Neonatal Apgar Scores Research Articles

Effect of Epidural Bolus Levobupivacaine and Lignocaine in Late Second Stage of Parturition in Combined Spinal Epidural Labor Analgesia

Background: Use of minimum local analgesic concentration in the epidural component of combined spinal epidural (CSE) effectively maintains analgesia in the first stage of labor. However, local anesthetic concentration needs to increase to achieve effective analgesia in the second stage as there are more recruitment of A-δ fiber occurs. This study compared the effect of epidural bolus of Levobupivacaine and Lignocaine in the late second stage of parturition in combined spinal epidural labor analgesia.Methods: This multicenterd, open-label, randomized controlled trial was conducted under supervision of Department of Anesthesia, Analgesia, and Intensive Care Medicine of Bangabandhu Sheikh Mujib Medical University from July 2019 to June 2020 including 80 parturients of 18-35 years old, ASA status I and II, full-term, primiparous, who were randomized into two groups to receive either 10ml bolus of 0.0625% levobupivacaine with fentanyl 2μg/ml or 10ml bolus of 0.5% lignocaine with fentanyl 2μg/ml after CSE analgesia at first stage of labor. Level of analgesia, duration of second stage of labor, quality of pain relief, maternal satisfaction, mode of delivery and APGAR score of neonate were evaluated.Results: During delivery, levobupivacaine group had a lower intensity of pain compared to lignocaine group (VAS score 1.89±0.67 vs 2.64±0.92, p = 0.001). Duration of second stage of labor in levobupivacaine group was significantly shorter compared to lignocaine group (48.4±16 minutes vs 63.5±28.4, p-value 0.007). Besides, quality of pain relief and maternal satisfaction were better in levobupivacaine group compared to lignocaine group. Moreover, instrumental delivery rate was high in lignocaine group. Fetal outcome measured as APGAR score was similar in both groups.Conclusion: Epidural bolus of levobupivacaine-fentanyl produces more adequate analgesia than lignocaine-fentanyl in late second stage of labor and does not increase instrumental delivery rate with similar fetal outcome.

Analysis of the Timing of Cervical Cerclage Treatment in Pregnant Women with Cervical Insufficiency and the Effect on Pregnancy Outcome.

Purpose To analyze the effect of the choice of timing of cervical cerclage treatment on pregnancy outcome in pregnant women with cervical insufficiency (CI). Methods The case data of 160 pregnant women admitted to our hospital for cervical cerclage due to CI from January 2020 to September 2021 were sampled. They were divided into the early group (14∼18 weeks of pregnancy, n = 86), the middle group (19∼27 weeks of pregnancy, n = 74) according to the different gestational periods of surgical treatment, and into the elective group (elective operation, n = 71) and the emergency group (emergency operation, n = 89) according to the different timings of surgical treatment. To compare the pregnancy outcomes of the four groups and the effects of different treatment timings on pregnant women and newborns. Results After the operation, the intrauterine infection rate in the early group was lower (8.14% (7/86)) than that (71.62% (53/74)) in the middle group, and the intrauterine infection rate (18.31% (13/71)) in the elective group was lower (61.80% (55/89)) than that in the emergency group (P < 0.05). After the operation, the late abortion rate in the early group was 8.14% (7/86) lower than 63.51% (47/74) in the middle group, and the late abortion rate in the elective group was 15.49% (11/71) lower than 61.80% (55/89) in the emergency group (P < 0.05). After the operation, the full-term birth rate (82.56% (71/86)) in the early group was higher (21.62% (16/74)) than that in the middle group, and the full-term birth rate (73.24% (52/71)) of the elective group was higher (24.72% (22/89)) than that in the emergency group (P < 0.05). After the operation, there was no significant difference in the preterm birth rate between the early group and the middle group (8.14% vs 14.86%), and between the elective group and the emergency group (11.27% vs 12.36%) (P > 0.05). There was no significant difference in neonatal Apgar scores between the early group and the middle group (7.30 ± 0.98 vs 7.14 ± 0.91) scores, and between the selective group and the emergency group (7.15 ± 0.82 vs 7.07 ± 1.07) scores (P > 0.05). There was no significant difference in gestational week extension time between the early group and the middle group (6.52 ± 1.77 vs 6.99 ± 1.69) days and between the elective group and the emergency group (6.44 ± 1.37 vs 6.82 ± 1.70) days (P > 0.05). The length of hospital stay was (7.28 ± 1.39 vs 10.89 ± 2.65) days in the early group and the middle group, with the early group being shorter than the middle group (P < 0.05), and the length of hospital stay was (8.72 ± 1.23 vs 9.30 ± 1.39) days in the elective group and the emergency group, with the elective group being shorter than the emergency group (P < 0.05). Conclusions The therapeutic effect and pregnancy outcome of cervical cerclage are affected by the timing of treatment. Among them, the effect of elective operation at 14∼18 weeks of pregnancy is more ideal, which is worthy of clinical promotion.

Poor Apgar Score of Neonates Born to the Females Presenting with Pregnancy Induced Hypertension for Delivery

Background: Pregnancy induced hypertension (PIH) is defined as BP ? 140/90 mmHg, taken after a period of rest on two occasions or ?160/110 mmHg on one occasion in a previously normotensive woman. One of the most important aspects is the outcome of pregnancy with PIH. Poor Apgar score is commonly observed in females with PIH. So we conducted this study to find the extent of problem in local population. Objective: To assess the frequency of poor Apgar score of neonates born to the females presenting with pregnancy induced hypertension at term (37-41 weeks) for delivery.&#x0D; Study Design: Descriptive case series. Setting: Unit 4, Department of Gynecology &amp; Obstetrics, Sir Ganga Ram Hospital, Lahore. Duration of Study: 6 months after approval of synopsis i.e. from: 09-11-2021 to 10-05-2022 Patients. Methods: 125 pregnant females with PIH were followed till delivery by researcher herself. After delivery, neonate was assessed for Apgar score at 1 &amp; 5 minutes, if &lt;7, then it was labeled as poor Apgar score. All this information was recorded on proforma. Statistical analysis was done using SPSS version 20.&#x0D; Results: The mean age of patients was 30.50±6.22years. The mean gestational age was 39.78±1.66weeks. The mean BMI was 26.99±5.13kg/m2. There were n=59 (47.2%) male neonates while n=66 (52.8%) female neonates. The mean Apgar score at 1minute was 7.29±1.36 while at 5minutes was 7.70±1.29. Poor Apgar score was noted in n=19 (15.2%) neonates while n=106 (84.8%) neonates had normal Apgar score. Conclusion: The frequency of poor Apgar score (at 1 minute and continuously &lt;7 at 5 minutes) was 15.2% in neonates born to females with PIH. The neonates with poor Apgar Score were admitted to NICU and were managed according to standard hospital protocol

The Effectiveness and Safety of Ropivacaine and Medium-Dose Dexmedetomidine in Cesarean Section.

Objective: To study the effects of epidural anesthesia with different doses of dexmedetomidine and ropivacaine on postoperative hemodynamics and neonatal outcome of cesarean section parturients. Methods. A total of 90 parturients who underwent cesarean section admitted to our hospital from January 2019 to January 2020 were selected as the research objects and were divided into groups A, B, and C according to different dosages of dexmedetomidine, with 30 cases in each group. Groups A, B, and C were given dexmedetomidine 0.5 μg/kg, 0.8 μg/kg, 1.0 μg/kg, respectively, combined with 0.2% ropivacaine. The anesthesia effect, traction response, hemodynamic indexes, and neonatal Apgar score of the three groups were compared; the “Numerical Rating Scale (NRS) Score” was used to assess the postoperative pain of the parturients, and the “Ramsay Sedation Scale” was used to assess the sedation state of the parturients. Results. The superior anesthesia effect of group B was obtained compared with groups A and C (P < 0.05). Group B witnessed a lower degree of grade III stretching response, as compared to group A (P < 0.05). In comparison with groups A and C, superior results of the heart rate and mean artery pressure (MAP) of group B at T1 and T2 were obtained (P < 0.05). The neonatal Apgar score in group B was lower than those in groups A and C (P < 0.05), and the NRS score of group B was also lower than that of group A (P < 0.05). Compared with groups A and C, group B yielded a more favorable outcome in terms of the Ramsay score (P < 0.05). Conclusion. The use of medium-dose dexmedetomidine in cesarean section parturients is safer and can effectively reduce the impact on maternal hemodynamics, which is worthy of promotion and application.

ENTONOX VERSUS PETHIDINE FOR PAIN RELIEF DURING THE ACTIVE PHASE OF LABOR

Background &#x0D; Labour pain is one of the acute severe pains women suffer during their lives. Various methods have been tried to manage it.&#x0D; Objectives &#x0D; The aim was to compare analgesic effects and outcomes of Entonox versus Pethidine for labour pain.&#x0D; Patients and Methods&#x0D; The non-blinded Randomised clinical trial was performed on 221 pregnant women admitted to the Labor Ward of Sulaimani Maternity Teaching Hospital from January 2020 to January 2021. Women were randomly allocated the group I of 111 pregnant women who received Entonox and group II of 110 pregnant women who received 1 mg/kg of Pethidine. A visual analogue scale (VAS) pain score was used before 30 and 60 minutes after drug administration. In addition, a Neonatal Apgar score of one and five minutes was recorded.&#x0D; Results&#x0D; There were no significant demographic feature differences between both groups. Mean pain scores before drugs were 7.8±1.6 and 7.8±1.3 after 30 minutes were 4.6±1.6 and 5.7±1.6, and after 60 minutes were 3.8±1.5 and 3.9±1.6 for Entonox and pethidine groups, respectively. Entonox decreased pain score better than Pethidine after 30 minutes (p-value of &lt;0.001); however, Pethidine decreased pain score better than Entonox after 60 minutes (p-value of &lt;0.001). Mean Apgar scores in 1st minute were 8.6±.87 and 8.41±1.28, and in 5th minute was 9.84±.37 and 9.62±.82 for Entonox and pethidine groups, respectively. Significant association of drugs with Apgar score at 5th minute was found. &#x0D; Conclusion&#x0D; Entonox was better for acute pain management within 30 minutes; Pethidine was better for longer than 60 minutes.

Perinatal trends and birth outcomes of Syrian refugee and turkish women

Aim: The impact of migration on health is far-reaching, making migrant populations particularly vulnerable, fueling health inequalities and resulting in serious implications for global health. The aim of our study to assess antenatal care, pregnancy and neonatal outcomes of Syrian refugee women in Turkiye. Material and Methods: Syrian and Turkish pregnants who delivered between 2013-2019 were recruited and categorized into groups according to maternal age at delivery. First trimester combined test, second trimester triple test, preterm delivery, maternal anemia; neonatal stillbirth, APGAR scores, birth weight and breastfeeding status were assessed. Results: 4992 Syrian and 6846 Turkish pregnants were included. Maternal anemia was higher in Turkish patients in 20-34 and ≥35 groups. First trimester combined test, APGAR scores and birth weights were lower in Syrian women. Preterm rates higher in Turkish patients in only 20-34 age group. Second-trimester triplet tests were only higher in Turkish women in ≥35 age group. Low birth weight was higher in younger Syrian patients. Satisfying breastfeeding results were found in Syrian women. Conclusion: Our study stated that Syrian women are at risk of low birth weight in adolescent and 20-34 age groups and low rates in first trimester combined test in all age groups. However decreased risk of pregnancy complications such as maternal anemia, preterm delivery, cesarean delivery and satisfying breastfeeding results were found in Syrian patients.

Effectiveness of Nursing Risk Management in Neonatal Asphyxia Resuscitation Care.

Objective To analyze the effectiveness of nursing risk management in neonatal asphyxia resuscitation care and to observe and summarize the nursing measures and outcomes. Methods A total of 60 neonatal asphyxia cases from January 2021 to December 2021 were recruited and assigned via a random number table method at a ratio of 1 : 1 to receive either routine care plus nursing risk management (the observation group, n = 30) or routine care (the control group, n = 30). Outcome measures included blood gas index, neonatal Apgar score, neonatal behavioral neurological assessment (NBNA) score, nursing satisfaction, and complications. Results The differences in partial pressure of oxygen (PaO2) and partial pressure of carbon dioxide (PaCO2) between the two groups before care were not statistically significant (P > 0.05), while after care, PaO2 in the observation group had a higher level of PaO2 and a lower level of PaCO2 than the control group (P < 0.01). The two groups showed similar Apgar scores and NBNA scores before care (P > 0.05), while after care, routine care plus nursing risk management resulted in higher Apgar scores and NBNA scores versus routine care alone (P < 0.01). The nursing satisfaction rate in the observation group (96.67%) was significantly higher than that of the control group (73.33%) (P=0.030). Nursing risk management plus routine care was associated with a significantly lower incidence of complications (6.67%) compared to routine care (26.67%) (P=0.038). Conclusion Nursing risk management in neonatal asphyxia resuscitation care showed outstanding outcomes in improving neonatal blood gas index, neurological function, and Apgar score, while reducing the occurrence of complications and achieving high nursing satisfaction.

Pentazocine versus tramadol-paracetamol combination as analgesia in labor: A randomized controlled trial

Objectives: Labor should be a satisfactory experience and effective pain management should be employed as recommended by the American Congress of Obstetricians and Gynaecologists. In developing countries, pain management in labor is still a big challenge and the search for the ultimate labor analgesia is still ongoing. The objectives of the study were to determine whether the synergistic analgesic effect of the combination of tramadol and paracetamol will produce analgesia comparable to pentazocine with a better side effect profile. Material and Methods: This was a randomized controlled, double-blinded trial of tramadol-paracetamol combination versus pentazocine as labor analgesia and was carried out at the University of Abuja Teaching Hospital, Abuja, between June 2018 and March 2019. A total of 218 eligible parturients recruited at term, were counseled on labor analgesia, its benefits, and the options made available to them and educated on the pain scoring system. Parturients were allocated into two groups using computer-generated numbers with the WINPEPI software. Group A was given tramadol-paracetamol combination, while Group B received pentazocine, both at standard doses. Hourly pain scores, APGAR scores, labor duration, patients’ satisfaction, and side effects were collated. The level of significance was set at &lt;0.05. Results: Tramadol-paracetamol was administered to 109 (50.9%) while pentazocine was administered to 105 (49.1%) of the study participants. The mean age in the tramadol-paracetamol group was 29.6 ± 4.8 years, and in the pentazocine group, it was 28.8 ± 4.5 years. The difference in pain scores on the visual analog scale was statistically significant at the 3rd and 4th h (P = 0.02 and 0.004), but not significant in the 1st and 2nd h (P = 0.05 and 0.22) in the two groups. Overall, the average pain score in the tramadol-paracetamol group was significantly higher compared to the pentazocine group (5.27 ± 1.86 vs. 4.72 ± 1.54; P = 0.02). The 1st and 5th min APGAR scores (P = 0.44 and 0.67, respectively) of neonates in the tramadol-paracetamol and pentazocine groups were comparable. Nausea and drowsiness occurred more frequently in the pentazocine group at P-values of 0.047 and 0.0015, respectively. There was no statistically significant difference in the duration of labor between the tramadol-paracetamol and pentazocine groups. not statistically significant, a higher proportion of parturients in the pentazocine group was satisfied compared with the tramadol-paracetamol group (71.4% vs. 63.3%; P = 0.13). Conclusion: This study showed that intravenous pentazocine provides better pain relief in labor, but the tramadol-paracetamol combination has fewer side effects.

Impact of Intraspinal Nerve Block Anesthesia on Intrapartum Fever and the Neonate.

Objective To evaluate the impact of intraspinal nerve block anesthesia on intrapartum fever and the neonate. Methods In this prospective study, between October 2019 and December 2020, 90 eligible primiparous women enrolled in the obstetrics and gynecology department of our hospital for delivery were recruited and assigned via the random number table method at a ratio of 1 : 1 to either an analgesic group given intraspinal nerve block anesthesia for labor or a nonanalgesic group without anesthesia for labor. Outcome measures included intrapartum body temperature, cases of intrapartum fever, Apgar scores of neonates, visual analogue scale (VAS) scores, delivery mode, and indomethacin use. Results Intraspinal nerve block anesthesia was associated with a higher body temperature at 4 h and 5 h after analgesia and more cases of intrapartum fever versus no anesthesia (P < 0.05). There were no significant differences in the Apgar scores between the two groups (P > 0.05). Participants given intraspinal nerve block anesthesia had lower VAS scores during labor versus those without anesthesia (P < 0.05). The differences in the delivery mode between the two groups were not significant (P > 0.05). Intraspinal nerve block anesthesia resulted in a significantly higher demand for indomethacin versus no anesthesia (P < 0.05). Conclusion Intraspinal nerve block anesthesia is clinically effective in labor analgesia but may cause increased body temperature or even overt clinical fever, so close clinical observation of maternal temperature changes is required to mitigate the effects of anesthesia on the mothers. No adverse consequences of intraspinal nerve block anesthesia on the newborns were reported in this study.

Effect of Midwives’ Application of Intelligent Delivery Room Management System on Delivery Outcome

Objective To investigate the impact of midwives using an intelligent delivery room management system on the outcome of deliveries. Method A total of 100 primiparas admitted to the department of obstetrics and gynecology of our hospital from January 2019 to June 2020 were selected as the research objects. They were randomly assigned to one of two groups: control or observation. The control group got standard obstetric care. On the basis of the control group, midwives in the observation group applied the intelligent delivery room management system for delivery management. The outcomes of childbirth, postpartum anxiety, and postpartum depression were recorded and compared between the two groups. Results The observation group's first and second stages of labour were shorter than the control group's (P < 0.05), postpartum NRS score was lower than the control group's (P < 0.05), neonate Apgar score was higher than the control group's (P < 0.05), and the rate of vaginal delivery to caesarean section was lower than the control group's (P < 0.05). There was no statistical significance in prenatal S-AI scores between the observation group and the control group (P > 0.05). After delivery, the S-AI score of the observation group was lower than that of the control group, and the comparison result was statistically significant (P < 0.05). There was no significant difference in prenatal EPDS scores between the observation group and the control group (P > 0.05). After delivery, the EPDS score of the observation group was lower than that of the control group, and the comparison result was statistically significant (P < 0.05). Conclusion Midwives may employ sophisticated delivery room management technologies to improve birth outcomes and reduce maternal anxiety and depression, and it is something that should be extensively promoted in clinic.

Comparison of hemodynamic changes and fetal outcome between normotensive and preeclamptic parturient undergoing elective cesarean section under spinal anesthesia: A prospective observational cohort study

BackgroundMaternal hypotension is a common problem during spinal anesthesia resulting in adverse maternal and fetal outcomes. According to theoretical knowledge, it is more common in severe preeclamptic parturients undergoing cesarean section with spinal anesthesia. ObjectiveTo compare fetomother outcome in normotensive and severe preeclamptic parturients undergoing elective cesarean section under spinal anesthesia. MethodologyA prospective cohort study was conducted from Novembers to May 30, 2019 on 84 ASA II and III pregnant mothers. After preloading with 500 ml–1000ml crystalloids, a 0.5%isobaric bupivacaine of 10 mg–12.5 mg was administered for spinal anesthesia.Vital signs (SBP, DBP, MAP and HR) were recorded every 3 min till 30 min, every 5 min then after. Neonatal Apgar scores at one and 5 min after birth and intraoperative fluids consumption were recorded. Data distribution was checked by Shapiro walk's test. Chi-square test was used to calculate the incidence of hypotension between groups; both paired and unpaired t-tests were also used to calculate the percent fall in blood pressure and heart rate from baselines of each group and intergroup respectively, and P-value less than 0.05 were considered statistical significance. ResultsThe incidence of hypotension (over a period of 30 min after spinal anesthesia) in the preeclamptic patients (31%) was less than that of the healthy parturients (59.5%). There was no statistically significant difference in heart rate of both groups before and after induction of spinal anesthesia. The 5th minute Apgar score recordings were also comparable between the groups. ConclusionThis study showed that the incidence and magnitude of spinal anesthesia-induced hypotension was less in severely preeclamptic parturient than healthy parturient who underwent elective cesarean delivery under spinal anesthesia and fetal outcome was comparable.

Compliance with clinical guidelines increases the safety of vacuum-assisted delivery.

Vacuum-assisted delivery (VAD) is a common and safe obstetric procedure. However, occasionally serious complications may occur. Clinical guidelines and College Statements have been developed to reduce the risk of serious adverse events. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) College Statement C-Obs 16 has not been evaluated to see if advice improves outcomes. The aim was to evaluate whether compliance with RANZCOG College Statement C-Obs 16 advice reduced the risk of serious adverse outcomes, specifically clinically significant subgaleal haemorrhage and major birth trauma. Retrospective audit of VADs in a level five hospital (NSW Maternity and Neonatal capability framework) from January 2020 to 2021. There were 1960 women who delivered in the study period, of whom 252 (12.8%) delivered by vacuum, and complete data were available from 241 cases. Statement compliance was observed in 81%. The main deviation from Statement compliance was pulls exceeding three. Statement compliance was associated with a significant reduction in the incidence of subgaleal haemorrhage (0% vs 11%, P= 0.0002), major birth trauma (3% vs 22%, P= 0.0001), requirement for neonatal resuscitation (14% vs 35%, P= 0.0026) and Apgar scores at oneminute less than six (5% vs 22% P= 0.0006). Statement compliance was associated with a significant reduction in maternal blood loss at delivery (388 mL vs 438 mL, P= 0.01). Noncompliance with Statement advice was observed significantly more often in pregnancy complicated by gestational diabetes (3% vs 15%, P= 0.02) and birth requiring instrument change (4% vs 13% P= 0.031). Compliance with a College Statement is associated with lower rates of subgaleal haemorrhage and major neonatal trauma. The main deviation from compliance was pulls in excess of three. Keyword: birth trauma, clinical guidelines, quality and safety in healthcare, subgaleal haemorrhage, vacuum delivery.

A Comparative Study on the Effects of Spinal Versus General Anaesthesia on Apgar Score of the Neonates among Patients Enduring Elective Caesarean Section

Objective: The purpose of this analysis was to do the comparison of the effect of general anesthesia and spinal anesthesia on neonatal Apgar score in patients enduring elective cesarean section. Study design: A Randomized control trial. Place and duration: In the department of Anesthesia, pain and intensive care Divisional Headquarters teaching Hospital Mirpur Hospital for six-months duration from July 2021 to December 2021. Methods: In this study, 120 patients in the cesarean section operating room list were alienated into 2 equal groups. Group I (n = 60) were given spinal anesthesia and in group II (n = 60), general anesthesia was given. There was no significant difference in height, weight and age of patients. Patient information is recorded on the designed performa. Comparisons were made between groups I and II. Apgar scores were assessed 1 and 5 minutes after birth and recorded as proforma. Results: The patients mean age of the group-I was 30.04 ± 4.9 years and 29.81± 5.84 years in the group-II. The mean change between the groups was not statistically substantial (p = 0.66). The patients mean weight in the first group was 70.95 ± 10.31 kg and in the second group it was 73.50 ±11.28 kg. Infants born to women who received spinal anesthesia had a higher Apgar score at 1 minute and 5 minutes compared to females who were given general anesthesia (P &lt;0.001). The highest proportion of patients in the first group exhibited better Apgar score than patients in the second group. Conclusion: Neonates of females who had cesarean section under spinal anesthesia had better APGAR score than under general anesthesia. Keywords: Apgar score, spinal anesthesia, general anesthesia, neonatal

Distributed Big Data Analytics Method for the Early Prediction of the Neonatal 5-Minute Apgar Score before or during Birth and Ranking the Risk Factors from a National Dataset

One-minute and five-minute Apgar scores are good measures to assess the health status of newborns. A five-minute Apgar score can predict the risk of some disorders such as asphyxia, encephalopathy, cerebral palsy and ADHD. The early prediction of Apgar score before or during birth and ranking the risk factors can be helpful to manage and reduce the probability of birth producing low Apgar scores. Therefore, the main aim of this study is the early prediction of the neonate 5-min Apgar score before or during birth and ranking the risk factors for a big national dataset using big data analytics methods. In this study, a big dataset including 60 features describing birth cases registered in Iranian maternal and neonatal (IMAN) registry from 1 April 2016 to 1 January 2017 is collected. A distributed big data analytics method for the early prediction of neonate Apgar score and a distributed big data feature ranking method for ranking the predictors of neonate Apgar score are proposed in this study. The main aim of this study is to provide the ability to predict birth cases with low Apgar scores by analyzing the features that describe prenatal properties before or during birth. The top 14 features were identified in this study and used for training the classifiers. Our proposed stack ensemble outperforms the compared classifiers with an accuracy of 99.37 ± 1.06, precision of 99.37 ± 1.06, recall of 99.50 ± 0.61 and F-score of 99.41 ± 0.70 (for confidence interval of 95%) to predict low, moderate and high 5-min Apgar scores. Among the top predictors, fetal height around the baby’s head and fetal weight denote fetal growth status. Fetal growth restrictions can lead to low or moderate 5-min Apgar score. Moreover, hospital type and medical science university are healthcare system-related factors that can be managed via improving the quality of healthcare services all over the country.

Evaluation of blood transfusion rate in obstetric patients.

The aim of this study was to analyse the obstetric patients who underwent transfusion in the gynecology and obstetrics clinic. Obstetric patients who underwent a blood transfusion in the peripartum period were included in the study. A total of 213 patients who needed blood transfusion were identified. Patients' age, gravida, parity, gestational week, delivery types, blood transfusion indication and time, transfusion rate, blood products used, number of transfusions, peripartum hysterectomy status, neonatal APGAR scores and hemoglobin (Hb), hematocrit (Hct), red blood cell (RBC), platelet (Plt) values which counted before and after transfusion were recorded by scanning patient files from the hospital registry system. The overall blood transfusion rate of the patients who gave birth in our clinic was 2.51%. Uterine atony (50.7%) and chronic anemia (32.9%) were found as the most frequent indications of blood transfusion in the patients included in the study. Antenatal mean Hb of all transfusion patients was 9.8; postpartum mean Hb was 8.2. Pre-transfusion mean Hb, RBC, Hct, Plt values calculated as 7, 3.9, 30.3, 245.2, respectively; post-transfusion mean Hb, RBC, Hct, Plt values were 9, 3.52, 27.5, 215.1, respectively. Due to blood replacement, supply difficulties and transfusion complications, the profit-loss relationship should be individualized and clearly demonstrated before it is applied to the patient. In unpredictable obstetric situations that cause bleeding, staying up to date on current guidelines on pharmacological, hematological and surgical interventions and having an active blood transfusion center in the healthcare provider is very important in reducing maternal mortality and morbidity rates.

Combined Efficacy of Balloon Occlusion and Uterine Artery Embolization on Coagulation Function in Patients with High-Risk Placenta Previa during Cesarean Section.

Purpose The present study was performed in order to investigate the conbined effect of balloon occlusion and uterine artery embolization on coagulation function in patients with high-risk placenta previa during cesarean section. Methods There involved a total of 38 patients with high-risk placenta previa undergoing cesarean section in our hospital from August 2019 to January 2021. The patients enrolled were randomly divided into study group (19 cases, receiving balloon occlusion combined with uterine artery embolization) and control group (19 cases, receiving conventional cesarean section). The operation time, intraoperative blood loss, plasma injection volume and hospital stay of the two groups were recorded. Moreover, the postoperative coagulation function indexes, including thrombin time (TT), fibrinogen (FBI), activated partial thromboplastin time (APTT) and prothrombin time (PT), were monitored and compared. Neonatal Apgar score and postoperative complications of the two groups were regarded as parameters for comparison. Results The intraoperative blood loss, plasma injection volume and hospital stay of the study group were significantly lower compared with the control group (P < 0.05), whereas the operation time of the two groups was comparable (P > 0.05). Compared with the control group, the levels of TT, APTT and PT were lower while the level of FBI was higher in the study group (P < 0.05). The Apgar 1-min and 5-min scores of newborns were compared between the two groups (P > 0.05). However, the incidence of postoperative complications in the study group showed evidently lower outcomes compared with the control group (P < 0.05). Conclusion The combined approach of balloon occlusion and uterine artery embolization offered potential for improving the coagulation function of patients with high-risk placenta previa during cesarean section. In addition, the approach reduced the amount of blood loss and plasma injection, shortened the length of hospital stay, which was believed available for wide clinical application.

A prospective cohort study of adverse fetomaternal outcomes among overweight, obese, and normal weight pregnant women with term singleton pregnancy in a tertiary care hospital

Background: Globally, overweight and obesity are the common risk factors with increasing frequency for adverse fetomaternal outcomes. In resource-poor countries, it is emerging as a threat for favorable pregnancy outcome even with the prevalence of high hunger index. Aims and Objectives: This study aims to determine the impact of obesity and overweight in pregnancy on fetomaternal outcomes in comparison to normal weight mothers. Materials and Methods: A prospective cohort study was conducted in a tertiary care center for 1½ years with singleton term pregnancies and 64 mothers with body mass index (BMI) ≥25 kg/m2 (cases) were compared with 64 normal weight mothers with BMI 18.5–24.9 kg/m2 (controls). Maternal and perinatal outcome was analyzed during antenatal, intranatal periods and after delivery along with the follow-up of newborns up to early neonatal period. Results: After optimizing the two groups in different sociodemographic status, the result shows significantly higher weight gain (P&lt;0.001), incidence of gestational diabetes mellitus (P&lt;0.001), hypertensive disorders of pregnancy (P&lt;0.001), and macrosomia (P&lt;0.001) in overweight and obese pregnant women than their normal weight counterparts. Increased cesarean section rate (P&lt;0.001), postpartum hemorrhage (P&lt;0.005), neonatal low Apgar score at 5 min (P&lt;0.05), neonatal intensive care unit admission (P&lt;0.05), and higher rate of early neonatal death were also observed in cases group than controls group. Conclusion: Pre-pregnancy intervention for optimization of maternal weight with proper surveillance of every pregnant mother of this subset and vigilant neonatal care may improve the obstetric and perinatal outcome.

Efficacy and safety of dexmedetomidine-ropivacaine versus sufentanil-ropivacaine for epidural labor analgesia: a randomized controlled trial.

Sufentanil combined with ropivacaine is commonly used for epidural labor analgesia, but it may cause some adverse effects. Dexmedetomidine is suitable for long-term and short-term intraoperative sedation and analgesia, and it can reduce the use of the opioid sufentanil. This study compared the efficacy and safety of dexmedetomidine and sufentanil combined with ropivacaine for epidural labor analgesia. A randomized, triple-blinded, controlled trial was performed for epidural labor analgesia. All included parturient women were randomized 1:1 by computer to receive ropivacaine combined with dexmedetomidine (group RD) or sufentanil (group RS) from October 2020 to February 2021. The primary outcomes were the pain relief of parturient women assessed by the visual analog scale (VAS) score, and the physical status of newborns assessed by the neonatal behavioral neurological assessment (NBNA) score and Apgar score. Secondary outcomes included the duration of labor stages and adverse reactions of parturient women and newborns. A total of 160 parturient women were included in this study, with 80 in each group. The VAS scores were lower in both groups after the injection of analgesics (in 120 min; RD: 2.6±1.0 vs. RS: 2.5±0.8; P=0.489), and there was no significant difference. The newborns' NBNA (RD: 39.9±0.4 vs. RS: 39.8±0.5; P=0.368) and Apgar scores (RD: 9.8±0.7 vs. RS: 9.7±0.8; P=0.424) were higher than normal standard (NBNA >37; Apgar >7) in both groups, and there were also no significant differences. No differences in parturient women's demographic characteristics, vital signs, Ramsay Sedation Scale (RSS) values, blood loss, duration of labor stages (first and second stages), onset time of analgesia, and dose of analgesics were found between the 2 groups (all P>0.05). The incidence of adverse reactions in parturient women and newborns was low in both groups. Dexmedetomidine or sufentanil combined with ropivacaine for epidural labor analgesia had similar analgesic effects in clinical practice. Chinese Clinical Trial Registry ChiCTR2000038702.

Outcome of pregnancy in patients with primary sclerosing cholangitis.

Data on the clinical course of primary sclerosing cholangitis (PSC) during pregnancy remain scarce. Herein, we assessed the maternal and fetal outcomes of pregnancy in this condition. We reviewed 104 consecutive female outpatients with PSC using a structured questionnaire. The outcomes were assessed both before and after the diagnosis of PSC. In total, 62 patients (60%) reported 126 pregnancies. Of these, 25 patients reported 44 pregnancies occurring after the diagnosis of PSC. There were two (5%) pregnancies in progress, and among the completed pregnancies there were 34 (80%) live births, six (14%) miscarriages, one (2%) stillbirth, and one (2%) termination. The median neonatal APGAR score was 10, the median body weight was 3375g and the median body length was 55cm. In three pregnancies, there was a flare-up of inflammatory bowel disease. In 45 patients, 82 pregnancies occurred before PSC was diagnosed with comparable maternal and fetal outcomes. Out of 42 pregnancies following PSC diagnosis, in 29 UDCA was continued. There was no difference in the fetal outcomes between the UDCA and non-UDCA groups. Pregnancy in patients with PSC seems to be well tolerated, but should be closely monitored by an obstetrician and an experienced hepatologist.

High- vs low-dose oxytocin in lean and obese women: a double-blinded randomized controlled trial

Women with obesity are likely to experience longer lengths of labor and are at an increased risk of cesarean delivery. We hypothesized that high-dose oxytocin would decrease the time to delivery in a cohort of women with obesity undergoing induction of labor. This study aimed to assess whether women with obesity benefited from higher doses of oxytocin for induction of labor. A double-blinded randomized controlled trial was conducted to evaluate the effect of low-dose and high-dose oxytocin on length of labor. We recruited women who were undergoing induction of labor at ≥37 weeks of gestation. Patients were randomly assigned in a 1:1 ratio to receive low-dose or high-dose oxytocin stratified by obesity level (obese and lean). The primary outcome was length of time (minutes) to vaginal delivery. The secondary outcomes included overall cesarean delivery rate, cesarean delivery for labor arrest, maximum oxytocin infusion rate, oxytocin infusion discontinuation, oxytocin infusion decrease, blood loss, neonatal intensive care unit admission, and neonatal Apgar scores. A total of 140 patients were randomized into receiving low-dose and high-dose oxytocin stratified into obese and lean stratum (35 for all strata). The primary outcome, time to vaginal delivery, was similar between the low-dose and high-dose oxytocin groups in the lean stratum (796 [±411] vs 694 [±466] minutes; P=.363) and the stratum with obesity (715 [±497] vs 762 [±594] minutes; P=.733). Kaplan-Meier curves between the low-dose and high-dose oxytocin groups were not significantly different in the lean stratum (P=.391) and the stratum with obesity (P=.692). There were 5 cesarean deliveries (14.29%) in the low-dose oxytocin lean stratum vs 2 cesarean deliveries (5.71%) in the high-dose oxytocin lean stratum (P=.232). There were 4 cesarean deliveries (11.43%) in the low-dose oxytocin stratum with obesity vs 1 cesarean delivery (2.86%) in the high-dose oxytocin stratum with obesity (P=.164). There was no difference in the incidence of postpartum hemorrhage between the lean stratum (P=0.526) and the stratum with obesity (P=0.212). There was no difference in mean estimated blood loss between the lean stratum (P=.472) and the stratum with obesity (P=.215). There was no difference in time to delivery between the low-dose and high-dose oxytocin protocols in either the lean cohorts or cohorts with obesity undergoing induction of labor. We did observe a trend toward a lower rate of cesarean delivery in both lean women and women with obesity when high-dose oxytocin was used.