NICU Admission Rates Research Articles

Pregnancy Outcomes with Intrahepatic Cholestasis

Introduction: ICP is a reversible rare disorder prevailing in 2% of pregnancies resulting in debilitating feto-maternal consequences. Maternal problems resolves soon after delivery but fetal complications result in multiple deteriorations. Present study was undertaken to assess the pregnancy outcomes with ICP on both mother and fetus. Methodology: A prospective study design was used and study was conducted in tertiary health care sector in department of obstetrics and gynecology for period of 2 years. 80 mothers with history of pruritus, aminotransferase levels > 30 IU/L and alkaline phosphatase > 300 IU/L were included in this study. Pregnancies with other liver disorders were excluded. Study was conducted after institutional approval. Data was analyzed using SPSS version 23.0 and descriptive statistics were used to display the data in the form of frequency and percentages. Results: ICP accounted for many adverse feto-maternal outcomes. Results show sleep disturbance in 68.75%, PROM in 73%, risk of PPH 10% and 75.5% births were through operative method attributable to ICP. ICP caused fetus distress in 20% cases, MSL in 23.75% of babies, preterm birth (25%) and LBW babies (18.75%), rate of NICU admission (18.75%) and still birth revealed in 2.5% cases in this study. Conclusion: Present study depict the ill effects of ICP on both mother and fetus. Maternal effects are reversible but fetal effect cause permanent impairment for rest of fetus life. There is need for vigilant monitoring of the pregnant women affected with ICP to avoid such painful events. Keywords: Pregnancy, Intrahepatic, Cholestasis, Outcomes.

Standard-Dose Oral Dextrose Gel for Neonatal Hypoglycemia

Standard-Dose Oral Dextrose Gel for Neonatal Hypoglycemia

Perinatal Outcomes of High-Risk Patients Delivered by Resident Versus Private Practice Physicians [A138

INTRODUCTION: This study compared perinatal outcomes of deliveries performed by resident and private practice physicians. METHODS: This is a secondary analysis of a large institutional review board‒approved, National Institutes of Health–funded retrospective cohort study of pregnant patients with chronic hypertension, diabetes, and/or fetal growth restriction who delivered singletons at a tertiary-care maternity hospital from January 2002 to March 2013. Maternal and neonatal outcomes of deliveries by resident physicians were compared to those of private practice physicians. The primary outcome was mode of delivery. RESULTS: The cohort included 9,744 deliveries: 1,928 resident and 7,816 private. Compared to private patients, resident patients were younger; more likely to be non-White, multiparous, or cigarette-smoking; and more likely to have public or no insurance, low BMI, or chronic hypertension. Private practice patients were more likely to have fetal macrosomia and diabetes. After adjusting for these factors, resident patients had 18% lower risk of cesarean delivery (CD) overall (aRR, 0.82; 95% CI, 0.76–0.88), driven by a 45% reduction in elective CD (aRR, 0.55; 95% CI, 0.43–0.70). Resident patients also had lower rates of episiotomy (aRR, 0.71; 95% CI, 0.58–0.88), but higher rates of endometritis (aRR, 1.93; 95% CI, 1.49–2.49) and NICU admission (aRR, 1.19; 95% CI, 1.04–1.36). CONCLUSION: In this cohort of high-risk pregnant patients, delivery by resident physicians was associated with a reduction in CD, particularly elective CD, and episiotomy. A focus on understanding the choice of private practice patients to undergo elective cesarean delivery and their providers to perform elective cesarean delivery may help reduce preventable morbidity.

Gestational Weight Gain in Patients With Obesity and Diabetes: A Comparison of 2009 Institute of Medicine Versus 2019 JAMA Recommendations [A270

INTRODUCTION: Excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Current guidelines established by the United States' Institute of Medicine (IOM) in 2009 recommend GWG of 11–20 lb for all obese patients. In 2019, a JAMA meta-analysis proposed recommending less weight gain in obesity (0–13 lb), not accounting for pre-existing maternal co-morbidities. We aim to ascertain whether, in obese diabetic pregnancies, GWG within the updated JAMA guidelines is associated with better outcomes. METHODS: IRB approval was obtained. Using a large urban hospital's de-identified obstetric database, obese diabetic patients from 2011 to 2020 were categorized into two groups: IOM and JAMA, depending on their GWG. Diagnosis codes were used to assess outcomes. Chi-square test, independent samples T-test, and Wilcoxon rank-sum test were used. RESULTS: Of 240 patients with obesity and diabetes, 135 fell within IOM weight gain guidelines and 65 within JAMA. The groups were not significantly different in age, BMI, A1C, or proportion with prior cesarean delivery. For maternal outcomes, chronic hypertension was independently associated with weight gain within the JAMA guidelines versus IOM (55% vs. 36%, P=.0082). There were no significant differences in rates of cesarean delivery (P=.73) or pre-eclampsia (P=.92). For neonatal outcomes, no differences were noted in NICU admission (P=.73), macrosomia (P=.72), or preterm delivery (P=.21) rates. CONCLUSION: For women with obesity and diabetes, chronic hypertension was associated with marginally less weight gain. Further research may be needed before clinicians advise the stricter GWG recommendations in the new JAMA guidelines rather than the current standard of IOM guidelines.

Association of Intrapartum CTG with Fetomaternal Outcome

Objective: To determine the association of intrapartum CTG with fetomaternal outcome Material and Methods: A total number of 120 pregnant females who presented in the department of obstetrics and gynecology with labour pain were included in this cross-sectional analysis. A written informed consent was taken from all patients. The study was conducted in the department of Obstetrics & Gynaecology at Islam Teaching Hospital, Sialkot from January, 2021 to September, 2021. At presentation in the labor room, 20 minutes CTG was performed and patients were divided into two groups, those having abnormal trace including suspicious and pathological trace (Group A) and normal cardiotocography (CTG) pattern (Group B). After that the patients were followed till delivery to determine the feto-maternal outcomes e.g. APGAR score, NICU admission, perinatal mortality and caesarean section rate. Results: The mean age was 26.9±4.12 years in group A and 27. 1 ± 3.9 years in group B (p-value 0.78). On comparison of maternal outcomes, caesarean section was done in 38 (63.3%) patients in group-A and in 17 (28.3%) patients in group-B (p-value <0.0001).Regarding neonatal outcomes, NICU admission was needed in 9 (15%) patients in group A, versus in 4 (6.7%) patients in group B (p-value 0.14). Perinatal mortality occurred in 03 (5.0%) patients in group A and in no patient in group B (p-value 0.07). APGAR score at 5 minutes was >7 in 46 (76.7%) patients in group A versus in 52 (86.7%) patients in group B (p-value 0.18). Conclusion: The intrapartum abnormal CTG cannot be used as the only tool to identify fetal hypoxia during labor. It may lead to increased caesarean section rate because of high false positive rate of abnormal CTG. Keywords: Cardiotocography, Fetal Distress, Cesarean section

Isosorbide Mononitrate Versus Dinoprostone for Cervical Ripening During Labor Induction: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

The objective of this study was to conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that evaluated isosorbide mononitrate (ISMN) versus dinoprostone, a prostaglandin E2 (PGE2) analogue, in promoting cervical ripening during labor induction. We searched five major databases from inception till 02 May 2021. We assessed the risk of bias of included studies. We meta-analyzed various endpoints (n=12) and pooled the endpoints as mean difference (MD) or risk ratio (RR) with 95% confidence interval (CI). Overall, 4 RCTs met the inclusion criteria, comprising 818 patients; equally 409 patients were allocated to ISMN and PGE2 groups. Overall, the RCTs had a low risk of bias. The mean change in Bishop score at 24 h was significantly lower in disfavor of the ISMN group. The mean time from drug administration to delivery was significantly longer in disfavor of the ISMN group. The rate of oxytocin need was significantly higher in disfavor of the ISMN group. The rate of vaginal delivery at 24 h was significantly lower in disfavor of the ISMN group. The rates of headache and palpitations were significantly higher in disfavor of the ISMN group. The rate of abnormal fetal heart rate was significantly lower in favor of the ISMN group. There was no significant difference between both groups with regard to rates of cesarean delivery, postpartum hemorrhage, uterine hyperstimulation, and NICU admission. Compared with PGE2, ISMN appeared less effective for cervical ripening prior to labor induction and correlated with higher drug-related maternal toxicities.

Role of Cerebro-Placental Ratio in prediction of adverse perinatal outcome in hypertensive disorder of pregnancy

Hypertensive disorder of pregnancy is a multisystem disorder associated with an increased risk of perinatal mortality worldwide. Doppler velocimetry of uterine, umbilical, and fetal vessels is an established method of antenatal monitoring identifying fetus at risk. The cerebroplacental ratio (CPR) is emerging as an important predictor of the adverse perinatal outcome as it considers both umbilical and middle cerebral artery doppler. The aim of this study is to find the role of CPR in the prediction of adverse perinatal outcome in the hypertensive disorder of pregnancy. A prospective descriptive study was done on women admitted to a tertiary care hospital in Kathmandu from July 2020 to June 2021 after taking ethical clearance from Institutional Review Committee. A total of 136 hypertensive pregnant women beyond 34 weeks of gestation underwent Doppler ultrasound, and CPR ratio <1.08 (done within one week of delivery) was considered abnormal. During the study, CPR was normal in 101 women (74.3%) and was abnormal in 35 women (25.7%). The study showed that the rate of cesarean section was high in women with abnormal CPR than with normal CPR (77.1% vs 45.5%). The caesarean section done for fetal distress (70.4% vs 39.1%), Apgar score < 7 in 5 minutes (14.3% vs 3.0%), NICU admission rate (54.3% vs 27.7%), and duration of NICU stay (3.9 + 4.08 vs 0.79 +1.94 days) were high in women with abnormal CPR. The cerebroplacental ratio in hypertension in pregnancy can provide useful information regarding fetal well-being and help us in improving fetal outcomes.

Frequency of Grades of Meconium-Stained Liquor and Compare the Frequency of Fetal Outcome according to Grades of Meconium-Stained Liquor

Objective: To determine the different grades of meconium-stained liquor and association of fetal outcome (still birth, poor Apgar score, NICU admissions) among meconium-stained liquor patients according to their grades. Subject and Methods: This prospective case series study was conducted at the department of obstetrics and Gynaecology, civil Hospital Karachi, for 6 months from April 2019 to September 2019. After per vaginal examination meconium-stained amniotic liquor and grades of meconium-stained liquor were confirmed and these patients were monitored by auscultation of fetal heart sounds by pinard stethoscope and cardiotocography performed and when patients delivered, the frequency of fetal outcome according to grades noted and was documented on pre-designed proforma. Results: A total of 150 patient women were studied, their average age was 28.62±4.19 years and mean gestational age was 38.38+1.00 weeks. There 56% multiparous women. Of all meconium-stained liquor, grade II was commonest 40%, grade I 30% and grade III 30%. Still birth was 2.0%, poor Apgar score was 24.7% and rate of NICU admission was 28.0%. Maternal age, parity and gestational age effects were statistically significant on grade of liquor (p-<0.05). Conclusion: Meconium-stained liquor grade II was observed to be high. The adverse fetal outcomes in terms of still birth, low Apgar score and neonatal intensive care unit admission were observed to the significancy associated with meconium-stained liquor grades II and III. Meconium-stained amniotic fluid as a serious problem so early decision should be taken to improve the fetal outcome. Keywords: Meconium-stained amniotic fluid, still birth, poor Apgar score

Association of Intrapartum CTG with Fetomaternal Outcome

Objective: To determine the association of intrapartum CTG with fetomaternal outcome Material and Methods: A total number of 120 pregnant females who presented in the department of obstetrics and gynecology with labour pain were included in this cross-sectional analysis. A written informed consent was taken from all patients. The study was conducted in the department of Obstetrics & Gynaecology at Islam Teaching Hospital, Sialkot from January, 2021 to September, 2021. At presentation in the labor room, 20 minutes CTG was performed and patients were divided into two groups, those having abnormal trace including suspicious and pathological trace (Group A) and normal cardiotocography (CTG) pattern (Group B). After that the patients were followed till delivery to determine the feto-maternal outcomes e.g. APGAR score, NICU admission, perinatal mortality and caesarean section rate. Results: The mean age was 26.9±4.12 years in group A and 27. 1 ± 3.9 years in group B (p-value 0.78). On comparison of maternal outcomes, caesarean section was done in 38 (63.3%) patients in group-A and in 17 (28.3%) patients in group-B (p-value <0.0001).Regarding neonatal outcomes, NICU admission was needed in 9 (15%) patients in group A, versus in 4 (6.7%) patients in group B (p-value 0.14). Perinatal mortality occurred in 03 (5.0%) patients in group A and in no patient in group B (p-value 0.07). APGAR score at 5 minutes was >7 in 46 (76.7%) patients in group A versus in 52 (86.7%) patients in group B (p-value 0.18). Conclusion: The intrapartum abnormal CTG cannot be used as the only tool to identify fetal hypoxia during labor. It may lead to increased caesarean section rate because of high false positive rate of abnormal CTG. Keywords: Cardiotocography, Fetal Distress, Cesarean section

Comparison of clinical features and perinatal outcomes between pre-variant and post-variant periods in pregnant women with SARS-CoV-2: analysis of 1935 cases.

PurposeTo compare the clinical features and perinatal outcomes of pregnant women with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pre-variant and post-variant periods.MethodsThis prospective cohort study includes pregnant women with SARS-CoV-2 who were followed-up at Ankara City Hospital between 11, March 2020 and 15, September 2021. Demographic features, clinical characteristics and pregnancy outcomes were compared between the pre-variant (n = 1416) and post-variant (n = 519) groups.ResultsThe rates of severe and critical cases significantly increased in the post-variant group (9.7% vs 2%, p < 0.001). The rates of respiratory support (26.8% vs 7.3%, p < 0.001), ICU admission (12.9% vs 1.8%, p < 0.001) and maternal mortality (2.9% vs 0.4%, p < 0.001) were significantly higher in the post-variant group. A significant increase was observed for pregnancy complications in the post-variant group (45.6% vs 18.8%, p = 0.007). The rates of preterm delivery (26.4% vs 4.4%, p < 0.001) and NICU admission (34% vs 18.8%, p < 0.001) were significantly higher in the post-variant group. Positive, weak, statistically significant correlations were observed between the post-variant period, disease severity and maternal mortality (r = 0.19, r = 0.12 and p < 0.001).ConclusionPost-variant COVID-19 period was associated with a severe course of the disease and increased rates of adverse obstetric outcomes in pregnant patients.

Postpartum depression, mode of delivery, and indication for unscheduled cesarean delivery: a retrospective cohort study.

To examine the relationship between postpartum depression (PPD), mode of delivery (MOD), and indication for unscheduled cesarean delivery (uCD). Patients with antenatal and postpartum Edinburgh Postnatal Depression Scale (EPDS) scores were compared by MOD and indication for uCD if applicable. Patients with an antenatal EPDS>12 were excluded to ascertain the incidence of new depression. The primary outcome was EPDS≥13 by MOD. The secondary outcome was EPDS≥13 by indication for uCD. Seven hundred and thirty eight patients met inclusion criteria. There were statistically significant differences in MOD by age, race, BMI, and multi-gestation pregnancy. Patients delivered via uCD had a higher rate of peripartum complications and NICU admission. There were no differences in medical comorbidities or use of psychiatric medications by MOD. There was no difference in EPDS by MOD. The rate of PPD was higher in patients with uCD for non-reassuring fetal heart tones (NRFHT) compared to other indications for uCD (p=0.02). While there was no difference in the incidence of PPD by MOD, the incidence of PPD was higher among patients delivered via uCD for NRFHT. These findings may have implications for patient counseling, post-operative mental health surveillance, and support of postpartum patients.

Increased abdominal circumference as predictor of macrosomia without evidence of adverse obstetrical or neonatal outcomes

Ultrasound is used as a screening tool for suspected fetal macrosomia, primarily focused on estimated fetal weight (EFW). The interpretation of isolated increased abdominal circumference (AC), however, is unclear. We aimed to determine if increased AC alone, in the setting of normal EFW and the absence of diabetes, is associated with any adverse obstetric or neonatal outcomes. This is a secondary analysis of a prospective observational study of individuals with negative diabetes screening between 2016-2020. Third trimester ultrasound data was examined to develop our study group (AC ≥ 95%tile, EFW< 95%tile) and comparison group (AC< 95%tile, EFW< 95%tile). Obstetric (induction, shoulder dystocia, primary Cesarean rate, postpartum hemorrhage) and neonatal (large for gestational age (LGA) phototherapy, hypoglycemia, NICU admission) outcomes were compared using chi-square analyses. We performed logistic regression to evaluate which antepartum factors may be most predictive of AC ≥ 95%tile and created ROC curves with gestational weight gain (up to 28weeks) and glucose tolerance testing (GTT). A total of 1239 individuals were included in the study population. Those with AC ≥ 95%tile (n = 40) had an increased rate of LGA (17% vs 2.4%, p< 0.001). There were no differences between rates of induction, shoulder dystocia, primary Cesarean, postpartum hemorrhage, phototherapy, neonatal hypoglycemia, or NICU admission (Table 1). Using logistic regression, weight gain and GTT values were found to be significant in predicting AC ≥ 95%tile. ROC curves were developed, the better model being GTT (AUC 0.637), suggesting a 1 hour GTT > 105 may be predictive of AC ≥ 95%tile (Figure 1). AC ≥ 95%tile was associated with macrosomia, but not with other adverse obstetric/neonatal outcomes. Additionally, a 1 hour GTT > 105, while normal, seems to be a risk factor for AC ≥ 95%tile and should be considered indication for a third trimester growth scan. Further studies are needed to determine if antepartum surveillance should be recommended in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Trends in neonatal intensive care unit admissions by race/ethnicity in the United States, 2008\u20132018

To examine temporal trends of NICU admissions in the U.S. by race/ethnicity, we conducted a retrospective cohort analysis using natality files provided by the National Center for Health Statistics at the U.S. Centers for Disease Control and Prevention. A total of 38,011,843 births in 2008–2018 were included. Crude and risk-adjusted NICU admission rates, overall and stratified by birth weight group, were compared between white, black, and Hispanic infants. Crude NICU admission rates increased from 6.62% (95% CI 6.59–6.65) to 9.07% (95% CI 9.04–9.10) between 2008 and 2018. The largest percentage increase was observed among Hispanic infants (51.4%) compared to white (29.1%) and black (32.4%) infants. Overall risk-adjusted rates differed little by race/ethnicity, but birth weight-stratified analysis revealed that racial/ethnic differences diminished in the very low birth weight (< 1500 g) and moderately low birth weight (1500–2499 g) groups. Overall NICU admission rates increased by 37% from 2008 to 2018, and the increasing trends were observed among all racial and ethnic groups. Diminished racial/ethnic differences in NICU admission rates in very low birth weight infants may reflect improved access to timely appropriate NICU care among high-risk infants through increasing health care coverage coupled with growing NICU supply.

Cerebroplacental ratio for prediction of adverse intrapartum and neonatal outcomes in a term uncomplicated pregnancy

BackgroundFetal hypoxia is one of the major causes of high perinatal morbidity and mortality rates. Doppler ultrasound tests such as cerebroplacental ratio (CPR) evaluation are commonly used to assess blood flow disturbances in placento-umbilical and feto-cerebral circulations. A low cerebroplacental ratio has been shown to be associated with an increased risk of stillbirth regardless of the gestation or fetal weight. We conducted this study to assess the fetal cerebroplacental ratio in prediction of adverse intrapartum and neonatal outcomes in a term, uncomplicated pregnancy to reduce fetal and neonatal morbidity and mortality.ResultsIt was found that neonates with CPR ≤1.1 had significantly higher frequencies of cesarean delivery (CS) for intrapartum fetal compromise compared to those with CPR >1.1 (p=0.043). Neonates with CPR ≤1.1 had significantly lower Apgar score at 1 min and 5 min than those with CPR >1.1 (p=0.004) and (p=0.003), respectively. Neonates with CPR ≤1.1 had significantly higher rates of NICU admission than those with CPR <1.1 (p=0.004).ConclusionThe cerebroplacental ratio shows the highest sensitivity in the prediction of fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at term. The cerebroplacental ratio index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

Parallel Loop Binding Compression Suture, a Modified Procedure for Pernicious Placenta Previa Complicated With Placenta Increta.

Objective: To evaluate the efficacy and safety of parallel loop binding compression suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta.Methods: This retrospective study was performed in patients with pernicious placenta previa complicated with placenta increta or percreta between November 2014 and December 2020 at the Qilu Hospital of Shandong University. Patients underwent parallel loop binding compression suture surgery were defined as study group, and patients underwent traditional surgery with figure-of-eight sutures as the main hemostatic method were defined as control group. Postpartum hemorrhage was evaluated as the primary outcome. The secondary outcomes included age, gestational weeks, operative time, fetal childbirth time, prevention of hysterectomy, blood transfusion, duration of postoperative catheterization, duration of antibiotic treatment, and postoperative hospitalization (days). Additionally, neonatal outcomes were evaluated.Results: A total of 124 patients were enrolled in the study, including 38 patients receiving parallel loop binding compression suture surgery in the study group, and 86 patients in the control group. With parallel loop binding compression suture, the average operation time was significantly reduced (109.0 ± 33.5 vs. 134.4 ± 54.2 min, p = 0.00), and the volume of blood lost were also decreased (2152.6 ± 1169.4 vs. 2960.5 ± 1963.6 ml, p = 0.02), which correspondingly reduced RBC transfusion (7.2 ± 3.5 vs. 10.3 ± 8.7 units, p = 0.03) and FFP transfusion (552.6 ± 350.3 vs. 968.0 ± 799.8 ml, p = 0.00). The fetal childbirth time was extended (14.1 ± 5.6 vs. 11.0 ± 8.0 min, p = 0.03), however, there was no increase in NICU admission rates (36.9 vs. 34.9%, p = 0.83). Except for one premature infant (32 weeks) death in the control group, all infants at our hospital were safely discharged after treatment.Conclusion: Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta. Besides, it has no adverse effects on newborns.

Maternal-Perinatal Variables in Patients with Severe Preeclampsia Who Develop Acute Kidney Injury.

Introduction: At present, we are witnessing an increase in preeclampsia, especially the most severe forms, which are associated with an increased risk of maternal-perinatal morbidity and mortality. As a severity criterion, acute kidney injury (AKI) has been associated with a worse prognosis, and for this reason, the maternal and perinatal variables associated with AKI in patients with severe preeclampsia (SP) were analysed in this study. Methods: An observational, retrospective, single-centre study of patients with SP treated at a tertiary hospital between January 2007 and December 2018 was conducted. The case criteria based on the criteria established by the ACOG Practice Guidelines for Gestational Hypertension and Preeclampsia. AKI is considered when serum creatinine exceeds 1.1 mg/dL in a pregnant woman with previously normal renal function. In patients with existing chronic kidney disease (CKD), it is referred to as AKI if the baseline serum creatinine increases by 1.5 fold. Pregestational, gestational and postpartum variables were analysed up to 12 weeks postpartum using univariate and multivariate logistic regression analysis. Results: During the study period, 76,828 births were attended, and 303 pregnant women were diagnosed with SP. The annual incidence of SP increased gradually throughout the study period, reaching 1.79/100 births/year in 2018. Acute kidney injury (AKI) occurred in 24.8% of the patients. The multivariate analysis revealed an increased association with a history of previous CKD, the use of assisted reproductive techniques and caesarean section. Uric acid and thrombotic microangiopathy (TMA) had a high correlation with AKI. Indications for caesarean section are associated with AKI in SP. Regarding perinatal outcomes in cases of AKI, there was a higher percentage of neonates who required foetal lung maturation with steroids and an increased need for NICU admission. No case of maternal death was recorded; however, an increase in neonatal mortality was found among patients who did not develop AKI. After 12 weeks postpartum, 72 patients were referred to the nephrology consultation for persistent hypertension, proteinuria or renal failure. Conclusions: In preeclampsia, AKI is a common complication, especially among patients with a history of CKD, those who became pregnant using assisted reproduction techniques and those who delivered via caesarean section. The perinatal impact of AKI is mainly centred on a higher rate of NICU admission and a lower mortality rate. Among biochemical and haematological markers, the uric acid level prior to renal failure has a direct and significant correlation with the risk of AKI, as does the development of TMA in patients with preeclampsia. Therefore, the monitoring of renal function in cases of preeclampsia should be strict, and referral for a nephrology consultation may be necessary in some cases.

A Quasi-Experimental Study to Compare the Effect of Respectful Maternity Care Using Intrapartum Birth Companion of Her Choice on Maternal and Newborn Outcome in Tertiary Care Centre.

Traditionally during labour woman is supported by another woman. However, in hospitals, continuous support during labour has often become the exception rather than the routine. Worldwide, there is a growing concern about the disrespect and abuse of women seeking maternity care. This prompted us to decide to change the obstetric care practices by providing a birth companion of her choice to women during labour and compare their maternal and newborn outcomes with the data from the same institute before intervention. This was a quasi-experimental study conducted in the Department of OBGY, GMCH, Aurangabad for 20months and compared with the previous data from the same institute before implementation of the birth companion policy. The impact of this intervention was evaluated by caesarean section rate, episiotomy rates and admission to neonatal intensive care units, and data was analysed by an appropriate statistical test. The rate of caesarean Section (20%) and episiotomy (8.57%) was significantly lower in the intervention group than in the control group. The rate of NICU admission and time required for initiation of breastfeeding was significantly lower in the intervention than in the control group. Around 86.6% of women from the intervention group were fully satisfied with the role of birth companion and 13.4% were partially satisfied. Our study demonstrated that the use of an intrapartum birth companion of her choice helped us improve maternal and newborn outcomes without any harm. We recommend generalizing the policy of use of the trained birth companion of her choice in the private as well as the public sector.

Management of pregnant women with COVID-19: A tertiary pandemic center experience on 1416 cases.

The aim of this study is to share the comprehensive experience of a tertiary pandemic center on pregnant women with COVID‐19 and to compare clinical outcomes between pregnancy trimesters. The present prospective cohort study consisted of pregnant women with COVID‐19 who were followed up at Ankara City Hospital between March 11, 2020 and February 20, 2021. Clinical characteristics and perinatal outcomes were compared between the pregnancy trimesters. A total of 1416 pregnant women (1400 singletons and 16 twins) with COVID‐19 were evaluated. Twenty‐six (1.8%) patients were admitted to the intensive care unit (ICU) and maternal mortality was observed in six (0.4%) cases. Pregnancy complications were present in 227 (16.1%) cases and preterm labor was the most common one (n = 42, 2.9%). There were 311, 433, and 672 patients in the first, second, and third trimesters of pregnancy, respectively. Rates of mild and severe/critic COVID‐19 were highest in the first and second trimesters, respectively. The hospitalization rate was highest in the third trimester. Pregnancy complications, maternal mortality, and NICU admission rates were similar between the groups. The course of the disease and obstetric outcomes may be different among pregnancy trimesters. A worse course of the disease may be observed even in pregnant women without any coexisting health problems.

Inpatient vs. outpatient management of uncomplicated preterm premature rupture of membranes: a clinical trial

Background: Preterm premature rupture of membranes (PPROM) is spontaneous rupture of fetal membranes before 37 weeks of gestation. PPROM cases that are clinically stable with no sign or symptom of intrauterine infection and normal fetal assessment are usually managed expectantly in hospital settings or at home. This study aimed at comparing the inpatient and outpatient management among women with uncomplicated PPROM.Methods: This non-randomized clinical trial was performed in an academic hospital, Mashhad University of Medical Sciences in 2017-2018. Women with confirmed PPROM who received initial treatments during the primary 72 hours of hospitalization were assigned into inpatient (n=45) or outpatient (n=35) management groups according to the patient's decision. The obstetrical, maternal and neonatal outcomes under the focus of this study included latency period, gestational age at delivery, delivery route, delivery reason, WBC and neutrophil count, neonates’ weight, Apgar score, NICU admission, and death in the first 28 days after delivery. Data were analyzed by Statistical Package for Social Science (IBM SPSS) version 23. P 0.05). Neonatal Apgar score, death, and NICU admission rate or period were not significantly different between the two groups (p>0.05).Conclusion: Homecare for the selected PPROM women could be a suitable expectant strategy without compromising neonatal or maternal outcomes.

Does the Summer Season Affect the Amniotic Fluid Volume during Pregnancy?

Amniotic fluid is crucial for the well-being of the fetus. Recent studies suggest that dehydration in a pregnant woman leads to oligohydramnios. We assessed the variation in the amniotic fluid index (AFI) during the summer and non-summer seasons and evaluated neonatal outcomes. We retrospectively reviewed electrical medical records of pregnant women who visited the Konkuk University Medical Center for antenatal care, between July 2005 and July 2019. A total of 19,724 cases from 6438 singleton pregnant women were included after excluding unsuitable cases. All AFI values were classified as 2nd and 3rd trimester values. Additionally, borderline oligohydramnios (AFI, 5–8) and normal AFI (AFI, 8–24) were assessed according to the seasons. The average AFI between the summer and non-summer season was statistically different only in the 3rd trimester; but the results were not clinically significant. In the 3rd trimester, the summer season influenced the increased incidence of borderline oligohydramnios. The borderline oligohydramnios group showed an increased small-for-gestational-age (SGA) rate and NICU admission rate. In the summer season, the incidence of borderline oligohydramnios was seen to increase. This result would be significant for both physicians and pregnant women.