Neonatal Intensive Care Unit Admission Rate Research Articles

The Effect of Food Environment on Pregnancy Outcomes [ID 2683379

INTRODUCTION: In large urban cities, fast food restaurants and convenient stores dominate the food sector leaving limited access to quality healthy foods. Food insecurity is a modifiable risk factor of social drivers of health. We hypothesize that low-access food environment is associated with gestational diabetes, preterm deliveries, hypertensive disorders, and other comorbidities. METHODS: A retrospective cohort study was performed to determine the effects of food environment on pregnancy outcome using geographic data from 3,898 patients who delivered after 20 weeks of gestation in a large inner-city hospital between 2014 and 2019. The USDA Food Access Research Atlas was used to extrapolate census tract data from neighborhoods that have been previously identified as low-access areas. Demographics were obtained by chart abstraction. Chi-squared tests were used for analysis. RESULTS: Of the 3,684 patients, 1,377 (37.4%) of the population lived in low-access food environments. There is a higher rate of neonatal intensive care unit (NICU) admission in low-access food environments compared to high access (8.6% versus 7.5%; P<.001). Contrarily, there is a lower rate of gestational diabetes mellitus (11.3% versus 13.6%; P=.0381) and preterm delivery (13.2% versus 16.7%; P=.0043) in women living in low-access food environments. There was no significant difference between hypertensive disorders (P=.0874) and fetal growth restriction (P=.8465). CONCLUSION: This study demonstrates that low-access food environment is associated with statistically significant higher rates of NICU admission. Unlike other risk factors, food environment is a modifiable risk factor, and as women's health providers, it is important to address all social drivers of health, including food insecurity.

EARLY NEONATAL MORBIDITIES AMONG TERM AND LATE PRETERM INFANTS IN A TERTIARY CARE CENTRE - A COMPARATIVE STUDY

Background: Late preterm infants are the largest subgroup of preterm infants but they are also a group that is seldom studied. The overall NICU admission rates of these group has been increasing worldwide. Only few studies have been conducted to assess the neonatal morbidity and mortality in late preterm infants [1-4]. Understanding morbidity risk among late preterm infants important for helping newborn care providers to anticipate and to manage morbidity during the birth and also possibly assist in guiding nonemergency obstetric intervention decisions. The present study is an attempt to obtain actual data on incidence, pattern of early neonatal morbidities, and to compare it with term infants. Aims and Objectives: To compare early neonatal morbidity (within first 7 days of life) in late preterm infants with term infants. Methodology: A hospital based prospective observational study conducted among 110 newborns in postnatal ward & Neonatal Intensive Care Unit (NICU) of Government medical college, Kannur during 1year period (March 2022 - March 2023). Study population: All term & late preterm newborns of Government medical college, Kannur. We assessed morbidities like RDS, hypoglycemia, NEC, Jaundice, sepsis and HIE and compared the incidence between term and late preterm neonates during the study period. Results were analyzed using a statistical software package SPSS, version 20.0. Results: Among 110 study population ,43% were late term infants while 56% were term infants. Morbidities like RDS (22.9%), sepsis (8%), hypoglycemia (3%), neonatal jaundice (33%), NEC (16%), HIE (2%) were found to be significantly higher in late preterm infants when compared to term infants. Conclusion: Late preterm infants are at higher risk for a number of neonatal complications like respiratory distress syndrome, neonatal jaundice, sepsis, feeding problems, hypoglycemia and HIE. All these in turn leading to higher rates of NICU admission and late discharge from hospital during first seven days of life.

The effect of intrahepatic cholestasis in pregnancy combined with different stages of hepatitis B virus infection on pregnancy outcomes: a retrospective study.

To investigate the impact of intrahepatic cholestasis of pregnancy (ICP) with hepatitis B virus (HBV) infection on pregnancy outcomes. We selected 512 pregnant women, collected the data including maternal demographics, main adverse pregnancy outcomes and maternal HBV infected markers HBeAg and HBV-DNA loads status, then have a comparative analysis. There were 319 solitary ICP patients without HBV infection (Group I) and 193 ICP patients with HBV infection. Of the latter, there were 118 cases with abnormal liver function(Group II) and 80 cases with normal liver function(Group III). All HBV-infected pregnant women with ICP were divided into hepatitis Be antigen (HBeAg)-positive group (102 cases) and HBeAg-negative group (91 cases), according to the level of the serum HBeAg status; and into high viral load group (92 cases), moderate viral load group (46 cases) and low viral load group (55 cases) according to the maternal HBV-DNA level. Group II had a higher level of serum total bile acids, transaminase, bilirubin as well as a higher percentage of premature delivery, neonatal intensive care unit (NICU) admission and meconium-stained amniotic fluid (MSAF) compared with the other two groups(P < 0.05), but there were no significant differences in the above indicators between the Group I and Group III. Among the HBV-infected patients with ICP, HBeAg-positive group had a higher level of serum transaminase, bilirubin and bile acid as well as earlier gestational weeks of delivery, lower birth weight of new-borns and a higher rate of NICU admission than HBeAg-negative group (P < 0.05). Those with a high viral load (HBV-DNA > 106IU/ml) had a higher level of transaminase, bilirubin, and bile acid as well as shorter gestational weeks of delivery, lower birth weight of new-borns and a higher rate of NICU admission compared with those with a low or moderate viral load (P < 0.05). HBV-infected pregnant women with ICP combined with abnormal liver function have more severe liver damage, a higher percentage of preterm birth and NICU admission. HBeAg-positive status and a high HBV-DNA load will increase the severity of conditions in HBV-infected pregnant women with ICP. HBV-infected patients with ICP who have abnormal liver function, HBeAg-positive or a high viral load should be treated more actively.

Incidence of neonatal morbidity in small-for-gestational-age twins based on singleton and twin charts.

To compare morbidity, as measured by length of stay in the neonatal intensive care unit (NICU), in twin and singleton gestations classified as small-for-gestational age (SGA) according to estimated fetal weight < 10th percentile on twin or singleton growth charts. NICU length of stay was compared in 1150 twins and 29 035 singletons that underwent ultrasound assessment between 35 + 0 and 36 + 6 weeks' gestation. Estimated fetal weight was obtained from measurements of head circumference, abdominal circumference and femur length using the Hadlock formula. Gestational age was derived from the first-trimester crown-rump length measurement, using the larger of the two twins. Singletons and twins were compared in terms of NICU admission rate and length of stay according to classification as SGA by the Fetal Medicine Foundation singleton and twin reference distributions. The overall proportions of twins and singletons admitted to NICU were similar (7.3% vs 7.4%), but twins tended to have longer lengths of stay in NICU (≥ 7 days: 2.4% vs 0.8%; relative risk (RR), 3.0 (95% CI, 1.6-4.4)). Using the singleton chart, a higher proportion of twins were classified as SGA compared with singletons (37.6% vs 7.0%). However, the proportion of SGA neonates entering NICU was similar (10.2% for twins and 10.1% for singletons) and the proportion of SGA neonates spending ≥ 7 days in NICU was substantially higher for twins compared with singletons (3.7% vs 1.4%; RR, 2.6 (95% CI, 1.4-4.7)). When singleton charts are used to define SGA in twins and in singletons, there is a greater degree of growth-related neonatal morbidity amongst SGA twins compared with SGA singletons. Consequently, singleton charts do not inappropriately overdiagnose fetal growth restriction in twins and they should be used for monitoring fetal growth in both twins and singletons. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.

Applying Tension to the Transcervical Foley Balloon and Delivery Times in Term Nulliparous Women Undergoing Induction of Labor: A Randomized Controlled Trial.

To investigate the effects of applying tension to a transcervical Foley balloon on delivery time in term nulliparous patients undergoing labor induction. This cluster randomized clinical trial included 279 term nulliparous women presenting for labor induction with a plan for cervical ripening through transcervical Foley balloon placement. Participants were assigned to either the tension group (n=138) or the no-tension group (n=141) on the basis of randomized, weekly clusters (26 total clusters). The primary outcome measured was the time from initial Foley balloon insertion to delivery. Secondary outcomes included cesarean delivery rates, peripartum infection, and neonatal intensive care unit (NICU) admission. Our prior data suggested that delivery time in the tension group would be about 1,053 minutes. We estimated a sample size of 260 (130 per group, 26 clusters) on the basis of a 25% difference, power of 80%, and two-sided α of 0.05. A total of 279 term nulliparous patients were included in the analysis. The median time from Foley placement to delivery was 1,596 minutes (range 430-3,438 minutes) for the tension group and 1,621 minutes (range 488-3,323 minutes) for the no-tension group ( P =.8); similar results were noted for time to vaginal delivery. No significant differences were observed in the secondary outcomes, including the rates of cesarean delivery (34.1% vs 29.8%, P =.7), peripartum infection, and NICU admission, between the two groups. Applying tension to a transcervical Foley balloon in term nulliparous women undergoing labor induction did not significantly reduce delivery time or improve secondary outcomes. ClinicalTrials.gov , NCT05404776.

Prevalence of Preterm Birth and Perinatal Outcomes in a Tertiary Hospital in Malaysia.

Background Preterm birth (PTB) is defined as neonates that are born alive>22 weeks of gestation and <37 weeks of gestation. Because of the immaturity of different organ systems, 14.84 million newborns worldwide are born prematurely, which is the largest contributing factor to mortality and morbidity. Although studies have been conducted in this field, the magnitude of PTB is a major issue in most developing countries including Malaysia. Objective To assess the prevalence of PTB and the perinatal outcome among women delivered in a tertiary university hospital in Malaysia. Methods This was a cross-sectional study evaluating all singleton live births weighing>500g and delivered at>22+1weeks of gestation between January 2015 and December 2019 in Universiti Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia. Data were collected from the hospital's recorded birth registry. The primary outcome was the PTB rate. Data were entered and analysed using Statistical Product and Service Solutions (SPSS) (version 28.0; IBM SPSS Statistics for Windows, Armonk, NY). Results A total of 26,022 singleton live births were reported for the period 2015-2019. PTB rates showed a sharp 6% decrease from 2015 to 2016, after which the trend was inconsistent until 2019. The risk of preterm babies being admitted to the neonatal intensive care unit (NICU) or the ward compared to the risk of neonatal mortality increases for babies of identified sex, delivered via caesarean, and with a birth weight between 2 and 3 kgs. Babies born at a gestational age between 22+1and 33+6have a higher risk of neonatal mortality compared to late preterm babies. Conclusions The PTB incidence trend was inconsistent from 2015 to 2019 in a tertiary university hospital in Malaysia, with a far higher prevalence compared to national data. The high NICU admission and mortality rates among preterm infants mean urgent strategies and policies are needed to improve perinatal outcomes.

Efficacy of Vaginal Progesterone for Maintenance Therapy after Arrested Preterm Labor: A Randomized Controlled Trial

Objective: To evaluate whether 400 milligrams of vaginal progesterone, as a maintenance tocolysis, could prolong the latency to delivery, prevent preterm birth, reduce adverse neonatal outcomes, and delay cervix shortening after arrested preterm labor. Materials and Methods: An open-label randomized controlled trial was conducted on 80 singleton pregnant women with symptomatic preterm labor, who were successfully arrested with Nifedipine as acute tocolysis, at gestational ages 24 to 33 weeks and 6 days, at Hatyai Hospital. Participants were then randomly allocated using a permuted block of four to either the vaginal progesterone group or the control group. Results: The vaginal progesterone group resulted in a longer mean latency to delivery at 47.3±17.1 versus 34.2±18.1 days (p&lt;0.001), a lower preterm birth rate at 12.5% versus 35.0% (p=0.036), a higher gestational age at delivery of 38.5±1.3 versus 36.7±2.5 weeks (p&lt;0.001), and improved birth weight of 2,932.6±309.9 versus 2,627.1±517.3 grams (p=0.002). There were no significant differences in the delay of cervical shortening at –3.2±2.8 versus –4.7±5.0 mm (p=0.192) or the rate of neonatal intensive care unit (NICU) admission of 4% versus 11% (p=0.086) or the rate of birth asphyxia of 5% versus 10% (p=0.675). Conclusion: Administering 400 milligrams of vaginal progesterone as a maintenance tocolysis in arrested preterm labor effectively prolongs latency to delivery, reduces the rate of preterm birth, and improves birth weight. However, it fails to delay cervical shortening and does not decrease the rate of NICU admission or occurrence of birth asphyxia. Keywords: Arrested preterm labor; Preterm birth; Vaginal progesterone; Maintenance therapy

Continuous glucose monitoring metrics and pregnancy outcomes in insulin-treated diabetes: A post-hoc analysis of the GlucoMOMS trial.

To investigate the association between continuous glucose monitoring (CGM) metrics and perinatal outcomes in insulin-treated diabetes mellitus in pregnancy. In a post-hoc analysis of the GlucoMOMS randomized controlled trial, we investigated the association between the metrics of an offline, intermittent CGM, glycated haemoglobin (HbA1c) and perinatal outcomes per trimester in different types of diabetes (type 1, 2 or insulin-treated gestational diabetes mellitus [GDM]). Data were analysed using multivariable binary logistic regression. Outcomes of interest were neonatal hypoglycaemia, pre-eclampsia, preterm birth, large for gestational age (LGA) and Neonatal Intensive Care Unit (NICU) admission. The glucose target range was defined as 3.5-7.8 mmol/L (63-140 mg/dL). Of the 147 participants (N = 50 type 1 diabetes, N = 94 type 2 diabetes/insulin-treated GDM) randomized to the CGM group of the GlucoMOMS trial, 115 participants had CGM metrics available and were included in the current study. We found that, in pregnancies with type 1 diabetes, a higher second trimester mean glucose was associated with LGA (odds ratio 2.6 [95% confidence interval 1.1-6.2]). In type 2 and insulin-treated gestational diabetes, an increased area under the curve above limit was associated with LGA (odds ratio 10.0 [95% confidence interval 1.4-72.8]). None of the CGM metrics were associated with neonatal hypoglycaemia, pre-eclampsia, shoulder dystocia, preterm birth and NICU admission rates for pregnancies complicated by any type of diabetes. In this study, in type 2 diabetes or insulin-treated GDM, the glucose increased area under the curve above limit was associated with increased LGA. In type 1 diabetes, the mean glucose was the major determinant of LGA. Our study found no evidence that other CGM metrics determined adverse pregnancy outcomes.

The Impact of Advanced Maternal Age on Pregnancy Outcomes: A Retrospective Multicenter Study.

The aim of this multicenter retrospective cohort study was to examine the impact of maternal age on perinatal outcomes in multiparas, stratified according to maternal age in one- and two-year increments. The analysis involved 302,484 multiparas who delivered between the years 2003 and 2021 in four university-affiliated obstetrics departments. Maternal age was considered both as a continuous variable and in two-year intervals, as compared with a comparison group of parturients aged 25-30 years. The study focused on cesarean delivery and neonatal intensive care unit (NICU) admission as primary outcomes. The findings revealed that cesarean delivery rates increased as maternal age advanced, with rates ranging from 6.7% among 25-30 year olds, rising continuously from 13.5% to 19.9% between the age strata of 31 and 42, to exceeding 20% among those aged ≥ 43 years (p < 0.01 for each stratum when compared to 25-30 year old group). Similarly, NICU admission rates rose from 2.7% in the comparison group to 6% in parturients aged 45-46 years (p < 0.01 for each stratum when compared to 25-30 year old group). The study highlights the association between incrementally advanced maternal age and increased rates of maternal and neonatal complications, necessitating global awareness of these implications for family planning decisions and maternal care.

Maternal and Neonatal Outcomes of Twin Pregnant Women With Anemia.

The aim of this study was to investigate the prevalence of anemia in twin pregnancies and the influence of anemia on maternal and neonatal outcomes. This retrospective study included twin pregnant women who delivered in a tertiary hospital in China from January 2018 to December 2018. Patients were divided by WHO criteria (hemoglobin <11.0 g/dL): the anemic and nonanemic groups. Patients with anemia were further classified as recovered or unrecovered subgroup after oral iron therapy. Maternal and neonatal outcomes in women carrying twins were compared using Student's t test and the chi-squared test or the Fisher exact test. Univariable and multivariable logistic regression models were used to determine the association of maternal and neonatal characteristics with anemia. Linear regression analysis was used to estimate mean birth weight and gestational week. The prevalence of anemia was 42.6% (182/427) in twin pregnancies. The anemic group had higher rates of low 1-minute Apgar score (4.4% vs. 1.8%, p = .028), perinatal death (1.9% vs. 0.2%, p = .012) and neonatal intensive care unit (NICU) admission (27.2% vs. 20.2%, p = .017; adjusted OR, 1.478; 95% CI [1.07, 2.044]). The recovered subgroup had lower NICU admission rate (13.5% vs. 30.3%, p = .006; OR, 0.388; 95% CI [0.186, 0.809]), higher gestational week and birth weight (β, 0.954 week; 95% CI [0.114, 1.794] and β, 171.01 g; 95% CI [9.894, 332.126] respectively). The prevalence of anemia in twin gestation is high. Anemia is associated with adverse neonatal outcomes, and correction of anemia significantly improved the pregnancy outcomes.

Prenatal Health Care Outcomes Before and During the COVID-19 Pandemic Among Pregnant Individuals and Their Newborns in an Integrated US Health System

The COVID-19 pandemic accelerated the use of telemedicine. However, data on the integration of telemedicine in prenatal health care and health outcomes are sparse. To evaluate a multimodal model of in-office and telemedicine prenatal health care implemented during the COVID-19 pandemic and its association with maternal and newborn health outcomes. This cohort study of pregnant individuals using longitudinal electronic health record data was conducted at Kaiser Permanente Northern California, an integrated health care system serving a population of 4.5 million people. Individuals who delivered a live birth or stillbirth between July 1, 2018, and October 21, 2021, were included in the study. Data were analyzed from January 2022 to May 2023. Exposure levels to the multimodal prenatal health care model were separated into 3 intervals: unexposed (T1, birth delivery between July 1, 2018, and February 29, 2020), partially exposed (T2, birth delivery between March 1, 2020, and December 5, 2020), and fully exposed (T3, birth delivery between December 6, 2020, and October 31, 2021). Primary outcomes included rates of preeclampsia and eclampsia, severe maternal morbidity, cesarean delivery, preterm birth, and neonatal intensive care unit (NICU) admission. The distributions of demographic and clinical characteristics, care processes, and health outcomes for birth deliveries within each of the 3 intervals of interest were assessed with standardized mean differences calculated for between-interval contrasts. Interrupted time series analyses were used to examine changes in rates of perinatal outcomes and its association with the multimodal prenatal health care model. Secondary outcomes included gestational hypertension, gestational diabetes, depression, venous thromboembolism, newborn Apgar score, transient tachypnea, and birth weight. The cohort included 151 464 individuals (mean [SD] age, 31.3 [5.3] years) who delivered a live birth or stillbirth. The mean (SD) number of total prenatal visits was similar in T1 (9.41 [4.75] visits), T2 (9.17 [4.50] visits), and T3 (9.15 [4.66] visits), whereas the proportion of telemedicine visits increased from 11.1% (79 214 visits) in T1 to 20.9% (66 726 visits) in T2 and 21.3% (79 518 visits) in T3. NICU admission rates were 9.2% (7014 admissions) in T1, 8.3% (2905 admissions) in T2, and 8.6% (3615 admissions) in T3. Interrupted time series analysis showed no change in NICU admission risk during T1 (change per 4-week interval, -0.22%; 95% CI, -0.53% to 0.09%), a decrease in risk during T2 (change per 4-week interval, -0.91%; 95% CI, -1.77% to -0.03%), and an increase in risk during T3 (change per 4-week interval, 1.75%; 95% CI, 0.49% to 3.02%). There were no clinically relevant changes between T1, T2, and T3 in the rates of risk of preeclampsia and eclampsia (change per 4-week interval, 0.76% [95% CI, 0.39% to 1.14%] for T1; -0.19% [95% CI, -1.19% to 0.81%] for T2; and -0.80% [95% CI, -2.13% to 0.55%] for T3), severe maternal morbidity (change per 4-week interval , 0.12% [95% CI, 0.40% to 0.63%] for T1; -0.39% [95% CI, -1.00% to 1.80%] for T2; and 0.99% [95% CI, -0.88% to 2.90%] for T3), cesarean delivery (change per 4-week interval, 0.06% [95% CI, -0.11% to 0.23%] for T1; -0.03% [95% CI, -0.49% to 0.44%] for T2; and -0.05% [95% CI, -0.68% to 0.59%] for T3), preterm birth (change per 4-week interval, 0.23% [95% CI, -0.11% to 0.57%] for T1; -0.37% [95% CI, -1.29% to 0.55%] for T2; and -0.15% [95% CI, -1.41% to 1.13%] for T3), or secondary outcomes. These findings suggest that a multimodal prenatal health care model combining in-office and telemedicine visits performed adequately compared with in-office only prenatal health care, supporting its continued use after the pandemic.

The Pregnancy Outcome in Women with Polycystic Ovary Syndrome

Background: In women of reproductive age, polycystic ovarian syndrome (PCOS) is a prevalent endocrine condition. Menstrual irregularities (oligomenorrhea or amenorrhea), hirsutism, persistent acne, androgen-dependent alopecia, abdominal obesity, hypertension, and infertility are all clinical signs of PCOS.Objective: To assess the success of pregnancy in patients with polycystic ovary syndrome.Materials and Methods: This observational cross-sectional study was carried out in the Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital, Enayetpur, Sirajganj, Bangladesh from June 2020 to May 2022 for a period of two years. Women diagnosed with PCOS were willing to participate in our study were recruited from obstetrics Out patient Department (OPD) and antenatal ward of Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital. After obtaining an informed consent from them, a detailed interview schedule containing socio- demographic details, menstrual/marital/ obstetric/past/personal/ family history was taken.Results: Concerning complications Preeclampsia was found in 5 (9.1%) of the PCOS patients but not in the non-PCOS patients. The differences in gestational age and mode of birth between the two groups were not statistically significant (p&gt;0.05). Perinatal outcome: 21 (39.6%) PCOS patients were admitted to the Neonatal Intensive Care Unit (NICU), compared to 11 (20.0%) non-PCOS patients. Which of the two groups was statistically significant (p&lt;0.05).Conclusion: The present study suggested that preeclampsia is a relatively common condition, and complications such gestational hyperglycemia, gestational hypertension, and preeclampsia were frequent in the PCOS group. In comparison to the non-PCOS group, the PCOS group had considerably greater rates of low birth weight and NICU admission. KYAMC Journal Vol. 14, No. 01, April 2023: 30-34

MT47 Does the Use of New Technology By Care Managers Have an Impact on Neonatal Intensive Care Unit (NICU) Admissions and Length of Stay?

Neonatal intensive care units (NICU) provide essential medical care to neonates; however, they are associated with hospital-acquired infections, less maternal-newborn bonding, and high costs. Implementing strategies to lower NICU admission rates and shorten NICU length of stay (LOS) is essential. This study uses causal-inference methods to evaluate the impact of care managers using new technology to identify and risk stratify pregnancies on NICU admissions and NICU LOS.

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

Background: At or after 37 weeks of pregnancy, the decreased cerebroplacental ratio (CPR) denotes high risk of fetal complication. when low-risk foetuses with lower CPR have intrapartum distress within 72 hours after the start of labour, the prevalence of obstetric intervention is greater. This work aimed to assess CPR as evaluated during term pregnancy and before onset of the labor in normotensive and hypertensive pregnancies and its relationship with perinatal outcomes with reference to Intrauterine growth restriction (IUGR), fetal distress, APGAR score, birth weight and admission at Neonatal Intensive Care Unit (NICU). Methods: This prospective observational study was performed on 40 pregnant cases, their age ranging in years from 20 to 35, singleton living pregnancy, gestational age (37-40) weeks and before onset of labor and cephalic-presenting fetus. Participants were divided into two equal groups: normotensive cases and hypertensive cases. Results: Significant difference between two studied group regarding abdominal circumference (AC), Amniotic fluid index (AFI), estimated fetal weight (EFW), Umbilical Artery pulsatility index (UAPI), middle cerebral arterial pulsatility index (MCAPI), CPR, APGAR scores at one and five minutes were substantially reduced while rates of cesarean sections and NICU admissions were significantly higher in hypertensive compared with normotensive women. The cutoff value was 1.1 for CPR yielded a sensitivity of 90%, a specificity of 70%, a PPV of 75% and a NPV of 88% with 83% accuracy and with AUC of 0.955. Conclusions: CPR has high predictive value of perinatal outcome as Apgar score and rate of NICU admission in hypertensive pregnant women.

Cerebroplacental ratio assessment after age of fetal maturity in normotensive and hypertensive pregnancies and prediction of perinatal outcome

Background: At or after 37 weeks of pregnancy, the decreased cerebroplacental ratio (CPR) denotes high risk of fetal complication. when low-risk foetuses with lower CPR have intrapartum distress within 72 hours after the start of labour, the prevalence of obstetric intervention is greater. This work aimed to assess CPR as evaluated during term pregnancy and before onset of the labor in normotensive and hypertensive pregnancies and its relationship with perinatal outcomes with reference to Intrauterine growth restriction (IUGR), fetal distress, APGAR score, birth weight and admission at Neonatal Intensive Care Unit (NICU). Methods: This prospective observational study was performed on 40 pregnant cases, their age ranging in years from 20 to 35, singleton living pregnancy, gestational age (37-40) weeks and before onset of labor and cephalic-presenting fetus. Participants were divided into two equal groups: normotensive cases and hypertensive cases. Results: Significant difference between two studied group regarding abdominal circumference (AC), Amniotic fluid index (AFI), estimated fetal weight (EFW), Umbilical Artery pulsatility index (UAPI), middle cerebral arterial pulsatility index (MCAPI), CPR, APGAR scores at one and five minutes were substantially reduced while rates of cesarean sections and NICU admissions were significantly higher in hypertensive compared with normotensive women. The cutoff value was 1.1 for CPR yielded a sensitivity of 90%, a specificity of 70%, a PPV of 75% and a NPV of 88% with 83% accuracy and with AUC of 0.955. Conclusions: CPR has high predictive value of perinatal outcome as Apgar score and rate of NICU admission in hypertensive pregnant women.

Hypertensive Disorders of Pregnancy and the Risk of Developing Hypertension Outside of Pregnancy Based on Updated Hypertension Guidelines [ID: 1377015

INTRODUCTION: The purpose of this study is to determine whether hypertensive disorders of pregnancy (HDP) affect the development of chronic hypertension (HTN) within 5 years postdelivery based on updated guidelines by the American Heart Association (AHA). METHODS: This IRB-approved study evaluated women who delivered at one hospital from 2014 to 2016. Participants were determined to be normotensive or with HDP. Inclusion criteria for the HDP group was diagnosis of gestational HTN or preeclampsia at 20 weeks of gestation or greater. Exclusion criteria were previous diagnosis of HTN and age over 40. Women were followed up to 5 years postdelivery to assess development of chronic HTN, defined by the 2017 AHA guidelines as systolic greater than 130 mm Hg or diastolic greater than 80 mm Hg. RESULTS: Sixty-four participants (30.9%) developed chronic HTN within 5 years of delivery. Of these participants, 6.25% were from the normotensive pregnancy group, while 84.4% were from the preeclampsia with severe features group, with adjusted odds ratio of 11.38 (CI 4.67–22.46). Compared to the 5-year normotensive group, the 5-year chronic HTN group was associated with higher maternal body mass index (BMI) (P=.0146), preterm delivery (P=.0231), and neonatal intensive care unit (NICU) admission (P=.04). CONCLUSION: The rate of chronic HTN development 5 years postdelivery was significantly higher in participants with HDP, notably preeclampsia with severe features. Participants with development of chronic HTN had increased BMI during pregnancy, preterm delivery, and NICU admission rates as compared to participants with 5-year normotensive pressures. Awareness of the prevalence and risk factors for development of chronic hypertension provides areas of focus for future investigations.

Race and Ethnicity and Disparities in Neonatal Outcomes in Twin Pregnancies [ID: 1375610

INTRODUCTION: Twin pregnancies are associated with adverse neonatal outcomes. We aimed to investigate disparities in neonatal outcomes by maternal race and ethnicity. METHODS: This was an IRB-approved, retrospective cohort of twin deliveries at a single institution between 2001 and 2018. Pregnancies delivered less than 23 weeks’ gestational age (GA), fetal demise, or major anomaly were excluded. The primary exposure, race and ethnicity, was self-reported as follows: non-Hispanic White, Hispanic, non-Hispanic Black, Asian/Pacific Islander, and other/mixed race. The primary outcome was neonatal intensive care unit (NICU) admission of at least one twin. Secondary outcomes included 5-minute Apgar less than 7 for either twin, GA at delivery, small for GA (SGA) neonate (&lt;10th percentile for GA), and NICU length of stay. Chi-square, ANOVA, and Student’s t test were performed for univariate analyses. Logistic regression modeling was performed to control for baseline differences. RESULTS: Eight hundred four twin pregnancies were identified; 48% of patients identified as non-Hispanic White, 30% as Hispanic, 10% as Asian/Pacific Islander, 5.6% as non-Hispanic Black, and 6.6% as other/mixed race. Age, parity, chorionicity, and body mass index differed between groups. The overall rate of NICU admission was 77.5% and did not differ by race and ethnicity (P=.05). Pregnancies with at least one SGA neonate varied significantly by race and ethnicity (P=.02). Gestational age at delivery, Apgar of less than 7, and ICU length of stay did not differ. CONCLUSION: The risk of having an SGA neonate varies by race and ethnicity in twin gestations, with highest rates among non-Hispanic Black women. Additional racial and ethnic disparities in neonatal morbidity were not found. Disparities in rate of preterm birth were not seen in this cohort.

Effect of Vaginal Washing before Intravaginal Prostaglandin Insertion on Induction of Labor: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

Saline vaginal douching prior to intravaginal prostaglandin application might increase the vaginal pH, leading to improvement of prostaglandin bioavailability, by which the outcomes of labor induction can be greatly improved. Thus, we aimed to evaluate the effect of vaginal washing with normal saline before insertion of vaginal prostaglandin for labor induction. A systematic search was done in PubMed, Cochrane Library, Scopus, and ISI Web of Science from inception to March 2022. We selected randomized controlled trials (RCTs) that compared vaginal washing using normal saline versus no vaginal washing in the control group before intravaginal prostaglandin insertion during labor induction. We used RevMan software for our meta-analysis. Our main outcomes were the duration of intravaginal prostaglandin application, duration from intravaginal prostaglandin insertion to active phase of labor, duration from intravaginal prostaglandin insertion till total cervical dilatation, labor induction failure rate, incidence of cesarean section (CS), and rates of neonatal intensive care unit (NICU) admission and fetal infection postdelivery. Five RCTs were retrieved with a total number of 842 patients. Duration of prostaglandin application, duration from prostaglandin insertion to active phase of labor, and time interval from prostaglandin insertion to total cervical dilatation were significantly shorter among vaginal washing group (p < 0.05). Vaginal douching prior to prostaglandin insertion significantly decreased the incidence of failed labor induction (p < 0.001). After the removal of reported heterogeneity, vaginal washing was linked to a significant decline in CS incidence (p = 0.04). In addition, the rates of NICU admission and fetal infection were significantly lower in the vaginal washing group (p < 0.001). Vaginal washing with normal saline before intravaginal prostaglandin insertion is a useful and easily applicable method for labor induction with good outcomes. · Induction of labor is frequently used in the obstetrics field.. · We assessed vaginal washing impact before prostaglandin insertion for labor induction.. · Vaginal washing is an easily applicable method for labor induction with good outcomes..

Association of Active Postnatal Care With Infant Survival Among Periviable Infants in the US

Active postnatal care has been associated with center differences in survival among periviable infants. Regional differences in outcomes among periviable infants in the US may be associated with differences in active postnatal care. To determine if regions with higher rates of active postnatal care will have higher gestational age-specific survival rates among periviable infants. This cohort study included live births from 22 to 25 weeks' gestation weighing 400 to 999 g in the US Centers for Disease Control and Prevention (CDC) WONDER 2017 to 2020 (expanded) database. Infants with congenital anomalies were excluded. Active postnatal care was defined using the CDC definition of abnormal conditions of newborn as presence of any of the following: neonatal intensive care unit (NICU) admission, surfactant, assisted ventilation, antibiotics, and seizures. Data were analyzed from August to November 2022. Regional gestational age-specific survival rates were compared with rates of active postnatal care in the 10 US Health and Human Services regions using Kendall τ test. We included 41 707 periviable infants, of whom 32 674 (78%) were singletons and 19 467 (46.7%) were female. Among those studied 34 983 (83.9%) had evidence of active care, and 26 009 (62.6%) survived. Regional rates of active postnatal care were positively correlated with regional survival rates at 22 weeks' gestation (rτ[8] = 0.56; r2 = 0.31; P = .03) but the correlation was not significant at 23 weeks' gestation (rτ[8] = 0.47; r2 = 0.22; P = .07). There was no correlation between active care and survival at 24 or 25 weeks' gestation. Regional rates of both NICU admission and assisted ventilation following delivery were positively correlated with regional rates of survival at 22 weeks' gestation (both P < .05). Regional rates of antenatal corticosteroids exposure were also positively correlated with regional rates of survival at 22 weeks' gestation (rτ[8] = 0.60; r2 = 0.36; P = .02). In this cohort study of 41 707 periviable infants, regional differences in rates of active postnatal care, neonatal intensive care unit admission, provision of assisted ventilation and antenatal corticosteroid exposure were moderately correlated with survival at 22 weeks' gestation. Further studies focused on individual-level factors associated with active periviable care are warranted.

Does lack of exposure to individual antidepressants at different points during pregnancy associate with reduced risk of adverse newborn outcomes?

The objective of this study was to determine if the lack of exposure to individual antidepressants at certain times in pregnancy improved maternal and infant outcomes. This was a retrospective cohort study of 2741 pregnant women prescribed antidepressant(s) before or during pregnancy. Data were obtained from electronic medical records. Analysis was limited to women prescribed one of five antidepressants (bupropion, citalopram, escitalopram, fluoxetine, sertraline). Period of exposure was determined using prescription order dates. Primary outcomes were neonatal intensive care unit (NICU) admission and adaptation syndrome in the newborn. Logistic regression, adjusted for maternal age, race, and insurance, compared consistent exposure throughout pregnancy versus (A) no exposure in the third trimester, (B) no exposure early in pregnancy, and (C) exposure in the midtrimester alone. Compared to women prescribed an antidepressant continually throughout pregnancy, NICU admission was less likely for women lacking exposure in the third trimester if they had been taking bupropion (aOR 0.43, 95% CI 0.21-0.90) or escitalopram (aOR 0.49, 95% CI 0.28-0.85). Women previously taking escitalopram but lacking third trimester exposure also had lower odds of adaptation syndrome (aOR 0.19, 95% CI 0.07-0.48). No differences were found in other outcomes for women taking other antidepressants or for any outcomes for women who lacked early pregnancy drug exposure compared to exposure throughout pregnancy. For the five antidepressants included in this study, lack of exposure early or late in pregnancy compared to consistent exposure throughout pregnancy generally did not change newborn outcomes. The exceptions were bupropion and escitalopram, where lack of exposure in the third trimester associated with lower rates of adaptation syndrome or NICU admission. These data may help pregnant women with depression in need of drug therapy to have informed discussions with providers about the potential risks and benefits to continuing or stopping drugs at different times during pregnancy.