Obstetric Management Research Articles

Neobladder saving caesarean section in a pregnant woman with congenital bladder exstrophy.

To propose an obstetric management model for patients with congenital bladder exstrophy (BE) and multiple previous surgeries, recognizing the unique anatomical variations of each patient and emphasizing the importance of personalized treatment approaches. We present the obstetric management and delivery of a 32-year-old pregnant woman with congenital BE, focusing on antenatal anatomical assessment, accurate delivery planning and key surgical steps during an elective caesarean section. Additionally, we conduct a comprehensive review of the current literature to enhance understanding of the reproductive implications associated with this exceptionally rare condition. Following urological magnetic resonance imaging and intraoperative ultrasound, a successful neobladder-saving caesarean section was performed at 37weeks, resulting in the delivery of a healthy infant with no maternal complications. Obstetric management in women with congenital BE presents unique challenges due to its significant impact on urinary and reproductive functions. Careful delivery planning and antenatal anatomical assessment are crucial for optimizing both maternal and fetal outcomes. A personalized, multidisciplinary approach can help minimize potential complications.

Time to recovery of neonatal sepsis and its predictors in public hospitals of North Shoa Zone, Central Ethiopia

BackgroundNeonatal sepsis remains one of the most common causes of morbidity and mortality among neonates in developing countries. It can cause severe morbidities and sequelae, even though patients survive. Prolonged recovery time of neonatal sepsis leads to hospitalization, increased cost of treatments, antimicrobial resistance, disseminated intravascular coagulation, respiratory failure, septic shock, brain lesions, renal failure, and cardiovascular dysfunction, and eventually death. Thus, this study aimed to identify the time-to-recovery of neonatal sepsis and its predictors among newborns admitted to public hospitals in the North Shoa Zone, Central Ethiopia.MethodsA retrospective cohort study was conducted among 508 septic neonates admitted to selected public hospitals in the North Shoa Zone between March 1, 2021, and March 1, 2023. A systematic random sampling method was used to select eligible medical records. The data were collected through the open data kit (ODK) Collect Android app and consequently exported to STATA version 17 for analysis. The data were analyzed using both univariable and multivariable Cox regression models. The adjusted hazard ratio (AHR) with its corresponding 95% confidence interval (CI) was employed.ResultsOf all septic neonates, 441 were recovered. The predictors of time-to-recovery of neonatal sepsis were premature rupture of membrane (PROM) (AHR = 0.37; 95% CI: 0.21, 0.63), intrapartum fever (AHR = 0.49; 95% CI: 0.32, 0.75), chest-indrawing (AHR = 0.50; 95% CI: 0.36, 0.68), fifth-minute appearance, pulse, grimace, activity, and respiration (Apgar) score less than seven (AHR = 0.54; 95% CI: 0.38, 0.77), gestational age between 37 and 42 weeks (AHR = 1.35; 95% CI: 1.06, 1.70), septic shock (AHR = 0.52; 95% CI: 0.31, 0.85).ConclusionThe median time to recovery from neonatal sepsis in this study was comparable to the previous studies. Premature rupture of membranes, intrapartum fever, term gestational age, low fifth minute Apgar score, chest indrawing, and septic shock were the predictors of time-to recovery of neonatal sepsis. Therefore, birth attendants are advised to closely adhere to the obstetrics management protocols when providing care for women who have intrapartum fever and premature rupture of membranes, as this will help to minimize neonatal sepsis and the subsequent delay in recovery.

STUDI KASUS: FAKTOR PEMICU SERING BUANG AIR KECIL DAN DAMPAKNYA TERHADAP KUALITAS TIDUR IBU HAMIL TRIMESTER III

Pregnancy is a time of significant physiological, psychological, and emotional changes in a woman's body. As the fetus develops, the mother's body undergoes changes that affect various bodily functions, one of which is increased urinary frequency. This case study was conducted on 10 third-trimester pregnant women who experienced frequent urination and its impact on their sleep. The study aims to identify triggering factors and assess the impact on sleep quality in third-trimester pregnant women. Sleep disturbances caused by frequent waking to urinate can negatively affect the physical and mental well-being of pregnant women. The study involved several third-trimester pregnant women who reported frequent nighttime urination. The results show that the majority of the participants woke up 2-5 times each night to urinate, leading to fragmented sleep and reduced sleep duration and efficiency. These sleep disturbances are associated with excessive daytime sleepiness, fatigue, and a decline in the quality of life of the pregnant women. Additionally, the findings also indicate that physical factors such as the enlarged uterus pressing on the bladder and hormonal changes play a significant role in increasing urinary frequency. The obstetric care management in this case study recommends interventions such as education on fluid intake regulation, Kegel exercises, and relaxation techniques like yoga to reduce sleep disturbances. It is hoped that this case study can provide insights for healthcare professionals to offer more effective management to improve the sleep quality and overall well-being of pregnant women.

Implementation of Risk Factor Detection System Using k-NN Method to Reduce Maternal Mortality Rate at Sumbersari Primary Health Centre

The Maternal Mortality Rate has become a major issue for the Indonesian government as it can be used to measure the reproductive health level of a country. In 2023, the maternal mortality rate in Jember Regency was recorded at 150 per 100,000 live births. Sumbersari Primary Heath Centre is one of Primary Health in Jember, located in the city. Still had cases of maternal mortality, with two recorded cases The Jember Regency government has implemented various interventions, including the implementation of integrated antenatal care (ANC), the preparation of emergency obstetric and neonatal management guidelines, and collaboration with educational institutions to support pregnant women, strengthen maternal and neonatal referrals, and enhance the PONED and PONEK maternity teams. In line with these programs, there is a need for synergy in utilizing information technology to support the Jember government’s efforts to reduce maternal mortality rates through the creation of an early detection system to predict maternal deaths. This research will develop an early detection system for maternal mortality using the KNN method. The attributes used include gestational age, weight, haemoglobin, blood pressure A, blood pressure B, facial swelling, stillbirth, breech birth, bleeding during pregnancy, hydramnios, post-term pregnancy, transverse presentation, preeclampsia/eclampsia, anaemia, tuberculosis, malaria, and heart failure. The system development will utilize the prototype method. The test results show that the system can be used to predict maternal mortality with an accuracy

Identification of a Founder GLDN Variant Associated With "Lethal" Arthrogryposis in Nunavik Inuit: Implications for Obstetrical and Long-Term Survivors' Management.

Biallelic variants in GLDN have recently been associated with lethal congenital contracture syndrome 11 (LCCS11), a form of fetal akinesia deformation sequence (FADS) with high neonatal mortality. In this report, we describe five individuals from two Canadian Inuit families originating from different communities in Nunavik all affected with FADS and harboring a rare homozygous missense variant, [NM_181789.4:c.82G >C p.(Ala28Pro)] in GLDN. Two pregnancies presented with significant obstetrical complications including placental abruption and hemorrhage. Four infants died shortly after birth, while one survived past the neonatal period. This individual, while apparently asymptomatic during infancy, then presented with progressive neuromuscular and respiratory compromise that became more evident in adolescence. Data from a Nunavik Inuit cohort demonstrated a minor allele frequency (MAF) of 0.03571 for this variant compared to 0.00001341 in the general population, suggesting a founder effect in the Nunavik Inuit population. Our findings support the presence of a founder variant associated with LCCS11 in Nunavik Inuit populations. Our data corroborate those of other reports, demonstrating that LCCS11 is not universally lethal, but long-term survivors are at risk of progressive neuromuscular compromise. We also highlight in this report the significant obstetrical complications associated with this fetal-onset condition.

Obesity and postpartum hospital use among individuals without additional medical comorbidities.

The objective of this study was to examine whether obesity without preexisting or gestational comorbidities is associated with postpartum hospital use (PHU). We studied 2016 to 2018 birth certificate and discharge data on 178,729 New York City births without International Classification of Diseases, Tenth Revision (ICD-10) codes at delivery for diabetes; hypertension; placental disease; anemia; thyrotoxicosis; bariatric surgery; and pulmonary, cardiac, renal, bleeding, autoimmune, digestive, neuromuscular, mental, or substance-use disorders. We defined PHU as ≥1 readmissionor emergency department visit within 30 days of delivery discharge. We used ICD-10 codes to specify postpartum hypertension, infection, or hemorrhage during PHU (i.e., "cause-specific PHU") because these are leading mortality causes. We examined associations between prepregnancy BMI and PHU using multivariable logistic regression. PHU incidence was 3.7% for those with normal weight, 5.1% for those with overweight, 6.3% for those with class 1 or 2 obesity, and 9.1% for those with class 3 obesity. A positive association persisted after adjustment. Obesity was associated with cause-specific PHU of postpartum hypertension (adjusted odds ratio [aOR]: 2.2, 95% confidence limits [CL]: 1.8-2.7, normal weight referent) and wound infection (aOR: 1.5, 95% CL: 1.2-1.8), but not hemorrhage (aOR: 0.9, 95% CL: 0.7-1.3), mastitis, or genitourinary infection (aOR: 1.1, 95% CL: 0.9-1.3). Among individuals without other comorbidities, elevated BMI was associated with PHU. Findings can inform obstetric management to reduce morbidity during the critical fourth trimester.

Conjoined Twins at the Centre Hospitalier Universitaire Mère-Enfant, Fondation Jeanne Ebori (CHUMEFJE) in Libreville: Difficulties in the Management of 2 Cases

Conjoined twins (Siamese twins) are among the rare and complex complications of twin pregnancy, with a prevalence of 1 in 50,000 to 100,000 births. We report two cases of conjoined twins managed at the Mother-Child University Hospital Jeanne Ebori Foundation in Libreville. The first case involved craniopagus twins born prematurely by cesarean section at 30 weeks, both of whom experienced poor adaptation to extra-uterine life. The second case, omphalopagus twins, was a term vaginal delivery where one twin required resuscitation. Both cases highlight the importance of antenatal diagnosis for appropriate obstetric and postnatal management. This report highlights the challenges of managing such cases in resource-limited settings and the need for enhanced prenatal screening and multidisciplinary collaboration to improve outcomes.

The Experiences of Midwives in the Management of Obstetric Emergencies: A Phenomenological Study in the Kwahu West Municipality, Ghana

Introduction Obstetric emergencies are sudden, unexpected life-threatening medical conditions that occur during pregnancy, labour, delivery or puerperium and are challenging moments because of frightening and traumatic experiences. Obstetric emergencies, which threaten the well-being of the woman and the unborn child, account for the majority of causes of maternal death. Objective The study sought to explore Midwives’ experiences in obstetric emergencies in the Kwahu West Municipality of Ghana Methods A phenomenological study design with a qualitative approach was employed to explore the midwives’ experiences in the management of obstetrics. Participants were selected using purposive sampling. The sample size of 13 was reached upon data saturation. A semi-structured interview guide was used to interview midwives who have experienced and managed obstetric emergencies. The obtained data was transcribed and analysed using a thematic analysis approach. Results Overall, five themes and 13 subthemes emerged. The emerging themes encompass factors influencing midwives’ experiences in managing obstetric emergencies, Reactions of midwives during obstetric emergencies, Challenges of midwives in managing obstetric emergencies, Healthcare challenging factors, and Client-centred limitations. Conclusion It is evident that midwives play a critical role in addressing obstetric emergencies, often being the frontline healthcare providers in such situations. Their experiences shed light on both the challenges they face and the strategies they employ to provide effective care under demanding circumstances. The findings highlight the need for further investment in training and resources for midwives, particularly in rural areas where access to healthcare services may be limited.

Outcomes Associated with a Patient Blood Management Program in Major Obstetric Hemorrhage: A Retrospective Cohort Study.

Obstetric patient blood management (PBM) strategies were used at Corniche Hospital in 2018, initially focusing on minimizing bleeding, with other clinical strategies implemented incrementally. This study assesses program outcomes in patients with major obstetric hemorrhage of 2000 mL or greater. A retrospective study of 353 women admitted to The Corniche Hospital between 2018 and 2023 who experienced major obstetric hemorrhage of 2000 mL or greater. The primary outcome measure was units of red blood cell (RBC), fresh-frozen plasma (FFP), and platelet units transfused. Secondary outcomes included pretransfusion hemoglobin in patients with no active bleeding, hemoglobin levels 3 weeks postdischarge, anemia predelivery, blood product-acquisition cost savings, mortality, composite morbidity (transfusion reaction, acute lung injury, thrombosis, sepsis, postpartum hysterectomy), hospital and high-dependency unit length of stay, and all-cause emergency readmissions within 28 days. Comparing baseline (2018) with the final year (2023), the mean units of RBCs, FFP, and platelets transfused per admission decreased from 4.18 to 0.67 (P-trend <.001), resulting in blood acquisition savings of US$ 175,705. Over the same period the percentage of women anemic predelivery decreased from 40.3% to 23.8% (P-trend = 0.015) and the mean pretransfusion hemoglobin level in nonactively bleeding patients decreased from 7.54 g/dL to 6.35 g/dL (P-trend < .001). The mean hemoglobin rise 3 weeks postdischarge increased from 2.41 g/dL in 2018 to 4.26 g/dL in 2023. There were no changes in adjusted composite morbidity, hospital, or high-dependency unit length of stay. In women with a major obstetric hemorrhage of 2000 mL or greater, the implementation of an obstetric PBM program was associated with reduced blood product utilization, reduced costs, reduced anemia, and increased hemoglobin rise postdischarge.

An audit of the indications for peripartum hysterectomies performed at a tertiary institution in Johannesburg, South Africa: A retrospective study.

Peripartum hysterectomy (PH), the surgical removal of the uterus during or shortly after childbirth, is a critical procedure in maternal health care. Definitions of PH vary globally, leading to challenges in understanding its occurrence. Our study aimed to provide comprehensive insights into PH in a South African context, investigating indications, demographic characteristics, clinical and histopathological diagnoses, complications, and outcomes. A retrospective record review study design was used, focusing on PH cases at a tertiary facility in Johannesburg, South Africa (SA), between January 2018 and December 2020. Medical records were systematically examined to identify trends, indications, and outcomes associated with PH. Data collection encompassed demographic characteristics, obstetric history, clinical indications, clinical and histopathological diagnoses, and complications. Data analysis used descriptive statistics, interrater reliability tests, and comparative findings with previous SA studies. The study included 56 pregnant women with a median age of 32 years (interquartile range: 25-35) who underwent PH between January 2018 and December 2020 at Charlotte Maxeke Johannesburg Academic Hospital in South Africa. We found that pregnancy-related sepsis (PRS) emerged as the most common indication of PH, as reported among 18 (32.1%) of the women, with an 88.8% histopathological confirmation rate. Abnormal placentation (14/56, 25%) and PPH (8/56, 14%) were other common indications. Clinical and histopathological diagnoses exhibited a strong level of agreement (70.9%), emphasizing the importance of accurate diagnostics. Our study found a shift in the primary historical indications, such as uterine atony and uterine rupture in South Africa, with PRS emerging as the primary indication in recent years(2009-2020). Clinical assessment complemented by histopathological findings remains critical for improved obstetric complication management.

The Annual Economic Burden of Uterine Fibroids in the United States (2010 Versus 2022): A Comparative Cost-Analysis.

In 2010, the estimated annual cost of uterine fibroids in the United States ranged from 5.9 to 34.4billion USD. In the past decade, more uterine-sparing and fertility preserving interventions have become available to treat symptomatic fibroids. This comparative cost-analysis aims to evaluate change in societal costs of uterine fibroids in the US between 2010 and 2022 given changing fibroid and obstetric management, population growth, and inflation. A systematic review was conducted to update uterine fibroid, treatment, and obstetric complication prevalence, direct costs of medical and surgical interventions, indirect productivity costs, and obstetric costs attributable to fibroids in 2022. A comparative cost-analysis with paired t-tests was performed using baseline data published in 2010. Percent (%) changes between 2010 and 2022 were reported. NIH research funding for fibroids and other common diseases was compared. All costs were converted to 2023 USD. The number of US women with uterine fibroids increased by 10.6% from 2010 to 2022. Over this period, the economic burden of uterine fibroids increased up to 41.4billion USD compared to 34.4billion USD in 2010. Overall costs increased to 42.2billion USD after incorporating new costs associated with MRgFUS and infertility. Direct costs of medical management decreased while costs of surgical interventions increased as a result of evolving treatment-seeking behavior. Lost work costs continue to account for the largest proportion of the economic burden for fibroids. Cesarean section delivery remains the largest contributor (average 80.0%) to indirect obstetrical costs. Despite the rise in the number of individuals affected by uterine fibroids and its sizable annual cost to society, uterine fibroids research continues to be underfunded.

Do vaginal swabs alter empirical clinical management in obstetrics and gynaecology: A retrospective case-series and activity-based costing of the vaginal swab.

Vaginal swab microbiological testing is commonly performed as routine clinical management for various obstetric and gynaecological presentations. The clinical utility and cost-effectiveness of vaginal swab microscopy, culture and susceptibilities (MCS) in altering empirical management is ill-defined. To describe the clinical use of vaginal swabs in a tertiary women's hospital emergency department (ED), measure the impact of vaginal swabs on altering empirical clinical management, and to determine the economic cost of vaginal swab MCS. Retrospective case-series of vaginal swabs collected at a single, tertiary women's ED between January 2021 and July 2021. Symptomatology, clinical diagnosis, test results, and pre-swab and post-swab clinical management were determined upon medical record review. Economic costs of vaginal swab MCS were retrospectively determined via internal accounting records, permitting unit-level activity-based costing. A total of 660 vaginal swabs from 584 clinical episodes were included. Vulvovaginitis was the most common indication for swab collection (34.5%, 167 samples). Altered empirical management was observed in 9.8% of all swabs (95% CI 7.4-12.2%), with marked variability between clinical indications. Antimicrobial initiation was the most common alteration in management (8.9%, 95% CI 8.7-9.1%). The estimated cost of vaginal swab MCS was $29.71 AUD; labour, consumables and disposal costs accounted for 69.3, 29.8 and 0.9%, respectively. The impact of vaginal swab MCS on empirical clinical management is context-specific and variable. The majority of swabs performed do not impact upon empirical management. Antimicrobial initiation is appreciably more common than antimicrobial cessation with vaginal swab results.

Gestational diabetes: an update sixty years after O'Sullivan and Mahan.

Sixty years after the landmark publication by O'Sullivan and Mahan, the current paper seeks to review and place into context the importance of gestational diabetes (GDM) both as a marker of increased risk of adverse maternal and fetal pregnancy outcomes and as an indicator of future maternal and infant health risks. We review the evolution of GDM as a diagnosis, the ongoing debate regarding diagnostic approaches, the underlying pathophysiology, the epidemiology and the importance of GDM in the context of the global epidemics of diabetes and obesity. Focusing on clinical management, we review lifestyle based therapy and pharmacotherapy for GDM, consider obstetric management and outline the short term and lifelong health risks posed by a GDM diagnosis.

Obstetric and gynecological management in a patient with abnormal invasion of the placenta (placenta percreta)

Pathological placental invasion is a dangerous anomaly during pregnancy, which causes increased maternal morbidity and mortality. Patients with abnormal placental invasion may experience life-threatening uterine bleeding during delivery, particularly in cases of placenta percreta. This often requires surgical intervention, specifically a hysterectomy, which some researchers refer to as the “gold standard” treatment for pathological placental invasion, with rates ranging from 47% to 77.8%. Conversely, other researchers recommend a conservative approach, involving the complete removal of the placenta percreta, excision of damaged areas on the uterine walls and bladder, and metroplasty and restoration of the integrity of the. This article presents a clinical case of a 40-year-old patient with a complicated obstetric history, including abnormal placental invasion (placenta percreta) involving the anterior wall of the uterus and the bladder. Delayed diagnosis of such pathology leads to inappropriate treatment and, consequently, acute massive bleeding, posing a risk to the patient’s health and life. The applied comprehensive diagnostic and therapeutic measures facilitated the preservation of the pelvic organs and restoration of the patient’s reproductive function.

Routine third-trimester ultrasonography and child neurodevelopmental outcomes: a follow-up of a pragmatic cluster-randomised controlled trial

ABSTRACT Aims/Background Routine third-trimester ultrasonography is increasingly conducted to screen for foetal growth restriction (FGR) and reduce adverse perinatal and child neurodevelopmental outcomes using timely obstetric management. While it did not reduce adverse perinatal outcomes in previous trials, evidence regarding its association with child neurodevelopmental outcome is absent. We examined whether routine third-trimester ultrasonography is positively associated with child developmental and behavioural/emotional outcomes compared to usual care. Design/Methods Dutch mothers with a low-risk pregnancy participating in a subsample (n = 1070) of a nationwide cluster-randomised trial reported infant (age 6 months) and toddler (age 28 months) developmental milestones (Ages and Stages Questionnaire) and toddlers’ internalising and externalising problems (Child Behavior Checklist). Usual care (n = 380) comprised selective ultrasonography. The intervention strategy (n = 690) included two routine third-trimester ultrasounds next to usual care. Both strategies applied the same interdisciplinary protocol for FGR detection and management. Results Adjusted linear mixed-level regressions revealed that routine third-trimester ultrasonography was positively but modestly related to z-standardised infant developmental milestones at 6-month follow-up, B = 0.20, 95%CI [0.07; 0.32], p = 0.003, compared to usual care. At 28-month follow-up, these strategies did not differ in child developmental outcome and internalising and externalising problems. Conclusion Routine third-trimester ultrasonography was positively but modestly associated with infant development. In toddlerhood, routine ultrasonography was not related to child developmental and behavioural/emotional outcomes. Overall, these findings do not support the implementation of routine third-trimester ultrasonography for low-risk pregnant women for reasons concerning children’s early neurodevelopmental outcomes.

ID: 328517 Ultrasound-guided obstetric spinal anesthesia management in patients with pre-existing dorsal root ganglion stimulators

ID: 328517 Ultrasound-guided obstetric spinal anesthesia management in patients with pre-existing dorsal root ganglion stimulators

Significant kidney disease in pregnancy: Feasibility and outcomes of a national population-based study using the Australasian Maternity Outcomes Surveillance System.

Current understanding of clinical practice and care for maternal kidney disease in pregnancy in Australia is hampered by limitations in available renal-specific datasets. To capture the epidemiology, management, and outcomes of women with significant kidney disease in pregnancy and demonstrate feasibility of a national cohort study approach. An Australian prospective study (2017-2018) using a new kidney disease-specific survey within the Australasian Maternity Outcomes Surveillance System (AMOSS). Women who gave birth with acute kidney injury (AKI), advanced chronic kidney disease (CKD), dialysis dependence or a kidney transplant were included. Demographic data, renal and obstetric management, and perinatal outcomes were collected. Among 58 case notifications from 12 hospitals in five states, we included 23 cases with kidney transplant (n = 12), pre-existing CKD (n = 8), newly diagnosed CKD (n = 2) and dialysis (n = 1). No cases of AKI were reported. Reporting rates were better in states with study investigators and, overall, cases were likely under-reported. Nearly 35% of women had a non-delivery-related antenatal admission. Nephrology involvement was 78.3% during pregnancy and 91% post-partum. Adverse events were increased, including pre-eclampsia (21.7%), and preterm birth (60.9%). Women had high rates of aspirin (82.6%) and antihypertensive (73.9%) use, indwelling catheter for labour/delivery (65.2%), caesarean delivery (60.9%), and blood transfusion (21.7%). This first-ever Australian prospective study of significant kidney diseases in pregnancy provided novel insights into renal-specific clinical patterns and practices. However, under-reporting was likely. Future studies need to overcome the challenges of case identification and data collection burden.

Predicting Whelping Day with Early Pregnancy Ultrasonography and Induction of Parturition using Mifepristone on the Expected Delivery Date in Bitches

Background: Inducing whelping in canines is becoming an accepted practice in obstetrical management to ensure safe pregnancy outcomes, although pinpointing the exact day for induction poses challenges. The precise timing of delivery is vital for foetal survival, as the placenta¢s nutrient supply cannot sustain the foetus beyond the expected delivery date (EDD). Additionally, completing the full gestation term is crucial for comprehensive organ development, especially for the maturation of the lungs. Methods: The present retrospective observational study was aimed to evaluate the accuracy of whelping day prediction by early pregnancy ultrasonography and to propose a viable whelping induction protocol with mifepristone on the EDD to improve the overall reproductive efficiency in canines. Result: Among 115 pregnancies in Group I, 69.57 % whelped exactly on the predicted day (±0), 93.04% whelped within ±1 day and 100% within ±2 days. In Group II, among 124 pregnancies 69.35% whelped on or before the EDD. Of the 38 bitches that did not whelp by the evening of EDD and which were given two doses of mifepristone, 73.68% whelped within 24 h. An additional 4 of the remaining 10 bitches whelped within 36 hours, resulting in an overall whelping induction response of 84.21 % and a cumulative vaginal birth rate of 95.16%. Six bitches (4.84%) required a caesarean section (CS) 36 h post-induction. The percentages of normal whelping, dystocia and CS varied significantly across Groups I, II and III, with Group II showing a significant reduction in dystocia and caesareans, supporting the hypothesis of inducing whelping with mifepristone on the prediction day to have more vaginal births. The percentage of animals that had CS in Groups I, II and III were 14.78, 4.84 and 56.67, respectively. The perinatal mortality rates were 14.83%, 10.47% and 25.15% in Groups I, II and III, respectively, with Group II showing significantly better puppy survivability.

Incidence, Causes and Outcomes of Postpartum Hemorrhage in Eastern Ethiopia: A Multicenter Surveillance Study

ObjectivesMaternal mortality remains an unfinished global agenda and postpartum hemorrhage (PPH) remains one of the leading causes. The aims of this study were to describe the incidence, underlying causes, and case fatality rate of PPH in public hospitals in eastern Ethiopia.MethodsThis study was part of a larger Ethiopian Obstetric Surveillance System (EthOSS) project — a multicenter surveillance of women admitted to 13 public hospitals in eastern Ethiopia due to any of the five major obstetric conditions: obstetric hemorrhage, eclampsia, uterine rupture, sepsis, and severe anemia – conducted from April 1, 2021 to March 31, 2022. All registers in maternity units of those hospitals were reviewed to identify eligible women and collect data on sociodemographic and obstetric characteristics, management and maternal outcomes at discharge or death. Findings were reported using descriptive statistics.ResultsAmong 38,782 births registered during the study period, 2043 women were admitted with at least one of the five major obstetric conditions. Of these 2043, 306 women (15%) had PPH corresponding with an incidence rate of 8 (95% CI: 7–9) per 1000 births. Uterine atony was the main underlying cause in 77%; 81% of women with PPH received at least one uterotonic drug, and 72% of women for whom blood was requested received at least one unit. Of the 70 hospital based maternal deaths, 19 (27%) died from PPH, making a case fatality rate of 6 per 100.ConclusionsAlthough the overall incidence of PPH appeared low, it was still the underlying cause of death in one out of four women who died. The contributing factors might be that one in five women with PPH did not receive any uterotonic drug and the low blood transfusion. Ongoing audit, followed by targeted action, is essential to improve care quality and reduce adverse maternal outcome. The relatively low incidence may reflect under-recording in paper-based records, implying that further research into methods to optimize the surveillance is needed.

Hereditary Angioedema in Pregnancy: A Case Report and Review of Obstetric Anesthesia Management.

Hereditary angioedema (HAE) is a rare disorder due to C1 esterase inhibitor deficiency, causing recurrent swelling. Pregnancy can exacerbate HAE due to estrogen fluctuations alongside peripartum stress and trauma. We present a pregnant patient with HAE who underwent induction of labor and vaginal delivery with neuraxial anesthesia. Management included C1-inhibitor prophylaxis, 48 hours of postpartum monitoring, and a self-treatment plan at discharge. Angioedema prevention involves timely anesthesia consultation, accessible emergency airway equipment, early neuraxial anesthesia, planned vaginal delivery, and 48 to 72 hours of close postpartum monitoring. Readily available C1-inhibitor and a multidisciplinary approach with these recommendations are crucial for peripartum management.