.MethodsA case–control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software.ResultsThe odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal–fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia.ConclusionBirth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

Peripartum Cardiomyopathy with the Cardiac Function Restored by Cabergoline.

Peripartum cardiomyopathy (PPCM) is a left ventricular systolic dysfunction associated with heart failure (HF) in late-term pregnancy or peripartum. A 29-year-old pregnant woman with no history of cardiac disease noted lower extremity edema around 34 weeks' gestation with significant weight gain. She delivered twins via caesarean section, and the edema regressed postpartum. On postpartum day 4, however, she experienced difficulty breathing at night and was diagnosed with HF owing to PPCM. HF treatment along with cabergoline was initiated. With low prolactin blood levels, her symptoms and cardiac function improved over time. This case demonstrated the usefulness of anti-prolactin therapy with cabergoline in PPCM.

Clinico-Demographic Profile of Term Newborns Admitted with Respiratory Distress at a Tertiary Hospital in India

Background: Respiratory distress (RD) is the most common cause of morbidity and mortality in newborns. Over the last three decades, significant improvements have been introduced to decrease the incidence, severity, and mortality of neonatal RD. This study aims to analyze the clinical and demographic profile of term newborns with RD and to explore associated risk factors and co-morbidities. Methods: This analytical cross-sectional study included 250 term newborns (gestational age: 37 to 42 weeks) diagnosed with RD. The study was conducted at the Department of Pediatrics, Santosh Medical College, over a one-year period from June 2018 to June 2019. Results: The male-to-female ratio was 1.7:1. Among the admissions, 65% were term pregnancies and 35% were late-term pregnancies. Severe RD was observed in 10% of newborns, while 35% had moderate RD. There was a significant correlation between gestational period and RD severity (P = 0.024), and hospital stay also exhibited a significant association with RD severity (P = 0.001). Meconium-stained amniotic fluid was the most common maternal risk factor (25%), while sepsis was the most prevalent co-morbidity (23%). Transient tachypnea of the newborn (TTNB) was the leading cause of RD, accounting for 47% of cases. Conclusions: A comprehensive clinical assessment and appropriate investigations are vital for accurate diagnosis and effective treatment of infants with RD. Swift identification of severe underlying conditions is essential for improving outcomes.

Doxycycline hyclate in late-term pregnant mares: pharmacokinetics, diffusion to the fetoplacental unit and safety in the resulting foal

Doxycycline is a second-generation tetracycline with excellent tissue penetration, high-protein-binding, and 5-10-fold higher lipophilic character than tetracycline. It is used to treat difficult-to-identify and atypical pathogens in diseases such as granulocytic anaplasmosis, Potomac fever, Lyme disease, and placentitis caused by Leptospira and nocardioform Actinomycetes. Despite routine use of doxycycline in pregnant mares, there is no data on their pharmacokinetics during pregnancy, transplacental diffusion, or potential toxicity to the fetus and resulting foal. This study aimed to determine the pharmacokinetics of doxycycline in the late-pregnant mare, its diffusion to the fetoplacental unit and its safety in the neonate. The study hypothesizes that doxycycline crosses the equine fetoplacental unit after administration during late-term pregnancy and is safe for the resulting foal. In experiment 1, six mares received a dose of compounded doxycycline hyclate (10mg/kg, p.o.) at 300d of gestation. Doxycycline plasma concentrations were measured with LC-MS/MS at 0, 0.25, 0.5, 0.75, 1, 2, 3, 4, 6, 8, 10, 12, 24, and 48h after administration to confirm absorption and pharmacokinetics. The compounded doxycycline used herein was absorbed rapidly, and maximum plasma concentrations were achieved in 0.79h. Pharmacokinetic parameters of the doxycycline were similar to previous studies using commercial canine preparations. In experiment 2, transplacental diffusion and safety to the resulting foal were studied after administration of repeated doses ofdoxycycline to late-term pregnant mares. Seven mares received doxycycline (10mg/kg p.o. q12h) from 320d of gestation until foaling, and six gestationally-age-matched mares served as controls. Once impending signs of imminent parturition were detected coupled with mammary gland secretion pH ≤6.4, foaling was induced with oxytocin (10-units, intramuscularly) to ensure a controlled sampling of fetal fluids. Fetal fluids and foal synovial fluids were harvested at foaling to determine doxycycline concentrations with LC-MS/MS. After parturition, foals had daily clinical examinations, blood chemistry, and complete blood cell counts performed for seven days. Shapiro-Wilk was used to test normal distribution and data were analyzed with ANOVA and Tukey's as post hoc. Mares received doxycycline on average for 15±2d (range 9-23d). No adverse side effects were associated with doxycycline treatment, and complete blood cell count or blood chemistry pre- and post-partum remained within normal reference ranges. Gestation length for doxycycline-treated mares (335±2d) was similar to controls (339±4) (P=0.4). Concentrations of doxycycline were 9-fold higher in the allantoic fluid (73.5±13.9ng/mL) than amniotic fluid (8.3±3.3ng/mL) and 1.5-fold higher in the foal's plasma (35.5±4.3ng/mL than its synovial fluid (23.6±4.3ng/mL). In conclusion, doxycycline was well-absorbed and detectable in fetal fluids, foal plasma, and synovial fluid, and no adverse effects were observed in mares nor their foals.