Newborn Apgar Scores Research Articles

Efecto de la oxitocina en el Apgar bajo en recién nacidos prematuros y a término

Efecto de la oxitocina en el Apgar bajo en recién nacidos prematuros y a término Oxytocin efect's in the low Apgar scores in premature and term newborns Carlos Minchón, Teresita Vizconde, Diana Minchón y Jhonatan Díaz Universidad Nacional de Trujillo, cminchonm@gmail.com Universidad Católica del Perú - Trujillo, tvizconde_o@hotmail.com Universidad Privada Antenor Orrego, dvine_@hotmail.com Universidad Nacional de Trujillo, jhonatan_tk@hotmail.com DOI: https://doi.org/10.33017/RevECIPeru2011.0040/ RESUMEN El Apgar es un indicador rápido del estado cardiorespiratorio y neurológico del recién nacido y si es bajo el estado del recién nacido se considera no satisfactorio. El Apgar al primer minuto de vida constituye un índice de depresión y a los cinco minutos o posteriores reflejan la insuficiencia de las maniobras de reanimación, la necesidad de realizar esfuerzos terapéuticos adicionales y habitualmente la gravedad del problema subyacente del neonato. En el presente trabajo se evalúa el efecto de la oxitocina en el Apgar bajo en prematuros y nacidos a término en el Hospital Belén de Trujillo-Perú. El estudio observacional transversal comprendió 4812 partos de gestantes de 15 años o más y con hasta 42 semanas de gestación, atendidos en el periodo mayo 2005 - mayo 2008. Los datos se procesaron con PASW Statistics 18 y EPIDAT 3.1. La oxitocina fue empleada en 2088 partos y en 12% de los partos nacieron prematuros. El Apgar bajo estuvo presente al primer minuto de vida en el 7.52% de recién nacidos y a minuto 5 en el 1.37%. La oxitocina constituye un factor protector contra el Apgar bajo solo al 5’ (RR=0.453, IC95%: 0.261-0.784), lo cual fue determinado empleando estimaciones confidenciales de Mantel-Haenszel (M-H). El análisis estratificado que se realizó indicó que el efecto protector de la oxitocina es estadísticamente significativo en prematuros tanto al primer minuto (RR=0.593, IC95%: 0.395-0.892) como al quinto minuto (RR=0.346, IC95%: 0.144-0.830) de vida de los recién nacidos. Descriptores: Oxitocina, Apgar bajo, recién nacido, análisis estratificado, Mantel-Haenszel. ABSTRACT The Apgar score is an indicator of the newborn´s cardiorespiratory and neurological conditions. The study evaluates the oxytocin effect’s in the low Apgar scores in newborns at term and premature in the Hospital Belen of Trujillo from Peru. The cross-sectional study included 4812 births in pregnant women aged 15 years or more and up to 42 weeks of gestation, treated at the Belen Hospital’s - Trujillo, from May 2005 - May 2008. The data were processed with PASW Statistics 18 and EPIDAT 3.1. Oxytocin was used in 2088 births and 12% of births were born preterm. Low Apgar score was present in the first minute of life at 7.52% of newborns and 5 min in 1.37%. Oxytocin is a protector factor against low Apgar only at the fifth minute (RR = 0.453, 95% CI: 0261-0784), findings confirmed by Mantel-Haenszel estimates. The protector effect of oxytocin, determined by the stratified analysis, is especially important in premature neonates both in the first minute (RR = 0.593, 95% CI 0395-0892) and at the fifth minute (RR = 0.346, 95% CI: 0144-0830). Keywords: Oxytocin, low Apgar score, newborn, stratified analysis.

Retrospective evaluation of anesthetic techniques in pregnant women with renal transplantation

Background/aimThe aim of this study was to evaluate anesthesia management in cesarean operation of pregnant women who underwent renal transplantation and the effects on postoperative renal function, retrospectively.Materials and methods After obtaining the approval of the ethics committee of our hospital, the records of pregnant women who underwent kidney transplantation and cesarean section between 2007 and 2017 were retrospectively analyzed. The patients’ demographic data, concomitant disease history, the treatment received, and type of anesthesia were retrospectively evaluated and recorded in the follow-up form.Results It was found that a total of 47 women who underwent renal transplantation had 47 live births by cesarean section. The mean age of the pregnant women was 30 ± 5.34 years. The mean time between renal transplantation and conception was 95.34 ± 55.02 months. It was found that 14 (29%) of a total of 47 patients had their first pregnancy. The number of patients with a gravidity of 4 and above was 9 (19%). A total of 21 (44.7%) pregnant women had spontaneous miscarriage. Five (10.6%) patients were treated with curettage for therapeutic purposes. Twenty-two (46%) of the patients whose immunosuppressive therapy was continuing were treated with azathioprine, tacrolimus, and prednisolone. The mean gestational age of delivery was 36.5 ± 1.59 weeks. The rate of prepregnancy hypertension diagnosis was 25.5% (n = 12), while the rate of developing gestational hypertension was 21.3% (n = 10). Spinal anesthesia was administered to 42 (91%) of 47 patients who underwent cesarean section. In the preoperative period, the mean value of serum blood urea nitrogen was 62.88 ± 41.97 mg/dL and the mean serum creatinine level was 3.21 ± 6.17 mg/dL. In the postoperative period, these values were 44.4 ± 29.9 mg/dL and 1.91 ± 1.63 mg/dL, respectively. When the pre- and postoperative serum urea and creatinine levels were compared, they were found to be lower in the postoperative period. However, there was no statistically significant difference (P > 0.05). The mean weight of the newborns was determined as 2707.3 ± 501.5 g. While the number of newborns with a low birth weight (<2500 g) was 18 (38%), among them 3 (0.6%) were below 2000 g. It was found that 36.2% (n = 17) of the newborns required intensive care. None of the patients developed graft rejection.Conclusion If there is no contraindication, regional anesthesia may be preferred in the first place for pregnant women with renal transplantation. We suggest that this method of anesthesia has some advantages in terms of maintaining postoperative renal function and higher Apgar scores in newborns with low birth weight.

Labor analgesia: Comparison of epidural patient-controlled analgesia and intravenous patient-controlled analgesia

In our study, patient controlled epidural analgesia (PCEA) and patient controlled intravenous remifentanil analgesia (PCIVA) were compared for VAS, and also their side effects on mother and newborn. In this study, 37 pregnant women with a single fetus, who had labor analgesia, were divided into groups of PCIVA (Group 2) and PCEA (Group 1). Bupivacaine 1.25 mg/ml and fentanyl 2 mcg/ml in 100 ml epidural solution were prepared for Group 1. The infusion dose was 15 ml, 5 ml divided doses. We set 5 ml/h basal infusion, 5 ml patient-controlled bolus and 20 min lock time. We prepared 2 mg remifentanil in 100 ml intravenous solution for Group 2. We set 20 mcg/h infusion, 0.05mcg/kg patient-controlled bolus and five min lock time. VAS, maternal-fetal heart rate, blood pressure, oxygen saturation, nausea-vomiting and sedation were recorded during labor. We recorded Apgar scores and maternal satisfaction at the end of labor. The findings showed that both groups could provide adequate analgesia. However, VAS scores were higher in Group PCIVA. The mother satisfaction and newborn's Apgar scores were similar. In both groups, desaturation, which is requiring oxygen support, was not determined. The oxygen saturations were lower in Group 2. The side effects and patient satisfaction were similar in both groups. Although PCIVA was found to be satisfactory concerning maternal satisfaction, VAS after 2nd hour were higher compared to PCEA. PCEA is the gold standard in labor analgesia. However, we believe that PCIVA is a good alternative to epidural analgesia in cases where epidural analgesia is contraindicated or where the patient does not want an epidural.

Adölesan gebelikler

ADOLESCENT PREGNANCIESAim: To make a comparison between adolescents and primigravid adults ( between 19 and 35 years old) who delivered in Kırşehir at 2016 regarding maternal hemoglobin and hematocrit levels, Apgar scores of newborns, fetal birthweights and mode of delivery.Materials and methods: The files of patients who delivered in Ahi Evran University Training and Research Hospital between 01.01.2016 and 31.12.2016 were investigated. The primigravid pregnants were allocated into two groups as group 1 aged 18 and lower and group 2 aged between 19 and 35. Groups were compared in terms of maternal hemoglobin and hematocrit levels, Apgar scores of newborns, fetal birthweights and mode of delivery.Results: 118 patients were included in the study. There was 53 pregnant in group 1 and 65 pregnant in group 2. The mean age of adolescents was 17,51 ± 0,72, and the mean age of adults was 23,95 ± 4,43. There was no statistically significant difference between the groups in terms of maternal hemoglobin and hematocrit levels, fetal birth weights and first and fifth minutes Apgar scores of newborns (p ˂ 0,069, p ˂ 0,128, p ˂ 0,128, p ˂ 0,391, p ˂ 0,773, p ˂ 0,921).Cesarean section rate of adolescents was significantly lower than that of adults (p = 0.002). There was no statistically significant difference between the groups according to cesarian indications (p = 0,450). Conclusion: Because the mean age of adolescents was high and only primigravid adult pregnant were included in the control group there was no significant difference between the groups in terms of maternal hemoglobin and hematocrit levels, fetal birthweights and first and fifth minutes Apgar scores of newborns. Cesarian section rate of adolescents was significantly lower than that of adults. There was no statistically significant difference between the groups according to cesarian indications.

Arterial blood gas and acid-base balance in patients with pregnancy-induced hypertension syndrome.

This study aimed to investigate the expression of arterial blood gas and acid-base balance in patients with pregnancy-induced hypertension syndrome and their influence on newborns. A total of 348 patients with pregnancy-induced hypertension syndrome (research group) admitted and treated in the First People's Hospital of Jining from March 2013 to March 2016 were retrospectively analyzed, and another 156 cases of healthy pregnant women who were physically examined were selected as the control group. Blood gas analysis was performed on pregnant women, and pH value, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), bicarbonate radical (HCO3−) and base excess (BE) were included as test indexes. Apgar score was made for newborns for neonatal asphyxia. The evaluation was performed at 1, 5, and 10 min after birth to analyze the correlation between the maternal arterial blood pH and the neonatal Apgar score. The pH value, and PO2 and HCO3− levels in the research group were lower than those in the control group (p<0.05). PCO2 and BE levels in the research group were higher than those in the control group (p<0.05). The incidence of neonatal mild asphyxia (Apgar score, 4–6 points) and neonatal severe asphyxia (Apgar score, <4 points) in the research group were higher than that in the control group (p<0.05). The Apgar score of newborns was positively correlated with the pH value of the arterial blood of pregnant women. Blood gas analysis in patients with pregnancy-induced hypertension syndrome is useful to a certain extent to evaluate the condition of the patient. The combination of the pH value of the patient and the Apgar score of the newborns may help improve the judgement rate of neonatal asphyxia so as to improve the quality of childbirth by early monitoring and intervention of the newborns.

Effect of ropivacaine on painless delivery and its effect on mother and infant

Objective To investigate the effect of ropivacaine on painless delivery and its effect on mother and infant. Methods From March 2016 to May 2017, 64 cases of maternal painless labor demand in the Eighth People's Hospital of Taiyuan were chosen as the observation group, 42 cases of natural childbirth pregnant women in the Eighth People's Hospital of Taiyuan were selected as control group.The degree of labor pain, pregnancy outcome and the effect on mother and infant were compared. Results The excellent rate of normal delivery, oxytocin usage rate in the observation group were 50%, 7.81%, respectively, which were better than those in the control group (all P<0.05). The Apgar scores of newborns at 1 min 5 min after birth in the observation group were (8.92±1.20)points, (9.43±0.56)points, respectively, which were higher than those in the control group (t=5.362, 4.036, all P<0.05). The postpartum lactation of the observation group was 54.69%, and had no statistically significant difference compared with the control group.After delivery, the level of NO in the observation group was higher than that in the control group [(94.2±9.6)μmol/L vs.(82.6±5.6)μmol/L], and the cortisol level was lower than that in the control group [(726.3±68.1)ng/mL vs.(892.7±136.4)ng/mL], the differences were statistically significant (all P<0.05). Conclusion Ropivacaine combined with spinal and epidural anesthesia is an ideal way for painless delivery, with good analgesic effect, which can improve the natural delivery rate and has little effect on mother and child. Key words: Ropivacaine; Anesthesia; Natural childbirth

Are gestational and type II diabetes mellitus associated with the Apgar scores of full-term neonates?

ObjectiveTo compare Apgar scores of full-term newborns of mothers with gestational (GDM) or type II diabetes mellitus (T2DM) with scores of newborns of mothers without impaired glucose tolerance.Study designThis was a retrospective data collection study (n=297). We reviewed 1-minute and 5-minute neonatal Apgar scores of newborns of mothers with GDM (n=100) or T2DM (n=97). Our control group consisted of newborns of mothers without a prior history of impaired glucose tolerance (n=100). ANOVA and linear model with corrected errors were used and adjusted for newborn sex and weight, and maternal age. Chi-squared analysis was performed for newborn sex.ResultsThe mean 1-minute and 5-minute Apgar scores were 7.8 and 8.9 for the GDM group and 7.7 and 8.9 for the T2DM group, respectively. There was no statistical difference in the 1-minute and 5-minute Apgar scores between the GDM group and controls (P=0.89 and P=0.13, respectively) nor in the scores between the T2DM group and controls (P=0.67 and P=0.40, respectively).ConclusionMaternal history of GDM and T2DM does not appear to be associated with the 1-minute and 5-minute Apgar scores of full-term newborns of mothers with GDM and T2DM as compared to newborns of mothers without a history of impaired glucose tolerance.

Associations between glucokinase and glucokinase regulatory protein gene polymorphisms and clinical parameters in pregnant women

ABSTRAKTWstęp: Ciąża wiąże się ze zmianami w metabolizmie węglowodanów, które mogą wywierać wpływ na noworodka. Podstawowym macierzyńskim czynnikiem środowiskowym, który reguluje wzrost płodu, jest dostarczanie substratu do łożyska, a glukoza jest głównym substratem energetycznym do wzrostu wewnątrzmacicznego. Podstawowym źródłem glukozy są węglowodany z diety. Glukokinaza (GCK) jest enzymem odpowiedzialnym za regulację wychwytu i magazynowania glukozy. Białko regulatorowe glukinazy (GCKR) moduluje glukokinazę, która katalizuje wątrobową fosforylację glukozy, prowadząc do syntezy glikogenu i triacylogliceroli.Celem badania była ocena związku między polimorfizmami GCK rs1799884 i GCKR rs780094 a parametrami klinicznymi u kobiet w ciąży.Materiały i metody: Do badania włączono 207 kobiet w ciąży z prawidłowymi wartościami doustnego testu tolerancji glukozy (OGTT). Przeanalizowano związek między badanymi polimorfizmami a parametrami klinicznymi takimi jak: masa ciała przed ciążą, masa ciała przy porodzie, wzrost masy ciała w czasie ciąży, wskaźnik masy ciała (BMI) przed ciążą, BMI przy porodzie, wzrost BMI w trakcie ciąży, czas trwania ciąży, masa ciała noworodka, wynik w skali APGAR i stężenia glukozy dla OGTT.Wyniki i wnioski: Nie stwierdzono zależności istotnych statystycznie między polimorfizmami GCK rs1799884 i GCKR rs780094 a badanymi parametrami klinicznymi, z wyjątkiem wyższego wzrostu BMI podczas ciąży u kobiet z genotypem CC GCK rs1799884.

The effect of operating room active warming intervention on maternal hypothermia after planned cesarean

Objective To explore the effect of operating room active warming intervention on maternal hypothermia after planned cesarean. Methods According to the random number table method, from December 2016 to December 2017, 92 patients after heart failure were divided into the control group of 45 patients and the experimental group with 47 patients. Patients in the control group were conducted with the routine warming intervention, while warmed IV fluids combined with forced-air warming as active warming intervention was processed in the experimental group. The core temperature, the incidence of hypothermia, bedside shivering assessment scale, thermal comfort scores and new-born Apgar score between the two groups of patients were compared. Results Compared with the control group, the field of core temperature were significantly higher than those in the control group (F=5.96, P 0.05). Conclusion Operating room active warming intervention may have a beneficial effect on maternal hypothermia after planned cesarean, but the relevant efficacy was not shown in thefield of Apgar score. Key words: Active warming intervention; Cesarean section; Maternal hypothermia

The pre-operation of the cesarean of the patients with the load of carbohydrate effect on the insulin resistance and the blood glucose level of the newborn

Objective To evaluate the comfort satisfaction and the insulin resistance of patients with cesarean section and the effects of the postoperative blood sugar on the newborns during the operation. Methods Forty patients who were got elective C-section were selected and divided randomly into two groups(n=20): oral carbohydrate group(CHO group), oral placebo group(P group). Both groups used epidural anesthesia, and a routine preoperative fasting 300 ml carbohydrate drinks(it contains 14.1 g of carbohydrates per 100 ml of drink) was administrated orally 2 h before anesthesia in oral CHO group. Patients in oral placebo group were given an equal amount distilled water instead of carbohydrate. The levels of blood glucose, plasma insulin and glucagons were tested after 2 h and after fetus delivery. According to levels of blood glucose and insulin, homeostasis model assessment(HOME) was applied to calculate the index of insulin resistance(HOMA-IR) and insulin sensitivity index(HOMA-ISI). After fetus delivery, neonates blood glucose was tested immediately. Meanwhile, the subjective comfort satisfaction of the two groups patients were also tested. Results After fetus delivery, blood glucose levels of two groups were significantly elevated than the levels of 2 h after loading(P<0.05). But there is no difference of blood glucose levels between two groups. Compare with levels of 2 h after loading, patients in P group had higher insulin levels, elevated HOMA-IR levels and lower HOME-ISI levels than levels of patients in CHO group (P<0.05). Patients in P group had higher glucagon levels that patients in CHO group. Patients in CHO group have less sense of hunger. Patients of two groups have no difference on sense of vomiting. The neonates blood glucose levels in the CHO group was higher than those in P group(P<0.05). Apgar scores of newborns in two groups are not different. Conclusions C-section preoperative oral intake of carbohydrate can safely reduce the insulin resistance and relieve the feelings of thirst, and help to raise blood glucose levels in newborns. Key words: Csection; Carbohydrate; Insulin resistance; Newborn; Blood glucose

Effect of preloading different kinds of liquid combined with phenylephrine on parturient and neonate during epidural anesthesia for cesarean section

Objective To investigate the effect of preloading different kinds of liquid combined with phenylephrine on parturients and neonate during epidural anesthesia for cesarean section. Methods Sixty patients who were eligible to cesarean section were randomly divided into two groups(n=30): hydroxyethyl starch(6% in normal saline) 500 ml(group H) and lactated ringers solution 1 000 ml(group R). All patients were treated with a phenylephrine infusion 0.5 μg·kg-1·min-1. Phenylephrine infusion protocol was continued until the time of fetal extraction. Recorded the HR, SBP and DBP at beginning of anesthesia(T0), 3 min(T1), 10 min(T2) before cesarean section, 3 min(T3), 10 min(T4) after delivery the fetus. The maternal perioperative adverse events of parturients and the Apgar score of the newborn at 1, 5 min were recorded after fetal delivery. At the same time, umbilical vein blood gas analysis results of the fetus after delivery was also recorded. Results Compared with group R, HR was significantly decreased at T4 in group H. Compared with group H, SBP at T2 group R decreased significantly(P 0.05) . Rates of nausea and vomiting, dizziness, chest tightness are not significant different between the two groups(P>0.05). Conclusions Preloading with 6% of hydroxyethyl starch before cesarean section was beneficial to getting more stable hemodynamics and less negative effect on newborn baby. Key words: Phenylephrine; Infusions, intravenous; Fluid therapy; Cesarean section

Feasibility of hydroxychloroquine adjuvant therapy in pregnant women with systemic lupus erythematosus

Objective: This study aims to investigate the clinical effects of hydroxychloroquine adjuvant therapy in pregnant women with Systemic Lupus Erythematosus (SLE). Methods: A total of 78 pregnant women with SLE from February 2016 to August 2017 were recruited and divided into two groups, control (n=39) and observation (n=39), by using a random number table. The observation group received hydroxychloroquine adjuvant therapy, whereas the control group received conventional symptomatic treatment. The lupus activity during pregnancy, term birth rate, pregnancy and fetus outcomes, new-born Apgar score, and neonatal weight of the two groups were compared. Results: The occurrence rate of lupus during pregnancy in the observation group was 25.64%, which was significantly lower than that of the control group (51.28%) (P<0.05). The observation group achieved significantly higher term birth rate (84.62%) than the control group (58.97%) (P<0.05). The occurrence rates of bad pregnancy and fetus outcomes of the observation and control groups were 17.95% and 44.44%, respectively, which showed a significant difference (P<0.05). The new-born Apgar score and neonatal weight of the observation group were 9.61 ± 0.25 and 2.78 ± 0.56 kg, whereas those of the control group were 8.10 ± 0.31 and 2.47 ± 0.58 kg, showing a significant difference (P<0.05). Conclusions: Hydroxychloroquine adjuvant therapy exerts outstanding clinical effects to pregnant patients with SLE. This therapy not only improves pregnancy outcome but also reduces the occurrence of lupus. This method has a very high clinical application value and is worthy of further clinical research and applications.

The Relationships among Postpartum Fatigue, Depressive Mood, Self-care Agency, and Self-care Action of First-time Mothers in Bangladesh.

Postpartum fatigue can impact maternal well-being and has been associated with levels of perceived self-care. This study aimed to examine the relationship among fatigue, depressive mood, self-care agency, and self-care action among postpartum women in Bangladesh. A descriptive cross sectional survey was done with 124 first-time mothers from two tertiary hospitals in Dhaka, Bangladesh. The Modified Fatigue Symptoms checklist, Denyes' Self Care Instrument, the Edinburgh Postnatal Depression Scale, and items on sociodemographic and delivery-related characteristics, were used in Bengali via translation and back-translation process. High fatigue levels were found in 18.5%(n=23) and 73.4% had possible depression (n=91). There was a significant negative relationship between fatigue and self-care agency (r=-.31, p < .001), and self-care action (r=-.21, p < .05). Fatigue differed by level of self-care agency (t=4.06, p < .001), self-care action (t=2.36, p=.023), newborn's APGAR score (t=-2.93, p=.004), parental preparation class participation (F=15.53, p < .001), and postpartum depressive mood (t=-4.64, p < .001). Findings suggest that high level of self-care efficacy and behaviors can contribute to fatigue management, and highlight the need for practical interventions to better prepare mothers for postpartum self-care, which may, in turn, alleviate postpartum fatigue.

The Effects of Birth Weight on Newborn Apgar Score with Other Potential Medical and Child Risk Factors, Brussels Cohort Study

The Effects of Birth Weight on Newborn Apgar Score with Other Potential Medical and Child Risk Factors, Brussels Cohort Study

Low Apgar scores in term newborns and long-term gastro-intestinal morbidity: a population-based cohort study with up to 18 years of follow-up

Introduction: Low Apgar scores (<7) measured at age 5 minutes can predict short-term infant morbidity and mortality. Although an association exists between low Apgar scores and neuropsychological disorders, other childhood disorders were not thoroughly studied. We aimed to study the possible association between low 5-minute Apgar scores in term newborns and their long-term childhood gastrointestinal (GI) morbidity.Methods: A population-based cohort analysis was performed comparing total and different subtypes of GI-related pediatric hospitalizations among newborns with normal (≥7) and low (<7) 5-minute Apgar scores. The analysis included all term singletons born between the years 1999 and 2014 at a single tertiary regional medical center. Infants with congenital malformations, multiple gestations, and all perinatal deaths were excluded from the analysis. GI-related morbidities included hospitalizations involving a predefined set of ICD-9 codes, as recorded in the hospital computerized files. A Kaplan–Meier survival curve was constructed to compare the cumulative GI morbidity, and a Cox proportional hazards model was used to adjust for confounders.Results: The study population, including 223 244 term singletons, was followed for an average of 10.02 ± 6.0 years (0–18 years, median 10.25) following discharge from birth hospitalization. Low 5-minute Apgar scores were recorded in 585 (0.3%) newborns. Incidence of GI-related hospitalizations was higher among the low versus the normal 5-minute Apgar score group (7.4 versus 5.2%; 8.6/1000 person years (PY) versus 5.2/1000 PY, respectively; p = .02; odds ratio =1.66, 95%CI 1.36–1.96). The association remained significant and independent while adjusting for gestational age, fetal weight, offspring gender, maternal age, maternal smoking, hypertension, and diabetes (Adjusted HR =1.57, 95%CI 1.16–2.12, p = .003).Conclusions: Low 5 minutes Apgar score is associated with an increased risk for long-term pediatric GI morbidity of the offspring. Our results suggest that Apgar scores can be used as a possible predictor for long-term pediatric morbidities and thus may necessitate appropriate surveillance in this vulnerable group of children.

Investigation of possible maternal and fetal factors which affect umbilical coiling index

Aim: The aim of this study was to investigate the possible maternal and fetal factors, which affect the Umbilical Coiling Index (UCI).Methods: This prospective, observational, analytic study was conducted using the data of 380 women with term pregnancy and newborns who presented at a University Hospital. Hemoglobin (Hb), ferritin, iron, and the total iron binding capacity (TIBC) of the maternal blood were measured, and transferrin saturation was estimated based on the ratio between serum iron and TIBC. Blood gases, ferritin, iron, and TIBC of the umbilical cord were also measured, and the transferrin saturation was calculated. The length and thickness of the umbilical cord, numbers of coilings, weight of placenta, neonatal weight were registered. The UCI was calculated dividing the total number of coils by the length of the umbilical cord (in cm).Results: A positive, linear, and statistically significant relationship was found between the UCI scores and the umbilical cord blood transferrin saturation, umbilical cord thickness, and the first- and fifth-min APGAR scores (p = .044, p < .001, p = .008, p = .022, respectively). No statistically significant relationship was found between the maternal Hb values and the UCI scores (p = .472). In addition, there was no statistically significant relationship between the UCI scores and maternal ferritin, maternal transferrin saturation and umbilical cordon ferritin levels (p = .940, p = .681, and p = .975, respectively).Conclusions: A positive correlation was found between the UCI and umbilical cord transferrin saturation and between the newborn APGAR scores. However, this finding is not sufficient to explain the relationship of the umbilical cord dynamics with the newborn wellbeing and coiling.

Effects of pushing techniques during the second stage of labor: A randomized controlled trial

ObjectiveSpontaneous pushing is a method that is used in the management of the second stage of labor and suggested to be more physiological for the mother and infant. The present study aims to evaluate the effects of pushing techniques on the mother and newborn. Materials and methodsThis randomized prospective study was performed between June 2013–March 2014 in a tertiary maternity clinic in Istanbul. 80 low risk, nulliparous cases were randomized to pushing groups. Valsalva pushing group was told to hold their breath while pushing. No visual-verbal instructions were given to spontaneous pushing group and they were encouraged to push without preventing respiration. Demographic data, second stage period, perineal laceration rates, fetal heart rate patterns, presence of meconium stained amniotic liquid, newborn APGAR scores, POP-Q examination and Q-tip test results were evaluated in these cases. ResultsThe second stage of labor was significantly longer with spontaneous pushing. Decrease in Hb levels in valsalva pushing group was determined to be higher than spontaneous pushing group. An increased urethral mobility was observed in valsalva pushing group. ConclusionsAlthough the duration of the second stage of labor was longer compared to valsalva pushing technique, women were able to give birth without requiring any verbal or visual instruction, without exceeding the limit value of two hours and without affecting fetal wellness and neonatal results.

Influence of WeChat social platform on the psychological state and pregnancy outcome of pregnant and lying-in women

Objective To investigate the influence of WeChat social platform on the psychological state and pregnancy outcome of pregnant and lying-in women. Methods A total of 80 pregnant and lying-in women who received prenatal examination from July, 2014 to September, 2015 were selected as study objects, divided into two groups (40 patients each) randomly. Intervention was conducted to the usual care of control group. WeChat social platform was added to observation group based on control group. The understanding degree, HAMD, HAMA score, pregnancy outcome, delivery and newborn Apgar score of the two groups of pregnant and lying-in women to pregnancy knowledge were compared. Results The understanding degree of pregnant and lying-in women in observation group was superior to control group, and the difference had statistical significance(P<0.05). After intervention, HAMD and HAMA scores of observation group were lower than control group, and the difference had statistical significance(P<0.05). The natural parturition rate, postpartum hemorrhage and breast feeding rates of observation group were 70.00%, 5.00% and 92.50% were superior to control group (35.00%, 20.00% and 57.50%), and the difference had statistical significance(P<0.05). The postpartum hemorrhage quantity, post-partum time in bed and total delivery time of the observation group were lower than control group, and the difference had statistical significance(P<0.05). The Apgar score of newborn in observation group was obviously higher than control group, and the difference had statistical significance(P<0.05). Conclusions The building of WeChat social platform can effectively improve the mental state of pregnant and lying-in women, psychological state, relieve the unhealthy emotions of tension, anxiety and depression and be in favor of pregnancy outcome.Meanwhile, the cognition degree of pregnant and lying-in women to pregnancy knowledge should be improved, which is worth having popularization and application. Key words: WeChat social platform; Maternal psychological state; Pregnancy outcome; Knowledge; Gestation

Outcomes of the patients diagnosed incidentally appendicitis during cesarean section.

Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016. Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean dia-meter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

Case 2: A Neonate Affected by Maternal Pica

A male infant is born at 38 6/7 weeks’ gestation via vaginal delivery to a 23-year-old gravida 3, para 2-0-0-2 woman. On the first day after birth, he is found to have a critically elevated blood lead level (BLL). The infant was tested because of the mother’s prenatal history of an elevated BLL. History revealed the mother had ingested soil from her backyard and used ethnic products from a local store (not tested for lead) throughout the pregnancy. The backyard soil was later tested by the New York City Department of Health and Mental Hygiene (NYC DOHMH), which revealed high lead levels. Five months before delivery, the maternal BLL was 10 μg/dL (0.48 μmol/L). Repeat maternal BLL on postpartum day 2 was 49 μg/dL (2.3 μmol/L). At birth, the newborn Apgar scores were 9 and 9 at 1 and 5 minutes, respectively, the birthweight was 3.57 kg, and the length was 50 cm (body surface area of 0.21 m2). The infant’s venous BLL on the first and second day after birth was 78 μg/dL (3.8 μmol/L). On admission, the infant had unremarkable routine chemistry studies, a hemoglobin of 17 g/dL (170 g/L), and mean corpuscular volume of 90 um3 (90 fL). On the third day after birth, the newborn was transferred from the NICU of an affiliate hospital to our institution for dual chelation therapy with calcium disodium versenate (CaNa2EDTA) and succimer, as recommended by the Centers for Disease Control and Prevention (CDC) and NYC DOHMH guidelines. Succimer is a chelating agent that has 2 sulfhydryl groups capable of complexing to lead, making it water soluble, and thus increasing the urinary excretion of lead. CaNa2EDTA is another chelating agent that chelates lead that has taken the place of calcium and promotes its urinary excretion. …