Normal Spontaneous Vaginal Delivery Research Articles

Second case of spontaneous left ureter rupture during normal spontaneous vaginal delivery

Second case of spontaneous left ureter rupture during normal spontaneous vaginal delivery

A Medical Student Obstetric Curriculum Consisting of Online Modules and a Normal Spontaneous Vaginal Delivery Simulation Exercise.

In many medical schools, students are exposed to obstetrics for 2 weeks during the third-year obstetrics and gynecology clerkship. Hence, the purpose of this study was to evaluate the effectiveness of a curriculum combining online obstetric modules and a normal spontaneous vaginal delivery (NSVD) simulation on medical student knowledge and comfort pertaining to obstetrics at the start of the clerkship. Students completed the curriculum at the start of the clerkship. They completed questionnaires before and after each module and the simulation. The questionnaires assessed knowledge, management comfort level, and satisfaction with module/simulation. Comfort level and satisfaction scores were based on a 1-5 Likert scale (1 = very uncomfortable/unfavorable, 5 = very comfortable/favorable). Satisfaction scores for online modules were compared with those for a historical cohort of traditional lectures on the same topics. Students also rated satisfaction with the curriculum. Sixty students participated. Mean knowledge and comfort scores significantly increased from 7.2 to 9.2 (P < .001) and from 2.7 to 3.9 (P < .001) before and after the modules, respectively. Although satisfaction scores for traditional lectures were significantly higher than for online modules (4.7 vs. 4.4, P < .001), online modules were still favorably received. Mean satisfaction score for the NSVD simulation was 4.8. Overall, satisfaction score for the curriculum was 4.5. An obstetric curriculum consisting of online modules and simulation significantly increases medical student learner knowledge and comfort and is associated with a high level of satisfaction.

Кровоизлияния в сетчатку у новорожденных. Клинические особенности и факторы риска

Material and methods. The study included newborns born at the Perinatal Center of St. Petersburg State Pediatric Medical University in the period from July 2021 to October 2022. Anamnestic and other risk factors for the development of retinal hemorrhages were assessed in newborns with and without retinal hemorrhages (RH). Depending on the severity of RH (according to the results of the examination on the RetCam retinal camera), the newborns were divided into groups in which the bilaterality of the RH was assessed, localization in the layers and area of the retina, with an emphasis on the macular region and the optic disk. Results. Of the 75 newborns, 16 had birth-related RH (23.1%). Normal spontaneous vaginal delivery showed the highest association with RH (odds ratio, 5.515; 95% confidence interval, 1.15–26.46, p&lt;0.001). Hemorrhages were more often bilateral (68.8%), intraretinal (87.5%) and localized in the central zone of the retina (81.3%). At the same time, severe RH were more often located in zones I and II, in each newborn they affected the optic nerve or macula, in 6.3% of cases they spread to the vitreous body, and in 25% they were accompanied by Roth’s spots. Conclusion. RH occur in 21.3% of full-term newborns and are largely associated with normal delivery. The main characteristics of hemorrhages in newborns differ notably depending on their severity. Severe retinal hemorrhages in newborns may have negative consequences for the development of visual functions at an older age, which requires further long-term studies. This study confirmed that the digital wide-angle retinal camera is an effective method for examining a large number of newborns with RH. Key words: newborn, retinal hemorrhages, vitreous hemorrhages, Roth’s spots

The effect of general anesthesia applied during cesarean section on newborn bilirubin

Aims: Today, delivery is often performed as normal spontaneous vaginal delivery (NSVD) and cesarean section operations. Deliveries with NSVD mostly take place in the delivery room without the need for additional anesthetic agents. General anesthesia and regional anesthesia techniques are applied in cesarean section operations. In this study; The aim of this study was to examine the effect of general anesthesia on newborn bilirubin and to compare it with the bilirubin level of babies born without general anesthesia with NSVD method. Methods: Between March 2022 and September 2022, 152 patients over the age of 18 with term pregnancy NSVD and elective cesarean section without complications were randomly included in the study. Cases diagnosed with liver and biliary tract disease, systemic liver and biliary tract effective drug use, DCOOMBS( +) and Covid (+) clinics were excluded. Results: Of the patients included in our study, 75 (49.3%) were given general anesthesia and 77 (50.7%) delivered with NSVD without general anesthesia. It was determined that the first hour bilirubin and the fourth hour bilirubin values were significantly higher (p &lt;0.05) in the general anesthesia group compared to the group that did not receive general anesthesia. In the group that did not receive general anesthesia, the APGAR 5th min score was found to be significantly (p &lt;0.05) higher than the general anesthesia group. APGAR 1 min value did not differ significantly (p &gt; 0.05) between the anesthesia-free and general anesthesia groups. Neonatal weight, head circumference, and infant height did not differ significantly between the groups that did not receive general anesthesia and those who did not receive general anesthesia (p&gt; 0.05). Conclusion: Among the groups that did not receive general anesthesia and anesthesia; Bilirubin value was found to be higher among babies born by cesarean section under general anesthesia. It seems that it is more beneficial to avoid systemic effects as much as possible and to disseminate NSVD.

Comparison of efficacy and safety of the Dinoprostone Vaginal tape and Dinoprostone vaginal tablet for the induction of labor in para three and more women: A retrospective cohort Study

Background: Prostaglandins have a central role in the cervical ripening and parturition, and have been widely used for induction of labor (IOL). This study aimed to compare the effectiveness and safety of Dinoprostone vaginal tape (Propess) over Dinoprostone vaginal tablets (Prostin) for IOL and find which has better outcome to be applied in clinical practice. Participants and Methods: A retrospective cohort study was conducted via reviewing of medical records of multipara women admitted to King Fahad Medical City, Riyadh between January-2021 and December-2022 for IOL by Propess or Prostin. Results: A total of 87 multipara women were included in the study; 39 (44.8%) were treated by Propess and 48 (55.2%) were treated by Prostin for IOL. Full dilatation of the cervix after induction of labour was reported among majority of women (94.2%): being 92.1% among women treated with Propess and 95.8% among those treated with Prostin, however, this difference was not statistically significant, p&gt;0.05. Regarding mode of delivery, normal spontaneous vaginal delivery was reported among 84.9% of women; 86.8% among women treated with Propess and 83.3% among those treated with Prostin while emergency cesarean section delivery was reported among 10.5% of women; 7.9% among women treated with Propess and 12.5% among those treated with Prostin. However, these differences were not statistically significant, p&gt;0.05. Conclusion: The success rate of IOL among multipara women was high; however, no difference was reported between Propess and Prostin as regards the effectiveness (maximum cervical dilatation) and safety (rate of emergency cesarean section).

SAT612 Granulomatous Mastitis: An Unusual Presentation Of Prolactinoma

Abstract Disclosure: H.R. Alkaissi: None. E. Kim: None. S. McFarlane: None. Background: Granulomatous mastitis (GM) is a rare, benign inflammatory breast disease of unclear etiology with clinical presentation that is similar to inflammatory breast cancer and periductal lobular mastitis. It occurs mainly in younger females and during the postpartum period. Prolactin (PRL) is an essential hormone of pituitary and extrapituitary origin that promotes lactation and the development of mammary glands within breast tissues. In addition to its lactogenic effect, it has over 300 other effects, several of which are immunomodulatory, including the expression and secretion of proinflammatory cytokines from macrophages. Clinical Case: A 37-year-old African American woman presented with right breast pain and swelling for a few weeks. Her medical history includes amenorrhea for five years. She is gravida 1, para 1 with normal spontaneous vaginal delivery at the age of 20. Physical exam showed non-bloody, non-purulent nipple discharge bilaterally, otherwise unremarkable. A breast ultrasound showed a 1 cm complex cystic mass. Biopsy showed benign breast tissue, with noncaseating granulomas formed by macrophages (CD68 positive on immunohistochemistry). Ziehl-Neelsen staining for acid-fast bacilli was negative. Staining for fungi was also negative. Prolactin level was 237 ng/mL. TSH, IGF-1, and ACTH were within normal. Pituitary MRI showed a focus of abnormal signal and diminished enhancement measuring 2.8x3.2x4.2 mm within the left side of the pituitary gland is compatible with a microadenoma. The patient was started on bromocriptine 2.5mg daily. Discussion: Our patient represents a rare case of granulomatous mastitis in the setting of microprolactinoma, likely long-standing, given the five years history of amenorrhea. The immunomodulatory effect of PRL on several immune system cells, including B-cells, T-cells, and macrophages, might be an underlying mechanism. In a recent study of 25 samples of GM, metagenomics studies identified unusual organisms in 68% of the samples. Of these, Corynebacterium kroppenstedtii was the most common (60%), followed by Pseudomonas oleovorans (16%), Epstein-Barr virus (4%), Acinetobacter baumannii (4%), and Tepidiphilus thermophilus (4%). In addition, 50% of the patients had elevated PRL, and elevated immunological markers, such as C3 and IgA [1]. This suggests that GM results from an interaction between the presence of certain pathogens in a host with elevated PRL that mediates proinflammatory response.

Primary Bilateral Anophtalmia

A 3 months old female child, who was born with bilateral anophthalmia after a normal full-term pregnancy by normal spontaneous vaginal delivery to a 32 years old mother, who had antenatal care in local health center. According to the mother, pregnancy went without any kind of complications. This was a third pregnancy from healthy parents with 2 healthy children. There was no history of congenital infections or any significant teratogenic drug intake during pregnancy. There was no history of fever, body rashes and no exposure to X-rays; and no family history of diabetes or any congenital pathology.

Congenital epulis in a female newborn

Introduction: Congenital epulis, also known as Neumann’s tumor, is a benign soft-tissue lesion with an unclear cause. Congenital epulis manifests as a pink lump with a smooth surface in the mucosa of the maxillary or mandibular alveolar ridges. The lesion is more common in women and occurs more commonly in the maxillary alveolus than in the mandibular alveolus. Multiple theories have been proposed regarding the causes of congenital epulis; however, the etiology is still ambiguous. Case Report: A 1-day-old female neonate was delivered via normal spontaneous vaginal delivery and referred to our hospital as an oral mass for surgical evaluation and intervention. It was discovered on a detailed prenatal ultrasound. Postnatal brain magnetic resonance imaging (MRI) was performed, the mass was characterized, laser excision was performed, and a histopathological examination confirmed the diagnosis. The patient underwent postoperative follow-up and was normal. Conclusion: Congenital epulis is a rare, neonatal, congenital, and benign tumor. It requires removal by either surgical resection or laser excision owing to problems in feeding and respiration. Clinicians should always perform routine oral examinations for all newborns for the early diagnosis of this gingival tumor before it interferes with oral function.

The Correlation between Maternal Factors and Infants Lower Birth Weight

Background: Low birth weight (LBW) continues to remain a major public health problem worldwide. There are numerous factors contributing to LBW both maternal and fetal. The mortality of low birth weight can be reduced if the risk factors are detected early and managed by simple techniques. Objective: In this study our main goal is to assess the correlation between maternal factors and infants lower birth weight. Method: This research was conducted as a cross- sectional analysis at a tertiary care medical facility between January 2022 and January 2023. Where a convenience sample of 100 moms aged 11–19 who were hospitalized throughout the research period was chosen. Ultrasound and other diagnostic procedures verified the pregnancy. Results: During the study, the average age of the participants in the study group was 18.02±05 years, and only 19% of the patients visited the antenatal care facility more than four times. Among the study group, 34% of the participants had anemia, followed by 20% with premature rupture of membranes (PROM), 6% with preterm premature rupture of membranes (PPROM), 11% with mild eclampsia, 7% with severe eclampsia, 5% with gestational hypertension, and 6% with gestational diabetes. In terms of delivery methods, 40% had normal spontaneous vaginal delivery (NSVD), 28% had emergency lower segment cesarean section (LSCS), 17% had planned LSCS, and 13% underwent instrumental delivery. Regarding postpartum complications, 5% of the study group experienced postpartum hemorrhage (PPH), 2% had uterine atony, 3% had wound disruption, 1% had perineal tear, and 1% of the cases resulted in maternal death. Adverse neonatal outcomes were also observed, with 15% of the newborns having a body weight of less than 2500 grams, 11% having low APGAR scores, 12% developing neonatal jaundice, 2% experiencing intrauterine growth restriction (IUGR), 2% being stillborn, 1% having congenital anomalies, and 1% suffering from respiratory distress syndrome. ...

Episiotomy Wound Care through Herbal Preparations - A Case Report

The word mother itself is symbolic to God. Mother suffers much distress after childbirth due to painful perineum. Pain following episiotomy appears to be universal. Proper healing of episiotomy wound after delivery is a major concern. In Ayurvedic classics Ghritkumari (Aloe vera) has been mentioned as Varna Ropaka and Vishvataghani due to its Sheeta properties. Various studies have demonstrated the power of Aloevera on moisturizing, wound healing, fibroblast activity, collagen proliferation, angiogenesis, anti-inflammatory, antibacterial, antifungal, antiviral &amp; antioxidant effects. The application of Aloevera gel is best if extracted directly. The fresh gel from the plant has superior wound healing abilities. Allantoin, a substance in Aloevera, has considered a cell proliferant stimulant and a chemical debrider. Aloevera increases collagen content and degree of collagen cross – linkage within the wound. A 27 years female patient (Primigravida) was admitted in PTSR IPD with FTP with Labor pains. She delivered a healthy female baby with Normal Spontaneous Vaginal Delivery with Right Mediolateral Episiotomy. To analyze the effect of Aloevera pulp dressing on perineal healing after a normal delivery with a right mediolateral episiotomy wound. Episiotomy wound was cleaned with Triphala decoction then fresh Aloevera pulp was applied every 8 hourly on episiotomy wound for consecutive seven days. This study is being done for determining the impact of fresh Aloevera pulp on episiotomy healing in a primiparous woman. The result was assessed by using REEDA Scale.

Newborn with epispadias

A newborn was examined. The patient was born to 29-yearold women at 38 weeks and 5 days via normal spontaneous vaginal delivery. Prenatal care was uncomplicated.

Comparison of Perinatal and Neonatal Outcomes of Very Advanced Maternal Aged Pregnants and Early Adolescent Pregnant Women

Aims: In recent years, very early pregnancies and very advanced pregnancies have increased. In our study, we aimed to compare these groups in terms of maternal and fetal risks. Materials and Methods: This study retrospectively were compared the perinatal outcomes of women of reproductive age in 80 early adolescent pregnant (16 years and younger) and 67 older pregnant women (45 years and older) followed in Siirt Training and Research Hospital between 2017 and 2021 in Siirt Training and Research Hospital (Siirt, Turkey). In cases gravida, parity, hemogram, biochemistry, urine, week of birth, fetal weight, gender, APGAR 1-5. min, mode of delivery (vaginal delivery/ cesarean section), miscarriage, neonatal death, premature rupture of membranes (PROM), premature birth, placental ablation, fetal distress, intrauterine death, gestational diabetes mellitus (GDM), preeclampsia, surmaturation, polyhydramnios , oligohydramnios, presentation anomaly, multiple pregnancy, intrauterine growth retardation (IUGR), postpartum hemorrhage, placenta previa, maternal and fetal outcomes in three pregnant groups were evaluated. Results: Normal spontaneous vaginal delivery (NSVD)/Cesarean section (C/S)" parameter was found to be significantly higher in pregnant women aged 45 and above, while it was found to be significantly lower in the group aged 16 and below(p&lt;0.0001). Spontaneous abortion, on the other hand, was not found significantly in the 16-year-old and younger group compared to the other groups, while it was significantly higher in pregnant women aged 45 and above(p&lt;0.0001).The incidence of GDM was significantly higher in pregnant women aged 45 and over, but it was not determined in pregnant women aged 16 and younger (p=0.003). The incidence of preeclampsia was also found to be significantly higher in pregnant women aged 45 and over (p&lt;0.0001). The incidence of polyhydramnios was significantly higher in the risky pregnant group than in the control group (p=0.015). The incidence of presentation anomaly was found to be significantly higher in pregnant women aged 45 and over (p=0.012). No statistically significant difference was found in other parameters. Conclusion : Both early adolescent pregnancies and very advanced age pregnancies have their own problems. The obstetrician should be aware of these in his approach to both groups.

Outcomes of Pregnancy with Group B Streptococcal Infections in Najran, Saudi Arabia

Background: The gram-positive, beta-hemolytic, and chain-forming Group B Streptococcus (GBS), commonly known as Streptococcus agalactiae, may asymptomatically invade the human gastrointestinal and vaginal tracts. However, GBS may become very invasive and pathogenic to the mother and baby during pregnancy, having negative effects. Study Aim: This study aims to investigate the pregnancy outcomes of women who tested positive for genitourinary GBS infection during pregnancy in Najran, Saudi Arabia. Methods: Data was collected retrospectively from patient files in Armed Forces Hospital, Najran, Saudi Arabia. Data collected were entered to a Microsoft Excel sheet, then imported and analysed using the Statistical Package for Social Sciences. Results: The study included 272 women of whom 66.5% were 31 to 45 years old. Gestational diabetes was diagnosed in 8.5% of the sample, 71.7% had a normal spontaneous vaginal delivery (NSVD), 1.8% had previous abortions, and 27.2% of new-borns were admitted to the NICU after delivery. There was a significant association between NICU admissions and women employment status (p = 0.001), gravidity (p = 0.001), parity (p = 0.001), history of abortions (p = 0.001), medical conditions (p = 0.049), and mode of delivery (p = 0.049). Conclusion: According to the findings of our study, GBS infection during pregnancy is associated to more NICU admissions. NICU admissions were significantly correlated with gestational diabetes, hypertension, and hypothyroidism in mothers but not with intrapartum antibiotic use.

Examining the Association Between Episiotomy and Severe Perineal Tears in a Tertiary Care Center Implementing a Restrictive Episiotomy Policy.

Background Perineal lacerations are feared complications of vaginal delivery, especially the severe types (third- and fourth-degree tears). World Health Organization (WHO) recommended restrictive episiotomy practice after alarming literature linked the increase in severe tears with routine episiotomy. Therefore, this study aimed to measure the association between episiotomy and the incidence of third- and fourth-degree perineal tears and infections in women who underwent episiotomy versus those who did not at a tertiary care center implementing the restrictive episiotomy policy in Jeddah, Saudi Arabia. Methods This retrospective cohort study was conducted in the Department of Obstetrics and Gynecology at King Abdulaziz Medical City (KAMC), Western Region, between May 2016 and May 2018, targeting all pregnant women who underwent normal spontaneous vaginal delivery. The nonprobability convenient sampling technique was used for women who underwent episiotomy. Women without episiotomy (control group)were randomly selected in a 1:1 ratio. The prevalence (incidence) of episiotomy and its association with severe perineal tears were measured. Statistical data were analyzed using SPSS version 27 (IBM Corp., Armonk, NY). A p-value of less than 0.05 was considered significant. Result A total of 7436 deliveries were recorded. At KAMC, episiotomy had a prevalence of 10% and was more common in primipara. The incidence of third-degree tears was 3.3% in the episiotomy group and 0.8% in the control group (odds ratio, 4.1; p = 0.03). None had fourth-degree tears. Furthermore, the infection rate was not significantly different between the two groups (0.1% vs. 0.1%). Using Firth's logistic regression model, primipara emerged as an independent significant risk factor (OR, 3.5 [1.1-11.2]; p = 0.035)while the trend toward increased risk for tear development in the episiotomy group became statistically insignificant (OR, 2.3 [0.7-8.0]; p = 0.19). A post hoc examination to observe the association between episiotomy exposure and BMI using a stepwise logistic regression model showed that parity and age were independent risk factors for episiotomy, with OR values of 2.2 (1.6-3.2) and 0.9 (0.88-0.94), respectively (p < 0.001). The BMI became insignificant, with an OR of 1.0 (0.7-1.4) (p = 0.96). Conclusion The development of severe perineal tears in acenter with a restrictive episiotomy policy is rare. Parity has emerged as an independent risk factor for severe perineal tears.Prospective multicenter research with a larger sample size is recommended to validate this study's findings further and investigate other obstetric measures to reduce severe tears in primi mothers.

Elevated level of creatine phosphokinase in newborn: Clinical significance and association with congenital muscle diseases.

To establish the normal Creatine phosphokinase (CPK) range in newborns of all 3 modes of delivery and prove that high CPK level in neonates is not specific a indicator for muscular pathology. This is a prospective cohort study that is conducted in King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh and included 504 term neonates who were born between March 2021 and August 2021. Two hundred and fifty three were males and 251 were females. Data and consents were managed and collected using 2 coordinators. Duration of the second stage of labor, age on the first CPK test and fetal gestational age were significantly correlated with CPK values (r=0.197, r=-0.234, r=0.274, respectively). The normal ranges for each delivery type were 334 U/L-2667U/L in normal spontaneous vaginal delivery, 265U/L-1182U/L in elective cesarean section, and 223U/L-3082 U/L in emergency cesarean section. The CPK was elevated in all neonates in all 3 modes of deliveries. An elevated levels of CPK in neonates is not a specific indicator for any congenital muscular pathology.

Increased Rate of Spontaneous Pneumothorax in Infants of COVID-19 Positive Mothers

Abstract Objective The epidemiological and clinical characteristics of neonates born to women infected with coronavirus disease 2019 (COVID-19) during pregnancy were assessed, and the correlation between this infection and spontaneous pneumothorax in neonates born to mothers with COVID-19 was evaluated in the present study. Methods Records of 14 neonates in the neonatal intensive care unit with pneumothorax were collected and analyzed. Pregnant women were routinely screened for COVID-19 before birth. This study only included the neonates of mothers positive for severe acute respiratory syndrome coronavirus 2 immunoglobulin Mand immunoglobulin G and developing spontaneous pneumothorax. Antenatal, natal and postnatal risk factors, data related to demographic, epidemiological and clinical characteristics, treatment strategies, and breastfeeding history were obtained from medical records. Results The gestational age of the 14 neonates was 30 to 38 weeks. One male infant was born by normal spontaneous vaginal delivery, while all other infants were born by C-section. Though the mothers did not have a diagnosis of COVID-19 in their charts, they all reported one or more symptoms when interviewed. No mother had received a COVID-19 vaccination before or during pregnancy. No mother had undergone a hospital visit or doctor examination due to suspicion of COVID and COVID polymerase chain reaction test. COVID antibody titers were present during admission to hospital before birth. Conclusion The infants of pregnant cases with symptomatic or asymptomatic COVID-19 may develop respiratory distress and pneumothorax. Observational data obtained from case series similar to what is presented here may be accepted as a potential first step to producing hypotheses to test with preclinical or clinical models if it can be expanded in larger cohorts.

Determinants of maternal near miss events among women admitted to tertiary hospitals in Mogadishu, Somalia: a facility-based case–control study

BackgroundA maternal near-miss is a situation in which a woman was on the verge of death but survived a life-threatening obstetric complication that happened during pregnancy, childbirth, or within 42 days after the pregnancy's termination. Survivors of near-miss events share several features with mothers who have died and identifying determinants of maternal near miss will aid in improving the capacity of the health system to reduce severe maternal morbidity and mortality. Therefore, this study was designed to identify determinants of maternal near miss incidents among women hospitalized to tertiary hospitals in Mogadishu, Somalia.MethodsA facility-based unmatched case–control study was conducted in four tertiary hospitals in Mogadishu from May 1 to July 31, 2021. A total of five hundred thirty-three (178 cases and 355 controls) study participants were involved in the study. The discharge period, cases were recruited consecutively as they emerged, whereas controls were chosen using systematic sampling approach based on every fifth interval of those delivered through normal spontaneous vaginal delivery. Women who were hospitalized during pregnancy, delivery, or within 42 days of termination of pregnancy and met at least one of the maternal near-miss disease specific criteria were classified as cases, while women who were admitted and gave birth by normal vaginal delivery and resealed from the hospital without experiencing severe obstetric complications were considered controls. Participants were interviewed by well-trained research assistants using pre-tested structured questionnaire and the medical records were reviewed to identify maternal near-miss cases. Data were entered into and analyzed with SPSS 25.0. Logistic regression was used, and the significance level was set at p value ≤ 0.05.ResultsThe most common maternal near-miss morbidities identified were severe anemia (32%), severe pre-eclampsia (19.6%), severe ante partum haemorrhage (15.0%), abortion complications (8.4%), eclampsia (6.1%), ICU admission (5.6%), severe PPH (2.8%) and severe systemic infections (2.8%). The main factors associated with maternal near-miss were rural residency [OR = 2.685, 95%CI: (1.702–4.235)], age below 20 years [OR = 2.728, 95%CI: (1.604–4.5640)], unmarried [OR = 2.18, 2.18, 95%CI (1.247–3.81)], lack of formal education [OR = 2.829, 95%CI: (1.262–6.341)], husband’s unemployment [OR = 2.992, 95%CI: (1.886–4.745)], low family income [OR = 3.333, 95%CI (1.055–10.530)], first pregnancy before 18 years of age [OR = 3.091, 95% CI: (2.044–4.674)], short birth interval [OR = 5.922, 95%CI: (3.891–9.014)], previous history of obstetric complication [OR = 6.568, 95%CI: (4.286–10.066)], never attended ANC services [OR = 2.687, 95%CI: (1.802–4.006)], lack of autonomy in seeking medical help [OR = 3.538, 95%CI: (1.468–8.524)], delivery at non-health facility setting [OR = 4.672, 95%CI: (3.105–7.029)], experiencing the second delay [OR = 1.773, 95% CI: (1.212–2.595)] and stillbirth of the last pregnancy [OR = 5.543, 95%CI: (2.880–10.668)].Conclusionand recommendation.Lack of maternal education, lack of antenatal care, lack of autonomy to seek medical assistance, short birth interval, rural residence and delay in accessing obstetric services were identified as factors associated with maternal near-miss morbidity. As a result, the study suggests that those modifiable characteristics must be improved in order to avoid severe maternal complications and consequent maternal death.

Predictors of birth preparedness among women in Laikipia County, Kenya

Background: Maternal complications are the second leading cause of death among women after HIV/AIDS. World Health Organization (WHO) estimates that about 94% of all maternal deaths worldwide occur in developing countries. Evidence shows that birth preparedness; the process of strategizing for normal spontaneous vaginal delivery and anticipating the action plan in an obstetric emergency, reduces maternal mortality.Methods: The study assessed the predictors of birth preparedness among women in Laikipia county, Kenya. It was a mixed method, cross-sectional analytical study conducted among 259 women who had delivered within one year prior to the study. Facilities were selected through simple random sampling, whereas participants were selected through systematic sampling. It was a facility-based study using structured questionnaire and key informant interview guide, and data analysed using Statistical package for the social sciences (SPSS).Results: The level of birth preparedness was 23.2%. Inferential statistical tests showed that education, occupation and income, were statistically significant associated with the level of birth preparedness p&lt;0.05, CI=95%). Logistic regression showed that tertiary education (AOR=8.469), formal employment (AOR=4.898) and, income above Kshs 39,000 (AOR=4.834) had a positive association with birth preparedness.Conclusions: The level of birth preparedness was low in Laikipia County. Woman’s education, occupation and household monthly income were the predictors of birth preparedness.

Biochemical Parameters of Thyroid Profile in Relation to Pregnancy in Last Trimester

Introduction: Thyroid hormones are basic for foetal development during pre and after birth period. During pregnancy, expanded amalgamation of thyroid hormones is required to meet fetal requirements, which leads to tall necessity of iodine. Pregnancy could be a stress for thyroid organ; it influences 3% women amid pregnancy and 10% ladies of child bearing age. About 18-20% of Australian ladies have thyroid counter acting agent positive test during first trimester of pregnancy. Objective: To study the relationship of thyroid profile parameters in relation to Pregnant females in last trimester of pregnancy Material and Methods Study design: Cross sectional Settings: Holy Family Hospital Rawalpindi Duration: 6 months, 1st July 2021 to 31st December 2021 Data Collection Procedure: A cross sectional study was conducted on 50 patients. The study was conducted in Holy Family Hospital Rawalpindi. Ethical approval was taken from ethical committee. An educated consent was taken from the participants. Study members were pregnant mothers with pregnancy going to antenatal clinic during last trimester of pregnancy. All subjects were examined for any indications and signs of hypothyroidism and hyperthyroidism. This was cross-sectional study Simple convenient sampling technique was applied and sample was calculated using classical test estimate calculation equation of Cochran. Thyroid profile parameters were assessed by ELIZA strategy. Results: A group of fifty healthy pregnant females was selected. The mean age of pregnant females of maternal group was 28.5+6.5. Mode of delivery in females as 28(56%) normal spontaneous vaginal delivery and 22(44%) undergoes C-section. Standard error of mean, Standard deviation and percentile values were calculated in maternal group of females. Conclusion: Trimester particular reference ranges of TSH, FT4 and FT3 of our study were lower than international recommenced levels of 2017 Guidelines of American Thyroid Affiliation. These values may be utilized to compare thyroid disease in pregnancy in our area Keywords: Thyroid Profile, T3, T4, TSH, Hormones, Pregnancy

Congenital cardiac masses: a case report

BackgroundCardiac tumors in infants and children are rare. The most common cardiac tumor is rhabdomyoma, which may be associated with tuberous sclerosis. However, not all cardiac rhabdomyomas are pathognomonic for tuberous sclerosis, and not all congenital cardiac tumors are rhabdomyomas. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care.Case presentationWe report a 36-year-old African American pregnant women. At 32 weeks 5 days gestational age, the male fetus had a fetal echocardiogram due to fetal arrhythmia. The fetal echocardiogram showed two small echogenic, RV apex and septal masses, suspicious of rhabdomyomas. After a routine pregnancy and a normal spontaneous vaginal delivery (39 weeks 1 day), the male baby was admitted to the neonatal intensive care unit for further monitoring and postnatal evaluation.ConclusionsRhabdomyomas are extremely rare and unique tumors. These tumors are very dangerous, but they usually regress after birth. During the prenatal period, early cardiac tumor detection provides important information about fetal wellbeing, delivery planning, and necessary postnatal care. We present this case to share our findings with our pediatric colleagues. Although a rarely reported case, we hope this cardiac rhabdomyoma case report and literature review can increase cardiac tumor awareness.