Neonatal Apgar Scores Research Articles

Does presence of subclinical hypothyroidism and thyroid auto antibodies affect pregnancy outcomes in pregnancy? A record-based cross-sectional study

ObjectiveOur aim in this study is to determine the relationship between TPOAb positivity and pregnancy outcomes in the subclinical hypothyroid patient group. Materials and methodsThis study was started with 21,321 pregnant women, but after the exclusion criteria, 11,387 pregnant women were included int his study. Demographic characteristics of each patient group included in the study, such as age, bodymass index (BMI), and laboratory parameters such as complete blood count (hemogram), liver and kidney function tests, type of delivery, birth weight, neonatal intensive care admission, 1st and 5th minute APGAR scores, glucose tolerance test results, whether there was high blood pressure during pregnancy, whether there was premature rupture of membranes were recorded from the hospital information system and patient files. ResultsPregnant women with subclinical hypothyroidism were divided into groups according to their TPOAb status. When maternal and neonatal outcomes were evaluated between groups; Among these four groups there was a statistically significant difference only in impaired glucose tolerance (IGT) antibody groups with and without subclinical hypothyroidism according to their positivity (p < 0.01). When the euthyroid TPOAb negative group was taken as reference, the risk of impaired and TPOAb positive groups (OR: 1.210; 95% CI: 0.936–1.563; P = 0.145), impaired in the group with subclinical hypothyroidism but TPOAb positivity glucose tolerance 1.358(OR: 1.358); 95% CI: 1.042–1.770; P = 0.023) fold increased by 3.556 (OR: 3.556) in the group with subclinical hypothyroidism and TPOAb positivity; (95% CI: 2.37–5.343; p < 0,001). ConclusionIn ourstudy, there was a significant difference only in terms of IGT between the Groups with and without subclinical hypothyroidism, depending on whether they were positive for TPOAb or not. Therefore, studies in volving larger patient groups are needed.

Role of Routine Mid-Trimester Uterine Artery Doppler for Surveillance of Placental Mediated Disorders in a Low-Risk Population.

Abnormalities in the placentation process can increase pregnancy-related complications like pre-eclampsia, placental abruption, intrauterine-fetal death (IUFD) or foetal-growth restriction (FGR). Our objective was to investigate the feasibility of utilising the mid-trimester uterine artery Doppler Pulsatility Index (PI), a non-invasive and effective screening tool, as a diagnostic measure to predict adverse pregnancy outcomes in a low-risk population in South India. This prospective cohort study was done in the Obstetrics and Gynaecology unit at Amrita Institute of Medical Sciences, South India, between August 2018 and January 2020. Uterine artery Doppler was performed along with the targeted anomaly scan between 18 and 24 weeks of gestation and a relationship was established with pregnancy outcome. Of 100 participants, abnormal uterine artery PI (PI > 90th centile) was found in 13 pregnancies, of which statistically significant association was found with hypertensive disorders (P=0.001), FGR (P=0.064) and preterm birth before 37 weeks (P=0.051). No association was found between abnormal uterine artery PI and neonatal birth weight (P=-0.3), APGAR score (P=0.35) and NICU admission (P=0.078). An early abnormal finding in the doppler study can modify the level of antenatal surveillance required along with appropriate timely interventions, thereby significantly reducing the associated maternal and neonatal morbidity and mortality. When combined with routine ultrasound in pregnancy, such an affordable and straightforward diagnostic modality can improve antenatal care by reducing complications even in a low-risk population.

Effect of glycopyrrolate on vasopressor requirements for non-elective cesarean section under spinal anesthesia: a randomized, double-blind, placebo-controlled trial

BackgroundThe study aimed to investigate whether prophylactic use of glycopyrrolate decreases the vasopressor requirements to prevent hypotension following spinal anesthesia during non-elective cesarean section.MethodIn this double-blind randomized clinical trial, 258 patients undergoing non-elective cesarean section were randomly assigned (1:1) to receive intravenous 0.2 mg glycopyrrolate or normal saline (placebo) before spinal anesthesia. The primary outcome was phenylephrine equivalent needed intraoperatively. Secondary outcomes included incidences of maternal hypotension, reactive hypertension, bradycardia, need for atropine, tachycardia, intraoperative nausea/vomiting, shivering, pruritus, dry mouth, dizziness; neonatal APGAR score at 1 min and 5 min, neonatal resuscitation needed, NICU admission and neonatal death.ResultsThree patients withdrew from the study due to failed spinal anesthesia. 128 patients in the glycopyrrolate group and 127 patients in the placebo group were analyzed. The mean phenylephrine equivalent needed was 1108.96 μg in the glycopyrrolate group and 1103.64 μg in the placebo group (mean difference, 5.32 μg [95% CI − 67.97 to 78.62]; P = 0.88). Hypotension occurred in 38 patients (30%) in the glycopyrrolate group as compared with 49 patients (39%) in the placebo group (P = 0.13). Tachycardia was reported in 70% of the participants in the glycopyrrolate group and 57% of those in the placebo group (P = 0.04). No statistically significant difference was noted in hypotensive episodes > 1, reactive hypertension, bradycardia, need for atropine, nausea, vomiting, shivering, and dry mouth between the two groups. Neonatal outcomes were similar in the two groups.ConclusionProphylactic use of glycopyrrolate does not decrease the requirements of vasopressor to prevent hypotension in non-elective cesarean section under spinal anesthesia.Trial registrationRegistration number: NCT04401345. Date of registration: 26/05/2020. Website: https://clinicaltrials.gov

Prevalence, maternal characteristics, and birth outcomes of preeclampsia: A cross-sectional study in a single tertiary healthcare center in greater Kuala Lumpur Malaysia.

Preeclampsia is associated with an increased risk of adverse maternal and perinatal outcomes. This study aimed to assess preeclampsia prevalence in a Malaysian referral maternity hospital and the association between preeclampsia and maternal characteristics and outcomes. A cross-sectional study was conducted between January 2010 and December 2020 using secondary data from a single tertiary healthcare center in Greater Kuala Lumpur, Malaysia. A total of 40,212 deliveries were included for analysis to investigate the association between conditions (maternal characteristics and adverse birth outcomes) and preeclampsia. Multivariable logistic regression was conducted to assess the association between multiple independent variables and the outcome variable (preeclampsia). The reported prevalence of preeclampsia was 1.6%. Pregnant women with preeclampsia had a higher risk of preterm delivery (67.7%), instrumental and cesarean delivery (74.7%), neonatal low birth weight (48.5%), neonatal 5-min Apgar score <7 (18.1%), and neonatal intensive care unit (NICU) admission (19.8%). There were significantly higher odds of developing preeclampsia among nullipara [adjusted odd ratio (adjOR) 1.792, 95% CI: 1.518-2.115], women with a previous history of preeclampsia (adjOR 5.345, 95% CI: 2.670-10.698) and women with multiple pregnancies (adjOR 1.658, 95% CI: 1.071-2.566). However, there is a significant association between maternal characteristic variables. There was a significant association when a combination of variables for risk assessment: the presence of anemia and gestational hypertension effect on preeclampsia (OR 26.344, 95% CI: 9.775-70.993, p < 0.002) and gestational hypertension without anemia on preeclampsia (OR 3.084, 95% CI: 2.240-4.245, p < 0.001). Similarly, an association was seen between chronic hypertension and younger age (<35 years old) on preeclampsia (OR 14.490, 95% CI: 9.988-21.021, p < 0.001), and having chronic hypertension with advanced maternal age (≥35 years old) on preeclampsia (OR 5.174, 95% CI: 3.267-8.195, p < 0.001). Both conditions had increased odds of preeclampsia, in varying magnitudes. Overall, the significant interaction effects suggest that a history of chronic or gestational hypertension has a different relationship to the incidence of preeclampsia depending on the maternal age and anemia status. Pregnant women with preeclampsia had significantly higher odds for preterm delivery (adjOR 6.214, 95% CI: 5.244-7.364), instrumental and cesarean delivery (adjOR 4.320, 95% CI: 3.587-5.202), neonatal low birth weight (adjOR 7.873, 95% CI: 6.687-9.271), 5-min Apgar score <7 (adjOR 3.158, 95% CI: 2.130-4.683), and NICU admission (adjOR 8.778, 95% CI: 7.115-10.830). Nulliparity, previous history of preeclampsia, and multiple pregnancies were associated with an increased risk of preeclampsia. The presence of different underlying conditions, such as chronic hypertension, anemia, and extremes of maternal age played an important role in increasing preeclampsia risk in the considered study. Larger samples are needed to validate such findings.

The Outcome of Low Dose of 0.5% Bupivacaine in Spinal Anesthesia during Lower Segment Cesarean Section (LUCS)

Background: The spinal anesthesia in a lower segment cesarean section continues to provide a challenge to the anesthetist in the form of either severe hypotension caused by a big bupivacaine dose or insufficient appropriate anesthesia level conditions caused by a little bupivacaine dose. Objective: In this study our main goal is to evaluate the efficacy of low dose of 0.5% Bupivacaine in spinal anesthesia during lower segment cesarean section. Method: This cross sectional comparative study was carried out at tertiary medical College from January 2021 to January 2021. Where a total of 100 pregnant women were included in the study? Patients, who agreed to the study, were randomized divided into two groups: Group A patients who received an intrathecal injection of 3 mL of bupivacaine 0.5%, n=50 and Group B patients who received an intrathecal injection of 2.5 mL of bupivacaine 0.5%, n=50. The method of randomization was by coin tossing. Results: During the study, majority were belonging to 26-33 years age group, 60% and 70% were multiparous. The satisfactory surgical sensory level was achieved in all cases in both groups with the following distribution. However, Only 19% cases in Group A were indicated to have ephedrine, whereas 89% in Group B were indicated to support their blood pressure with ephedrine. There were no differences between the two groups regarding the fluid intake (894 ± 126mL) in Group A versus 720 ± 212 mL in Group C with P &gt; 0.05). Neonatal Apgar score was 9 in the first 1 min and increased to 10 at 5 min. In addition, group A nausea and vomiting cases seen in 19% cases whereas in group B it was 23%. Conclusion: We can say that, unlike low dose, a large dose of hyperbaric bupivacaine in the spinal anesthetic for a lower segment cesarean section will result in excellent surgical circumstances with little hypotension. Further study is needed for better outcome.

Timing of cesarean delivery for women with four or more previous cesarean sections

Background/Aim: The number of recurrent cesareans is increasing worldwide, but the optimal timing for delivery in women who have had previous cesareans is controversial. The aim of this study is to determine the optimal timing of elective cesarean delivery in women with a history of four or more cesarean sections (CSs). Methods: This retrospective cohort study was conducted in a tertiary hospital; 195 patients with a history of four or more CSs were grouped according to their gestation weeks on operation day and analyzed in terms of demographic features and clinical data as well as maternal and neonatal outcomes. Gestation weeks were grouped as 37-38 weeks and 39 weeks. Logistic regression analysis was used to determine the effect of independent variables on maternal and fetal outcomes. Results: Of the 195 patients, 118 had CS between 37-38 weeks and 77 at 39 weeks. Clinical and demographic characteristics were similar among groups. The overall maternal complication did not differ between the groups (16.1% vs 16.9%, P = 0.885). The 1st and 5th minute APGAR scores were significantly lower in the 37-386 weeks group (P = 0.013 and P = 0.04, respectively). Logistic regression analysis found that neonatal 5th minute APGAR score was associated with a model including maternal age, number of previous CS, anesthesia type, gestational week at delivery, and neonatal birth weight. Conclusion: Timing CS at 39 weeks in patients with a history of four or more CSs was found not to worsen maternal outcomes. Additionally, planning at 39 weeks could improve newborn outcomes.

Effects of Perinatal Cognitive Behavioral Therapy on Delivery Mode, Fetal Outcome, and Postpartum Depression and Anxiety in Women.

Objective To explore the effects of perinatal cognitive-behavioral therapy on delivery mode, fetal outcome, and postpartum depression and anxiety in women. Methods The clinical data of 88 perinatal pregnant women who came to our hospital from May 2020 to May 2021 were retrospectively analyzed and grouped into the routine group and the cognitive behavioral intervention group according to different perinatal nursing methods, with 44 cases in the cognitive behavioral intervention group received by cognitive behavioral therapy, and 44 cases in the routine group obtained by routine obstetric care during the perinatal period. The anxiety of pregnant women was evaluated by the Hamilton Anxiety Scale (HAMA). The positive cooperation and negative response of the perinatal pregnant women in two groups were recorded. The trial delivery rate, mode of delivery, amount of intrapartum bleeding, neonatal Apgar score, and visual pain simulation score (VAS) within 48 hours after delivery of the pregnant women in the two groups were also recorded and compared. The incidence of depression of pregnant and lying-in women in the two groups was recorded on the 5th and 42nd day after delivery. Results After the intervention, the anxiety score of pregnant women in the cognitive behavioral intervention group was significantly lower than that in the routine group (P < 0.05). Following the intervention, the positive cooperation score of pregnant women in the cognitive behavioral intervention group was prominently higher than that in the routine group, and the negative cooperation score was observably lower than that in the routine group (P < 0.05). The rate of spontaneous delivery in the cognitive behavioral intervention group was significantly higher than that in the conventional group (P < 0.05), while the VAS score and blood loss in the cognitive behavioral intervention group were notably lower than those in the routine group (P < 0.05). The proportion of women with EPDS score <9 points, i.e., no postpartum depression both on the 5th and 42nd day after delivery, were significantly higher than those in the routine group (P < 0.05), whereas the proportion of patients with postpartum depression symptoms scored 9–13 points were markedly lower than those of the routine group (P < 0.05). Conclusion The cognitive behavioral therapy can improve the adverse physiological and psychological reactions of pregnant women with perinatal anxiety disorder, enhance the natural delivery rate and postoperative recovery, reduce the risk of neonatal asphyxia, and ensure the safety of mothers and infants in the perinatal period. Compared with routine nursing, this intervention method is more targeted and scientific, and is worthy of clinical promotion.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score.

BACKGROUNDGestational diabetes mellitus (GDM) refers to abnormal glucose tolerance during pregnancy, and it is often accompanied by obvious changes in glucose and lipid metabolism, and associated with adverse pregnancy outcomes. The incidence of fetal distress, polyhydramnios, puerperal infection, premature delivery, and macrosomia in pregnant women with GDM are higher than in those without GDM.AIMTo analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.METHODSA total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected. Among them, 377 aged < 35 years were selected as the right age group and 206 aged > 35 years were selected as the older group. The clinical data of the two groups were collected, and the relationship between age of the pregnant women with GDM and mode of delivery, maternal and neonatal outcomes, and neonatal Apgar score were compared. In the older group, 159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes. The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.RESULTSThe number of women with assisted pregnancy, ≤ 37 wk gestation, ≥ 2 pregnancies, one or more deliveries, and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group (P < 0.05). The natural delivery rate in the right age group was 40.85%, which was higher than 22.33% in the older group (P < 0.05). The cesarean section rate in the older group was 77.67%, which was higher than 59.15% in the right age group (P < 0.05). The older group had a higher incidence of polyhydramnios and postpartum hemorrhage, and lower incidence of fetal distress than the right age group had (P < 0.05). There was no significant difference in neonatal weight between the two groups (P > 0.05). The right age group had higher Apgar scores at 1 and 5 min than the older group had (P < 0.05). Significant differences existed between the poor and good outcome groups in age, education level, pregnancy mode, ≤ 37 wk gestation, number of pregnancies, and premature rupture of membranes (P < 0.05). Logistic regression showed that age, education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants (P < 0.05).CONCLUSIONDelivery mode and Apgar score of pregnant women with GDM are related to age. Older age increases the adverse outcome of mothers and infants.

Clinical Manifestation and Obstetric Outcomes in Pregnant Women with SARS-CoV-2 Infection at Delivery: A Retrospective Cohort Analysis.

This retrospective cohort study aimed to analyze the clinical manifestations, complications, and maternal-fetal outcomes in patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during delivery. The cohort included 61 pregnant women positive for SARS-CoV-2 infection at the time of delivery. Patients were divided into two groups: symptomatic and asymptomatic. We found a significantly higher rate of leukocytosis (p < 0.00078) and lymphopenia (p < 0.0024) in symptomatic women compared with asymptomatic ones. Other laboratory parameters, such as CRP (p = 0.002), AST (p = 0.007), LDH (p = 0.0142), ferritin (p = 0.0036), and D-dimer (p = 0.00124), were also significantly more often increased in the group of symptomatic pregnant women. Overall, symptomatic pregnant women with SARS-CoV-2 infection at the delivery show more often altered laboratory parameters compared with asymptomatic ones; nevertheless, they have a slightly higher but non-significant rate of preterm delivery, cesarean section, as well as lower neonatal birth weight and Apgar score, compared with asymptomatic women.

Association of fetal heart rate short term variability pattern during term labor with neonatal morbidity and small for gestational age status

ObjectiveTo assess the association of fetal heart rate short-term variability (STV) pattern during term labor with both neonatal composite morbidity (cord blood pH ≤ 7.10 and/or neonatal intensive care unit admission and/or Apgar score at 5 min <7) and small for gestational age (SGA) status. Study designRetrospective cohort in a single academic institution between January 2016 and December 2018. A total of 1896 women that delivered a singleton during labor in cephalic presentation after 37 weeks of gestation were included (948 women with SGA neonates and 948 women with appropriate weight for gestational age (AGA) neonates that were matched to women with SGA neonates based on maternal age, parity, induction of labor, gestational diabetes, gestational age at delivery and a history of one cesarean section using propensity score matching). STV was compared at labor onset (cervical dilation ≤ 4 cm), in the first stage of labor (cervical dilation = 6 cm) and in the second stage of labor (cervical dilation = 10 cm). A generalized linear mixed model was used to assess the association between SGA status, neonatal composite morbidity and STV. ResultsAfter adjustment for maternal origin, term, gestational diabetes, labor length, SGA status was not associated with any change in STV during labor (mean adjusted STV: −0.20 ms, 95 %CI[-0.58–0.17], p = 0.284 at labor onset, 0.29 ms, 95 %CI[-0.1– 0.68], p = 0.155, in the first stage of labor and 0.36 ms, 95 %CI[-0.02–0.74], p = 0.065 in the second stage of labor). In case of neonatal composite morbidity mean adjusted STV was lower in the first stage of labor (mean adjusted STV: −1.29 ms, 95 %CI[-2.1 – −0.43], p = 0.003) and in the second stage of labor (mean adjusted STV: −1.15 ms, 95 %CI[-1.96 – −0.34], p = 0.005). The results were similar with the addition of delivery mode and meconium-stained amniotic fluid in the model or non-reassuring fetal heart rate and meconium-stained amniotic fluid. ConclusionsThis work suggests that STV decrease during term labor is associated with fetal well-being, independently of fetal weight. This suggests that further prospective studies should consider the evaluation of this parameter in the prediction of neonatal compromise.

Analgesic Effects, Birth Process, and Prognosis of Pregnant Women in Normal Labor by Epidural Analgesia Using Sufentanil in Combination with Ropivacaine: A Retrospective Cohort Study.

Objective The objective is to evaluate the analgesic, labor, and prognostic effects of patient-controlled epidural analgesia (PCEA) versus sufentanil in conjunction with ropivacaine in normal labor. Methods Sixty pregnant women who had a normal delivery at our hospital between February 2019 and April 2021 were included. Pregnant women were arbitrarily assigned to a control group and a research group. Pregnant women in the control group received lidocaine analgesia and PCEA with sufentanil combined with ropivacaine in the research group. Satisfaction with care, fetal umbilical artery blood flow, VAS score, labor and bleeding, neonatal Apgar score and incidence of adverse events were analyzed. Results First, we made a comparison of satisfactory performance of nursing care. The satisfaction rate of the research group was 100.00%, compared to 83.33% for the control group. Nursing satisfaction was higher in the research group, and the difference was statistically significant (P < 0.05). Following analgesia, PI, RI, and S/D values of umbilical artery blood flow were lower in the research group than those in the control group, but the difference was not statistically significant (P > 0.05). The VAS scores at 10 min, 20 min, and 30 min were found to be lower in the research group than in the control group after analgesia, and the difference was statistically significant (P < 0.05). Bleeding was significantly lower in the research group for all stages of labor, and the difference was statistically significant (P < 0.05). Apgar scores at 1 minute, 5 minutes, and 10 minutes postpartum were greater in the research group than in the control group, and the difference was statistically significant (P < 0.05). As a final note, the incidence of pruritus, hypotension, respiratory depression, nausea, and vomiting was found to be lower in the research group than in the control group, and the difference was statistically significant (P < 0.05). Conclusion PCEA with sufentanil coupled with ropivacaine was used to perform labor analgesia. With significant reduction in maternal pain and assurance of labor, ropivacaine combined with sufentanil epidural labor analgesia did not reduce fetal umbilical artery blood flow without extended labor. It could not affect the labor process or the safety of the fetus, which is safe for the mother and fetus.

Cohort Study Summary of the Effects of Carboprost Tromethamine Combined with Oxytocin on Infant Outcome, Postpartum Hemorrhage and Uterine Involution of Parturients Undergoing Cesarean Section.

Carboprost tromethamine injection has a high safety factor in clinical application and has a good effect on uterine smooth muscle and vasoconstriction. Carboprost aminobutyriol combined with oxytocin may be beneficial to infant outcome and uterine involution after cesarean section. To investigate the effects of carboprost tromethamine combined with oxytocin on infant outcome, postpartum hemorrhage, and uterine involution in parturients undergoing cesarean section. A total of 120 parturients undergone cesarean section in our hospital from February 2019 to April 2021 were selected as the object of study. The parturients were randomly divided into control group (n = 60) and research group (n = 60). The control group was treated with oxytocin, and the research group was treated with carboprost aminobutyriol combined with oxytocin. The amount of maternal bleeding, uterine floor decline index, the end of lochia, poor rate of uterine involution, infant outcome, and the incidence of adverse drug reactions were compared between the two groups. The amount of bleeding in the research group was significantly lower than that in the control group (P < 0.05). The position of the last uterine floor and the index of uterine floor downward movement in the research group were significantly higher than those in the control group (P < 0.05). The disappearance time of bloody lochia and serous lochia in the research group was significantly shorter than that in the control group (P < 0.05). The end time of lochia in the research group was higher than that in the control group, and the rate of uterine involution in the research group was lower than that in the control group (P < 0.05). The neonatal weight and Apgar score in the research group were higher than those in the control group, and the hospitalization rate of neonatal ICU in the research group was significantly lower than that in the control group. The incidence of adverse reactions in the research group was significantly lower than that in the control group (P < 0.05). Carboprost aminobutyriol combined with carbestatin can effectively prevent the occurrence of bleeding after cesarean section, improve uterine involution, and improve neonatal birth quality, which is worth popularizing.

Comparison of Continuous Infusion of Ropivacaine and Fentanyl With Intermittent Bolus Doses of Ropivacaine and Fentanyl for Epidural Labor Analgesia: A Randomized Open-Label Study

BackgroundThe purpose of this study was to compare the efficacy of continuous epidural infusion with intermittent bolus doses for labour analgesia using ropivacaine 0.2% and opioids.MethodsIn this study, 70 primigravida patients were randomly divided into two groups of 35 each. Both groups received a loading dose of 10ml of 0.2% ropivacaine and 1μg/ml fentanyl in 5ml incremental doses while monitoring blood pressure and heart rate. Subsequently, Group I received a continuous epidural infusion of 0.2% ropivacaine with fentanyl at 10ml/hr, while Group II received 10 ml of 0.2% ropivacaine with fentanyl in bolus form every hour manually, with the first dose given after one hour of the initial loading dose. A rescue bolus dose of 5ml of 0.2% ropivacaine was given in both groups when they complained of breakthrough pain (VAS score >3). An additional 5ml bolus dose was given in both groups at the time of crowning. The blood pressure, heart rate, and severity of pain using the visual analogue scale (VAS) were assessed. Total drug volume utilized, the number of bolus doses, duration of the first and second stage of labour, rate of instrumental delivery and cesarean section, and neonatal Apgar scores were also recorded.ResultsThe total volume of drugs consumed and the number of boluses required for breakthrough pain were both significantly lower in Group II. There was a similar decrease in hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and mean arterial pressure) from baseline in both the groups with no significant difference between them. The onset of analgesia was significantly faster in Group I with both groups achieving optimum analgesia (VAS ≤ 3) within 20 minutes of the loading dose. Maternal motor blockade scores, the duration of the first and second stage of labour, the rate of instrumental delivery, cesarean section, and neonatal Apgar scores, did not show any statistically significant difference between the two groups.ConclusionBoth techniques, i.e. continuous epidural infusion and intermittent epidural boluses are effective for providing labour analgesia. But consumption of drugs and episodes of breakthrough pain was higher in the continuous infusion group (Group I).

Efficacy of fixed-dose phenylephrine bolus for treating post-spinal hypotension: Comparison between pre-eclamptics and normotensives.

Pre-eclamptic parturients may have an exaggerated response to vasopressors. This study compares the efficacy of a 50 μg fixed bolus of phenylephrine for treatment of post-spinal hypotension in pre-eclamptic versus normotensive parturients. After written informed consent and ethics committee approval, 30 normotensive and 30 pre-eclamptic parturients between 18 and 40 years with singleton term pregnancy about to undergo cesarean section (CS) under spinal anesthesia were included. Post-spinal hypotension was treated with a 50 μg fixed bolus of phenylephrine. The cumulative dose of phenylephrine, the number of boluses, and the median dose required to treat the first hypotensive episode, total number of hypotensive episodes, maternal side effects, neonatal appearance, pulse, grimace, activity, and respiration (APGAR) scores, and umbilical arterial cord blood pH were noted. Statistical analysis was done using Student's t-test, Mann-Whitney U-test, Chi-square test/Fisher's exact test as appropriate. A P <0.05 was considered significant. The cumulative dose and number of boluses of phenylephrine required to treat post-spinal hypotension were comparable. The median dose required to treat the first episode of post-spinal hypotension was also similar (p = 0.792). The time to develop the first hypotensive episode was significantly earlier for group N (p = 0.002). The efficacy of a single fixed bolus of 50 μg phenylephrine was similar in both groups (p = 1.000). Neonatal median APGAR scores at 1 min after birth were significantly higher for group N (p = 0.016). A fixed-dose bolus of 50 μg phenylephrine is safe and effective in treating post-spinal hypotension in pre-eclampsia. The efficacy of phenylephrine is comparable in pre-eclamptic and normotensive parturients.

Length of labour using vaginal misoprostol or dinoprostone for induction at various gestational ages: A retrospective cohort study

Introduction Induction of labour is a common procedure performed on labour and delivery. There are multiple ways to achieve cervical ripening, however, no studies have evaluated these methods based on a patient's gestational age. The goal of this study is to compare the length of labour at specific gestational ages in women being induced with either vaginal misoprostol or the dinoprostone insert. Methods A retrospective cohort study of 3774 singleton pregnancies from 2009 to 2019 at a health system with tertiary care and community hospitals was conducted. The primary outcome was time to insertion of medication to time to vaginal delivery. Secondary outcomes included length of first and second stages of labour, length of rupture of membranes, mode of delivery, neonatal Apgar scores at 1 and 5 min and neonatal intensive care unit admission. A generalized linear model was utilised for continuous outcomes and a logistic regression model was used for binary outcomes. Results Across all gestational ages, women who received vaginal misoprostol had a shorter labour course than women who received dinoprostone (in hours, preterm 18.2 vs. 26.3 p < 0.01, term 15.9 vs. 24.4 p < 0.01, late term 17.6 vs. 22.3 p < 0.01). Patients that received misoprostol had a shorter first stage of labour (in hours, preterm 18.2 vs. 25.7 p < 0.01, term 15.3 vs. 23.6 p < 0.01, late term 16.5 vs. 21.1 p < 0.01) and second stage of labour in the term and late term group (term 20.5 vs. 30.0 min. p < 0.01, late term 30.0 vs. 47.0, p = 0.05). Patients that received dinoprostone at term had higher odds of undergoing caesarean section (odds ratio (95% confidence interval): 1.34 (1.06, 1.70)). Conclusion Patients that received vaginal misoprostol was associated with shorter labour course across all gestational ages. Patients that received dinoprostone at term had an increased risk of caesarean section.

Comparative study between intrathecal bupivacaine versus intrathecal bupivacaine and fentanyl in elective caesarean sections

Background: Intrathecal administration of adjuvant drugs have been used increasingly for increasing the onset, duration and quality of analgesia. This study was designed to compare the efficacy of intrathecal hyperbaric bupivacaine with that of intrathecal hyperbaric bupivacaine with fentanyl for patients undergoing elective caesarean sections. Materials &amp; methods: 50 aged between 15 to 30 years, whose weight is 45 to 80 kg, belonging to ASA class I and II, scheduled for elective caesarean sections were selected and randomized into 2 groups. Group B received 9mg of hyperbaric bupivacaine 0.5% and group BF received 9mg of hyperbaric bupivacaine 0.5% with 10mcg of fentanyl. The onset of analgesia, onset of motor blockade, the duration of sensory blockade, the duration motor blockade, the quality of blockade, duration of analgesia, Intrathecal Injection to delivery time, APGAR SCORE of neonates, hemodynamic parameters of parturient and side effects were recorded. Results: There was significant difference between the two groups in the meantime to onset of sensory anaesthesia (group BF 3.28±0.73mins, group B 3.84±1.06mins; p value=0.009). The onset of motor blockade was similar in both the groups. Excellent block was achieved in 80% patients in group B compared to 100% of patients in group BF.

Effects of yoga on cardiometabolic risks and fetomaternal outcomes are associated with serum nitric oxide in gestational hypertension: a randomized control trial

Gestational hypertension (GH) is associated with adverse cardiometabolic and pregnancy outcomes. Though yoga is known to be beneficial in pregnancy, the effects of yoga rendered for twenty weeks starting from 16th week of gestation in pregnant women having risk of GH on the incidence of hypertension, cardiometabolic risks and fetomaternal outcomes have not been studied. A randomized control trial was conducted on 234 pregnant women having risk of GH receiving standard antenatal care (Control group, n = 113), and receiving standard care + yoga (Study group, n = 121). Interventions were given for twenty weeks starting at 16th week of gestation. Baroreflex sensitivity (BRS), heart rate variability (HRV), insulin resistance, lipid-risk factors, and markers of inflammation, oxidative stress and vascular endothelial dysfunction (VED) were assessed before and after intervention. Incidence of new-onset hypertension, level of cardiometabolic risks at 36th week, and fetomaternal-neonatal outcomes in the perinatal period, were noted. The link of hypertension, pregnancy outcomes and cardiometabolic risks with nitric oxide (NO), the marker of VED was assessed by analysis of covariance, Pearson’s correlations, and multilinear and logistic regressions. In study group, 6.61% women developed hypertension compared to 38.1% in the control group following 20-week intervention and there was significant decrease in risk of developing GH (RR, 2.65; CI 1.42–4.95). There was less-painful delivery, decreased duration of labor, increased neonatal birthweight and Apgar score in study group. Increase in total power of HRV (β = 0.187, p = 0.024), BRS (β = 0.305, p < 0.001), and decrease in interleukin-6 (β = − 0.194, p = 0.022) had significant association with increased NO. Twenty weeks of practice of yoga during pregnancy decreases the incidence of hypertension, improves fetomaternal outcomes, and reduces cardiometabolic risks in pregnant women having risk of GH. Decreased blood pressure, increased HRV, BRS and birth weight and decreased inflammation were associated with improved endothelial function.Trial registration: Clinical Trials Registry of India (CTRI), registration number: CTRI/2017/11/010608, on 23.11.2017.

Total failure of spinal anesthesia for cesarean delivery, associated factors, and outcomes: A retrospective case-control study.

Spinal anesthesia is the anesthetic technique of choice for patients undergoing cesarean delivery. In the present study, total spinal anesthesia failure was defined as a case when an absent blockade or inadequate surgery required general anesthesia administration with an endotracheal tube. This study aimed to investigate factors related to this condition and report its maternal and neonatal outcomes.This retrospective matched case–control study was conducted by recruiting 110 patients with failed spinal anesthesia and 330 control patients from September 1, 2016, to April 30, 2020, in the largest university hospital, Thailand.Of 12,914 cesarean deliveries, 12,001 patients received single-shot spinal anesthesia (92.9%) during the study period. Total spinal anesthesia failure was experienced by 110/12,001 patients, giving an incidence of 0.9%. Factors related to the failures were a patient body mass index (BMI) ≤29.5 kg/m2 (adjusted odds ratio 1.9; 95% confidence interval 1.2–3.1; P = .010) and a third-year resident (the most senior trainee) performing the spinal block (adjusted odds ratio 2.4; 95% confidence interval 1.5–3.7; P < .001). In the group with failed spinal anesthesia, neonatal Apgar scores at 1 and 5 minutes were lower than those of the control group (both P < .001). Two patients in the failed spinal anesthesia group (2/110; 1.8%) had difficult airways and desaturation.Independent factors associated with total spinal anesthesia failure were a BMI of ≤29.5 kg/m2 and a third-year resident performing the spinal block. Although the incidence of total failure was infrequent, there were negative consequences for the mothers and neonates. Adjusting the dose of bupivacaine according to the weight and height of a patient is recommended, with a higher dose appropriate for patients with a lower BMI.

Trial of labor after two cesarean sections: A retrospective case-control study.

The objective of this study was to compare neonatal and maternal outcomes among women with two previous cesarean deliveries who undergo trial of labor after two cesarean section (TOLA2C) versus elective repeat cesarean delivery (ERCD). Our primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included APGAR score <7 at 5 min, TOLA2C success rate, uterine rupture, postpartum hemorrhage, maternal blood transfusion, maternal bowel and bladder injury, immediate postpartum infection, and maternal mortality. This retrospective cohort study was undertaken at a community medical center from January 1, 2008 to December 31, 2018. Inclusion criteria were women with a vertex singleton gestation at term and a history of two prior cesarean sections. Exclusion criteria included a previous successful TOLA2C, prior classical uterine incision or abdominal myomectomy, placenta previa or invasive placentation, multiple gestation, nonvertex presentation, history of uterine rupture or known fetal anomaly. Maternal and neonatal outcomes were assessed using Fisher exact test and Wilcoxon rank sum test. A total of 793 patients fulfilled study criteria. There were no differences in neonatal intensive care unit admissions or 5-min APGAR scores <7 between the two groups. Sixty-eight percent of women who underwent TOLAC (N=82) had a successful vaginal delivery. The uterine rupture rate was 1.16% (N=1) in the TOLA2C group with no case of uterine rupture in the ERCD group. No difference in maternal morbidity was noted between the two groups. No maternal or neonatal mortalities occurred in either group. There was no difference in maternal or neonatal morbidity among patients in our study population with two previous cesarean sections who opted for TOLA2C versus ERCD.

The impact of withholding nitrous oxide in labour during the COVID-19 pandemic on maternal and neonatal outcomes.

Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID-19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID-19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post-partum blood loss and neonatal APGAR scores did not change.