Meconium In Amniotic Fluid Research Articles

Utilizing machine learning to predict the risk factors of episiotomy in parturient women

BackgroundEpisiotomy has specific indications that, if properly followed, can effectively prevent women from experiencing severe lacerations that may result in significant complications like anal incontinence. However, the risk factors related to episiotomy has been the center of much debate in the medical field in the past few years. ObjectiveThe present study used a machine learning model to predict the factors that put women at the risk of having episiotomy using intrapartum data. Study designThis was a retrospective cohort study design. Factors such as age, educational level, residency place, medical insurance, nationality, attendance at prenatal education courses, parity, gestational age, onset of labor, presence of a doula during labor, maternal health conditions like anemia, diabetes, preeclampsia, prolonged rupture of membrane, placenta abruption, presence of meconium in amniotic fluid, intrauterine growth retardation, intrauterine fetal death, maternal body mass index, and fetal distress were extracted from the electronic health record system of a tertiary-care medical center in Iran, from January 2022 to January 2023. The criteria for inclusion were vaginal delivery of a single pregnancy. Deliveries done through scheduled/emergency cesarean section or at the mother's request were excluded. The participants were divided into two groups: those who had vaginal deliveries with episiotomy and those who had vaginal deliveries without episiotomy. The significant variables, as determined by their P-values, were selected as features for the eight machine-learning models. The evaluation of performance included area under the curve (AUC), accuracy, precision, recall, and F1-Score. ResultsDuring the study period, out of 1775 vaginal deliveries, 629 (35.4%) required an episiotomy. Each model had an AUC value assigned to it: linear regression (0.85), deep learning (0.82), support vector machine (0.79), light gradient-boosting (0.79), logistic regression (0.78), XGBoost classification (0.77), random forest classification (0.76), decision tree classification (0.75), and permutation classification—knn (0.70). Linear regression had a better diagnostic performance among all the models with the area under the ROC curve (AUC): 0.85, accuracy: 0.80, precision: 0.74, recall: 0.86, and F_1 score: 0.79). Parity, labor onset, gestational age, body mass index, and doula support were the leading clinical factors related to episiotomy, according to their importance rankings. ConclusionsUtilizing a clinical dataset and various machine learning models to assess the risk factors of episiotomy resulted in promising results. Further research, focusing on intrapartum clinical data and perspectives of the birth attendant, is necessary to enhance the accuracy of predictions.

Home birth in Croatia - a medico-legal perspective today.

In Croatia, the model of obstetrics-midwifery management of childbirth in maternity hospitals is still in effect, and this is how > 99% of Croatian women give birth. However, in my view, midwives are still not sufficiently educated for completely independent work notwithstanding their university education. The Law on Midwifery defined the role of the midwife in home birth without, however, setting out other organisational-communication and professional provisions. Then it began with sporadic midwifery home births of a few per year, which grew quite rapidly, especially with the impact of the Covid-19 virus pandemic, to about 100 out of a total of about 38,000 births that are performed annually in the Republic of Croatia in maternity hospitals. Since the start of planned home births many bad perinatal outcomes have been recorded in hospital maternity wards who have admitted women after such deliveries. These include puerperal sepsis, protracted labour of several days, neglected protracted labour with perinatal asphyxia and aspiration of meconium amniotic fluid and resuscitation of the newborn (who later developed cerebral palsy), severe postpartum haemorrhage with obstetric shock and postpartum hysterectomy, episiotomy infection, and stillbirth at term pregnancy. Therefore, planned home birth in Croatia should now be regarded as an unsafe birth in extraordinary circumstances and the person who takes charge of it must be professionally prepared, educated and have numerous social skills. Most Croatian gynaecologists and obstetricians give support to midwives in their efforts to be professional and independent when at work, including the controlled and legal implementation of the planned home birth. We unreservedly support self-aware midwives to maintain their profession as highly ethical and professional as possible above the wishes of non-professionals who call for autonomy, so that we do not have to discuss such problems of malpractice of Croatian midwifery in the 21st century.

НОВАЯ КОРОНАВИРУСНАЯ ИНФЕКЦИЯ БЕРЕМЕННЫХ ЖЕНЩИН: ОСОБЕННОСТИ ТЕЧЕНИЯ БЕРЕМЕННОСТИ И ВОЗМОЖНОСТИ ПРОГНОЗИРОВАНИЯ ПНЕВМОНИИ НОВОРОЖДЕННЫХ

Introduction. Pregnancy profoundly impacts the immune system, yet the influence of gestational age at COVID-19 contraction and its implications for perinatal outcomes remain uncertain. Aim. This study aimed to evaluate the effects of COVID-19 contracted at various gestational stages on pregnancy and perinatal outcomes. Materials and Methods. Retrospective analysis of medical records from 113 mother-newborn pairs, including COVID-19-positive pregnant women, was conducted at the clinical sites of the Department of Obstetrics and Gynecology of the Novosibirsk State Medical University from 2021 to 2022. The sample was categorized into three study groups based on gestational age at COVID-19 contraction, with a control group of COVID-19-negative pregnant women. Results. Findings revealed a higher incidence of mild COVID-19 in Group 1, while Groups 2 and 3 exhibited a moderate course (p=0.03). Additionally, Groups 2 and 3 demonstrated a higher prevalence of pneumonia (p=0.03) and antibiotic therapy (p=0.02). Complications such as preeclampsia (p=0.002), oligohydramnios (p<0.001), and fetal growth restriction (p=0.02) were more frequent in patients with COVID-19 during pregnancy. Furthermore, fetal distress was more common in study groups 1 and 2 (p=0.002). Neural network analysis allowed for the prediction of pneumonia in newborns with 98.2% accuracy based on factors such as gestational age at COVID-19 contraction, disease severity, presence of oligohydramnios and fetal growth retardation, meconium amniotic fluid, and delivery date. Conclusions. In conclusion, COVID-19 contraction before 34 weeks of gestation often complicates pregnancy, leading to placental insufficiency, preeclampsia, and gestational diabetes mellitus, thereby increasing the risk of early delivery and the birth of low-birth-weight children with reduced adaptive capabilities. The development of pneumonia in these newborns exacerbates their condition, often resulting in perinatal losses. Utilizing a neural network for pneumonia prediction may potentially mitigate perinatal losses.

RISK FACTORS ASSOCIATED WITH BIRTH ASPHYXIA

This study aimed to identify factors contributing to prenatal asphyxia in full-term neonates born at Hayatabad Medical Complex in Peshawar. The research was conducted over one year (January 2022 to January 2023) at the Pediatrics Department of Hayatabad Medical Complex in Peshawar. The study involved mothers delivering twins vaginally, comprising 100 newborns with gestational ages between 37 and 42 weeks and birth weights from 2,000 to 4,000 grams. A case-control design was employed, categorizing infants with Apgar scores of five or less at one minute as cases and those with scores exceeding five as controls. Data collection utilized a customized form, capturing demographic variables and risk factors. Statistical analysis employed SPSS version 26.0, applying the chi-square test for comparison. The results showed significant differences between cases and controls regarding gender distribution, birth weight, mode of delivery, maternal age, and gestational age. Key risk factors, including parity, fetal distress, meconium in amniotic fluid, and prolonged labor, displayed significant differences between cases and controls. The study concluded that birth asphyxia is influenced by factors such as meconium-stained amniotic fluid, prolonged labor, and fetal distress. Obstetrician involvement in ongoing research enhances data reliability. Community-specific risk factors underscore the need for tailored interventions to mitigate birth asphyxia. Despite study limitations, including a single-center design, the findings contribute valuable insights for future research and targeted strategies.

Does cesarean section prevent adverse neonatal outcomes associated with meconium amniotic fluid?

BackgroundMaking decisions regarding the mode of delivery in the cases of meconium amniotic fluid (MAF) presents a challenge for healthcare providers. We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section (CS) versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes. MethodsIn this retrospective study, we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 2020-2022. Mothers with certain adverse pregnancy conditions were excluded from the study. These conditions included: abnormal fetal heart rate and pattern, bloody amniotic fluid, malpresentation, abnormal placentation, chorioamnionitis, intrauterine growth restriction, intrauterine fetal death, obstructed labor, and maternal comorbidities. The MAF mothers were divided into two groups based on the method of delivery: those who had CS and those who had a normal vaginal delivery (NVD). Demographic factors, obstetrical factors, and neonatal outcomes were compared between the two groups. ResultsOut of 746 MAF mothers, 213 (28.5%) underwent CS, while 533 (71.4%) had NVD. There were no significant differences between the groups in terms of demographic characteristics. Among MAF mothers who had CS, 66.2% were primiparous, and 33.8% were multiparous. For those who had NVD, 35.1% were primiparous, and 64.9% were multiparous. The first and 5-min Apgar values, rates of asphyxia, neonatal intensive care unit (NICU) admission, and neonatal death were not statistically different between the two delivery modes. The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery. Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS (11.1% vs. 2.3%), no correlation was found between the mode of delivery and the need for resuscitation using logistic regression. ConclusionsOur research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers. Further studies are needed to provide more substantial evidence to support this conclusion.

Exploring the impacts of a nuchal cord on perinatal outcomes in vaginal delivery

Objectives: To investigate the frequency of cord entanglement and neonatal outcomes in vaginal deliveries. Methods: A total of 24,623 patients who had vaginal delivery at at Kayseri City Hospital between July 2018 and January 2023 were included in the study. The incidence of nuchal cord was determined in the study group. The characteristics and perinatal outcomes of groups with and without nuchal cord were compared. Chi-square test was used for statistical evaluation. A p value less than 0.05 was considered significant in the evaluation. Results: The rate of cord entanglement in the neck at birth was 15.7%. There was no statistically significant difference between the infant weights, genders, maternal ages, hospitalization rates in the neonatal intensive care unit, and apgar scores at the 1st and 5th minutes of the babies included in the study. We detected amniotic fluid with meconium in 506 (13.1%) patients with a nuchal cord and 270 (1.3%) without a nuchal cord, and the difference was found to be significant. Conclusions: There is no significant relationship between vaginal deliveries with the nuchal cord and poor perinatal outcomes, except for meconium amniotic fluid. For this reason, pregnant women diagnosed with nuchal cord in the third trimester can deliver vaginally, but they should be carefully monitored in terms of meconium and related complications. However, neonates with nuchal cord do not have significantly longer neonatal hospital stays, and thus the adverse effects of nuchal cord may be transient.

The Culture of Drinking Herbal Medicine in Pregnant Women: A Phenomenological Study

Background: Pregnant women who drink herbal medicine can increase the risk of meconium amniotic fluid, and meconium amniotic fluid is a risk factor for asphyxia in newborns. Objectives: Identify three forms of culture in drinking herbal medicine in pregnant women, namely the mother's values and ideas about drinking herbal medicine, herbal drinking activities, and material on the culture of drinking herbal medicine. Methods: This research is a qualitative method with a phenomenological approach. Informants in this study consisted of pregnant women and key informants consisted of families of pregnant women, cadres, ustadzah, midwives, and herbal medicine providers. Results: The cultural forms of drinking herbal medicine include: 1) Values and Ideas. Drinking herbal medicine for pregnant women is still practiced because of their subjective norms and normative beliefs from the surrounding environment. All informants believed that herbal medicine could provide benefits rather than negative effects, and only midwives stated that herbal medicine had negative effects, namely meconium amniotic fluid, and even asphyxia. 2) The activity of drinking herbal medicine. Pregnant women drink herbal medicine from the beginning of pregnancy until delivery. The frequency of taking herbal medicine was various. Religious figures and community leaders have an important role in the culture of drinking herbal medicine. 3) Herbal ingredients. The herbs consumed by each informant were different, there were informants who consumed homemade herbs and bought them at the market. Conclusions: The culture of drinking herbal medicine is still carried out because the local community's belief about the benefits of herbal medicine is still high, and lack of public knowledge about the effects of drinking herbal medicine on pregnant women.

Diagnosis and management of intrahepatic cholestasis in pregnancy

Intrahepatic cholestasis of pregnancy is caused by a dysfunction of the hepatocytes, typical of pregnancy. High concentrations of sex hormones and genetic predisposition appear to be important factors for their development. The incidence depends on the ethnic composition of the population and the diagnostic criteria used. It is characterized by increasing and persistent pruritus, increased concentrations of bile acids, usually in the late second or third trimester of pregnancy. It leads to the occurrence of uteroplacental hypoxia that increases the risk of meconium amniotic fluid, preterm delivery, preeclampsia, postpartum hemorrhage, neonatal respiratory distress syndrome, and perinatal death. Therapeutic management is aimed at reducing clinical symptoms, normalizing maternal biochemical changes, and preventing fetal complications. The main pharmacological treatment consists of the administration of ursodeoxycholic acid. The objective of this research is to evaluate the diagnosis and management of intrahepatic cholestasis of pregnancy

Application of machine learning to identify risk factors of birth asphyxia

BackgroundDeveloping a prediction model that incorporates several risk factors and accurately calculates the overall risk of birth asphyxia is necessary. The present study used a machine learning model to predict birth asphyxia.MethodsWomen who gave birth at a tertiary Hospital in Bandar Abbas, Iran, were retrospectively evaluated from January 2020 to January 2022. Data were extracted from the Iranian Maternal and Neonatal Network, a valid national system, by trained recorders using electronic medical records. Demographic factors, obstetric factors, and prenatal factors were obtained from patient records. Machine learning was used to identify the risk factors of birth asphyxia. Eight machine learning models were used in the study. To evaluate the diagnostic performance of each model, six metrics, including area under the receiver operating characteristic curve, accuracy, precision, sensitivity, specificity, and F1 score were measured in the test set.ResultsOf 8888 deliveries, we identified 380 women with a recorded birth asphyxia, giving a frequency of 4.3%. Random Forest Classification was found to be the best model to predict birth asphyxia with an accuracy of 0.99. The analysis of the importance of the variables showed that maternal chronic hypertension, maternal anemia, diabetes, drug addiction, gestational age, newborn weight, newborn sex, preeclampsia, placenta abruption, parity, intrauterine growth retardation, meconium amniotic fluid, mal-presentation, and delivery method were considered to be the weighted factors.ConclusionBirth asphyxia can be predicted using a machine learning model. Random Forest Classification was found to be an accurate algorithm to predict birth asphyxia. More research should be done to analyze appropriate variables and prepare big data to determine the best model.

The Incidence and Outcomes of Late-Term Pregnancy.

Little is known about the outcomes of late-term pregnancy. In this study, we aim to assess the incidence and adverse prenatal outcomes associated with late-term pregnancy. We retrospectively assessed all singleton pregnant mothers who gave birth at Khalij-e-Fars Hospital in Bandar Abbas, Iran, between January 2020 and 2022. All preterm and post-term deliveries were excluded. Mothers were divided into two groups: late-term mothers (41 0/7-41 6/7 weeks of gestation) and term mothers (37 0/7-40 6/7 weeks of gestation). Demographic factors, obstetricfactors, maternal comorbidities, and prenatal outcomes were extracted from the electronic data of each mother. The incidence of late-term births was calculated. The chi-squared test was used to compare differences between the groups. Logistic regression models were used to assess the association of prenatal outcome with late-term pregnancy. There were 8,888 singleton deliveries during the study period, and 1,269 preterm and post-term pregnancies were ruled out. Of the 7,619 deliveries, 309 (4.1%) were late-term, while 7,310 (95.9%) were term. There were no sociodemographic differences between term and late-term mothers. The late-term group had a higher prevalence of primiparous mothers, and the term group had a higher prevalence of diabetes. Late-term mothers had a higher risk of macrosomia (adjusted odds ratio (aOR): 2.24 (95% confidence interval (CI): 1.34-3.01)), meconium amniotic fluid (aOR: 2.32 (95% CI: 1.59-3.14)), and fetal distress (aOR: 2.38 (95% CI: 1.54-2.79)). When compared to term pregnancy, the risk of low birth weight (LBW) was lower in late-term pregnancy (aOR: 0.69 (95% CI: 0.36-0.81)). Late-term pregnancy was found to be more likely to be associated with macrosomia, meconium amniotic fluid, and fetal distress, but serious maternal and neonatal adverse events were comparable to term pregnancy.

Associação entre o transtorno do espectro do autismo e eventos periparto: estudo de caso-controle

Objective:To assess the association between peripartum events and autism spectrum disorder (ASD) development in children and adolescents.Methods:The current research is a case–control study in northern Minas Gerais state, Brazil. The inclusion criteria in the case group included individuals whose medical records reported an autistic disorder diagnosis, individuals had this diagnosis further confirmed by Northern Minas Autistic Support Association and specialized clinics, and their mothers had to answer positively to the question: “Was your child diagnosed with autism spectrum disorder?” in the data collection instrument. Thus, the case group included 253 mothers of children/adolescents of 2–15 years old diagnosed with autism. The inclusion criteria in the control group included 852 individuals belonging to the same age group and enrolled in the same schools as the case group. A semi-structured questionnaire was applied for mothers of children/adolescents, and the multiple logistic regression model was adopted for data analysis. Gross and adjusted Odds Ratios (ORa) were used to estimate the magnitude of the associations.Results:Autistic disorder was associated with the presence of meconium in amniotic fluid (AF) (ORa 1.67; 95% confidence interval [95%CI] 1.06–2.65) and cesarean delivery type (ORa 1.65; 95%CI 1.17–2.32). Emergency cesarean section increased autistic disorder development likelihood (ORa 2.38; 95%CI 1.61–3.51). Children and adolescents with ASD were more likely to have been exposed to two or more unfavorable peripartum events and obstetric complications than control groups (ORa 1.59; 95%CI 1.01–2.51).Conclusions:Meconium stained amniotic fluid, delivery by cesarean, and two or more unfavorable peripartum events are variables that should be considered in studies about ASD etiology.

The incidence and risk factors of meconium amniotic fluid in singleton pregnancies: an experience of a tertiary hospital in Iran

BackgroundSeveral common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development; however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies.MethodsThis study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors.ResultsOf 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20–34 years old (aOR: 3.07, 95% CI: 1.87–4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76–8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92–9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11–4.99).ConclusionsAdolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.

THE INFLUENCE OF PERINATAL RISK FACTORS ON THE DEVELOPMENT OF MECONIUM ASPIRATION SYNDROME IN NEWBORN: IMPORTANT IN THE ROUTINE PRACTICE OF DOCTOR-NEONATOLOGIST

The article summarizes the data on known risk factors for meconium aspiration syndrome (MAS) and those that continue to be studied to increase the effectiveness of the organization and provision of primary resuscitation for newly born, intensive care fornewborns with MAS, prevention of aspiration pneumonia and complications of MAS, including early and late neonatal sepsis. MAS hasnot lost its relevance in recent years, despite studies of this problem on all continents and in almost every country in the world, which is associated with a high incidence of MAS, aspiration pneumonia, persistent pulmonary hypertension, and pneumothorax. The frequency of meconium in amniotic fluid is from 10 to 24%, and the implementation of meconium aspiration syndrome occurs in 3-12% of cases. MAS increases the frequency of antenatal, intranatal fetal death, as well as neonatal mortality to 4.2% in the case of severe meconiumaspiration. Despite the scientifically proven link between the occurrence of meconium amniotic fluid and individual factors, includingpregnancy, infection and hypoxia, which play a key role in the development of MAS, the degree of influence of these factors at differentstages of pregnancy is still being studied. A study of the effect of hypoxia and infection on the imbalance between fetal defecation,urination, swallowing, respiratory tract secretion and amniotic fluid clearance. The differences between the value of physiological intrauterine defecation and pathological discharge of meconium in utero against the background of the infectious process in the mother (microbial colonization of the amniotic cavity funisitis), and fetal distress are shown. The role of delayed pregnancy, infection, andhypoxia during pregnancy in the development of MAS is emphasized, with an emphasis on the chronic course of these processes. It waspointed out that gestational age over 41 weeks cannot be considered a primary factor, in the risk of developing MAS, and the fact that body weight at birth is also important in the appearance of amniotic fluid contaminated with meconium and the development of MAS. If a pregnant woman has a microbial invasion of the amniotic cavity: chorioamnionitis or funisitis, the development of MAS is possible in a child born prematurely. Emphasized diagnostic value of intrauterine infection - a risk factor for MAS due to an increase in the normof several inflammatory mediators identified in umbilical cord blood. The influence of circulatory disorders occurring in utero under theinfluence of stress and shock factors (functional disorders in the mother-placenta-fetus system, hypertension, late hestosis in the mother,dehydration, infection, metabolic disorders, bad habits). The additional focus of neonatologists to ensure objective monitoring of thecondition of the fetus in maternity hospitals during the briefing, predicting the course of MAS will be insufficient justification for theindications for the use of oxytocin. Timely detection of new risk factors for MAS, the addition of importance in the development of MASwill help to improve and timely update birth protocols, in the presence of amniotic fluid contaminated with meconium, resuscitation andpost-resuscitation care for newborns, optimize clinical routes.

Neonatal Outcome of 100 Cases of Term Pregnancy Having Meconium Stained Liquor in a Tertiary Level Hospital

Background : Presence of meconium in amniotic fluid is potentially a serious sign of fetal compromise and associated with an increased perinatal mortality and morbidities.Meconium stained amniotic fluid is considered a harbinger of fetal compromise because of its direct correlation with fetal distress and increased likelihood of aspiration of meconium with resultant deleterious effects on the neonatal lung. The purpose of the study was to find the neonatal outcome of pregnancy associated with meconium staining amniotic fluid. Outcome variable were birth weight, Apgar score, admission in NICU, neonatal complications, neonatal mortality and morbidity.
 Materials and methods : The present prospective observational study was conducted in the Department of Obstetrics and Gynaecology in Bangabandhu Sheikh Mujib Medical University, Dhaka and Dhaka Medical College Hospital. A total of 100 pregnant women admitted in the labour ward with meconium stained liquor were the study population.
 Results : Nearly three-quarter (72%) of the patients were between 20 – 30 years followed by 17.2% more than 30 years and 10.8% below 20 years old. Over half (52.2%) of the neonates needed resuscitation and 58.7% had to be admitted in ICU. More than 90% of the neonates had normal birth weight and only 9.7% were of low birth weight. Over half (51.1%) of the neonates developed meconium aspirate syndrome and 10.5% respiratory distress syndrome. Neonatal jaundice and neonatal sepsis were observed in 5.4%, 4.3% neonates respectively. Ten neonates (10.5%) died early in the neonatal life, while 1(1.1%) was still-born. low APGAR score (< 7) at 1 and 5 minutes of birth was found in 63.6% and 53% of the cases respectively with thick meconium stained amniotic fluid as opposed to 26.3% and 17.7% of the cases respectively having thin meconium stained amniotic fluid (p = 0.002 and p = 0.014 respectively). Thick meconium tend to be associated with meconium aspiration syndrome (p < 0.001). Neonates needing immediate resuscitation and admission in ICU was staggeringly higher in the former group than those in the latter group (p < 0.001). The incidence of perinatal death was significantly higher in patients with thick meconium stained fluid than that in patients with thin meconium (p = 0.029).
 Conclusion : The study concluded that meconium stained amniotic fluid is associated with low APGAR score, higher incidence of MAS, ICU admission and perinatal death and their severity depends on the concentration of meconium.
 JCMCTA 2022 ; 33 (1) : 15-20

Español Peru

ABSTRACT: Objectives: To determine the association between maternal perinatal factors and early neonatal sepsis in a Chimbote hospital. Methodology: Analytical, cross-sectional, retrospective study and design of cases and controls. Fifty-one newborns with early neonatal sepsis (cases) and 51 healthy newborns (control) were compared, from the neonatology service of La Caleta hospital, period 2016-2020; using bivariate and multivariate statistics (odds ratio, 95% confidence interval, chi square and logistic regression p value). Results: The male sex was found to have an odds ratio: 2.07; 95% CI (0.93 to 4.61); prematurity odds ratio: 3.91, 95% CI (0.76 to 19.98); low birth weight odds ratio: 2.67, 95% CI (0.49 to 14.44); urinary tract infection odds ratio: 6.77, 95% CI (1.41 to 32.36); premature rupture of membranes> 18 hours odds ratio: 1.98, 95% CI (0.61 to 6.37); chorioamnionitis odds ratio: Undefined, 95% CI (Undefined); meconium amniotic fluid odds ratio: 7.37, 95% CI (1.98 to 27.31), acute fetal distress odds ratio: 12.25, 95% CI (1.50 to 99.80); and dystocic delivery odds ratio: 3.50, 95% CI (1.36 to 8.99). Conclusions: Presenting meconium amniotic fluid, acute fetal distress, dystocic delivery and urinary tract infection were risk factors associated with early neonatal sepsis. The evidence analyzed was not sufficient to conclude that the sex of the neonate, low birth weight, prematurity, chorioamnionitis, and prolonged rupture of membranes were risk factors for early neonatal sepsis.

Prospective study on influence of perinatal factors on the development of early neonatal hypoglycemia in late preterm and term infants

Introduction and objectiveNeonatal hypoglycemia offers multiple controversies. The study aims to assess the main factors involved in the development of early hypoglycemia in term and late preterm infants, and the implication of different environmental circumstances. MethodsA prospective cohort study in infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. Three capillary blood glucose determinations were performed during the eight first hours after birth. Sample size: 207, 59 neonates developed hypoglycemia. ResultsPrenatal risk factors include gestational diabetes with poor glycemic control, twin pregnancy and gestational age. The presence of meconium amniotic fluid and planned cesarean delivery are associated with a higher probability of hypoglycemia. After birth, skin to skin contact, breastfeeding, soft lightening, and normothermia are described as protective factors. The predictive model that combines the type of lightening, body temperature and the excess of bases level, correctly classifies 98% of the severe hypoglycemia cases, with a high Nagelkerke R2 value (0.645) and specificity of 99.5%. ConclusionsPostnatal environmental factors seem to be directly related to early hypoglycemia development, so it is essential to support the maternal-child union and breastfeeding. Our results allow better identification of neonates who are not subsidiary to performing blood glucose determinations because they have little risk of developing it.

Neonatal Encephalopathy in the Term Newborn

Perinatal brain injury is the third leading cause of child mortality globally. Purpose: Evaluation of perinatal risk factors for encephalopathy in neonates in order to prevent deaths and disabilities Method: This is a prospective, case-control study conducted in the Maternity Hospital “K. Gliozheni” during the time period 2012 – 2016. 65 newborns at term ≥37 weeks diagnosed with encephalopathy according to the Thompson classification >5 within 12 hours of birth were compared with a control group, infants without encephalopathy in a 1:1 ratio selected casual and gender-appropriate. Results: Total antepartum risk factors were found in (70.8%) of cases and (18.5%) of controls (p<0.01). Sentinel events were found in 38.5% of cases and in 9.2% of controls. (p<0.01). Acute intrapartum events in total were found in (38.5%) of cases and (9.2%) of controls (p<0.01). 43.1% of babies had a combination of antepartum and intrapartum factors (p<0.01). Significant and independent predictive factors of risk for neonatal encephalopathy resulted: from maternal factors, mother’s age >35 years (p=0.03). Of the intrapartum factors: pregnancy with twins (p<0.01), hypertension/preeclampsia (p<0.01), non-reactive FHR before delivery (p<0.01). MEDICUS No. 6, ISSUE 2/ 2022 103 From intrapartum factors: breech birth (p=0.01), emergency cesarean section (p=0.01), meconial amniotic fluid (p=0.02), prolonged birth (p=0.01). Conclusion: Knowledge of perinatal risk factors associated with neonatal encephalopathy is essential for developing interventions to prevent neonatal death and disability.

Risk Factors of Birth Asphyxia : Literature Review

Background: Birth asphyxia is a condition of failure to start breathing in neonates or unable to maintain spontaneous breathing at birth. Neonatal asphyxia is a contributor to 30-35% of neonatal deaths. The incidence of birth asphyxia in infants in developing countries is 10 times greater than in developed countries, especially if maternal and neonatal health services are inadequate. The incidence of asphyxia is inseparable from the accompanying risk factors. Therefore, this study aims to determine the risk factors for the incidence of asphyxia in newborns based on fetal and maternal factors. Method: This research is a literature review where researchers will review articles that are relevant to predetermined criteria. Articles were screened based on titles, abstracts, keywords, inclusion criteria, and the contents of the entire text, and the seven most relevant articles were obtained for review. Result: The results of a literature search showed that the most risk factors for the incidence of birth asphyxia were: Fetal factors consisting of low birth weight, prematurity, meconium amniotic fluid, malpresentation, and umbilical cord entanglement. Then on maternal factors, the most risk factors were prolonged labor, preeclampsia, primigravida mothers, and post-term pregnancies. Conclussion : Based on the results of a search of seven literature, researchers have taken the most mentioned factors and grouped these factors into 2 factors, namely fetal factors and maternal factors.

Early Neonatal Outcome of Clinically Diagnosed Fetal Distress in Low Resource Areas

Introduction: Fetal distress is a high risk obstetric situation associated with increased perinatal morbidity and mortality. It is also a major contributor to operative interventions in the majority hospitals of developing countries. The objective of this study was to observe clinically diagnosed fetal distress and early neonatal outcome after delivery. Materials and Methods: This hospital based cross-sectional study was carried out in Department of Obstetrics and Gynecology at Bashundhara Addin Medical College Hospital, Keraniganj during the period of January to December 2019. 212 women in active phase of labor at term pregnancy who met the inclusion and exclusion criteria were enrolled. Fetal distress was diagnosed by abnormal FHR and /or presence of meconium in amniotic fluid after rupture of membrane. Neonatal outcome was assesss by 1st & 5th mins Apgar Scores after delivery, babies requiring immediate resuscitation and admission to neonatal care unit & recorded. Result: Among fetal distress 11.32% babies had Apgar score <7 as compared to babies without fetal distress that had 5.66% apgar score <7 at 5th minutes(p<0.05). 28.3% fetal distressed born babies required NICU admission rather than only 9.44% of without fetal distress. Conclusion: This study shows relative adverse neonatal outcome for fetal distressed babies than without distress. Medicine Today 2021 Vol.33(2): 152-155

Analysis of Cow-Calf Microbiome Transfer Routes and Microbiome Diversity in the Newborn Holstein Dairy Calf Hindgut.

Hindgut microorganisms in newborn calves play an important role in the development of immunity and metabolism, and optimization of performance. However, knowledge of the extent to which microbiome colonization of the calf intestine is dependent on maternal characteristics is limited. In this study, placenta, umbilical cord, amniotic fluid, colostrum, cow feces, and calf meconium samples were collected from 6 Holstein cow-calf pairs. Microbial composition was analyzed by 16S rRNA gene high-throughput sequencing, and maternal transfer characteristics assessed using SourceTracker based on Gibbs sampling to fit the joint distribution using the mean proportions of each sample with meconium as the “sink” and other sample types as different “sources.” Alpha and beta diversity analyses revealed sample type-specific microbiome features: microbial composition of the placenta, umbilical cord, amniotic fluid, colostrum, and calf feces were similar, but differed from cow feces (p < 0.05). Compared with profiles of meconium vs. placenta, meconium vs. umbilical cord, and meconium vs. colostrum, differences between the meconium and amniotic fluid were most obvious. SourceTracker analysis revealed that 23.8 ± 2.21% of the meconium OTUs matched those of umbilical cord samples, followed by the meconium-placenta pair (15.57 ± 2.2%), meconium-colostrum pair (14.4 ± 1.9%), and meconium-amniotic fluid pair (11.2 ± 1.7%). The matching ratio between meconium and cow feces was the smallest (10.5 ± 1%). Overall, our data indicated that the composition of the meconium microflora was similar compared with multiple maternal sites including umbilical cord, placenta, colostrum, and amniotic fluid. The umbilical cord microflora seemed to contribute the most to colonization of the fecal microflora of calves. Bacteria with digestive functions such as cellulose decomposition and rumen fermentation were mainly transmitted during the maternal transfer process.