Management Of High-risk Pregnancies Research Articles

Successful Management of High-Risk Pregnancy with TORCH Infection History and Chronic Hypertension

A 41-year-old pregnant woman of Javanese ethnicity attended the outpatient clinic of a private hospital, presented with fifth pregnancy and no living children due to a history of ectopic pregnancy, two times IUFD, and one time neonatal death. The patient also had a history of chronic hypertension and asthma. The examination showed positive IgG Toxoplasma and CMV antibody levels. The patient's blood pressure also never touched the normal limit since the beginning of pregnancy. At the end of pregnancy, she had very high blood pressure and proteinuria. According to WHO Maternal Mortality Rate (MMR) is still very high, where two of the five highest causes are infection and hypertension in pregnancy. High risk pregnancies require special attention in monitoring during pregnancy and management. In a history of bad obstetrical history it is necessary to screen for infection which can be done by antibody serology testing. A positive IgG indicates immunity to the virus, if possible it is necessary to check IgG Avidity to determine whether therapy is still needed or can rely on the immune system that has been formed. Chronic hypertension (Systolic Blood Pressure (SBP) > 140 mmHg and / or Diastolic Blood Pressure (DBP) > 90 mmHg since < 20 Weeks Gestational Age (WGA) until 42 days after delivery). First-line Labetalol and Nifedipine or second-line Methyldopa and Hydrochlorothiazide should be considered depending on the condition and gestational age. If there are signs of preeclampsia, termination should be done if possible, along with antihypertensives and anticonvulsants such as MgSO4.

Evaluation par régression logistique binaire de déterminants de la mortalité néonatale dans la province du Kongo Central

Neonatal mortality disturbs the whole of humanity. Its frequency remains very high throughout the world, but more so in developing countries. The DRC is ranked among the countries with the highest number of neonatal deaths in the world with the ratio of 47 per 1000 live births, (Kalonji DC et al 2018). Indeed, the province of Kongo Central has not remained indifferent to this health problem. With a view to improving newborn health during the neonatal period, the present study is conducted and envisages identifying the determinants of neonatal mortality in Kongo Central Province. For this study, the general population consisted of all newborns in the Province of Kongo Central from 2021 to 2022. A random sample of 117 cases met the inclusion criteria, of which we matched 1 case to 2 controls. After data analysis, we found the following results: the overall neonatal mortality rate was 333 per thousand live births. The logistic regression model identified the following determinants of neonatal mortality: age (OR= 1.16562 IC95 [1.035635 -1.3163]. p=0.0105), age less than 2 years (OR= 2.01966 IC95 [1.021601-4.058]. p=0.0449) and acute fetal distress (OR=2.62027IC95 [1.179464-5.878]. p=0.0181). In order to improve neonatal health, pregnant women should be made aware of the importance of prenatal consultations for early detection and appropriate management of high-risk pregnancies. They should be present at the onset of labor and give birth in the presence of qualified personnel.

Harmonizing high-risk pregnancies: A comprehensive investigation into maternal and fetal well-being

High-risk pregnancies are a global concern, with maternal and fetal well-being at the forefront of clinical care. Pregnancy’s three trimesters bring distinct changes to mothers and fetal development, impacting maternal health through hormonal, physical, and emotional shifts. Fetal well-being is influenced by organ development, nutrition, oxygenation, and environmental exposures. Effective management of high-risk pregnancies necessitates a specialized, multidisciplinary approach. To comprehend this integrated approach, a comparative literature analysis using Atlas.ti software is essential. Findings reveal key aspects vital to high-risk pregnancy care, including intervention effectiveness, case characteristics, regional variations, economic implications, psychosocial impacts, holistic care, longitudinal studies, cultural factors, technological influences, and educational strategies. These findings inform current clinical practices and drive further research. Integration of knowledge across multidisciplinary care teams is pivotal for enhancing care for high-risk pregnancies, promoting maternal and fetal well-being worldwide.

Enhancing the competencies of obstetrical nurses and midwives in high-risk pregnancy management through simulation-based training in Lao people's democratic republic: A pilot study

BackgroundSimulation-based training has been widely used as a valuable strategy for learning and evaluating clinical skills at different levels of nursing and midwifery education. The impact of simulation training on intensive management for high-risk pregnancy in a low-resource setting has been limited. AimTo examine the effect of simulation-based training with low-fidelity mannequins on obstetrical nurses and midwives’ knowledge, attitude, and skills for high-risk pregnancy management in a low-resource setting. MethodDuring September 2023, twenty-five obstetrical nurses or midwives who worked in five tertiary public hospitals in Vientiane Prefecture participated in the three-day training workshops for intensive management in high-risk pregnant women and newborns that used a simulation-based training approach integrating problem-based learning. The evaluated criteria of knowledge, attitudes, and skills pre- and post-test scores were statistically compared. FindingsWorkshop trainees demonstrated an increase significantly in knowledge for high-risk pregnancy management (p = 0.012), attitude toward high-risk pregnancy management (p = 0.000), and attitude toward simulation-based training design (p = 0.002). The clinical skills were used on the simulation performance checklist, and the pre-posttest gain in overall performance scores had a statistically significant difference (p = 0.000). The mean score of postpartum hemorrhage management skills was 11.48±2.23, which increased the highest score among all skills. ConclusionsThe simulation-based training in high-risk pregnancy management improves the knowledge, attitude, and skills of nurses and midwives in low-resource settings. Next steps include direct observation of trainees in the clinical setting to assess their competence in ensuring patient safety, achieving positive pregnancy outcomes, and enhancing satisfaction.

Pulmonary Embolism in high risk pregnancy: A case Study

Management of high risk pregnancy is challenging for the care givers, and healthy feto-maternal outcome is the utmost aim for antenatal care. A good pre-pregnancy screening program, vigilant monitoring for obstetrical complications in prenatal and postnatal periods, multidisciplinary approach and timely decisions are key factors for successful management.

Medical management of canine high-risk pregnancies with single pup syndrome

Medical management of canine high-risk pregnancies with single pup syndrome

Changes in Knowledge and Management Skills of ANMs To Screen, Manage and Refer Pregnant Women with Five High-Risk Conditions: Results from A Pre-Post-Training and A Six-Month Follow-Up Assessment in Telangana, India

Background: Auxiliary Nurse Midwives (ANMs) are key providers of maternal, newborn and child health services, and are the first point of contact for high-risk pregnancies (HRPs). In partnership with Government of Telangana, under Integrated HighRisk Pregnancy Tracking and Management (IHRPTM) program, all the ANMs of the state were trained to screen and manage five HRPs: anaemia; gestational diabetes-GD; pregnancy induced hypertension-PIH; ante-partum haemorrhage-APH; and quality-Antenatal care (ANC). Assessed pre- and post-class-room and six months after class-room training capabilities of ANMs. Methods: Immediate-gains through class-room-training and six-months after class-room training knowledge/skills from 7,553 and 529 ANMs respectively, were assessed using a checklist of 15 questions per HRP-condition. Also obtained, qualitative insights about class-room training. Results: Due to class-room training, there was 8-17% improvement in immediate-gain in knowledge/skills to diagnose, manage/ refer women with HRPs. Improvement in mean correct responses (out of 15 questions per-HRP) between pre-and-post-training assessments was maximum for GD: mean 7.6 at pre-training, improved to 10.2 by post-training; APH: 9.7 to 11.7; qualityANC: 10.2 to 11.7; PIH: 9.3 to 10.7; and anaemia:11.0 to 12.3. Gain in knowledge/skills as Cohen’s-d effect-size was large (0.7-0.8) for GD, APH, quality-ANC, PIH, and medium (0.6) for anaemia, as pre-training knowledge/skills was already better for anaemia. Mean gain per HRP was more than three questions in four districts and < 0.5 questions in two districts. Mean gain did not differ much according to age, work experience and training-time. As compared to pre-training level, retention of knowledge/skills, six-to-nine months after class-room training dropped substantially (Cohen’s-d effect-size≤ 0.2) for all HRPs, except for anaemia (d=0.4). Training gave them confidence to stabilize emergency cases at sub-centre level before referring to higher facility! Conclusion: Through IHRPTM’s protocol-based training: screening, management/referral of HRPs by ANMs is feasible. Standardized-training supplemented with handholding leads to provision of obstetric care.

IJCM_254A: A Study on Level of Satisfaction among Beneficiaries Under Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) in Rural Field Practice Area Of Guntur Medical College. Guntur, Andhra Pradesh: A Cross-sectional Study

Background: With 30,000 estimated maternal deaths in a year across the country, high MMR remains a matter of grave concern, and thus it is paramount to ensure quality ANC to each pregnant woman, identify the high risk pregnancies (HRPs) and track these for counselling, management birth preparedness and referral till the outcome to close the loop. Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) was launched in 2016, as a fixed-day, assured, comprehensive quality ANC service on the 9th of every month to every pregnant woman across the country. Screening, identification, line listing and appropriate management of high-risk pregnancies by OBGY/CEmOC/ BEmOCspecialist and referral to appropriate higher facilities are some of the fundamental elements of PMSMA Objective: To determine the level of satisfaction among beneficiaries under PMSMA scheme Methodology: A cross-sectional study was done among 300 pregnant women who were delivered within 6 months from the date of the study and who had registered & availed the Ante-Natal Care (ANC) services under Rural field Practice area of Guntur Medical college. Guntur. Andhra Pradesh. The data thus collected were entered into Microsoft-Excel spreadsheet and was analyzed using IBM SPSS software Version 24.0 Results: Out of 300 beneficiaries, 237(79%) were satisfied with the cleanliness of wards & toilets followed by 278(92.69%) with Adequate privacy During Examination, 287(97.67%) with basic laboratory investigation, 166(55.34%) with transport facilities during discharge. The majority of study participants were in the age group of 20-30 years i.e. 269 (89.70%) and most of their educational status above intermediate i.e. 207(69%) Conclusion: If every pregnant woman in India is examined by a Medical Officer/Specialist and Investigated appropriately at least once during the PMSMA, the Abhiyan can play a crucial role in reducing the number of maternal deaths & High-Risk Pregnancy (HRP) in our country

Non-invasive in-utero quantification of vascular reactivity in human placenta.

Placental vascular reactivity (PlVR) indicates the ability of the placental vasculature to match blood supply to fetal demand. Many pregnancy disorders alter the characteristics of PlVR, resulting in suboptimal oxygen delivery, although current understanding is limited by the lack of non-invasive, repeatable methods to measure PlVR in utero. Our objective was to quantify PlVR by measuring the placental response to transient changes in maternal carbon dioxide (CO2) using blood-oxygen-level-dependent (BOLD) magnetic resonance imaging (MRI). We hypothesized that PlVR will increase with gestational age to meet the changing demands of a growing fetus, and that PlVR will be driven by a maternal response to changes in CO2 concentration. This was a cross-sectional study of 35 women with a healthy singleton pregnancy, of whom 31 were included in the analysis. The median gestational age was 32.6 (range, 22.6-38.4) weeks. Pregnant women were instructed to follow audiovisual breathing cues during a MRI scan. Maternal end-tidal CO2 (EtCO2) was measured concurrently with resting placental BOLD MRI for a total of 7-8 min. Preprocessing of magnetic resonance images consisted of manual delineation of placental anatomy and motion correction. In each placental voxel, vascular reactivity was computed using a coherence-weighted general linear model between MRI signal and EtCO2 stimulus. Global PlVR was computed as the mean of voxel-wise PlVR values across the placenta. PlVR, quantified by the placental response to induced, transient changes in maternal CO2, was consistently measured in utero using BOLD MRI. PlVR increased non-linearly with advancing gestational age (P < 0.001) and was higher on the fetal side of the placenta. PlVR was associated positively with fetal brain volume after accounting for gestational age. PlVR did not show any significant associations with maternal characteristics. We present, for the first time, a non-invasive paradigm to quantify PlVR in ongoing human pregnancies without the use of exogenous gases or contrast agents. Our findings suggest that PlVR is driven by a fetal response to changes in maternal CO2. Ease of translation to the clinical setting makes PlVR a promising biomarker for the identification and management of high-risk pregnancies. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Digital health technologies for high-risk pregnancy management: three case studies using Digilego framework.

High-risk pregnancy (HRP) conditions such as gestational diabetes mellitus (GDM), hypertension (HTN), and peripartum depression (PPD) affect maternal and neonatal health. Patient engagement is critical for effective HRP management (HRPM). While digital technologies and analytics hold promise, emerging research indicates limited and suboptimal support offered by the highly prevalent pregnancy digital solutions within the commercial marketplace. In this article, we describe our efforts to develop a portfolio of digital products leveraging advances in social computing, data science, and digital health. We describe three studies that leverage core methods from Digilego digital health development framework to (1) conduct large-scale social media analysis (n = 55 301 posts) to understand population-level patterns in women's needs, (2) architect a digital repository to enable women curate HRP related information, and (3) develop a digital platform to support PPD prevention. We applied a combination of qualitative coding, machine learning, theory-mapping, and programmatic implementation of theory-linked digital features. Further, we conducted preliminary testing of the resulting products for acceptance with sample of pregnant women for GDM/HTN information management (n = 10) and PPD prevention (n = 30). Scalable social computing models using deep learning classifiers with reasonable accuracy have allowed us to capture and examine psychosociobehavioral drivers associated with HRPM. Our work resulted in two digital health solutions, MyPregnancyChart and MomMind are developed. Initial evaluation of both tools indicates positive acceptance from potential end users. Further evaluation with MomMind revealed statistically significant improvements (P < .05) in PPD recognition and knowledge on how to seek PPD information. Digilego framework provides an integrative methodological lens to gain micro-macro perspective on women's needs, theory integration, engagement optimization, as well as subsequent feature and content engineering, which can be organized into core and specialized digital pathways for women engagement in disease management. Future works should focus on implementation and testing of digital solutions that facilitate women to capture, aggregate, preserve, and utilize, otherwise siloed, prenatal information artifacts for enhanced self-management of their high-risk conditions, ultimately leading to improved health outcomes.

Umbilical artery half peak systolic velocity deceleration time: a novel Doppler parameter for prediction of neonatal outcomes in pregnant women with preeclampsia.

To assess the effectiveness of half peak systolic velocity deceleration time (hPSV-DT) in predicting neonatal outcomes in pregnant women with preeclampsia and to compare its usefulness with the conventional umbilical artery (UA) pulsatility index (PI) approach. A prospective cohort study was conducted among pregnant women with preeclampsia who were admitted to the Department of Perinatology, Ministry of Health Ankara City Hospital between 01 September 2022 and 01 January 2023 at 28-41weeks gestational age. 55 patients were divided into two groups: the study group with UA hPSV-DT value < 5th percentile (n = 22) and the control group with UA hPSV-DT value ≥ 5th percentile (n = 33). UA hPSV-DT calculates the time in milliseconds needed to halve the maximal velocity of the UA waveform using Doppler ultrasonography. Birth weight, gestational age at birth, 1st minute APGAR, 5th minute APGAR, and umbilical cord pH values were significantly lower in the anormal hPSV-DT group (p < 0.05). Additionally, the rates of admission to NICU, respiratory distress syndrome (RDS), delivery time < 34weeks, and birth weight < 2500g were significantly more frequent in the anormal hPSV-DT group compared to the normal hPSV-DT group (p < 0.05). UA-PI > 95th percentile was detected in only 2 (8%) of 23 patients whose newborns were admitted to the NICU (p = 0.149), while hPSV-DT < 5th percentile was detected in 16 (69%) of 23 patients (p < 0.001). According to ROC analysis, the area under the curve was 0.82 (95% CI 0.06-0.28) for admission to the NICU. The best balance of sensitivity/specificity in ROC curves was 221.5 (82.6% sensitivity, 69.1% specificity, p < 0.001). UA hPSV-DT was successful in predicting composite adverse perinatal outcomes in pregnant women with preeclampsia. It is a promising novel method that is accurate, quantitative, reproducible, and easily applicable. With further studies, this method may be a primary diagnostic tool in the management of high-risk pregnancies and in determining the optimal timing of delivery.

Comparative evaluation of gestosis score vs uterine artery pulsatility index in predicting gestational hypertension: A study protocol

Background: Gestational hypertension and its consequences such as preeclampsia, eclampsia is a leading cause of maternal mortality in India. Multiple risk factors are already known to cause hypertension in pregnancy and with newer advances in the field of medicine, newer risk factors are also being detected which contribute to gestational hypertension. There is need to detect these risk factors so that women who are susceptible to developing hypertension in their pregnancy can be identified at the earliest and monitored and managed accordingly. This study includes two methods, gestosis score which is a newer method, and uterine artery Doppler pulsatility index which is commonly utilized in usually urban centers where ultrasonography facilities are available to look for these risk factors. Objective: The study intends to compare the results of both prediction approaches, the Gestosis score and the Uterine Artery Pulsatility Index in identifying women at risk for gestational hypertension so that these women can be monitored vigilantly for the development of hypertension during their pregnancies and contribute to better management and healthy outcomes of pregnancy. Methods: This study will include 140 pregnant women with gestational ages between 13 to 20 weeks. The gestosis score and mean uterine artery pulsatility index will be calculated. Women with a gestosis score of three or more are deemed at risk for gestational hypertension. Women with mean pulsatility index of 95th percentile or higher are labeled at risk of gestational hypertension. The outcomes of these two methods will be compared to assess which is more effective in predicting developing gestational hypertension. Expected outcome: The study aims to provide insights into the effectiveness of both the Gestosis Score and the Uterine Artery Pulsatility Index in predicting gestational hypertension. The results will contribute to employing better risk assessment in clinical practice and the management of high-risk pregnancies.

Acute intestinal pseudo-obstruction secondary to Sjogren’s syndrome in pregnancy: a case report and literature review

BackgroundIntestinal pseudo-obstruction (IPO) is a rare disease, and its clinical manifestations can resemble mechanical intestinal obstruction leading to unnecessary and potentially harmful surgery. Certain autoimmune diseases have been associated with IPO, however, cases secondary to Sjögren’s syndrome (SjS) are especially rare.Case presentationWe described the first case of SjS-associated acute IPO in pregnancy, which was successfully treated with combined immunosuppressive therapy and resulted in an uneventful caesarean delivery.ConclusionsWomen with SjS is likely to experience more complications during pregnancy, and IPO rather than the classic symptoms could be the first sign of SjS flares. IPO should be suspected in patients with unrelenting symptoms of small bowel obstruction, and a multidisciplinary approach can provide optimal management of such high-risk pregnancies.

Barriers and facilitators of the identification and management of high-risk pregnancies in tribal communities in Pune district in India: Findings from implementation research

Barriers and facilitators of the identification and management of high-risk pregnancies in tribal communities in Pune district in India: Findings from implementation research

Maternal and Perinatal Complications in Eclampsia Patients: Study in a Private Medical College, Dhaka, Bangladesh

Background: Eclampsia is a serious pregnancy complication that can lead to seizures and potentially fatal outcomes for both mother and baby. It is most common in developing countries but improved antenatal care and early intervention have significantly decreased its incidence in developed countries. Risk factors for eclampsia include pre-eclampsia, hypertension, obesity, and renal disease, and early detection and management are crucial for preventing adverse outcomes. Magnesium sulfate is the preferred treatment for seizures, and delivery timing depends on disease severity, gestational age, and fetal well-being. Maternal and perinatal mortality rates vary by country, highlighting the need for continued efforts to improve outcomes for those affected by eclampsia. The study aimed to observe the maternal and perinatal complications in eclampsia patients. Material &amp; Methods: This observational study was conducted at the Department of Gynecology, Gonoshasthaya Nagar Hospital, Dhaka, Bangladesh during the period of January 2020 to June 2020. We included a total of 270 patients with eclampsia who were admitted to a tertiary care hospital. A Purposive consecutive sampling method was followed for the selection of the participants. Results: This study analyzed the demographic and clinical characteristics, maternal and perinatal complications, and risk factors of 270 patients with eclampsia. The majority of patients were aged between 20-34 years (77.8%), and 61.1% were multiparous. Over half of the cases (55.6%) presented with eclampsia between 28-36 weeks of gestation, and 38.9% had a history of preeclampsia in a previous pregnancy. The most common symptoms reported were headaches (88.9%). All cases involved hypertensive disorders, and maternal death was reported in 1.9% of cases. Perinatal complications included low birth weight (44.4%), preterm delivery (36.3%), NICU admission (34.8%), stillbirth (4.4%), and early neonatal death (3.0%). Maternal mortality rates were highest among women aged 20-34 years (56.5%), while perinatal mortality rates were highest among women aged under 20 years (20.0%). The highest maternal mortality rate was observed among women with severe eclampsia (91.4%), and time to treatment was a crucial factor in maternal mortality rates. These findings underscore the need for timely and appropriate care to improve maternal and perinatal outcomes, particularly in high-risk populations. Conclusion: Eclampsia is a serious complication of pregnancy that can result in significant maternal and perinatal morbidity and mortality. Early detection, prompt management, and close monitoring of high-risk pregnancies are crucial in preventing adverse outcomes. Further research is needed to identify effective interventions for preventing and managing eclampsia.

Evaluation of second trimester uterine artery doppler indices in women diagnosed with COVID-19 during the first trimester of their pregnancy.

This study aimed at evaluating the hypothesis that 6-14 months pregnant women diagnosed with COVID-19 may have abnormal placental function detectable by increased uterine artery Doppler indices in the second trimester and whether these women could benefit from treatment.A total of 63 women were diagnosed with COVID-19 during the first trimester of their pregnancy and 68 healthy women were involved according to the exclusion criteria. In both groups, Doppler measurements were performed for the determination of high-risk pregnancy by increased uterine artery Doppler indices in the second trimester.It was observed that uterine artery Doppler indices (PI and RI) were significantly increased in second trimester women with COVID-19 infection compared to those without COVID-19. Furthermore, the number of women with a PI value exceeding the 95th percentile and the number of patients with early diastolic notch were higher in the COVID group compared to the control group.Doppler Ultrasound measurement may be a potential method for the management of high-risk pregnancies after asymptomatic/mild COVID-19 infection.

MATERNAL MORTALITY IN INDIA: PREVENTION AND ITSSTRATEGIES

Introduction: Maternal health is an important aspect of any countrys development in terms of equity and poverty reduction. The health of women before and during pregnancy, during childbirth, and after childbirth is referred to as Maternal Health. The Maternal Mortality Ratio (MMR) is an important indicator of the quality of the countrys health-care system. India has made remarkable progress in reducing maternal mortality over the last two decades. Methods: Relevant articles were searched using both electronically and print sources. Electronically from search engines such as PubMed and Google Scholar, as well as the WHO, CDC, and MoHFW websites. Print sources for the database included newspapers, the central library, and the departmental library of the Community Medicine, which included a variety of journals and standard textbooks. The following keywords were used in the literature search: maternal health, maternal death, maternal mortality and vaccination for pregnant women. Articles that did not contain these keywords were excluded from consideration. The search was not limited by publication year, and original articles, review articles, systematic reviews, and meta-analyses were all considered. Recommendation:Early detection and timely management of High-Risk Pregnancy (HRP) are critical factors in reducing maternal mortality.

Provincial Maternal and Child Information System in Inner Mongolia, China: Descriptive Implementation Study.

After the implementation of 2- and 3-child policies, the rising proportion of high-age and high-risk pregnancies put enormous pressure on maternal and child health (MCH) services for China. This populous nation with an increasing population flow imperatively required the support of large-scale information systems for management. Municipal MCH information systems were commonly applied in developed cities of eastern provinces in China. However, implementation of provincial MCH information systems in relatively low-income areas is lacking. In 2020, the implementation of a regional maternal and child information system (RMCIS) in Inner Mongolia filled this gap. This paper aimed to demonstrate the construction process and evaluate the implementation effect of an RMCIS in improving the regional MCH in Inner Mongolia. We conducted a descriptive study for the implementation of an RMCIS in Inner Mongolia. Based on the role analysis and information reporting process, the system architecture design had 10 modules, supporting basic health care services, special case management, health support, and administration and supervision. Five-color management was applied for pregnancy risk stratification. We collected data on the construction cost, key characteristics of patients, and use count of the main services from January 1, 2020, to October 31, 2022, in Inner Mongolia. Descriptive analysis was used to demonstrate the implementation effects of the RMCIS. The construction and implementation of the RMCIS cost CNY 8 million (US $1.1 million), with a duration of 13 months. Between 2020 and 2022, the system recorded 221,772 registered pregnant women, with a 44.75% early pregnancy registry rate and 147,264 newborns, covering 278 hospitals and 225 community health care centers in 12 cities. Five-color management of high-risk pregnancies resulted in 76,975 (45.45%) pregnancies stratified as yellow (general risk), 36,627 (21.63%) as orange (relatively high risk), 156 (0.09%) as red (high risk), and 3888 (2.30%) as purple (infectious disease). A scarred uterus (n=28,159, 36.58%), BMI≥28 (n=14,164, 38.67%), aggressive placenta praevia (n=32, 20.51%), and viral hepatitis (n=1787, 45.96%) were the top factors of high-risk pregnancies (yellow, orange, red, and purple). In addition, 132,079 pregnancies, including 65,018 (49.23%) high-risk pregnancies, were registered in 2022 compared to 32,466 pregnancies, including 21,849 (67.30%) high-risk pregnancies, registered in 2020. The implementation of an RMCIS in Inner Mongolia achieved the provincial MCH data interconnection for basic services and obtained both social and economic benefits, which could provide valuable experience to medical administration departments, practitioners, and medical informatics constructors worldwide.

Obstetric Determinants of Birth Weight Status of Babies Born at Jaramogi Oginga Odinga Teaching and Referral Hospital, Kenya

Background: Low birth weight (LBW) is a serious public health problem, especially in developing countries. Globally, 15.5% of all births are born LBW and 95.6% of them are in developing countries. In Kenya, 8% of babies are born LBW and at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), it is 11.1%. Despite several efforts such as antenatal care services put in place to improve the quality of maternal and child health, the rates of LBW are still high. LBW is a major cause of mortality and morbidity in infants. Objective: The objective of this study was to assess obstetric determinants of the birth weight status of babies born at JOOTRH, Kenya. Materials and Methods: This was a cross-sectional study with a sample size of 131 babies plus their mothers from a total population of 538 deliveries during the study period. Systematic random sampling was used to select the respondents. Data was collected using a questionnaire and record review checklist. Data analysis was done using descriptive statistics and inferential statistics, specifically logistic regression. Result: The study results showed that the prevalence of LBW was 13.7%. LBW was strongly associated with a birth interval of &lt; 24 months (AOR = 13.722), hypertension (AOR = 11.753), previous history of LBW (COR = 14.0), and gestation at birth (COR = 3.75). Gravidity, previous history of miscarriage and gestation at which antenatal visits started had no association with LBW. Conclusion: The prevalence of LBW is 13.7%, higher than the national rate of 8% and statistically significant with a Z score of 2.398, p = 0.016. The birth interval of &lt; 24 months, hypertension, previous history of LBW, and gestation at birth influenced the occurrence of LBW. Focused antenatal care to ensure early detection and management of high-risk pregnancies and educate pregnant mothers on the birth spacing of more than two years between two successive pregnancies to allow replenishment of nutrient stores is important in reducing LBW.

Sonographic estimation of gestational age using transverse cerebellar diameter among late trimester pregnancies in Kano, Northwest Nigeria

Background/Context: Accurate estimation of fetal gestational age (GA) is of paramount importance in the management of all pregnancies, especially for the planning of mode of the delivery and management of high-risk pregnancies. Obstetric ultrasonography is a simple, available, affordable, and noninvasive modality for estimating fetal GA due to its high safety profile. The fetal cerebellum is easily visualized and reliably identified on ultrasound in the posterior cranial fossa after 14 weeks of gestation. Aim: The aim of this study was to evaluate the utility of transverse cerebellar diameter (TCD) in determining GA in second- and third-trimester pregnancies and compare its accuracy with other established sonographically derived fetal biometric parameters. Materials and Methods: A total of 424 pregnant women in their second and third trimesters who were sure of their last menstrual period (LMP) were recruited into the study over a period of 6 months (May to November 2019) at the Radiology Department of AKTH-Kano, Nigeria. The corresponding fetal TCD and other established fetal biometric indices (biparietal diameter [BPD], head circumference [HC], abdominal circumference [AC], and femur length [FL]) were sonographically obtained and correlated. Pearson’s bivariate coefficient was used to establish the correlation between the traditional biometric indices with TCD and GA derived by LMP. Multivariate linear regression analysis was used to assess the accuracy of the studied indices in predicting GA. Results: The range for TCD in second- and third-trimester fetuses was 15.9–57.5 mm. The TCD parameter was more accurate (±1.753 days) than BPD (±2.298 days), HC (±2.337 days), and AC (±4.342 days) and marginally less accurate than FL (±1.165 days) in predicting GA among study subjects (P &lt; 0.001). Conclusion: TCD is a reliable and accurate parameter for GA estimation in late second- and third-trimester pregnancies when compared with established fetal biometric parameters among pregnant women in Kano, Nigeria.