Mean Apgar Score Research Articles

The benefit of additional embolization after perioperative balloon occlusion of pelvic artery during cesarean hysterectomy in placenta accreta spectrum.

Cesarean hysterectomy in the placenta accreta spectrum (PAS) remains challenging due to difficulty in controlling perioperative bleeding. To compare the effectiveness and safety of perioperative balloon occlusion with versus without pelvic artery embolization in PAS women who underwent a cesarean hysterectomy. A total of 26 pathological confirmed cases of PAS were retrospectively reviewed and categorized into two groups: perioperative balloon occlusion at either the anterior division of the internal iliac artery or uterine artery followed by gelfoam embolization (n = 12, study group) and perioperative balloon occlusion alone (n = 14, control group). Intraoperative estimated blood loss (EBL), a unit of packed red blood cell (pRBC) transfusion, surgical time, transfer to the intensive care unit (ICU), postoperative hospitalization days, postoperative complications, and Apgar scores were compared between the two groups. The median and interquartile range (IQR) intraoperative EBL in the study group (1200 mL [700-2100 mLl]) was significantly lower compared to those in the control group (1900 mL [1300-3200 mL]) (P = 0.044). There was no significant difference between the study and control groups in units of pRBC blood transfusion, surgical time, transfer to the ICU, postoperative length of stay, postoperative complications, and mean Apgar score at 1 min and 5 min. The perioperative combination of balloon occlusion followed by embolization of the pelvic artery before cesarean hysterectomy is more effective in reducing blood loss than perioperative balloon occlusion alone in PAS with no difference in postoperative complications or neonatal outcomes.

Comparison Of Bolus Ephedrine, Mephentermine And Phenylephrine For The Management Of Hypotension During Spinal Anaesthesia For Caesarean Section – A Clinical Study

Background: Anaesthesia to a parturient is not only unique but also requires highest degree of care because the anaesthesiologist has to look after two individuals, the mother and fœtus. Hypotension during spinal anaesthesia for caesarean delivery can have detrimental effects on both mother and neonate. These effects include decreased utero-placental blood flow, impaired foetal oxygenation with asphyxial stress and foetal acidosis and maternal symptoms of low cardiacoutput such as nausea, vomiting, dizziness and decreased consciousness. Vasopressor like Ephedrine, Mephentermine, Phenylephrine, are used for treating the hypotension. In this study we compared the efficacy of Ephedrine, Mephentermine and Phenylephrine in treating the hypotension for caesarean section and their desirable side effects. Materials and Methods: In this prospective randomised controlled study, 90 patients of ASA physical status I and II belonging to age group of 18-35 years undergoing elective or emergency LSCS under sub-arachnoid block were randomly allocated into 3 groups of 30patients each, Group E (Ephedrine) and Group M (Mephentermine) and Group P (Phenyephrine). Group E received Inj Ephedrine 6 mg IV bolus, Group M received Inj Mephentermine 6 mg IV bolus and Group P received Inj Phenylephrine 100 microgram IV bolus for spinal anaesthesia. The changes in hemodynamic parameters, neonatal outcome, side-effects and usage of rescue vasopressor were compared between the groups. Results: The mean age in group P was 24.2 years, in group E 25.7 years and in group M was 25.7 years, which was similar across the groups. The time between induction and delivery was 87.8 sec in group P, 89.4 sec in group E and 89.6 sec in group M. The time at which 1st vasopressor dose given was 5.2 min in group P, 4.8 min in group E and 4.87 min in group M. The mean heart rate was lower in group P at all the points of study after episode of hypotension. The bolus drug requirement was highest in group P with mean of 3.52 followed by group M with mean of 2.86 and group E with mean of 2.55. The group E required rescue analgesia 73% of time, group M 70% of time and group P also 70% of time in study. The mean APGAR score at 1 minute was 8.2 in group P, 8.4 in group E and 8.6 in group M. Conclusion: During subarachnoid block for cesarean delivery, all three of the study's vasopressors— phenylephrine, ephedrine, and mephentermine—effectively maintained arterial blood pressure and were safe to use in the treatment of hypotension. Compared to ephedrine and mephentermine, phenylephrine significantly lowered heart rate, which may be helpful for cardiac patients or those in whom tachycardia is not desired

INDUCTION OF LABOUR WITH SUBLINGUAL MISOPROSTOL COMPARED TO VAGINAL DINOPROSTONE IN TERMS OF NEONATAL OUTCOME IN WOMEN WITH PROLONGED PREGNANCY

Labor induction in postdate pregnancies can impact neonatal outcomes, including Apgar scores and the need for NICU care. Various induction agents, such as sublingual misoprostol and vaginal dinoprostone, offer differing efficacies. This study aims to compare the neonatal outcomes of these two agents to determine the more effective option for labor induction in postdate pregnancies. Objective: To compare neonatal outcomes, specifically Apgar scores <7 at 1 minute and NICU admissions within the first 24 hours, between neonates born to postdate women induced with sublingual misoprostol versus vaginal dinoprostone. Methods: This randomized controlled trial was conducted in the Department of Obstetrics and Gynecology, Unit 1, Holy Family Hospital, Rawalpindi, from January 2024 to July 2024. After Institutional Research Forum approval, 200 women meeting the selection criteria were randomized via the lottery method into two groups. Group I received 25 mcg of sublingual misoprostol every 4 hours up to 4 doses, and Group II received 3 mg vaginal dinoprostone every 6 hours up to 2 doses. Neonatal Apgar scores were recorded at delivery, and NICU admissions were monitored within 24 hours. Data were documented on structured proforma and analyzed using SPSS. Results: The mean maternal age in Group I was 27.17±4.71 years and in Group II 28.33±4.25 years. Both groups had comparable gestational ages (41.60±0.49 vs. 41.68±0.46 weeks) and parity (1.64±0.79 vs. 2.05±0.83). Group I neonates had higher mean Apgar scores at 1 minute (7.25±2.08) compared to Group II (6.62±2.07), with significant group differences (p=0.04). NICU admissions were required in 30% of neonates, with 48.8% needing NICU care, and fewer admissions in Group I (p=0.04). NICU care showed a significant association with maternal age over 28 years (p=0.000) and nulliparous status (p=0.007) but was not significantly different for those under 28 years or multiparous. Conclusion: Sublingual misoprostol demonstrated superior efficacy to vaginal dinoprostone in labor induction for prolonged pregnancies, with improved neonatal outcomes, including higher Apgar scores and fewer NICU admissions. Age and parity influenced outcomes, highlighting sublingual misoprostol as an effective choice for better neonatal health.

Effect Of Cerclage Suture Type On Pregnancy And Newborn Results: Mersylene Suture Versus Prolene Suture

Purpose: The aim of this study is to compare pregnancy and neonatal outcomes according to the type of the suture material used in the transvaginal cerclage operation. Materials and Methods: Patients who underwent transvaginal cervical cerclage due to cervical insufficiency in a tertiary health center between 2020 and 2024 were evaluated retrospectively. Demographic data regarding cerclage indications (ultrasound-based, prophylactic or physical examination-based), number of weeks of gestation in cerclage, cerclage suture type (prolene, mersilen), gestational week at cerclage insertion and delivery, routes of delivery were recorded. In addition, birth weight, 1st and 5th minute APGAR scores, and neonatal intensive care unit (NICU) requirements were recorded as neonatal parameters. Patients were divided into two groups according to cerclage suture type (mersilene or prolene) and maternal, newborn and pregnancy outcomes were compared between these groups. Results: Comparison of the groups in terms of age, gravidity, parity, number of miscarriages and BMI revealed significantly higher mean gravidity in group 1 compared to group 2 (P0.05). No difference was determined with regard to gestational week at cerclage application, cervical length, cervical dilatation just before cerclage insertion, gestational age at cerclage removal and delivery and birth weight (p>0.05). Groups were comparable in terms of subgroups established according to their numbr number of previous deliveries (p>0.05). Groups were comparable in terms of indications for cerclage insertion (p>0.05). Cesarean delivery rate was 40 % in group 1 while it was 43.6 % in groups 2, no statistical difference was determined in terms of rate of cesarean delivery (p>0.05). Similar number of newborns needed NICU admission between the two groups following delivery (17.5% versus 17.9 %p>0.05). Mean APGAR scores at 1st (6.8 versus 7.4) and 5 th (7.8 versus 8.3) min were comparable between the groups (p>0.05) Conclusion: Although mersilen stitch is commonly preferred, data analysis revealed similar results with prolene stitch in terms of maternal and neonatal outcomes.

Intracranial Arteriovenous Malformations During Pregnancy and Puerperium-A Retrospective Nationwide Population-Based Cohort Study.

The knowledge about the management of patients with brain arteriovenous malformations (AVM) during pregnancy is limited, owing partly to insufficient evidence about the outcomes of newborns. This study aims to explore symptomatic AVMs and their outcomes during pregnancy, delivery, and the postpartum period. We conducted a retrospective analysis by combining patients with symptomatic AVM from a nationwide population-based cohort of all women with a pregnancy resulting in delivery during 1987 to 2016 (n = 1 773 728 deliveries) and our AVM database (n = 805, 1942-2014). Cerebrovascular events during pregnancy were identified through International Classification of Diseases-9, International Classification of Diseases-10, or surgical procedure codes from the Hospital Discharge and Medical Birth Registers. Our analysis focused on treatment characteristics and outcomes of patients with AVM hemorrhage or symptomatic AVM during pregnancy, delivery, or puerperium. A total of 28 women with symptomatic AVMs during pregnancy, delivery, or postpartum period were followed for an average of 12.8 years (SD = 15.5) after admission. Among them, 21 (75%) experienced AVM hemorrhages during pregnancy, puerperium, or delivery. The mean age of patients was 28.9 years (SD = 5.5). Hemorrhages occurred predominantly during the second (n = 9, 43% of all ruptures) or the third trimester (n = 5, 24%). Two AVM ruptures occurred during labor. Treatment for AVM took place during pregnancy (n = 7, 25%) or puerperium (n = 3, 14%) in 10 patients (35.7%). Only 5 mothers (17.8%) had not been previously pregnant. There was no significant difference in mean Apgar scores between those with AVM hemorrhage (8.3) and those without (8.4). Most mothers in the study had prior pregnancies, suggesting a potentially weaker association between AVM rupture and pregnancy compared to previous reports. Notably, 2 AVM ruptures occurred during spontaneous vaginal deliveries. Outcomes were generally favorable in both mothers and infants. More research is needed to refine our understanding of the optimal timing for invasive treatment during pregnancy.

The Partograph: A Practical Guide for Preventing Prolonged Labour

Background: The partograph, a graphic recording of labour and features in the mother and foetus has been used since 1970 to detect labour that is not progressing normally. The partograph serves early warning system and assist in early decision of transfer, augmentation and termination of labour. It also increases the quality and regularity of observing mother and foetus in labour. Objectives: The study aimed to evaluate effect of using partograph on the management and outcome of labour. Materials and Methods: It was a prospective cross-sectional observational study conducted in the Department of Obstetrics and Gynaecology at Sher-E-Bangla Medical College Hospital, Barishal; Bangladesh over one (1) year from January 2017 to December 2017. A total 280 patients were enrolled in this study. Plotting on the partograph was started at cervical dilation of 4 cm on alert line. Results: The mean age of the participants was 23.4 ±4 years and mean gestational age was 38.3 ±1.74 weeks and 45% were primigravida. The mean Apgar score of the newborn after 5 minutes was 9.3 ±0.7. The mean duration for delivery on active labour was 4.3 ±2.5 hours in primigravida and 3.4 ±2.3 hours in multipara.Conclusion: The proper use of partographs and the application of the right decision at the right time can be achieved the best for maternal and neonatal outcomes. KYAMC Journal Volume: 14, No: 04, January 2024: 215-219.

Association of Placental Umbilical Cord Insertion Site with Maternal and Fetal Outcomes: A Prospective Study

Abstract Introduction Adequate fetal growth during pregnancy depends upon the normal development and insertion of the umbilical cord. Central/paracentral placental cord insertion is considered normal, while marginal/velamentous cord insertion is considered abnormal. Although the location of placental umbilical cord insertion can be determined by ultrasound (US), it is not included in the routine protocol of a targeted anomaly scan. Through this study, we determined different placental umbilical cord insertion sites by US and categorized them as normal and abnormal, identified the risk factors involved, and evaluated the outcome of pregnancies using standard protocols. The rationale of this study was to identify pregnancies that require frequent monitoring and surveillance for an optimal perinatal outcome. Methods A prospective cohort study was conducted in a tertiary care hospital for 18 months. A total of 345 pregnant women who attended the antenatal outpatient department between 18 and 22 weeks for targeted imaging for fetal anomalies scan were included in the study after informed consent. Detailed history followed by US documentation of the cord insertion site on the placenta was done and women were followed up throughout pregnancy to look for development of complications including hypertensive disorders, antepartum hemorrhage (APH), and fetal growth restriction (FGR). Intrapartum adverse events like fetal distress and intrapartum hemorrhage were assessed. Confirmation of US findings was done by macroscopic examination of the placenta and measuring the distance between the placental cord insertion and the edge of the placenta. The weight of the placenta was also documented. Newborns were evaluated for adverse outcomes like preterm birth, low birth weight, need for resuscitation, and neonatal intensive care unit (NICU) admission. Follow up of neonates and mothers was done till discharge. Results Placental cord insertion was accurately determined at the anomaly scan with 100% sensitivity and specificity. The study showed 44 abnormal placental cord insertions (ACIs)—42 had marginal and 2 had velamentous cord insertions. There was a high incidence of ACI noted in women aged more than 28 years, with body mass index of more than 26.38, multiparity, previous history of myomectomy, first trimester miscarriage, and conceived by assisted reproductive technology. Women with ACI had an increased risk of small for gestational age/FGR and APH and had an average baby weight of 2.7 kg, which was 200 g less than babies with normal cord insertion. They also had lower mean Apgar scores at 5 minutes and required resuscitation and NICU admission. Conclusion Our study concluded that it will be a good practice to document the placental cord insertion during the mid trimester anomaly scan so that we can identify the subset of pregnant women who are prone to develop complications, thereby providing adequate surveillance for an optimal perinatal outcome.

Impact of Replacement Therapy on Pregnancy Outcomes in Hemophilia Carriers: A Historical Cohort Study in Saudi Arabia.

This retrospective cohort study evaluates the safety and efficacy of replacement therapy with regard to pregnancy outcomes in hemophilia carriers. Hemophilia carriers face elevated bleeding risks during pregnancy, necessitating meticulous management, including replacement therapy with clotting factors. This research examines the records of 64 pregnant hemophilia carriers at King Fahad Medical City, Riyadh, from January 2010 to December 2023, analyzing their demographic details, hemophilia type and severity, replacement therapy specifics, and pregnancy outcomes. The study found that 62.5% of the participants had hemophilia A, with 43.8% categorized as severe. Most subjects (87.5%) received recombinant factor VIII at a median dosage of 30 IU/kg weekly. Adverse pregnancy outcomes included gestational hypertension (15.6%), preterm labor (18.8%), and postpartum hemorrhage (12.5%). The cesarean section rate was 28.1%. Neonatal outcomes were generally favorable, with median birth weights at 3100 g and mean Apgar scores of 8.2 and 9.1 at 1 and 5 min, respectively. Logistic regression analysis revealed no significant association between adverse events and therapy type or dosage, though a trend towards significance was noted with once-weekly administration (p = 0.082). The study concludes that replacement therapy is a viable method for managing hemophilia in pregnant carriers, leading to generally favorable maternal and neonatal outcomes. However, it underscores the importance of individualized treatment plans and close monitoring to effectively manage the risks associated with hemophilia during pregnancy.

Correlation of Apgar score, cord blood pH, and lactate with severity of birth asphyxia in a tertiary care hospital: A cross-sectional observational study

Background: A wide variety of clinical parameters and laboratory tests is employed to diagnose perinatal asphyxia such as Apgar score, umbilical arterial acidemia/base excess, intrapartum electronic fetal monitoring, fetal scalp pH measurement, and presence of meconium in amniotic fluid. Methodology: The current multicentric, cross-sectional observational study was conducted in neonatal intensive care unit of Department of Pediatrics, Military Hospital Jammu and RPGMC Tanda. The study population included term neonates with evidence of birth asphyxia. The quantitative data were represented as their mean ± standard deviation categorical and nominal data were expressed in percentage. The t-test was used for analyzing quantitative data, or else nonparametric data were analyzed by the Mann–Whitney test and categorical data were analyzed using Chi-square test. Results: Out of 115 babies with low APGAR (<7) at 1 min, the mean APGAR score was 5.09 with no hypoxic-ischemic encephalopathy (HIE) and 3.56 with HIE, mean cord blood pH levels were 7.29 with no HIE and 7.11 with HIE. Mean cord blood lactate was 5.8 with no HIE and 2.91 with HIE. The severity of HIE was also associated with low APGAR, low pH values, and higher lactate levels in cord blood. Conclusion: Umbilical cord blood parameters such as pH < 7.1, low APGAR (<5), and high lactate levels (>5 mmol/l) were significantly associated with perinatal asphyxia and its severity.

Hemodynamics following Prophylactic Phenylephrine Infusion in patients undergoing Cesarean Section under Spinal Anesthesia

Introduction: Phenylephrine is considered the vasopressor of choice in hypotension associated with obstetric spinal anesthesia. But the dose and mode of administration that is effective yet safe in mother as well as fetus remains controversial. We studied the hemodynamics of parturients who received prophylactic infusion of phenylephrine 50µg/min following spinal anesthesia. Methods: Patients posted for elective cesarean section received a prophylactic phenylephrine infusion of 50µg/min immediately after spinal anesthesia for 30 minutes. Parturients were also co-loaded with lactated Ringer’s solution 1litre. Blood pressure and heart rate was monitored at an interval of 3min initially and after the delivery of baby interval was increased to 5min. Episodes of hypotension, reactive hypertension and bradycardia in mother were recorded. Neonatal APGAR score at 1 and 5min was also recorded. Results: One hundred and forty parturients were included in the study. Twenty patients (14.28%) developed hypotension. Out of 20 patients who developed hypotension, 3 patients (15%) had a single episode, 11 patients (55%) had 2 episodes and 6 patients (30%) had 3 episodes of hypotension. Three patients (2.14%) had reactive hypertension. None of the patients had bradycardia. There was no episode of hypotension induced nausea vomiting. Mean APGAR score at 1min and 5min was 8 and 9 respectively. Conclusion: The prevalence of hypotension with prophylactic phenylephrine infusion was low. We found minimal episodes of reactive hypertension, no episodes of bradycardia and no adverse effect on fetus. It can be regarded a safe means to minimize hypotension in obstetric spinal anesthesia.

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study.

Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications(perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97,p= 0.252; 9.81 vs. 9.87,p= 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4;p= 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%,p= 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally (p= 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

A Prospective Cohort Study Investigating Adverse Perinatal Outcomes in Mosul, Iraq, among Women with Grand Multiparity

Introduction: This prospective case-control study aimed to compare the incidence of fetomaternal complications between grand multiparous women under the age of 35 and pregnant women with low parity in the same age group. Methods: The study was conducted at Al-khansaa and Al-Batool Teaching Hospitals from October 1, 2020, to June 1, 2021. One hundred pregnant women with singleton pregnancies in all three trimesters, aged between 18 and 34 years, were selected from the outpatient clinic and the ward. The participants were divided into two groups: Group A consisted of 50 grand multiparous women (with five or more deliveries), and Group B comprised 50 pregnant women with low parity (2-4 pregnancies) in the same age group. Results: The study found that gestational diabetes, anemia, meconium-stained amniotic fluid, cesarean section rate, postpartum hemorrhage, and neonatal intensive care unit admissions were significantly higher in the grand multiparity group compared to the low parity group. The mean Apgar scores at 1 and 5 minutes were significantly lower in Group A compared to Group B. Conclusion: The findings suggest that grand multiparity among younger mothers poses additional risks to pregnancy outcomes, including increased rates of gestational diabetes, anemia, postpartum hemorrhage, cesarean section, and neonatal intensive care unit admissions, especially in cases with inadequate antenatal care. The findings of this study underscore the need for further research in this area. Understanding the underlying mechanisms and risk factors associated with grand multiparity among younger mothers can lead to more targeted interventions and improved outcomes.

Maternal and Fetal Outcome in Patients with Vaginal Birth After Caesarean Delivery Comparison to and Elective Caesarean Section with Previous One LSCS

Introduction: Noteworthy improvements in maternal morbidity and mortality have been made possible by Caesarean section. However, vaginal birth after cesarean section (VBAC) is linked with better outcome in certain regards. The present study was aimed to study the maternal and fetal outcome in patients with VBAC and elective caesarean section with previous one LSCS.
 Methodology: Women with history of previous LSCS were divided in to two groups: Group 1- Women delivered by VBAD in the current pregnancy, and Group 2 - Women delivered by elective LSCS in the current pregnancy. Maternal and foetal outcome were assessed after delivery.
 Results: Total 90 women in each group were included in the study. The duration of active stage of labour was significantly higher in LSCS group compared VBAC group (p<0.05). Blood Transfusion and Premature rupture of membrane were not associated with any of the two groups. (p>0.05). The mean APGAR score at 1 min and 5 min were significantly better in VBAC group compared to in LSCS group (p<0.01). Mean stay of hospitalization was significantly higher in LSCS group (p<0.01).
 Conclusion: Better Bisho’s score has significantly more chances of successful VBAC. VBAC has better APGAR score at 1 min and at 5 min compared to LSCS group. Birth weight is not affected by the type of delivery after first caesarian delivery.

Prophylactic common iliac artery temporary clamping versus balloon occlusion for management of placenta accreta spectrum disorders: A prospective clinical trial.

The present study aims to compare prophylactic common iliac artery (CIA) temporary clamping and preoperative balloon occlusion for managing placenta accreta spectrum (PAS) disorders. Between January 2019 and June 2020, 46 patients with PAS disorders were included. Of them, 26 patients were offered CIA balloon occlusion (Group A), while temporary CIA clamping was done for the other 20 patients (Group B). Primary outcomes were procedure-related complications, and secondary outcomes included intraoperative and postoperative complications, reoperation rates, total procedure time, blood loss, and amount of blood transfusion. Blood loss was statistically non-significant higher in group B than in group A (p-value = 0.143). Only one patient in group A and three in group B needed reoperation. The bleeding continued for a mean of 1.6 days in group A and 1.7 days in group B, with non-significant statistical differences between both groups p value = 0.71. Nine patients in group A (34.6%) and four in group B (20%) required ICU admission. The mean Apgar score was 7 and 6.6 in babies of group A and group B patients, respectively. The median number of allogeneic blood transfusions performed was two in patients in group A and 1 in group B (p-value = 0.001). Both techniques offer good choices for patients with PAS to decrease mortality and morbidity rates. The selection of a better technique depends on institutional references and physicians' experience.

Maternal and Neonatal Outcomes of Gestational Thrombocytopenia in Pregnant Women from Kirkuk City, Iraq: A Case-Control Study

Background: Thrombocytopenia is the most common hematological disorder in pregnant women, second only to anemia. A platelet count of less than 150x109/L is regarded as low. It is the most common cause of thrombocytopenia during pregnancy when the platelet count does not fall below 70x109\L. Methods: A case-control study was carried out in the department of obstetrics and gynecology at Azadi Teaching Hospital, Kirkuk, Iraq. Two hundred pregnant women were enrolled in the study; they were divided into 100 cases and 100 controls. All participants were in labor at the time of admission. The cases were pregnant women with gestational thrombocytopenia, while the controls were pregnant women with a normal platelet count. A platelet count was performed for all participants using the Swelab Alfa Plus system. Results: mean gestational age and platelet count were significantly lower in patients than controls, while there was no statistically significant difference in age or parity between the study groups. Preterm labor, postpartum hemorrhage (PPH), intrauterine fetal growth restriction (IUGR), and intrapartum fetal distress were significantly higher in the patients than in the controls, and the mean APGAR score at 5 minutes was significantly lower in the patients compared to the controls. Conclusions: Pregnant women with gestational thrombocytopenia may be at higher risk of preterm labor, postpartum hemorrhage, IUGR, intrapartum fetal distress and a low neonatal APGAR score.

The Role of Neonatal Nosocomial Infection towards Health Behavior: A Multivariate Analysis and Deep Learning Approach of Informationized Health Management

Objectives: In this study, we investigated the impact of neonatal nosocomial infections on health behavior intentions using a multivariate analysis and deep learning approach within the framework of informationized health management. Methods: We analyzed the data of 155 neonates in our hospital from May 2019 to May 2020. The infected newborns were divided into an experimental and a control group, infection risk factors and their impact on health behavioral intentions were explored, and neonates were given informationized health management based on deep learning. Results: We have analyzed risk factors, infected parts of the respondents, adverse events before and after the intervention of the experimental group, and Apgar scores before and after the intervention of the experimental group. The parts of neonatal nosocomial infection were mainly in the respiratory, urinary, and digestive tracts which significantly impacted the formulation of health behaviors. The adverse events in the experimental group after the intervention was significantly lower than before (p < .05). Meanwhile, the mean Apgar score of the experimental group after the intervention was significantly higher than before (p < .001). Conclusion: Many high-risk factors for neonatal nosocomial infections significantly impact health behavior. Adopting informationized health management based on deep learning can reduce infection and improve neonates′ health.

APGAR SCORE: COMPARISON OF GENERAL ANAESTHESIA VS SPINAL ANAESTHESIA

Caesarean section is a common obstetric operation performed to save the lives of both the mother and baby. This study aimed to compare the APGAR score of neonates in patients who received general anesthesia or spinal anesthesia during the procedure. For this prospective randomized controlled trial, 160 ASA class I and II patients who underwent elective caesarean section at 37 weeks or more of gestation were selected. The patients were randomly divided into two equal groups, A and B, with 80 patients in each group. Group A received spinal anesthesia with a 25-gauge pain spinal needle using hyperbaric bupivacaine 1.5ml, while Group B received general anesthesia with an endotracheal tube. After the baby's delivery, the APGAR score was assessed at 1 minute and recorded on a proforma. The results showed that the mean APGAR score at 1 minute in group A was 8.49, while in group B, it was 6.53. The mean age in group A was 30.09 ± 3.35 years, and in group B, it was 29.86 ± 3.16 years. The mean birth weight of neonates in group A was 2999.80 ± 275.78 grams, while in group B, it was 3066.25 ± 281.66 grams.In conclusion, the study found that the APGAR score was better in spinal than in general anesthesia.

Postdate Pregnancy Maternal and Fetal Outcomes among Sudanese Women

Background: Postdated pregnancy is one of the most common obstetric problems associated with increased maternal morbidity, prenatal morbidity, and mortality. Pregnancy at 37-40 weeks of gestation is called the term from the last menstrual period. If the pregnancy exceeds 40 weeks, it is called a postdated pregnancy, but when pregnancy is prolonged beyond 42 weeks, it is called post-maturity or post-term pregnancy. Objective: This study aimed to determine the adverse effects of postdate pregnancy on mothers and fetuses. Methodology: This was a descriptive, prospective, cross-sectional, hospital-based study conducted at Omdurman Maternity Hospital from January 2018 to June 2018. An interview questionnaire was used to collect data. Data were collected by trained doctors in the labor room. One hundred and thirty-eight (138) postdated pregnant women were included in this study after obtaining informed consent through a structured questionnaire. Demographic and clinical data concerning personal history, booking status, mode of delivery, maternal complications, and fetal complications were recorded. Results: During the study period, 2751 women delivered, of which 138 were postdated deliveries, with a prevalence of 5%. Most women's age range was 31-34 years 48.6%). Their education level was mostly secondary school (42%). Primigravida 65%), booked were 75.4%. Previous history of postdate pregnancy was 34.1%, normal vaginal delivery was 79 .7%, cesarean section was 14.5%, and instrumental delivery 5.8%. Cesarean section indications were cervical dystocia (14.4%), cephalopelvic disproportion (9.5%), meconium-stained liquor with fetal distress (33.3%), pathological cardiotocography (CTC) (19%), and failure to progress (23.8%). Maternal complications included post-partum hemorrhage (PPH) (7.2%), perineal tears (.7%, cervical tears (1.4%), and postpartum infections (1.4%). Fetal complications were 14.5%, Shoulder Dystocia 2.9%, asphyxia (6.5%), and meconium aspiration (5.1%). The mean APGAR score was 1.1667, less than three in only 3.6%, and > 7 in 86.9%. Neonatal death was 3%. Approximately 18 neonates were admitted to the Neonatal Intensive care unit (NICU) and only five of them were admitted for more than one week. Conclusion: Postdate pregnancy prevalence in this study was 5%, which was associated with maternal risk of cesarean section delivery, instrumental delivery, postpartum hemorrhage, and postnatal infection.

Major Placenta Previa in Advanced Age Among Nulliparous With Cesarean Section: A Cross-Sectional Study

INTRODUCTION:Major placenta previa with advanced maternal age (AMA) is a significant risk factor for obstetric hemorrhage and associated maternal and neonatal complications.OBJECTIVE:The objective was to study major placenta previa in advanced age among nulliparous with cesarean section.METHODS:This prospective cross-sectional study analyzes 78 pregnant women of advanced age with major placenta previa under a cesarean section. Data were collected using interview questionnaires between January 2019 and June 2020.RESULTS:The mean gestational age at delivery was 35.7 ± 3 years. Antepartum hemorrhage, premature membrane rupture, and placenta accreta occurred in 15.4%, 35.9%, and 15.4% of cases, respectively. About 12.8% of women were at risk of post-traumatic stress disorder symptoms. Fetal distress, postpartum hemorrhage (PPH), and cesarean hysterectomy occurred in 37.2%, 46.2%, and 15.4% of patients. Mean Apgar scores in the first and fifth minutes were 7.0 ± 0.90 and 8.0 ± 0.82, respectively. The mean birth weight was 2.7 ± 0.14823. Of neonates, 37.2% were premature, 37.2% required resuscitation, less than half (44.9%) were admitted to the neonatal intensive care unit, and 37.2% had respiratory distress syndrome. Moreover, there is a statistically significant relationship between placenta accreta and cesarean hysterectomies and the occurrence of PPH. Also, a highly significant association was observed between the use of antenatal steroids, fetal distress, Apgar score <3 at 1 minute, and neonatal respiratory distress syndrome.CONCLUSION:Major placenta previa with AMA significantly influences pregnancy outcomes and is considered an obstetric emergency. Therefore, early detection of major placenta previa and proper management during clinical care is essential.

Frequency of PPHN in Neonates Having Confirmed Diagnosis of Meconium Aspiration Syndrome

Background: Optimal oxygenation, avoidance of respiratory and metabolic acidosis, normal blood pressure, sedation & pulmonary vasodilator treatment are among the management techniques for persistent pulmonary1hypertension of the newborn. Aim: To find frequency of PPHN in neonates having confirmed diagnosis of meconium aspiration syndrome. Study Design: Descriptive cross sectional study. Methodology: Total 240 neonates who fulfilled inclusion criteria were enrolled from Pediatrics Medicine Ittifaq hospital Lahore after getting informed consent form parents or attendants. Basic information like gestational age, gender, birth weight, APGAR score at 7 minutes, mode of delivery were taken (on antenatal record). All cases with confirmed diagnosis of MAS were underwent 2D Echocardiography and PPHN were diagnosed as per operational definition. All diagnostic procedure was done by a single consultant cardiologists. SPSS 20.0 was utilized to analyze the data. For quantitative data, mean and standard deviation were provided, while frequencies and percentages were provided for qualitative factors. Post stratification Chi-square test was applied taking p-value ≤ 0.05 as significant. Results: The mean birth weight was 3211.02±412.10 grams with min & max birth weight as 2500 and 3882 g. The mean APGAR score was 7.95±1.41. There were 85(35.4%) cases who had PPHN while 155(64.6%) cases did not have positive diagnosis of PPHN. Conclusions: It was concluded that frequency of PPHN in neonates having confirmed diagnosis of meconium aspiration syndrome is very high. So early screening during antenatal visits and adopting preventive strategies can only minimize the risk of meconium aspiration syndrome thus preventing PPHN. Keywords: Persistent Pulmonary Hypertension, Meconium Aspiration Syndrome, Meconium Stained Amniotic Fluid