Neonatal Outcomes Research Articles

Oligoasthenospermia is correlated with increased preeclampsia incidence in subfertile couples undergoing in vitro fertilization and embryo transfer: a secondary analysis of a randomized clinical trial

ObjectiveTo evaluate whether intergroup differences in the risk of maternal pregnancy complications following in vitro fertilization (IVF) vary with male factor. DesignA post hoc exploratory secondary analysis of data from a multicenter, randomized, controlled, non-inferiority trial (NCT03118141). SettingAcademic fertility centers. SubjectsA total of 1131 subfertile women with complete recording of their male partner's semen parameters during the trial were enrolled. All participants underwent intracytoplasmic sperm injection (ICSI) followed by frozen embryo transfer (FET) as part of their assisted reproductive technology (ART) treatment protocol. InterventionsWomen were divided into an oligoasthenospermia group (n=405) and a normospermia group (n=726) according to the quality of male sperm. Main Outcome MeasuresPregnancy complications, principally including the incidence of preeclampsia. ResultsNotably, we found that the risk of maternal preeclampsia was significantly higher in the oligoasthenospermia group than in the normospermia group (P=0.035). After adjustments for confounding factors by multivariate logistic regression analysis, the incidence of preeclampsia in the oligoasthenospermia group was still significantly higher than that in the normospermia group (6.55% vs. 3.60%; OR=0.529; 95% CI=0.282-0.992; P-adj=0.047). However, there were no significant differences in terms of embryo quality, cumulative live birth rate, other pregnancy complications or neonatal outcomes between the two groups (P>0.05). ConclusionOligoasthenospermia was associated with a higher risk of maternal preeclampsia in subfertile couples undergoing IVF-ET treatment. In clinical practice, it is essential to thoroughly evaluate the sperm quality and quantity of male partners before IVF-ET. Further research is needed to establish the causal relationships between semen quality and adverse pregnancy complications, particularly preeclampsia, and to explore potential interventions.

Use of interleukin-6 receptor antibodies in the second and third trimester of pregnancy: a retrospective cohort study

A paucity of data exists to inform the use of interleukin (IL)-6 receptor antibodies (anti-IL-6) in pregnancy, particularly in the third trimester. This study aimed to describe outcomes of pregnant women and their neonates exposed to these medications given after the first trimester to treat COVID-19. In this retrospective cohort study, we included all women with COVID-19 who were treated with an anti-IL-6 during pregnancy at two tertiary hospitals in London, UK-Guy's and St Thomas' NHS Foundation Trust and Imperial College Healthcare NHS Trust-between March 1, 2020, and Sept 30, 2022. Maternal demographics, clinical data, administered medications, and maternal and neonatal outcomes were assessed for all included women via a review of medical records and through maternal medicine networks. 25 women received an anti-IL-6 for COVID-19 in pregnancy during the study period and were followed up for 12 months. The group described were a population at high risk, with 24 requiring level two or three critical care. 24 women received tocilizumab and one received sarilumab. All women were prescribed at least three concomitant medications. 16 received the anti-IL-6 in the third trimester of pregnancy and nine during the seocnd trimester. There were no women with maternal neutropenia or pancytopenia; increases in liver enzymes in 16 of 20 women with available alanine aminotransferase data were in keeping with the severity of COVID-19 reported and all three women who developed a secondary bacterial infection mounted a C-reactive protein response. There was one maternal death due to COVID-19. All pregnancies resulted in livebirths and there was one twin pregnancy. 16 of 26 babies were born preterm. One baby died at age 6 months due to complications of extreme prematurity. A transient neonatal cytopenia was described in six of 19 babies in whom a full blood count was performed. Although these findings are likely to be in keeping with prematurity alone, we cannot exclude the possibility that transplacental transfer of anti-IL-6 was contributory. We report further data on the use of anti-IL-6 in the second and third trimesters of pregnancy for the management of COVID-19. When extrapolated, our data can inform shared decision making for individuals who would benefit from the use of anti-IL-6 into the third trimester of pregnancy for management of rheumatological disease. None.

COVID in pregnancy: Biomarkers of placental dysfunction and neonatal outcomes

COVID in pregnancy: Biomarkers of placental dysfunction and neonatal outcomes

Perinatal outcomes in indian women with Antiphospholipid Antibody Syndrome (APS): Five year experience from a tertiary care centre

BackgroundAntiphospholipid Syndrome (APS) is a systemic autoimmune thrombophilic condition characterized by obstetric manifestations, including pregnancy loss, preeclampsia and fetal growth restriction. Early diagnosis and management are key to improve maternal and neonatal outcomes. ObjectiveThe aim of this study is to assess the perinatal outcomes in APS, the development of various adverse pregnancy outcomes (APO), and their association with specific antibody profiles. Material methodsThis observational study was carried out on booked cases of singleton pregnancy and diagnosed cases of primary APS in our High-Risk Pregnancy (HRP) clinic from January 2018 to December 2022 after approval from institutional ethics committee. Forty-three confirmed cases of primary APS were enrolled and started on low-dose aspirin and low-molecular-weight heparin (LMWH) as per the patient's body weight after confirmation of fetal heart activity radiologically until 36 weeks of gestation as a standard of care. ResultsForty patients (93 %) had obstetric APS, and three patients (7 %) had thrombotic APS. During the course of the current pregnancy, adverse pregnancy outcomes (APO) developed in 12 (30 %) out of 40 cases of obstetric APS and in all 3 patients with thrombotic APS. Preeclampsia was seen in 11 (25.5 %), FGR in 12 (27.9 %), and preterm birth in 7 (16.2 %) cases. Patients with an antibody profile showing the presence of Anti-β2 GP-I positivity and ACL positivity had fewer APOs (20 % and 29 %) in comparison to patients with a LA and triple positive antibody profile (55 % and 50 %). ConclusionTreatment of pregnant women with APS causes significant improvement in the live birth rate. The late pregnancy complications like preeclampsia, FGR, and premature birth, occurring despite treatment still remains a challenge and emphasizes the need for stringent antepartum surveillance and timely delivery.

The association maternal cortisol levels and anxiety during labor with neonatal outcome: a cross-sectional

The association maternal cortisol levels and anxiety during labor with neonatal outcome: a cross-sectional

Pregnancy and delivery outcomes after abdominal vs. laparoscopic myomectomy: an evaluation of an American population database

ObjectiveTo evaluate population characteristics and obstetrical complications after abdominal myomectomy vs. laparoscopic myomectomy. DesignRetrospective cohort study, using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, with hospital discharge between 2004 and 2014. SettingsPopulation-based. Subject(s)13868 and 338 pregnancies following abdominal or laparoscopic myomectomy, respectively. ExposureObstetrics outcomes following abdominal and laparoscopic myomectomy were collected. MethodsMultiple and Binomial logistic regression were used and adjusted in different models for age, obesity, chronic hypertension, and pre-gestational diabetes mellitus. Main Outcome Measure(s)Pregnancy, delivery, and neonatal outcomes were analyzed. Result(s)Abdominal myomectomy were characterized by younger patients, lower rates of Caucasian, chronic hypertension, pregestational diabetes, active smoking, illicit drug use, and higher rates of previous cesarean delivery, and multiple gestations when compared to laparoscopic myomectomy. Pregnant women with laparoscopic myomectomy had decreased rates of pregnancy-induced hypertension [adjusted risk ratios (aRR) 0.12, 95% confidence intervals (CI) 0.006-0.24)], gestational hypertension (aRR 0.24, 95%CI 0.08-0.76), preeclampsia (aRR 0.18, 95%CI 0.07-0.48), and preeclampsia or eclampsia superimposed on chronic hypertension (aRR 0.03, 95%CI 0.005-0.3), gestational diabetes mellitus (aRR 0.14, 95%CI 0.06-0.34), preterm premature rupture of membranes (aRR 0.14, 95%CI 0.02-0.96), preterm delivery (aRR 0.36, 95%CI 0.23-0.55), and cesarean delivery (CD) (aRR 0.01, 95%CI 0.007-0.01) and small for gestational age (aRR 0.15, 95%CI 0.005-0.04), compared to abdominal myomectomy group. Laparoscopic myomectomy group had a higher rate of spontaneous aRR 35.57, 95%CI 22.53-62.66), and operative vaginal delivery (aRR 10.2, 95%CI 8.3-12.56), uterine rupture (aRR 6.1. 95%CI 3.2-11.63), postpartum hemorrhage (aRR 3.54, 95%CI 2.62-4.8), hysterectomy (aRR 7.74, 95%CI 5.27-11.4), transfusion (aRR 3.34, 95%CI 2.54-4.4), pulmonary embolism (aRR 7.44, 95%CI 2.44-22.71), disseminated intravascular coagulation (aRR 2.77, 95% CI 1.47-5.21), maternal infection (aRR 1.66, 95%CI 1.1-2.5) and death (aRR 2.04 95%CI 1.31-3.2)) and intra-uterine fetal death (aRR 2.99, 95%CI 1.72-5.2) compared to the abdominal myomectomy group. ConclusionsWomen who had a previous abdominal myomectomy have underlying risk factors for hypertension disorders of pregnancy and gestational diabetes. Women who underwent laparoscopic myomectomies have higher risks of bleeding, uterine rupture, resultant complications, and death, and should be monitored as high-risk patients, like abdominal myomectomies.

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review.

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions. Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period.According to modifiedCoopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Vacuum-assisted delivery: maternal and neonatal outcomes at a tertiary research hospital

Vacuum-assisted delivery: maternal and neonatal outcomes at a tertiary research hospital

A Comparative Study of Fetal and Maternal Outcomes in Registered and Unregistered Antenatal Cases in a Tertiary Care Center.

Background Antenatal care plays a crucial role in ensuring optimal maternal and neonatal health outcomes. However, disparities in access to prenatal care persist, with a subset of pregnant women failing to register for antenatal care, referred to as "unbooked" or "unregistered" pregnancies. This study aims to investigate the impact of registration status on pregnancy outcomes, considering various demographic, clinical, and socioeconomic factors. Understanding the factors influencing registration status and its implications on maternal and fetal health outcomes is essential for developing targeted interventions to improve prenatal care access and enhance overall pregnancy outcomes. Objective To see the difference in obstetrical complications along with feto-maternal outcomes in both registered and unregistered antenatal cases and to determine the correlation of maternal and fetal outcomes with antenatal care. Materials and methods This two-year observational study at Dr. D.Y. Patil Medical College's Obstetrics and Gynecology IPD in Pimpri, Pune, examined maternal and fetal outcomes in registered and unregistered pregnancies. Consent was obtained, and patients were categorized as registered and unregistered based on the number of antenatal visits. This was an observational prospective cohort study. Data on socioeconomic factors like income and education were analyzed to assess their association with registration status. Maternal outcomes included preterm delivery and complications such as preeclampsia, gestational diabetes, oligohydramnios, premature rupture of membranes, anemia, and postpartum complications. Fetal outcomes included birth weight and NICU admissions. Statistical analyses, including Chi-square tests, Fisher's exact test, and logistic regression, were used to examine relationships between variables and registration status. Results This study analyzed 502 cases, comprising 251 registered and 251 unregistered pregnancies, to investigate the impact of antenatal registration on maternal and fetal outcomes. Significant associations were observed between socioeconomic factors, such as lower income and education levels in unregistered pregnancies.Specifically, 46 (18.3%) unregistered cases were in the lowest income bracket, while 103 (41.0%) were in the lower-middle bracket, and the majority (132, 52.2%) had only completed secondary education. Unregistered pregnancies were linked to a higher prevalence of adverse outcomes, including preterm delivery (101, 40.23%), anemia (178, 70.9%), hypertensive disorders (30, 11.9%), gestational diabetes mellitus (16, 6.37%), fetal growth restriction (39, 15.3%), low birth weight (181, 72.1%), and NICU admissions (112, 44.6%), compared to registered pregnancies. Conclusion In conclusion, this study highlights the significant impact of registration status on pregnancy outcomes, emphasizing the need for comprehensive interventions to improve prenatal care access and to promote maternal and neonatal health equity. By addressing socioeconomic barriers and implementing targeted interventions, healthcare systems can strive towardensuring optimal pregnancy outcomes for all expectant mothers. This is done by ensuring that all antenatal patients are registered for prenatal care by involving a combination of strategies focused on support, education, and accessibility.

Factors Predicting Spontaneous Closure of Patent Ductus Arteriosus in Very Low Birth Weight Neonates.

Background Patent ductus arteriosus (PDA) is a relatively rare condition among neonates in the United States, estimated at approximately 1 in every 2,000 births. Managing hemodynamically significant patent ductus arteriosus (hsPDA) in very low birth weight (VLBW) neonates remains a challenge. This study aims to explore and report on the spontaneous closure of hsPDA in VLBW infants in a clinical setting. Methods We conducted a retrospective review of VLBW infants born from 2006 to 2014 at our institution. Infants included in the study were diagnosed with hsPDA via echocardiogram in the first week of life. We divided our population into two study groups: 1) those with PDA closure before discharge without medical/surgical treatment (spontaneous closure) and 2) those with closure by medical/surgical treatment. Relevant baseline data and PDA-related parameters were extracted from the medical records. Results A total of 108 infants were included in the study; 52 experienced spontaneous PDA closure, and 56 required treatment. Of the baseline characteristics, gestational age and mode of delivery differed significantly between the two groups. Within the adjusted model, cesarean section (CS) (OR: 0.18; 95% CI: 0.06-0.55), average pre-diagnosis partial pressure of carbon dioxide (PCO2) (OR: 0.92; 95% CI: 0.86-0.98), and pre-diagnosis daily fluid intake (OR: 0.96; 95% CI: 0.94-0.99) were associated with increased odds of spontaneous closure. Conclusion In our study of VLBW infants, several variables were associated with spontaneous hsPDA closure. Studies with larger sample sizes are much needed and have the potential to clinically impact the outcomes of neonates living with this relatively rare condition.

Correlation of global cardiac sphericity index and neonatal outcomes of appropriate for gestational age foetuses, small for gestational age foetuses and growth restricted foetuses delivered at term in Dr. Jose Fabella memorial hospital: a prospective cohort study

Correlation of global cardiac sphericity index and neonatal outcomes of appropriate for gestational age foetuses, small for gestational age foetuses and growth restricted foetuses delivered at term in Dr. Jose Fabella memorial hospital: a prospective cohort study

Association between adverse neonatal outcome and maternal haemodynamics and biomarkers in SGA and FGR

Association between adverse neonatal outcome and maternal haemodynamics and biomarkers in SGA and FGR

Surrogate endpoints for neonatal outcome: A rapid review.

Surrogate endpoints for neonatal outcome: A rapid review.

Incarcerated gravid uterus: a new treatment using the transvaginal ultrasound probe and narrative literature review

Background‘Incarcerated gravid uterus’ is a morbid complication that occurs in 1 in 3000 pregnancies. It is characterized by failure of a retropositioned uterus to become an abdominal organ between 12-14 weeks of gestation. If maternal symptoms develop or gestational age surpasses 14-16 weeks, replacement of a retropositioned uterus is recommended to reduce adverse outcomes. Previously described techniques for management include passive reduction, digital replacement, or more invasive methods such as laparoscopy, laparotomy, or sigmoidoscopy. These methods are either minimally effective, painful, or risky. ObjectiveThe objective of this report is to describe our clinical experience with a new minimally-invasive technique that uses the transvaginal ultrasound probe for uterine replacement in cases of incarceration, to conduct a narrative literature review on ‘incarcerated gravid uterus,’ and to propose an algorithm for management of this condition. Study DesignThis is a case series of eight patients with an incarcerated gravid uterus who were managed with the transvaginal ultrasound probe technique at one academic medical institution between March 2020 and July 2023, as well as a narrative review of the literature on ‘incarcerated gravid uterus.’ PubMed, Google Scholar, and Ovid MEDLINE databases were searched for the terms “incarcerated gravid uterus,” “uterine incarceration,” “uterine sacculation,” and “retroverted uterus” up to April 2024. ResultsThe transvaginal ultrasound probe technique resulted in successful uterine replacement, with resolution of symptoms, in all eight patients. All pregnancies resulted in live births with good neonatal outcomes—seven out of eight patients delivered at term, and one delivered in the late preterm period. ConclusionOur proposed technique for treatment of an incarcerated gravid uterus with the transvaginal ultrasound probe is simple, minimally-invasive and effective. Based on our experience and the narrative literature review, an algorithm for the management of an incarcerated gravid uterus is proposed.

Glycated Albumin to Predict Adverse Neonatal Outcomes among Women with Diabetes and Overweight or Obese Body Mass Index.

Glycated albumin (GA) has shown promise in predicting risk of adverse neonatal outcomes (ANO) in pregnant women with type 2 diabetes (T2DM) and gestational diabetes (GDM). However, previous studies showing a negative correlation between GA and body mass index (BMI) suggest that lower predictive cutoffs may be needed in populations with elevated BMI. We performed a case-control study of prospectively enrolled pregnant women with T2DM or GDM and BMI ≥25 kg/m2 matched to biobanked controls without diabetes. Serum collected during the second and/or third trimesters was used to measure the percentage of GA (% GA). Receiver operating characteristic (ROC) curves were used to examine % GA to predict an ANO composite, including macrosomia, hypoglycemia, respiratory distress syndrome, and/or hyperbilirubinemia for the second and third trimesters. The median BMIs for cases and controls were 34.0 and 31.0 kg/m2, respectively. The area under the ROC curve to predict the ANO composite was significant for second trimester values but ambiguous for third trimester due to its wide 95% CI. A cutoff of 12.3% GA during second trimester showed 100% sensitivity and 73% specificity. Transference of previously published reference ranges did not validate, suggesting lower ranges are needed for women with overweight/obesity. In this pilot study, % GA shows promise to stratify pregnant patients with diabetes and obesity into risk categories for ANO with excellent predictive ability in the second trimester. If this holds in larger studies, using second trimester % GA could allow additional intervention to improve blood glucose control and minimize ANO.

Vaginal Microflora in High Vaginal Swab in Prelabour Rupture of Membrane: A Descriptive Cross-sectional Study.

Premature rupture of membrane (PROM) refers to the disruption of the fetal membrane before the beginning of labor, resulting in spontaneous leakage of amniotic fluid. Cervicovaginal infection is an important risk factor of PROM and can lead to complications to mother and the child. This study aimed to delineate the bacterial patterns found in PROM so that the ideal appropriate responsive antibiotics can be chosen. A descriptive cross-sectional was done during the period of 6 months from December of 2023 to May 2023, to characterize the microorganisms in the vaginal fluid found in antenatal women presenting with premature rupture of membraneafter obtaining ethical approval (IRC number: 20102023/02). A total of 117 antenatal women diagnosed with premature rupture of membrane were included in the study. High vaginal swabs were collected for microbial culture and sensitivity. Data were entered using Microsoft Excel 2000 (v9.0) and Statistical Package for the Social Sciences (SPSS) software version 26.0 was used for analysis. Out of 117 samples, culture growth was present in the culture of high vaginal swabs of 23 (19.66%) women. The high vaginal swab cultures from the samples collected in women presenting with PROM reported 9 different types of pathogens E. coli in 12 (52.17%), Klebsiella in 4 (17.39%) and Pseudomonas in 2 (8.70%) cultures. This study reveals diverse microorganisms in premature rupture of membrane cases, with E. coli being the most common. Identifying these bacterial patterns is essential for selecting effective antibiotics, improving maternal and neonatal outcomes, and reducing morbidity and mortality by early detection and treatment of vaginal infections.

Preterm Neonates Admitted to the Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Prematurity is a significant cause of neonatal morbidity and mortality, especially in low-income and middle-income countries like Nepal. However, there is a paucity of data regarding its burden. This study aimed to determine the prevalence and outcomes of preterm neonates admitted to the neonatal intensive care unit of a tertiary care hospital. This descriptive cross-sectional study was conducted among preterm neonates at a tertiary care hospital between July 15, 2022 to July 14, 2023 after obtaining ethical approval from the Institutional Review Committee (Reference number: F-NMC/557/078-079). Neonates with gestational age less than 37 weeks were included in the study. Total sampling method was used. Among 980 neonates admitted to intensive care unit, preterm neonates were 112 (11.43%). A total of 69 (61.61%) preterm neonates were outborn, and 65 (58.04%) were male. The median gestational age and birth weight were 32 weeks (interquartile range: 30- 34 weeks) and 1500 gm (interquartile range: 1300-1800 gm), respectively. There were 60 (53.57%) neonates with sepsis, 51 (45.54%) with neonatal jaundice and 38 (33.93%) with respiratory distress. Death occurred in 12 (10.71%) preterm neonates in the hospital. The prevalence of preterm neonates was similar to other studies done in similar settings.

The Association Between Resolvin D1 Levels and Gestational Diabetes Mellitus: Implications for Perinatal Outcomes

OBJECTIVE: To evaluate maternal Resolvin D1 levels in women with gestational diabetes mellitus (GDM) and investigate the association between perinatal outcomes. STUDY DESIGN: This case-control study included 88 singleton pregnancies, conducted from August 2023 to January 2024, at a tertiary care center. Participants were divided into two groups: 44 pregnant women diagnosed with GDM comprised the study group, and 44 healthy pregnant women served as the control group. Additionally, the GDM group was categorized based on management approach into 21 women managed with diet alone and 23 women requiring insulin therapy. Maternal plasma Resolvin D1 levels and maternal-neonatal outcomes were then compared between groups. The analysis involved determining the optimal Resolvin D1 cut-off levels for predicting composite adverse neonatal outcomes in GDM using receiver operating characteristic curve (ROC) analysis. RESULTS: The plasma Resolvin D1 level in pregnant women with GDM was significantly higher compared to the control group (337±74.1 vs. 297±56.7, p<0.001). Furthermore, maternal plasma Resolvin D1 levels were associated with composite adverse neonatal outcomes [presence of at least one of the following conditions: preterm birth (<37 weeks), low birth weight (LBW) (<2500 grams), neonatal hypoglycemia, hyperbilirubinemia, APGAR score at 5th minute <7, respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU)], with a cut-off of >338.75, showing a sensitivity of 56.3%, a specificity of 79.2%, and an AUC of 0.675 (95% CI: 0.567-0.771, p=0.024). CONCLUSIONS: This study demonstrated that pregnancies affected by GDM exhibit elevated levels of Resolvin D1, which is associated with a higher incidence of composite adverse neonatal outcomes.

Effectivity of Walking Epidural Analgesia in Normal Labor to Reduce Labor Pain and Improve Neonatal Outcome

Background: In Indonesia itself, only 15% of 2,700 labor women felt the pain was tolerable, meanwhile 85% said the pain was moderate until unbearable. Usage of epidural anaesthesia for pain relief in labor is common but controversies still persist about its effect and side effect on labor process. Neuraxial block especially epidural also not yet well known in Indonesia.Objective: This research aims to study maternal visual analogue scale (VAS) score changes before and after walking epidural anesthesia (WELA) and fetal outcome after birth. Methods: This research is an experimental design with one pre-test and post-test group. Data was taken from Unggul Karsa Medika Hospital and Permata Hati Clinic medical records from 2017 until 2022. Ethical approval was approved by Unggul Karsa Medika Hospital Ethical Committee (003/KEP-LIT/III/2023). After that all of 450 patients’ data was then analyzed by Wilcoxon with IBM® SPSS Statistic 26th with α=0.05.Result: Statistical analysis shows there was significant decrease of pain severity with initial VAS 7.58 to 3.37 after WELA procedure (p 0.0001). APGAR scores of all the foetus were normal with no asphyxia present.Conclusion: Our findings demonstrate the benefit of WELA for both of mother and fetus. was significantly decrease in VAS score during labor. Fetal outcome was also notably great after labour process and usage of epidural could decrease the risk of fetal acidemia and distress which reduce caesarean section rate. Usage of WELA in Indonesia could be encourage and recommended as an alternative to elective caesarean section.

Pregnancy outcomes in correlation with placental histopathology in pregnancies complicated by fetal growth restriction with vs. without reduced fetal movements.

Fetal movements are crucial indicators of fetal well-being, with reduced fetal movements (RFM) suggesting potential fetal compromise. Fetal growth restriction (FGR), often linked to placental insufficiency, is a major cause of perinatal morbidity and mortality. This study aimed to investigate the neonatal, labor, and placental outcomes of FGR pregnancies with and without RFM at term. In this retrospective study, data from all term, singleton deliveries with FGR and concomitant RFM were obtained and compared to an equal control group of FGR without RFM. Maternal characteristics, pregnancy and neonatal outcomes, and placental histology were compared. The primary outcome was a composite of adverse neonatal outcomes. A multivariable regression analysis was performed to identify independent associations with adverse neonatal outcomes. During the study period, 250 FGR neonates with concomitant RFM and an equal control group were identified. The groups did not differ in maternal demographics aside from significantly higher rates of maternal smoking in the RFM group (p < 0.001). Polyhydramnios and oligohydramnios (p = 0.032 and p = 0.007, respectively) and meconium-stained amniotic fluid (p < 0.001) were more prevalent in the FGR+RFM group. Additionally, the RFM group showed higher rates of adverse neonatal outcomes despite having larger neonates (p = 0.047 and p < 0.001, respectively). No significant differences were observed in placental findings. Logistic regression identified RFM as an independent predictor of adverse neonatal outcomes (aOR 2.45, 95% CI 1.27-4.73, p = 0.008). Reduced fetal movements are significant and independent predictors of worse neonatal outcomes in FGR pregnancies, suggesting an additional acute insult on top of underlying placental insufficiency.