Low-risk Term Research Articles

Effectiveness of Single Fetal Membrane Sweeping in Reducing Elective Labor Induction for Postdate Pregnancies (38+0 to 40+6 Weeks): A Randomized Controlled Trial.

Postdate pregnancy is characterized by a heightened risk for both maternal and perinatal complications. Owing to the risks, clinicians frequently turn to elective labor induction as a management strategy for postdate pregnancies. However, patients are increasingly informed and apprehensive about this approach and its associated risks. This has prompted a search for alternative management methods that may encourage spontaneous labor in pregnant women. One such approach is the use of fetal membrane sweeping, a method known to increase the likelihood of spontaneous labor onset. Yet, it remains unclear whether a single fetal membrane sweeping procedure can effectively reduce the need for elective labor induction in postdate pregnancies while minimizing risks to both the mother and fetus. The primary objective of this study was to assess the efficacy of a single fetal membrane sweeping procedure conducted between 38+0 and 40+6 weeks of gestation in reducing the rate of elective labor induction among postdate pregnancies at Central Hospital Benin City, Nigeria. Secondary objectives included evaluating the impact of membrane sweeping on maternal and perinatal outcomes. This open-label superiority randomized controlled study was carried out from June 2020 to March 2021, following ethical approval from the Hospital Management Board (HMB). One hundred and forty eligible participants, without contraindications to vaginal delivery, were randomly assigned to one of two groups. The first group received a single fetal membrane sweeping procedure between 38+0 and 40+6 weeks of gestation, while the control group underwent vaginal examination only to assess the Bishop score. Participants weremonitored until delivery.Data analysis was performed. Results were considered statistically significant at p < 0.05. The implementation of a single fetal membrane sweeping procedure effectively reduced the incidence of elective labor induction. Specifically, the membrane sweep group exhibited a significantly lower rate of elective labor induction compared to the control group (9.0% vs. 27.1%; p=0.0083). Moreover, a substantial proportion of the treatment group (91.4%) experienced spontaneous labor, while the control group reported a rate of 72.9%. Thedifference was statistically significant (p=0.0054). Notably, the control group exhibited a significantly longer mean time interval from recruitment to delivery (10.67±3.51 days) than the membrane sweeping group (3.64±4.123 days; p<0.05). Also, postdate women in the membrane sweep group were less likely to require cervical ripening with Foley's catheter than those in the control group (33.3% vs. 100%; RR: 0.33 (0.11-1.03); p=0.0057). Still, maternal satisfaction was significantly higher in the membrane-sweeping group (p<0.01). No significant differences were noted across the groups in maternal and neonatal outcomes. In low-risk term pregnancies, a single fetal membrane sweeping procedure is a superior alternative to no membrane sweeping in reducing the rate of elective labor induction for postdate pregnancies and in shortening the duration of term pregnancy.

Performance of a Maternal Risk Stratification System for Predicting Low Apgar Scores.

Maternal risk stratification systems are increasingly employed in predicting and preventing obstetric complications. These systems focus primarily on maternal morbidity, and few tools exist to stratify neonatal risk. We sought to determine if a maternal risk stratification score was associated with neonatal morbidity. Retrospective cohort study of patients with liveborn infants born at ≥24 weeks at four hospitals in one health system between January 1, 2020, and December 31, 2020. The Expanded Obstetric Comorbidity Score (EOCS) is used as the maternal risk score. The primary neonatal outcome was 5-minute Apgar <7. Logistic regression models determined associations between EOCS and neonatal morbidity. Secondary analyses were performed, including stratifying outcomes by gestational age and limiting analysis to "low-risk" term singletons. Model discrimination assessed using the area under the receiver operating characteristic curves (AUC) and calibration via calibration plots. A total of 14,497 maternal-neonatal pairs were included; 236 (1.6%) had 5-minute Apgar <7; EOCS was higher in 5-minute Apgar <7 group (median 41 vs. 11, p < 0.001). AUC for EOCS in predicting Apgar <7 was 0.72 (95% Confidence Interval (CI) 0.68, 0.75), demonstrating relatively good discrimination. Calibration plot revealed that those in the highest EOCS decile had higher risk of neonatal morbidity (7.6 vs. 1.7%, p < 0.001). When stratified by gestational age, discrimination weakened with advancing gestational age: AUC 0.70 for <28 weeks, 0.63 for 28 to 31 weeks, 0.64 for 32 to 36 weeks, and 0.61 for ≥37 weeks. When limited to term low-risk singletons, EOCS had lower discrimination for predicting neonatal morbidity and was not well calibrated. A maternal morbidity risk stratification system does not perform well in most patients giving birth, at low risk for neonatal complications. The findings suggest that the association between EOCS and 5-minute Apgar <7 likely reflects a relationship with prematurity. This study cautions against intentional or unintentional extrapolation of maternal morbidity risk for neonatal risk, especially for term deliveries. · EOCS had moderate discrimination for Apgar <7.. · Predictive performance declined when limited to low-risk term singletons.. · Relationship between EOCS and Apgar <7 was likely driven by prematurity..

The Use of Evening Primrose Oil for Cervical Ripening in Low-Risk Women with Term Pregnancy: A Randomized Double-Blinded Controlled Trial

Background: Several methods have been developed for cervical ripening. The data regarding the efficiency of evening primrose oil (EPO) are inconsistent. The purpose of this study was to investigate the outcomes of EPO use on cervical ripening in low-risk women with term pregnancy. Patients and Methods: Low-risk term pregnant women referred to the obstetrics clinic of Imam Hossein Hospital in Tehran who were eligible according to the inclusion were randomized either to the case or control group. The case group received 1,000 mg vaginal EPO capsule, and the other group received a vaginal placebo capsule daily, similar to the original drug. The primary outcome was Bishop score, while the duration of labor phases and the inducing procedures were the secondary outcomes. Results: Forty-eight participants were randomized to each group and were considered for data analysis. Although Bishop score was not statistically different before the intervention, it was significantly higher in case group compared to the placebo group after the intervention (EPO = 5.83 ± 1.68, placebo = 5.19 ± 1.52, p value = 0.002). Four participants in the case group and two in the control group underwent cesarean section (p value = 0.677). The need for labor induction was significantly higher in the placebo group than EPO group (oxytocin injection: 10.4% vs. 31.3%, p value = 0.012, amniotomy: 75% vs. 41.7, p value = 0.001). Conclusion: The vaginal use of EPO could be considered as a safe and efficient approach for cervical ripening in low-risk term pregnant women.

Outpatient cervical ripening with balloon catheters: A Bayesian network meta-analysis of randomized controlled trials.

One in four labors are induced. The process of cervical ripening can be lengthy and pre-labor hospitalization is required. Outpatient cervical ripening can be an attractive alternative. To evaluate the efficacy and safety of outpatient cervical ripening with a balloon catheter compared with inpatient balloon catheter or prostaglandin E2 (PGE2). The PubMed, MEDLINE, Embase, ClinicalTrials.gov, and Cochrane Library databases were searched from their inception to October 15, 2022. Randomized controlled trials comparing the outpatient balloon catheter with inpatient balloon catheter or inpatient PGE2 for term cervical ripening. Bayesian network meta-analysis was performed. The primary outcome was the cesarean delivery rate. The secondary outcomes included instrumental delivery, the time from intervention-to-birth, oxytocin augmentation, total hospital duration, and maternal/neonatal adverse events. Twenty-nine randomized controlled trials with a total of 6004 participants were identified. No difference in the cesarean delivery rate was revealed among the three interventions. Compared with inpatient balloon catheter, outpatient balloon catheter had shorter total hospital duration (mean difference -8.58, 95% confidence interval -17.02 to -1.10). No differences were revealed in the time from intervention-to-birth, instrumental delivery, postpartum hemorrhage, 5-min Apgar score less than 7, umbilical cord arterial pH less than 7.1, and neonatal intensive care unit admission among the three interventions. Outpatient balloon catheter in low-risk term pregnancies is an available option that could be considered for cervical ripening. The safety and effectiveness are comparable to inpatient cervical ripening methods.

Assessment of the cerebroplacental ratio and uterine arteries in low-risk pregnancies in early labour for the prediction of obstetric and neonatal outcomes

BackgroundThe evidence-based management of human labor includes the antepartum identification of patients at risk for intrapartum hypoxia. However, available evidence has shown that most of the hypoxic-related complications occur among pregnancies classified at low-risk for intrapartum hypoxia, thus suggesting that the current strategy to identify the pregnancies at risk for intrapartum fetal hypoxia has limited accuracy. ObjectiveTo evaluate the role of the combined assessment of the cerebroplacental ratio (CPR) and uterine arteries (UtA) Doppler in the prediction of obstetric intervention (OI) for suspected intrapartum fetal compromise (IFC) within a cohort of low-risk singleton term pregnancies in early labor. MethodsProspective multicentre observational study conducted across four tertiary Maternity Units between January 2016 and September 2019. Low-risk term pregnancies with spontaneous onset of labor were included. A two-step multivariable model was developed to assess the risk of OI for suspected IFC. The baseline model included antenatal and intrapartum characteristics, while the combined model included antenatal and intrapartum characteristics plus Doppler anomalies such as CPR MoM < 10th percentile and mean UtA Doppler PI MoM ≥ 95th percentile. Predictive performance was determined by receiver–operating characteristics curve analysis. Results804 women were included. At logistic regression analysis, CPR MoM < 10th percentile (aOR 1.269, 95 % CI 1.188–1.356, P < 0.001), mean UtA PI MoM ≥ 95th percentile (aOR 1.012, 95 % CI 1.001–1.022, P = 0.04) were independently associated with OI for suspected IFC. At ROC curve analysis, the combined model including antenatal characteristics plus abnormal CPR and mean UtA PI yielded an AUC of 0.78, 95 %CI(0.71–0.85), p < 0.001, which was significantly higher than the baseline model (AUC 0.61, 95 %CI(0.54–0.69), p = 0.007) (p < 0.001). The combined model was associated with a 0.78 (95 % CI 0.67–0.89) sensitivity, 0.68 (95 % CI 0.65–0.72) specificity, 0.15 (95 % CI 0.11–0.19) PPV, and 0.98 (0.96–0.99) NPV, 2.48 (95 % CI 2.07–2.97) LR + and 0.32 (95 % CI 0.19–0.53) LR- for OI due to suspected IFC. ConclusionsA predictive model including antenatal and intrapartum characteristics combined with abnormal CPR and mean UtA PI has a good capacity to rule out and a moderate capacity to rule in OI due to IFC, albeit with poor predictive value.

Efficacy and Risks of Different Treatments for Oral Hyperpigmentation: A Systematic Review and Network Meta-Analysis.

Oral-pigmented lesions have raised aesthetic concerns, leading to multiple depigmentation techniques. This systematic review and network meta-analysis aimed to assess the efficacy of different treatments for oral hyperpigmentation. A computerized search was conducted on Science Direct, Medline via PubMed, Scopus, and Web of Science using the relevant keywords. English-language studies published between 2013 and 2023 that focused on patients with oral pigmented lesions subjected to different treatment modalities, such as laser or surgical intervention, were compared to determine their efficacy and safety profile. Data were analyzed using R software, applying frequentist models. A total of 27 studies were included. In contrast to the CO2 laser, Er: YAG laser was linked to a higher risk of bleeding (RR = 2.73, p < 0.01), whereas the diode laser had the most favorable score in minimizing bleeding index (P-score = 0.86). In terms of lower risk and postoperative pain score (RR = 0.01, p < 0.01), the Er,Cr:YSGG laser had the most favorable result (P-score = 1.00). The Er: YAG laser demonstrated the highest probability of preventing recurrence (RR = 0.28, p < 0.01), followed by the diode laser (RR = 0.42, p < 0.01). The choice of treatment for oral pigmentation should be based on individual patient needs and the desired outcomes. The Er: YAG laser seems highly effective in preventing pigment recurrence, the diode laser emerges as a top contender in managing bleeding risks, and the Er,Cr:YSGG laser is particularly efficacious in managing postoperative pain.

Neonatal outcomes of elective labor induction in low-risk term pregnancies

The rate of labor induction has increased in recent years. The results of previously conducted studies examining associations between elective induction of labor (IOL) and neonatal outcomes have been contradictory. The aim of this study was to examine the intrinsic neonatal risks following IOL. We conducted a population-based cohort study, including all women with recorded low-risk singleton pregnancies at a gestational age between 37 + 0 and 41 + 6 weeks in Sweden from 1999 to 2017. Data were collected from the Swedish Medical Birth register. Two study groups were compared—the elective induction group with the spontaneous labor onset group. The results showed that the rate of elective IOL increased from 7.2% in 1999 to 16.4% in 2017. Elective IOL was associated with a higher OR for chorioamnionitis, bacterial sepsis, intracranial hemorrhage, assisted ventilation, hyperbilirubinemia, APGAR < 7 at 5 min, and neonatal seizures compared to deliveries with spontaneous labor onset. Regarding mortality outcomes, no significant differences were shown between the groups for either early term or full-term deliveries. We conclude that IOL is associated with neonatal complications, although causality could not be established in this observational study. It is important to be aware of the increased risk and perform IOL with caution.

Concurrent validity of the ages and stages questionnaires with Bayley Scales of Infant Development-III at 2 years – Singapore cohort study

With increasing acceptance of universal developmental screening in primary care, it is essential to evaluate the local validity and psychometric properties of commonly used questionnaires like the parent-completed Ages and Stages Questionnaires, 3rd Edition (ASQ-3) in identifying developmental delays. The aim of this study is to assess the convergent validity of the ASQ-3 with the Bayley Scales of Infant Development-3rd edition (Bayley-III) in identifying developmental delay in a low-risk term cohort in Singapore. ASQ-3 and Bayley-III data was collected prospectively with generation of ASQ-3 cut-off scores using three different criteria: 1-standard deviation (SD) (Criterion-I) or 2-SD (Criterion-II) below the mean, and using a Receiver Operator Curve (ROC) (Criterion-III). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. Correlations between the ASQ-3 and Bayley-III domains were evaluated using Pearson coefficients. With all three criteria across different domains ASQ-3 showed high specificity (72-99%) and NPV (69-98%), but lower sensitivity (19-74%) and PPV (11-59%). Criterion-I identified 11-21% of children as "at-risk of developmental delay," and was the most promising criterion measure, with high specificity (82-91%), NPV (69-74%) and overall agreement of 64-71%. Moderate-strong correlations were seen between ASQ-3 Communication and Bayley-III Language scales (r=0.44-0.59, p<0.01). The lowest sensitivities were seen in the motor domains. ASQ-3 is reliable in low-risk settings in identifying typically developing children not at risk of developmental delay, but it has modest sensitivity. Moderate-strong correlations seen in the communication domain are clinically important for early identification of language delay, which is one of the most prevalent areas of early childhood developmental delay.

Changes in Salivary Oxytocin Level of Term Pregnant Women after Aromatherapy Footbath for Spontaneous Labor Onset: A Non-Randomized Experimental Study.

Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women. In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels. In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups. The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.

Assessment of the Impacts of Urbanization on Landslide Susceptibility in Hakha City, a Mountainous Region of Western Myanmar

In July 2015, more than 100 landslides caused by Cyclone Komen resulted in damage to approximately 1000 buildings in the mountainous region of Hakha City, Myanmar. This study aimed to identify potential landslide susceptibility for newly developed resettlement areas in Hakha City before and after urbanization. The study evaluated landslide susceptibility through statistical modeling and compared the level of susceptibility before and after urbanization in the region. The information value model was used to predict landslide susceptibility before and after urbanization, using 10 parameter maps as independent variables and 1 landslide inventory map as the dependent variable. Four landslide types were identified in the study area: shallow earth slide, deep slide, earth slump, and debris flow. Susceptibility analyses were conducted separately for each type to better recognize the different aspects of landslide susceptibility in planned urban areas. By comparing the results of the susceptibility index before and after urbanization, suitable urban areas with lower landslide susceptibility could be identified. The results showed that high-potential landslide susceptibility increased by 10%, 16%, and 5% after urbanization compared with before urbanization in three Town Plans, respectively. Therefore, Town Plan 3 is selected as the most suitable location for the resettlement area in terms of low risk of landslides.

Functional brain network properties of healthy full-term newborns quantified by scalp and source-reconstructed EEG

ObjectiveIdentifying the functional brain network properties of term low-risk newborns using high-density EEG (HD-EEG) and comparing these properties with those of established functional magnetic resonance image (fMRI) – based networks. MethodsHD-EEG was collected from 113 low-risk term newborns before delivery hospital discharge and within 72 hours of birth. Functional brain networks were reconstructed using coherence at the scalp and source levels in delta, theta, alpha, beta, and gamma frequency bands. These networks were characterized for the global and local network architecture. ResultsSource-level networks in all the frequency bands identified the presence of the efficient small world (small-world propensity (SWP) > 0.6) architecture with four distinct modules linked by hub regions and rich-club (coefficient > 1) topology. The modular regions included primary, association, limbic, paralimbic, and subcortical regions, which have been demonstrated in fMRI studies. In contrast, scalp-level networks did not display consistent small world architecture (SWP < 0.6), and also identified only 2–3 modules in each frequency band.The modular regions of the scalp-network primarily included frontal and occipital regions. ConclusionsOur findings show that EEG sources in low-risk newborns corroborate fMRI-based connectivity results. SignificanceEEG source analysis characterizes functional connectivity at the bedside of low-risk newborn infants soon after birth.

Admission Cardiotocography: Its Role in Predicting Perinatal Outcome in Term, Uncomplicated (Low Risk) Pregnant Women in Spontaneous Labour

Introduction: Labour admission cardiotocography (CTG) is commonly used non-invasive method of fetal monitoring in Sri Lanka. It may have a potentialto predict perinatal outcome in low-risk term pregnancies. Objectives: Objectives of the study were to determine the perinatal outcomes of normal, suspicious and pathological admission CTGs and role of labour admission cardiotocography as a predictive test for perinatal outcome in low-risk term pregnancies in spontaneous labour. Methods: This study was a prospective observational study done involving 445 low risk, term pregnancies in spontaneous labour. Labour admission CTG was performed in each pregnancy and categorized into normal, suspicious and pathological CTG according to criteria depicted by National Institute of Clinical Excellence (NICE) guideline 2007. Apgar score less than 7 at five minutes, resuscitation at birth, admission to neonatal intensive care unit (NICU), seizure within first 24 hours of birth and meconium-stained amniotic fluid were the primary outcome measures to assess fetal asphyxia. Mode of delivery in each category, nuchal cord at birth were also assessed. Results: Majority of participants were in 25-to-29-year age group and were nulliparous. Frequencies of normal, suspicious and pathological CTG were 74.8%, 18% and 7.2% respectively. Pathological CTG was significantly associated with low Apgar score compared to non-pathological CTG group (p 0.005) while other outcome measures were not significant. Rate of operative delivery was 68% in pathological group and 20.8% in non-pathological CTG group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of labour admission CTG to detect fetal asphyxia were 51.85%, 95.69%, 43.75% and 96.85% respectively. Conclusions: Incidence of pathological labour admission CTG was 7.2%. Apgar score less than 7 at five minutes of birth was significantly associated with pathological CTG group compared to non-pathological CTG (p 0.05). Worsening of CTG from normal to pathological showed increasing rate of operative delivery. Even though sensitivity and positive predictive values of labour admission CTG were low, specificity and negative predictive values were high for detecting low Apgar score. Therefore, labour admission CTG has a value in excluding adverse perinatal outcomes in low-risk term pregnancies in spontaneous labour.

Role of Cerebro-Placental Ratio in Predicting Adverse Outcomes in Low-Risk PregnanciesA Prospective Cohort Study

Introduction: Abnormal Cerebro-Placental Ratio (CPR) is associated with a substantial risk of adverse perinatal outcomes and the test seems to be particularly useful for follow-up of foetuses with sonographically diagnosed Foetal Growth Restriction (FGR). Aim: To determine the usefulness of doppler velocimetry, especially CPR at 35 weeks of gestation or later, in predicting intrapartum foetal heart rate abnormalities and adverse neonatal outcomes in low-risk term pregnancies. Materials and Methods: The present prospective cohort study was conducted at the Department of Obstetrics and Gynaecology in Bangalore Baptist Hospital, Bangalore from September 2019 to September 2020. A total of 60 pregnant women between the ages of 18 and 35 years with low-risk pregnancies, who present for the obstetrical ultrasound at 35 weeks of gestation or later with planned delivery at the hospital were included. All lowrisk pregnant women with estimated foetal weight (EFW) &gt;10th centile and abnormal Cerebro-Placental Ratio (CPR) &lt;10th centile were compared with those with normal CPR i.e., &gt;10th centile. An adverse obstetric outcome, like foetal distress, meconium aspiration syndrome or respiratory distress syndrome, mode of delivery, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality was analysed in the study population using chi-square test or Fischer’s-exact test. Results: In this study, there was a significant association between foetal distress and CPR with Odds Ratio (OR) of 4.21 i.e., foetal distress was 4.21 times higher in the abnormal group compared to the normal group. Among 20 cases with abnormal CPR, 11 had foetal distress i.e., 55% and among 40 cases with normal CPR, nine had foetal distress i.e., 22.5%. Among those with abnormal CPR, 15% had Amniotic Fluid Index (AFI) &lt;8 and among those with normal CPR, 0% had AFI &lt;8, showing a significant association. Conclusion: In low-risk patients with EFW &gt;10th centile and abnormal CPR, there was a significant association with adverse obstetric outcomes, requiring vigilant intrapartum monitoring.

Supporting Open Infrastructure through commercial partnerships

Watch the VIDEO. One of the key issues with open infrastructure within the scholarly communications and open science spaces is finding solutions for long-term sustainability. One important approach to this is ensuring that these infrastructures are also adopted and supported by the commercial sector, as in the case of key platforms we take for granted today, such as Linux. This can lead to significant benefits both for the scholarly community in terms of dependability and lower cost, and to companies in terms of lower risk, shared costs, and broadening impact on society. This presentation will present the approach taken by Ubiquity, a for-profit publishing services and open science platform, to base all of its products on open infrastructure. By deploying and contributing both financially and through open source code to infrastructure such as Open Journal Systems, Samvera repositories and OPERAS Metrics, Ubiquity is able to both strengthen these platforms for the wider community and to benefit significantly from their use. A cost-benefit analysis based on the Ubiquity example will be included to make the case for investment in open infrastructure by commercial companies. This will be further balanced by a discussion of ways to establish trust between the scholarly community and commercial providers, and the kind of guarantees these providers need to make based on our experience.

Role of the cerebro-placental-uterine ratio in predicting adverse perinatal outcome in low-risk pregnancies at term

PurposeThe cerebroplacental ratio (CPR) is associated with adverse perinatal outcome (APO) in low-risk pregnancies near term. A Doppler parameter, which also includes information from the uterine vessels could potentially improve detection of subclinical placental dysfunction. The aim of this study is to investigate the performance of cerebro-placental-uterine ratio (CPUR) related to APO prediction in low-risk term pregnancies in > 40 + 0 weeks.MethodsThis is a retrospective cohort study. All low-risk pregnancies in which feto-maternal Doppler was examined from 40 + 0 weeks and an appropriate for gestational age fetus was present were included. ROC (receiver operating characteristic curves) analyses were performed to assess the predictive value of CPUR. The presence of at least one of the following outcome parameters was defined as composite APO (CAPO): operative delivery (OD) due to intrapartum fetal compromise (IFC), admission to the neonatal intensive care unit, umbilical cord arterial pH ≤ 7.15, 5 min APGAR ≤ 7.ResultsA total of n = 114 cases were included. Mean gestational age at examination and delivery were 40 + 3 weeks and 40 + 6 weeks, respectively. Overall, CAPO occurred in 38 of 114 cases (33.3%). ROC analyses showed a significant association of CPUR (AUC = 0.67, p = 0.004) and CPR (AUC = 0.68, p = 0.002) with CAPO. Additionally, CPUR (AUC = 0.64, p = 0.040) showed a predictive value for OD due to IFC.ConclusionThe CPUR in > 40 + 0 weeks showed a predictive value for CAPO and OD due to IFC in low-risk pregnancies. However, the extent to which CPUR can be used to optimize delivery management warrants further investigations in prospective interventional studies.

Efficacy of 50 µg Versus 25 µg Vaginal Misoprostol for Cervical Ripening and Labor Induction: A Randomized Trial

Background: Cervical ripening is the process of initiating labor in women with an unripe cervix. Vaginally administered prostaglandin E1 analog (misoprostol) has been promising in cervical ripening and labor induction. However, optimal dosage and dose-dependent adverse effects in this administration route need further clarification. Objectives: This trial aimed to compare the efficacy and adverse effects of 50 mcg vs. 25 mcg of vaginal misoprostol in low-risk term pregnant women. Methods: This double-blind, single-center, randomized clinical trial included 200 low-risk term pregnancies undergoing labor induction with a Bishop score of 2 or less. Patients were assigned randomly to receive 25 mcg or 50 mcg of vaginal misoprostol every six hours up to four times until the active phase of labor was reached. The primary outcome included time to vaginal delivery (latent and active phase of labor), and secondary outcomes included the total dosage of prescribed misoprostol, the need for oxytocin for labor augmentation, and the cesarean section rate. Results: Misoprostol 50 micrograms resulted in a significantly shorter time in the first phase of labor (P-value = 0.002), the second phase of labor (P-value = 0.030), and the third phase of labor (P-value = 0.020). The number of administered misoprostol, the need for additional oxytocin, uterine hyperstimulation, cesarean delivery rate, Apgar score, umbilical artery pH, and neonatal intensive care unit (NICU) administration were statistically similar between the two groups. Conclusions: This study showed that 50 mcg of vaginal misoprostol (vs. 25 mcg) for cervical ripening could reduce labor phase duration without significantly increasing adverse maternal and neonatal outcomes.

Role of first trimester screening test in predicting the perinatal outcomes in low risk term pregnancies

Objective: This study aims to investigate the relationship between the nuchal translucency (NT) values measured in the first trimester and the well-being of the newborn. Methods: The study was planned as a retrospective cross-sectional study and was conducted between January 2018 and January 2020. A total of 2394 patients who had a combined test and delivered at our university hospital were included in the study. The demographic data of the pregnant women were recorded. NT MoM values, PAPP-A and β-hCG MoM values, birth weight, gender, need for neonatal intensive care (NICU), and Apgar scores were evaluated. Results: It was found that NT (MoM) values were similar among the SGA, AGA, and LGA groups (p=0.159). PAPP-A (MoM) values were similar in the SGA group compared to AGA and LGA infant groups (p=0.947). It was also found that β-hCG (MoM) values were similar in the AGA group compared to SGA and the LGA infant groups (p=0.694). When compared with those with NICU and non-NICU, the NT, PAPP-A, β-hCG, and birth weight values were again not found to be statistically significant (p&gt;0.05). The NT, PAPP-A, β-hCG, and male gender factors were evaluated in the Binary Logistic Regression Analysis, in which being an SGA baby was considered as a risk. It was found that a 1 mm increase in NT values increased the risk of having an SGA baby 2.63 times at a statistically significant level (OR=2.636, p=0.009, 95% CI: 1.277–5.440). PAPP-A, β-hCG levels, and having a male gender were not related to the risk of having an SGA baby. Furthermore, NT, PAPP-A, β-hCG levels, and having a male gender were not associated with the risk of NICU hospitalization. Conclusion: In conclusion, we could not predict the birth weight with increased NT MoM values that were detected in the first trimester combined test in this study; however, we found that the risk of having an SGA fetus increases with a weak rise in NT value.

Analysis of demographic characteristics affecting labour curve in low risk pregnant woman in tertiary care hospital in Central India

Background: Since decades labour curve given by E. Friedman in 1950 is used in obstetrics practices all over the world; but recent studies have highlighted labour progression pattern which deviates from Friedman’s curve. Recently there have been many studies done to focus on progress of labour in contemporary labouring females. Till date no other study has been focused on developing labour curves for Indian origin females. This study is done to evaluate pattern of labour progress in central Indian origin female. Objective: To analyse demographic characteristics affecting spontaneous labour progression in low risk pregnant females of central Indian origin. Material and methods: It was prospective observational study done from August 2017 to July 2018. Low risk term pregnant women with spontaneous onset of labour were included and findings were entered in a pre-structured format. Results: Mean age of study population was 24.43 years with a range of 18 to 35 years. Mean body mass index (BMI) of study population was 21.49 with a range of 18.5 -30 kg/m2. Maximum number of females were nulliparous i.e 79.10%. Mean cervical dilatation at admission was 4 cm. Mean duration of active phase of labour was 3.66 hrs. &#x0D;

An Observational Study to Assess the Role of Modified Biophysical Profile and Doppler Ultrasound in Determining the Fetal Well-being in Low-risk Term Pregnancy

An Observational Study to Assess the Role of Modified Biophysical Profile and Doppler Ultrasound in Determining the Fetal Well-being in Low-risk Term Pregnancy

Electroencephalogram in low-risk term newborns predicts neurodevelopmental metrics at age two years

ObjectiveTo determine whether neurodevelopmental biomarkers at 2 years of age are already present in the newborns’ EEG at birth. MethodsLow-risk term newborns were enrolled and studied utilizing EEG prior to discharge from the birth hospital. A 14-channel EEG montage (scalp-level) and source signals were calculated using the EEG. Their spectral power was calculated for each of the five frequency bands. Cognitive, language and motor skills were assessed using the Bayley Scales of Infant Development-III at age 2 years. The relationship between the spectral power in each frequency band and neurodevelopmental scores were quantified using the Spearman’s r. The role of gender, gestational age (GA) and delivery mode, if found significant (P < 0.05), were controlled by analyzing partial correlation. ResultsWe studied 47 newborns and found a significant association between gender, and delivery mode with EEG power. Scalp- and source-level spectral powers were positively associated with cognitive and language scores. At the source level, significant associations were identified in the parietal and occipital regions. ConclusionsElectrophysiological biomarkers of neurodevelopment at age 2 years are already present at birth in low-risk term infants. SignificanceLow-risk newborns’ EEG utility as a screening tool to optimize neurodevelopmental outcome warrants further evaluation.