Obstetric Emergency Department Research Articles

GIANT OMPHALOCELE ABOUT A CASE

We report the case of a giant omphalocele 10 cm in diameter diagnosed by ultrasound in the obstetric emergency department in a patient with a full-term pregnancy in labor, in whom an emergency cesarean section was indicated with fetal extraction, performance of emergency neonatal care, coverage of the omphalocele with non-adherent wet compresses and management by the pediatric surgeon with the result of uncomplicated operative sequelae without complications.

8501 Adrenal Incidentaloma In A Pregnant Woman Diagnosed With Preeclampsia

Abstract Disclosure: V.P. Vargas-Abonce: None. I.M. Hernandez-Riveros: None. J. Vasquez-Vasquez: None. F.D. Martínez-Sánchez: None. J.L. Hernandez-Castillo: None. A. Pretel Gutiérrez: None. T.G. Jaramillo-Salazar: None. M.E. Rodriguez García: None. E.K. Tenorio-Aguirre: None. Introduction: An adrenal incidentaloma is a tumor detected on imaging conducted for reasons other than suspected adrenal disease. Whether an incidentaloma should be addressed during pregnancy has not been discussed since this condition is very uncommon. The correct diagnosis and treatment of a functional adrenal tumor has significant implications for maternal-fetal morbidity and mortality. Case Presentation: A 25-year-old woman at 37 weeks of gestation presented to the obstetric emergency department with a headache accompanied by tinnitus and dizziness. Arterial blood pressure at admission was 180/120 mmHg, and biochemical urinary analysis showed proteinuria. A diagnosis of preeclampsia was made, and an emergency cesarean section was performed due to fetal bradycardia. A live single neonate was delivered with an Apgar score of 5/9 at 1 and 5 minutes respectively. During surgery, the patient's arterial blood pressure persisted at 190/110 mmHg despite treatment with 20 mg intravenous hydralazine. At her admission to the intensive care unit, an esmolol infusion was indicated, but the patient further presented tachypnea and tachycardia. A chest Angio tomography ruled out pulmonary thromboembolism, but imaging of the abdomen revealed a right adrenal mass of 6 cm with a heterogeneous enhancement in the arterial phase. Considering the clinical evolution and the findings in tomography, a pheochromocytoma was suspected. The antihypertensive treatment was switched from labetalol to prazosin, achieving control of blood pressure and clinical improvement. The patient was discharged after five days to continue the approach of an incidentaloma. Contrast-enhanced abdominal MRI reported a 9 cm right adrenal mass with a heterogeneous center and hypointense areas suggestive of necrosis. Plasma-free metanephrine was reported at 128 pg/mL (reference value <100 pg/mL) and normetanephrine at 3976 pg/mL (reference value <126 pg/mL). A right adrenalectomy was scheduled. Conclusion: In the workup of an incidentaloma, suggestive characteristics of malignancy in TC, and functional evaluation guided by the patient's clinical manifestations must be addressed concurrently. In this case, the presence of an adrenal incidentaloma larger than 4 cm with >10 HU in a pregnant woman diagnosed with preeclampsia who had an inadequate response to the standard treatment led to the consideration of a probable pheochromocytoma as a secondary cause of hypertension, which influenced the change of antihypertensive treatment to alpha-adrenergic blockade, followed by patient clinical improvement. Although the presence of a pheochromocytoma is much less common than preeclampsia as a cause of hypertension in pregnancy, a misdiagnosis can increase maternal morbidity and mortality by up to 15%. After adequate treatment of the obstetric emergency, the approach to incidentaloma in pregnancy is recommended. Presentation: 6/3/2024

Experiences of implementing and working with obstetric emergency triage: A qualitative study among Swedish midwifes, auxiliary nurses, and obstetricians

IntroductionObstetric emergency triage is a relatively new form of emergency triage and is not yet implemented in Sweden. Adaptations enables safe assessment of the childbearing woman, fetus and labor status. Failure to identify severely ill childbearing women and women post childbirth has repeatedly led to adverse outcomes. Introducing obstetric emergency triage constitutes a profound alteration in management that may challenge preconceived notions on how to provide best care. This study aimed at exploring and describing obstetric staff’s experiences of working with obstetric emergency triage. Materials and MethodsThirteen obstetricians, midwives and auxiliary nurses at an obstetric emergency department in eastern Sweden were recruited by purposeful sampling. Individual qualitative interviews underwent inductive qualitative content analysis according to Graneheim and Lundman. ResultsAn overarching theme − A new mindset − emerged from the analysis, comprising the four categories: Implications for the individual caregiver’s own work, An improved organization, Improved patient care. Initial skepticism to triage changed towards a positive attitude during implementation, identifying barriers and facilitators for successful implementation. ConclusionsThis first study exploring Swedish obstetric staff’s perception of obstetric emergency triage as a working method suggests that, given time for implementation, a new mindset in obstetric emergency care might develop. Triage provides structure and a sense of control through a clear and quick overview of childbearing women seeking emergency care and enhances teamwork by improving communication. Triage directs attention toward aberrations and promotes reflection and action, improving patient safety.

Low-dose Fractionated Spinal Anaesthesia for Elective Caesarean Section in a Patient with Large Atrial Septal Defect, Severe Pulmonary Hypertension and Preeclampsia: A Case Report

Atrial Septal Defect (ASD) is one of the most common acyanotic heart diseases presented in adults, with a higher prevalence among females. Patients often go unrecognised until middle age, unless complications such as arrhythmias arise. The physiological changes during pregnancy cause significant alterations in maternal haemodynamics. Cardiac valvular diseases, when present in obstetric patients, are among the leading causes of maternal mortality worldwide. These conditions pose a significant and unanticipated anaesthetic challenge, as the shunting of blood from left to right may precipitate hypoxia, hypercarbia, arrhythmias and cardiac failure. The presence of any other co-morbidities further complicates management. Hereby, the authors reported the successful management of a 30-year-old primigravida female at eight months of pregnancy, associated with a large ASD (34 mm), severe pulmonary hypertension, and preeclampsia, who underwent an elective Caesarean section (C-section). She presented at the Obstetric Emergency Department with dyspnoea at rest, which progressively deteriorated from the second month of pregnancy onward. She had no other complaints during her pregnancy. Echocardiography revealed a large Ostium Secundum ASD (OS-ASD) measuring 34 mm, almost leading to a single atrium physiology, with an ejection fraction of 45% and grossly dilated right atrium and right ventricle, as well as, severe Pulmonary Artery Hypertension (PAH). She underwent an elective Caesarean section with minimal haemodynamic alterations under fractionated spinal anaesthesia, with prophylactic adrenaline infusion. The effects were found to be beneficial and safe for the Caesarean section in patients with large ASD and preeclampsia.

The obstetrical emergency department: need, rationale, and guide to implementation

The past 2 decades have seen dramatic growth in the number of obstetrics and gynecology hospitalists, and many hospitals have created obstetrical-specific emergency departments. The goals of an obstetrics emergency department are to provide safe and efficient care to the pregnant dyad and postpartum patient, while generating revenue for emergency services provided. In an obstetrics emergency department, all patients must be evaluated in person by a licensed practitioner, whereas historically they may have been evaluated in person by nursing staff or a trainee. We make the argument that formation of an obstetrics emergency department has the potential to improve the safety and quality of patient care. In addition, the financial benefits to institutions are substantial and can subsidize the cost of maintaining obstetrician presence all the time in the hospital. There are various regulatory requirements to become certified, accredited, and licensed as an emergency department. In addition, there are many operational and systems issues that institutions should consider before implementation. We provide a guide for healthcare systems considering creating an obstetrics emergency department.

Uterine torsion as an elusive obstetrical emergency in pregnancy: is there an association between gravid uterus torsion and Ehlers–Danlos syndrome?: a case report

BackgroundTimely diagnosis of uterine torsion can lead to acceptable maternal and fetal outcomes. This article presents the case of a 42-year-old pregnant woman, diagnosed with a rare 270° uterine torsion, in whom proper management led to good maternal outcomes but, unfortunately, severe prematurity and metabolic acidosis led to neonatal death. Moreover, the mother was clinically suspected for Ehlers–Danlos syndrome.Case presentationIn December 2020, a 42-year-old pregnant Iranian woman, Gravid 3 para2 live2, at 30 weeks of gestation presented to the obstetric emergency department of Vali-Asr Hospital (Birjand, Iran) suffering from acute severe generalized abdominal pain, nausea, vomiting, and dizziness while she was hemodynamically unstable. After resuscitation, owing to persistent fetal bradycardia on fetal heart rate monitoring, she underwent an emergency cesarean section. Infra-umbilical midline skin incision was made, and when the abdominal cavity was opened, owing to abnormal appearance of the uterus, we further investigated the abdominopelvic cavity. Surprisingly, the uterus was dextrorotated by 270°. After uterine detorsion through a Kerr incision, a nonvigorous male baby was born with severe metabolic acidosis that led to his death soon after birth. Interestingly, we could find no predisposing factors such as pelvic abnormalities during surgery. Nevertheless, as her postoperative detailed physical examination revealed skin hyperextensibility, joint laxity, pelvic organ prolapse, and trivial exophthalmos, connective tissue disorders, mainly Ehlers–Danlos syndrome, were suspected. Unfortunately, for significant financial, cultural, and religious reasons, the patient refused to undergo further investigations. Additionally, despite severe congested uterus and subsequent uterine atony, timely diagnosis and anatomical correction of the gravid uterus before uterine incision prevented iatrogenic complications. The mother was discharged 2 days later without any postpartum complications.ConclusionAlthough uterine torsion is an extremely rare condition during pregnancy, based on severe associated maternal and perinatal complications, it is important to take this diagnosis into consideration as an differential diagnosis. Moreover, connective tissue disorders seem to be a potential risk factor for uterine torsion, although further studies on this subject are required.

Complete Congenital Atrioventricular Block Found by Ultrasound in Pregnancy

A 27-year-old woman at 7 months of pregnancy presented to the obstetric emergency department with a history of fetal bradycardia for 3 days. Her vital signs were within normal limits. Autoimmune disease screening revealed positive antinuclear antibodies and weakly positive anti–Sjögren's syndrome A antibodies. Color Doppler ultrasound of the fetal 4-chamber view showed low pulse rates, mitral regurgitation, and increased cardiothoracic ratio (Video E1 [available at http://www.annemergmed.com]), which might have certain clinical significance.

Impact of COVID-19 on the Incidence and Severity of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System.

COVID-19 has had an unprecedented impact on medical care use and delivery, including stark reductions in emergency department (ED) volume. The aim of this study was to assess changes in incidence of OB/GYN ED visits and disease severity at time of presentation during the COVID-19 pandemic. We conducted a multicenter retrospective study of OB/GYN-related ED visits before and during the COVID-19 pandemic. Incidence rates (IRs) and severity measures were compared across time periods and years. A total of 18,668 OB/GYN ED encounters occurred between January 1 and December 31, 2020, compared to 21,014 encounters between January 1 and December 31, 2019. During shelter-in-place, visits decreased by 41% compared to the pre-pandemic period in 2020 before returning to typical rates (incidence rate ratio (IRR) = 0.98 in fall/winter). We found a similar proportion of patients with hemoglobin < 7 g/dL for diagnoses associated with bleeding and patients with white blood cell count > 12,000 per µL in the setting of infection comparing corresponding time periods in 2019 and 2020. There were fewer formal OB/GYN consults, hospital admissions at time of presentation, and urgent surgical procedures performed across all periods in 2020; however, hospitalization within 7 days substantially increased in the first half of 2020. The incidence of OB/GYN ED visits declined substantially between March and August 2020 but then returned to pre-pandemic levels by fall/winter 2020. The decreased incidence was not accompanied by an increase in severity of presentation.

DO PRÉ-NATAL AO PUERPÉRIO: MUDANÇAS NOS SERVIÇOS DE SAÚDE OBSTÉTRICOS DURANTE A PANDEMIA DA COVID-19

ABSTRACT Objective: to analyze changes in maternal health care during the Covid-19 pandemic, according to reports by health professionals. Method: qualitative research, conducted with managers, physicians, nurses, residents and nursing technicians working in a prenatal outpatient clinic, obstetric emergency department, delivery center and obstetric inpatient ward of a high complexity federal public hospital in the Northeast of Brazil. Data were collected from December 2020 to August 2021. The sample, chosen intentionally, sought the diversity of characteristics and situations, was closed by the criterion of saturation of meaning. A structured questionnaire and a semi-structured interview script were used for data collection. The interviews were recorded and transcribed. Content analysis was used in the thematic modality. Results: 28 professionals were interviewed. Changes in the dynamics of obstetric care were identified and categorized as: prenatal care; and childbirth/postpartum. In prenatal care, there was a decrease in elective consultations; increased time between consultations; delayed care due to paramentation; implementation of new hygiene protocols; limitation of the number of companions; creation of new environments such as the Covid-19 isolation room for symptomatic pregnant women; teleservice and work overload due to the increased demand coming from Primary Health Care. In childbirth/postparum, the reports indicated a reduction in the number of beds; testing and isolation of symptomatic patients; limitating walking, restriction of companions and mandatory use of mask by pregnant woman. Conclusion: the restructuring of services and the creation of new spaces to care for patients with Covid-19 led to a reduction in the availability of vacancies for prenatal and postpartum consultations. The changes were accompanied by new service rules, with setbacks regarding the guarantee of rights.

Effects of COVID-19 pandemic period on neonatal mortality and morbidity

BackgroundCorona Virus Disease 2019 (COVID-19) in pregnant women has important impacts on perinatal and neonatal outcomes. However, there are a limited number of studies investigating the effect of the pandemic period on newborns. With this study, we aimed to determine the impact of the 2020 COVID-19 outbreak on prenatal care, obstetric outcomes, neonatal mortality and morbidity.MethodsThe retrospective results of patients hospitalized to the Tertiary Neonatal Intensive Care Unit between 1 March and 30 May 2020, the first peak period of the pandemic in our country, were compared with the data of the same period of the previous year.ResultsA total of 307 cases were included in our study. The mean gestational weeks of the neonates hospitalized in the Neonatal Intensive Care Unit during the COVID-19 period were higher than those in the control group (p: 0.003). During the pandemic period, an increase was found in the frequency of pregnant women presenting to obstetric emergency services in emergencies requiring acute intervention (p: 0.01). Compared to the control group, there was an increase in the number of infants with small for gestational age (SGA) diagnosis, 5th-minute Apgar score of <7, and newborns with a diagnosis of hypoxic-ischemic encephalopathy who were treated with hypothermia in the study group (p < 0.05). No difference was found in terms of maternal and neonatal mortality (p > 0.05).ConclusionsDuring the COVID-19 pandemic, it was shown that pregnant women disrupted their regular antenatal care, and more pregnant women were admitted to the obstetric emergency department with emergencies requiring acute intervention. This led to an increase in the number of cases diagnosed with SGA and hypoxic-ischemic encephalopathy in newborns. Our results will be useful for better management of current and future pandemic periods.

Trends in obstetric emergency department attendance the first months of the coronavirus pandemic

Many medical disciplines reported a decline in patient attendance during the coronavirus pandemic. Our paper examines the effects that the coronavirus pandemic had on obstetric Emergency Department (ED) attendances in a tertiary maternity centre in the Republic of Ireland. A retrospective cross-sectional analysis was performed on administrative data regarding the number of obstetric patients attending the ED from January to July in 2019 and 2020. These numbers were compared to the number of reported coronavirus cases in Ireland as released in official government publications. A paired sample t-test was carried out to see if there was a significant difference in attendance in the obstetric ED in 2020 compared to in 2019. When COVID-19 cases peaked at 17,377 in April 2020, ED attendance showed their largest decline of 27%. The cumulative decline in ED attendances from January to July in 2019 to 2020 was 13%. However, this decline was not found to be statistically significant. In contrast to other disciplines, the COVID-19 pandemic did not cause a decrease in obstetric ED attendance.

SARS-CoV-2 in asymptomatic pregnant women in South Brazil: RT-PCR and serological detection.

This study aims to detect the SARS-CoV-2 infection prevalence in asymptomatic pregnant women. A group of 195 asymptomatic pregnant women who attended the prenatal care outclinic and to the obstetric emergency department was tested concomitantly for SARS-CoV-2 by RT-PCR and serological tests. The virus was detected by RT-PCR in two (1.02%) cases and 17 (8.71%) patients had antibodies detected by immunochromatographic tests. Due to the high risk of this emerging infection in the health of pregnant women, fetuses and newborns, we suggest the universal screening of all pregnant women admitted to hospital through the combined method RT-PCR and serological.

Coronavirus Disease 2019 (COVID-19) and the Incidence of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System

The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented effects on medical care worldwide. Studies have shown a reduction in the number of patients presenting to the hospital for emergent conditions such as acute myocardial infarction, and emergency department (ED) volume has declined in some hospitals by as much as 50%.1–3 Currently, there is limited research on the effects of COVID-19 on the incidence of surgical emergencies, particularly in obstetric and gynecologic care.4,5 Moreover, it is unclear how health care system usage has changed after the peak of COVID-19 infections and during subsequent re-opening efforts. We examined the incidence of obstetric and gynecologic emergencies using data from Kaiser Permanente Northern California, an integrated health care system that serves more than 1 million reproductive-aged women annually.

Prevalence and risk factors for micronutrient deficiencies during pregnancy in Cayenne, French Guiana.

BackgroundInvolved in physical and brain development, immunity and metabolism, micronutrients have profound health effects. The nutritional status of pregnant women is a major determinant of foetal health. French Guiana has a rapid population growth. Social inequalities, cultural practices and gastrointestinal nematode infections in French Guiana could affect the prevalence of these deficiencies. The main objective of the present study was to estimate the prevalence of micronutrient deficiency among pregnant women in French Guiana. The secondary objective was to identify socio-demographic, dietary, obstetrical and neonatal risk factors associated with deficiencies.MethodsPregnant women over 22 weeks of pregnancy hospitalized for delivery at the Obstetrical Emergency Department of the Hospital Center in Cayenne from May 2018 to March 2019 were included. A socio-demographic and food questionnaire was administered. Medical data were collected from the medical records. Blood and urine samples were taken. The descriptive analysis used Student and chi-squared tests.ResultsA total of 341 women were included. The majority were born in Haiti (39%) and French Guiana (34%). At least one micronutrient deficiency was observed in 81% of women. Precarious women had a significantly greater risk of micronutrient deficiency during pregnancy compared to those with both normal and complementary health insurance.ConclusionsMicronutrient deficiencies in pregnant women in French Guiana are a public health problem, a fact that was previously overlooked in the context of rising obesity. With over half the women overweight or obese, and 81% with at least 1 micronutrient deficiency, balanced nutrition should be a major focus.

Prevalence of Drug abuse among ante partum females, Obstetric Department, Beni Suef University Hospital, Egypt

The consumption of drugs of abuse among females in the Health Services is a frequent problem, but oftenit is not diagnosed. Aims: We have analyzed the variations in the clinical profile of female patients came toobstetric emergency department in a period of sex months and made screening for various drugs to assessthe percentage of addicted females in this period of life. Secondly, we have assessed also the accuracy of thepresumptive method of detection compared to the confirmatory method. Method: Urine samples were takenfrom pregnant females came to obstetric emergency department, Beni Suef University hospital and wasscreened to detect the drugs of abuse that taken by these females by immunoassay and GC- mass and clinicalassessment of the babies were done. Results: from 300 females there were 20 cases Tramadol positiveby immunoassay but all of them were false positive when GC-mass was used. There was a questionedcross reactivity between Ranitidine and tramadol by Immunoassay needing for more researches. 62.3% ofthe female were no educated 42% of the female’s husbands were SHISHA smokers. Intra uterine growthretardation was the most common fetal complicationConclusions: scientific survey which done to detect drug abuse among group of people should never dependon immunoassay methods. The belief that women are more biologically complicated than men and thatthey were too busy caring for their children to participate in studies should be changed. Women should beincluded in clinical researches.

Changes in the obstetrical emergency department profile during the COVID-19 pandemic

Background The COVID-19 outbreak caused persons to be reluctant to seek medical care due to fear of contracting the infection. Objectives To evaluate the effect of the COVID-19 pandemic on admission rates to the delivery room and the feto-maternal unit, and to assess the effect on the nature of presenting obstetrical complaints to the emergency department. Study Design A retrospective cohort study in one medical center. The population was women > 20 weeks pregnant who presented to the obstetrical emergency department with self-complaints during 29 days at the peak of the pandemic outbreak, and a matched group during the exact period in the previous year. We compared between the groups: clinical, obstetrical, and demographic data, including age, area of residence, gravidity, parity, previous cesarean deliveries, high-risk pregnancy follow-up, the last 30 days admissions to the obstetrical emergency department, gestational age, chief complaints, cervical dilatation, cervical effacement, admissions to the delivery room or feto-maternal unit, time from admissions to the delivery room to birth, if applicable, and acute obstetrical complications diagnosed at the emergency department. Results During the pandemic outbreak, 398 women met study inclusion criteria, compared to 544 women in the matched period of the previous year. During the COVID-19 period, women visited the obstetrical emergency department at a more advanced mean gestational age (37.6 ± 3.7 vs. 36.7 ± 4.6, p = .001). Higher proportions of women in the COVID-19 cohort presented in active labor, defined by cervical dilation of at least 5 cm on admission to the labor ward [37 (9.3%) vs 28 (5.1%), p = .013)] and with premature rupture of membranes [82 (20.6%) vs 60 (11.0%), p < .001)], and consequently with more admissions to the delivery room [198 (49.7%) vs 189 (34.7%), p < .001)]. We also recorded a significant increase in urgent obstetrical events in the emergency department during the recorded COVID-19 pandemic [23 (5.8%) vs 12 (2.2%)), p = .004]. However, the rates of neonatal and maternal morbidity did not change. During the outbreak the proportion of visits during the night was higher than during the matched period of the previous year: [138 (34.7%) vs 145 (26.6%)), p = .008]. In a multivariate logistic regression, the higher rates of admission to the delivery room during active labor and of urgent events during the pandemic outbreak compared to the matched period in the previous year remained statistically significant. Conclusions The pandemic outbreak of COVID-19 caused a behavioral change among women who presented to the obstetrical emergency department. This was characterized by delayed arrival to the obstetrical emergency department and the delivery room, which led to a significant increase in urgent and acute interventions. The change in behavior did not affect the rates of maternal and neonatal morbidity.

Development of a High-Risk Maternal–Newborn Transport Team

To improve the process for safe transports of pregnant women and to develop a transport team for high-risk pregnant women and their neonates. It is the responsibility of a regional perinatal intensive care center to provide primary obstetric care to women with high-risk pregnancies and to their high-risk neonates. As the third largest birth system in the state, with more than 4,500 births last year, and the sole perinatal intensive care center in the region, the safety of pregnant women and their newborns is a priority. The health system and surrounding community needs are changing and now require a safe method to transport women with high-risk pregnancies who are in labor and women who are ready to give birth but are in a facility that does not offer inpatient labor and delivery services. The use of current resources within the established pediatric and neonatal transport team provided a solid foundation for developing the service line. A multidisciplinary group of stakeholders participated in the development, including transport team leadership, nurse and physician obstetric leadership, transfer center staff, as well as hospital administration. The addition of a perinatal nurse allows for the women in labor to receive proper care from the team as well as have the backup of a neonatal team in the event the mother gives birth. The new service also provides the ability to transport a woman who has given birth in an outlying emergency room in the same ambulance with her newborn safely. After 4 months of being in service, the team has safely transported 74 pregnant women and 7 mother–newborn pairs. Eleven of the women were from out of county, with a distance of 24 miles and greater to the regional care center. Sixty-two percent of the women were admitted for ongoing monitoring, birth, or emergent cesareans, and 36% of the women were triaged in the obstetric emergency department, monitored, and subsequently discharged. Currently, the transport team provides a high level of care for the surrounding five regional counties through a mobile intensive care unit. With the addition of a perinatal nurse, we are able to provide safe and critical services to pregnant women in our community.

Maternal and neonatal consequences in women with severe preeclampsia and patients with HELLP syndrome: a comparative study

Background: The (HELLP) syndrome is a severe health hazard in pregnancy described by elevated liver enzymes, low platelet count and hemolysis. It happens in 0.4 to 0.7% of all gestations and in 10-12% of cases with severe preeclampsia. Patients and methods: The present study was a prospective observational study that was made at Department of Obstetrics and Gynecology, Kasr Al-Ainy University Hospital, Cairo University, from September 2018 – March 2019. It included One Hundred and Thirty pregnant women diagnosed with hypertension in the current pregnancy complicated with severe preeclampsia, or HELLP Syndrome associated with abdominal ascites, recruited from the attendees of the Obstetric Emergency Department. The study was approved by the local institutional review board of the Faculty of Medicine, Cairo University. All ladies signed an informed consent. Results: There were statistically significant differences between the HELLP group and the severe preeclamptic group regarding maternal ICU admission and the need of multiple drugs to control the blood pressure being less in severe preeclampsia group. The need for ICU admission was much higher in the HELLP group (43.1%) compared to the severe preeclampsia group (9.2%) showing statistical significance (P&lt;0.001). Conclusion: Maternal and neonatal sicknesses are elevated between cases with HELLP syndrome. So, early diagnosis and definitive treatment can be made to enhance maternal and neonatal results.

Effect of non-pharmacological methods on vital signs during first stage of labor at Sohag University Hospital

Background: Labor is a normal physiological process, which while should be an occasion for rejoicing, it also accompanies it with lots of pain, agony, and discomfort and certain risks. The aim of the study was to assess the effect of back massage and reflexology on labor pain reduction and vital signs during first stage of labor. Subjects and Methods: Quasi-experimental design was used to conduct this research .This study was carried out at obstetric emergency department at Sohag University Hospital. A purposive Sample of 150 women. Tools used in this study, Tool I: Patient assessment sheet. Tool II: Visual Analogue Scale. Tool III: Hemodynamic stability. The main results: showed that there are statistically significant differences regarding pain reduction before and after applying back massage and reflexology during first stage of labor and no statistically significant differences regarding vital signs before and after applying them . Conclusion: Both back massage and reflexology have effect on pain reduction and don’t have effect on vital signs during first stage of labor. Recommendation: Further studies of efficacy as well as effectiveness are needed to determine the clinical applicability of back massage and reflexology in a large sample.

Emergency consultations in obstetrics: identification of decisive, contributing and associated factors.

Psychosocial and biological factors influence the perception of physical changes during pregnancy. Some pregnant women present to the obstetric emergency department (ED) with diverse symptoms not requiring urgent medical action. These visits result in over-consultation, tying up resources and inflating health care expenses. This study outlines factors associated with multiple ED visits during pregnancy, measures the prevalence of anxiety and depression, and explores the choice of maternity clinic for delivery aiming to elucidate options for care strategies. This prospective, cross-sectional, questionnaire-based bicentric study was performed in the obstetric outpatient departments of two university hospitals in Germany and recruited pregnant women between 12/2016 and 11/2017. The questionnaire included socio-demographics, obstetric history, anxiety (GAD-7), depression (PHQ-9), and health status (WHO-5, SF-12). This analysis included 496 women and showed that women with numerous ED visits were significantly younger (p < 0.0001), less educated (p = 0.0002), and more likely to be unemployed and single. Different prevalences for anxiety and depression were detected correlating with the number of ED visits although each showing only low effect sizes (0.024 resp. 0.015). Pregnant women attending the ED more often might benefit from health education, psychosomatic interventions, and social support to overcome their depression and anxiety to avoid non-urgent ED consultations. Further prospective studies are needed to support these findings.