Obstetric Unit Research Articles

Early Suckling and Post-Partum Bleeding

CONTEXT When working with parturient women, particular care must be taken at a sensitive phase like the immediate postpartum period. In order to minimise the quantity of vaginal blood loss, it is crucial to emphasise to those mothers the value of frequent breastfeeding and early start-up. The purpose of this study to investigate the effect of early suckling on postpartum bleeding . CONSTRUCTION A quasi experimental research design was utilized. CONTEXT The study was conducted at labor unit of Obstetrics and Gynecology department in Benha University Hospital. A SELECTED SAMPLE A purposive sample of (100) women's (50) in the group in commandwere given routine care and (50) women in the study squad, women encouraged to initiate early suckling immediately after birth. Tool I): A structured interviewing questionnaire II): Observation record on parturient women during stages of labor III): Breastfeeding assessment tool. there were highly statistically significant differences in duration of third stage of labor was at 5 minutes in women of study squad compared to women in the control group.Also, there were highly statistically significant differences found between the total mean score of the early initiation of breastfeeding among the study squad (10.2800±1.789) compared to (8.4800±2.233) of the group in command. It is possible to educate expectant mothers about the benefits of early breastfeeding at hospitals and birthing facilities.

Clinical Validation of the sFlt-1:PlGF Ratio as a Biomarker for Preeclampsia Diagnosis in a High-Risk Obstetrics Unit.

Preeclampsia is a multisystem disorder defined by new onset of hypertension with proteinuria after 20 weeks gestation. In part due to dysregulation of pro-angiogenic factors (e.g., placental growth factor [PlGF]) and anti-angiogenic factors (e.g., soluble fms-like tyrosine kinase 1 [sFlt-1]), preeclampsia results in decreased placental perfusion. An increased sFlt-1:PlGF ratio is associated with increased risk of preeclampsia. In this study, we evaluated sFlt-1:PlGF cutoffs and evaluated the clinical performance of sFlt-1:PlGF for predicting preeclampsia. sFlt-1:PlGF results from 130 pregnant females with clinical suspicion of preeclampsia were used to evaluate the diagnostic accuracy of different sFlt-1:PlGF cutoffs and to compare the clinical performance of sFlt-1:PlGF to traditional preeclampsia markers (proteinuria and hypertension). Serum sFlt-1 and PlGF were measured using Elecsys immunoassays (Roche Diagnostics) and preeclampsia diagnosis was verified by expert chart review. A sFlt-1:PlGF cutoff of >38 yielded the greatest diagnostic accuracy of 90.8% (95% CI, 85.8%-95.7%). Using a cutoff of >38, sFlt-1:PlGF exhibited a greater diagnostic accuracy than traditionally used parameters such as new or worsening proteinuria or hypertension (71.9% and 68.6%, respectively). sFlt-1:PlGF >38 exhibited a negative predictive value (NPV) of 96.4% for rule-out of preeclampsia within 7 days, and a positive predictive value (PPV) of 84.8% for predicting preeclampsia within 28 days. Our study shows the superior clinical performance of sFlt-1:PlGF over hypertension and proteinuria alone to predict preeclampsia at a high-risk obstetrical unit.

Impact of Implementation of the Maternal-Fetal Triage Index on Patients Presenting With Severe Hypertension

ABSTRACT The timely triage of pregnant patients presenting for emergent care is an important factor for decreasing maternal morbidity and mortality. The Maternal-Fetal Triage Index (MFTI) is an assessment tool developed by the Association of Women's Health, Obstetric and Neonatal Nurses in 2014 and endorsed by the American College of Obstetricians and Gynecologists (ACOG) in 2016 for triaging obstetrical patients presenting for emergent care. The Joint Commission has identified response time to severe hypertension, or preeclampsia, as one of its elements of performance. The aim of this study was to examine the management of women with severe hypertension before and after the implementation of MFTI. This was a prospective, observational study at a county-supported, urban academic hospital, serving medically indigent women. Included were women at ≥24 weeks of gestation, who presented in the hospital's obstetric triage unit with severe preeclampsia diagnosed by severe hypertension. Severe hypertension was defined as blood pressure (BP) ≥160/110 mm Hg. Excluded were those who were not admitted for delivery at the time of presentation. Patients with BP ≥160/110 mm Hg were given magnesium sulfate (MgSO4) prophylaxis and treated with intravenous hydralazine, labetalol, or immediate-release nifedipine. Patients admitted before the implementation of MFTI (between January 1, 2019, and December 31, 2019) represented epoch 1 of the cohort. Those admitted after MFTI implementation (between March 1, 2021, and September 30, 2021) made up epoch 2. Nursing staff used the criteria outlined in the MFTI to prioritize patient acuity. A 1 score is the highest priority, and a 5 score is the lowest priority. The primary outcome was the time interval to evaluate and manage women with severe hypertension before and after MFTI implementation, as measured by arrival time to provider assessment, arrival time to MgSO4 prophylaxis, and arrival time to the administration of antihypertensive medications. There were 370 patients in epoch 1, before MFTI implementation, and 254 patients in epoch 2, after implementation. The time from arrival to provider assessment improved significantly from epoch 1 to epoch 2 (median time: 44 minutes [interquartile range, 0–65 minutes] vs 17 minutes [IQR, 0–39 minutes], respectively; P < 0.001). The time from arrival to MgSO4 prophylaxis also improved (160 minutes [IQR, 109–256 minutes] vs 126 minutes [IQR, 85–258 minutes], respectively; P = 0.001). There was a decrease in the time from arrival to administration of antihypertensive medications between the 2 time frames (101 minutes [IQR, 61–177 minutes] in epoch 1 vs 66 minutes [IQR, 35–203 minutes] in epoch 2; P < 0.001). In a separate analysis, race and ethnicity did not factor into the performance of MFTI. Overall, there was an improvement in the evaluation and management of pregnant women with severe hypertension after the implementation of MFTI, regardless of race and ethnicity. Timely identification and management of this high-risk population may improve maternal morbidity and mortality.

Hysterectomy following severe primary postpartum hemorrhage: A five year review in Abidjan University Hospitals.

Hemostasis hysterectomy is a mutilating technique responsible for definitive side effect on the woman's fertility. The aim was to document to document hemostasis hysterectomies performed in obstetrics units of university hospitals in Côte d'Ivoire. This was a retrospective, cross-sectional, and descriptive study from January 2013 to January 2018 in the three university hospital centers of Abidjan. It involved all parturients of the said university hospital centers who presented a severe postpartum hemorrhage and in whom a hemostasis hysterectomy was performed. The overall frequency of hemostasis hysterectomy in the three university hospitals was 0.32%. The most common etiologies were atony and uterine rupture. Hemostasis hysterectomy was indicated immediately. The deaths recorded were most often intraoperative and in the immediate postoperative period. The reduction of its incidence requires a good surveillance of the third period of delivery.

Queueing inspired feature engineering to improve and simplify patient flow simulation metamodels

ABSTRACT We explore the interplay between domain-informed feature engineering, model performance, and model interpretability. This is a hybrid modelling and simulation study that merges the application of discrete-event simulation with alternative metamodelling techniques for modelling patient flow in health care. We consider two cases: a tandem queueing system of obstetric hospital units and a transient analysis of an outpatient clinic in which a finite number of scheduled patients arrive for care. We use several metamodels including various types of linear models, random forests, and neural networks. We evaluate the performance improvement of metamodel estimation when empowered with supplementary queueing theory knowledge. We consider three knowledge levels: no knowledge (no queueing-inspired features), basic (simple queueing features), and advanced (sophisticated queueing approximations). Our results show that queueing-related inputs improve the accuracy for the metamodels, independent of the model type. Moreover, queueing-related inputs improve model explainability and can lead to more parsimonious models. This has positive practical implications for implementing these types of models in actual health-care analytic projects.

Ocular Manifestations in Pregnancy-Induced Hypertension at a Tertiary Level Hospital in Karnataka, India.

Introduction Pregnancy-induced hypertension (PIH) is a hypertensive disorder in pregnancy that occurs after 20 weeks of pregnancy in the absence of previously known hypertension. PIH is a common and serious complication accompanying pregnancy. Pre-eclampsia and eclampsia are multisystem disorders that can involve end organs like kidneys, liver, eyes, haematopoietic system and placenta. Though ocular involvement is not uncommon in PIH, ocular examination is not always done in all cases of PIH. Timely detection of changes in retinal vasculature can be a hint to the underlying changes in the vascular system of the various end organs of the human body including placental circulation. Adequate management of PIH is very important for both fetal and maternal well-being. Aim To evaluate the ocular manifestations in women affected by PIH (mild pre-eclampsia, severe pre-eclampsia and eclampsia) presenting to a tertiary-level hospital. Methodology This was a hospital-based cross-sectional study carried out for a period of one year at a tertiary-level hospital. A total of 120 subjects diagnosed as cases of pre-eclampsia/eclampsia admitted to the eclampsia ward of the obstetric unit formed the study population. After taking history, a detailed ocular examination was done for all patients and the findings were noted. Results The mean age of the study population was 31.91 ± 4.38 years (range 21 to 39 years). The mean gestational age was 30.89 ± 3.98 weeks. Fifty-three (44.17%) were primigravida, 64 (53.33%) were multiparous, and three (2.5%) were grand multiparous. Sixty-two (51.67%) had mild pre-eclampsia, 50 (41.67%) had severe pre-eclampsia and eight (6.67%) had eclampsia. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) recorded in the study were 155.32 ± 11.89 mmHg and 104.3 ± 11.41 mmHg respectively. Ocular symptoms were present in 43 (35.83%) participants. Blurring of vision (19.17%)was the commonest ocular symptom observed in the study population followed by photopsia (13.33%), diplopia (9.17%), intermittent loss of vision (5.83%), ocular pain (6.67%), and scotoma (1.67%). Systemic symptoms included headache (11.67%), epigastric pain (3.33%), and nausea (5%). Anterior segment findings like conjunctival congestion, lid edema, and subconjunctival hemorrhage each accounted for 1.67% of the study population. Fundal changes were present in 33.33% of cases. Arteriolar narrowing was the commonest fundal finding amounting to 15.83%, followed by arteriovenous (AV) crossing changes also in15.83%, cotton wool spots in 5.83%, retinal haemorrhages in 8.33%, papilledema in 2.5%, and choroidal infarcts in 1.67% participants. Grade 1 hypertensive retinopathy was observed in 15.83% of participants, grade 2 in 8.33% of participants, grade 3 in 6.67% of participants and grade 4 in 2.5% of participants. The mean SBP and mean DBP were high among those with fundal changes (163.35 ± 10.25 mmHg and 111.15 ± 10.29 mmHg) compared to those without fundal changes (151.3 ± 10.58 mmHg and 100.88 ± 10.41 mmHg). This was statistically significant. Proteinuria showed significant correlation with retinal changes. Conclusion The retinal vasculature changes correlate with the severity of hypertension, hence, it is very important to seek ophthalmologic opinion for evaluation, diagnosis and prompt management of PIH.

Sonographic Assessment of Maternal Portal Vein Diameter in Healthy Pregnancy in South-South Nigeria

Background: The portal vein is one of the main sources of blood supply of the liver. About three quarters of the liver blood flow is from the portal vein.
 Objectives: To assess the mean normal portal vein diameter in healthy pregnant women, and correlate our observation with maternal age, parity and other baseline characteristics.
 Subjects and Methods: This descriptive, cross-sectional study was conducted at the Obstetrics and Radiology Units of the two tertiary health facilities, one secondary facility and one radio-diagnostic facility in Bayelsa State, South-South Nigeria, between April, 2022 and December, 2022. Data analysis was done using Statistical Product and Service Solutions for Windows® version 25, SPSS Inc.; Chicago, USA. Descriptive statistics (mean, standard deviation, frequency, and percentages) and Pearson product moment correlation were used for the analysis. The level of significance was set at p<0.05.
 Results: Mean portal vein diameter was 10.43 ± 1.58 mm, and ranged from 7.5 mm to 14.0 mm. Maternal age (ɼ = 0.51; p – 0.001) and parity (ɼ = 0.47; p – 0.001) correlated fairly strong and significantly with portal vein diameter. Gestational age (ɼ = 0.21; p – 0.001) and estimated foetal weight (ɼ = 0.16; p – 0.001) were significantly related to the portal vein diameter.
 Conclusion: This research has established baseline values for normal range of PV diameter in healthy pregnant women in the South-South region of Nigeria, and also revealed significant correlation of PV diameter with age, parity, gestational age and estimated foetal weight.

Preeclampsia: Recent Advances in Predicting, Preventing, and Managing the Maternal and Fetal Life-Threatening Condition.

Preeclampsia accounts for one of the most common documented gestational complications, with a prevalence of approximately 2 to 15% of all pregnancies. Defined as gestational hypertension after 20 weeks of pregnancy and coexisting proteinuria or generalized edema, and certain forms of organ damage, it is life-threatening for both the mother and the fetus, in terms of increasing the rate of mortality and morbidity. Preeclamptic pregnancies are strongly associated with significantly higher medical costs. The maternal costs are related to the extra utility of the healthcare system, more resources used during hospitalization, and likely more surgical spending due to an elevated rate of cesarean deliveries. The infant costs also contribute to a large percentage of the expenses as the babies are prone to preterm deliveries and relevant or causative adverse events. Preeclampsia imposes a considerable financial burden on our societies. It is important for healthcare providers and policy-makers to recognize this phenomenon and allocate enough economic budgets and medical and social resources accordingly. The true cellular and molecular mechanisms underlying preeclampsia remain largely unexplained, which is assumed to be a two-stage process of impaired uteroplacental perfusion with or without prior defective trophoblast invasion (stage 1), followed by general endothelial dysfunction and vascular inflammation that lead to systemic organ damages (stage 2). Risk factors for preeclampsia including race, advanced maternal age, obesity, nulliparity, multi-fetal pregnancy, and co-existing medical disorders, can serve as warnings or markers that call for enhanced surveillance of maternal and fetal well-being. Doppler ultrasonography and biomarkers including the mean arterial pressure (MAP), uterine artery pulsatility index (UtA-PI), and serum pregnancy-associated plasma protein A (PAPP-A) can be used for the prediction of preeclampsia. For women perceived as high-risk individuals for developing preeclampsia, the administration of low-dose aspirin on a daily basis since early pregnancy has proven to be the most effective way to prevent preeclampsia. For preeclamptic females, relevant information, counseling, and suggestions should be provided to facilitate timely intervention or specialty referral. In pregnancies complicated with preeclampsia, closer monitoring and antepartum surveillance including the Doppler ultrasound blood flow study, biophysical profile, non-stress test, and oxytocin challenge test can be arranged. If the results are unfavorable, early intervention and aggressive therapy should be considered. Affected females should have access to higher levels of obstetric units and neonatal institutes. Before, during, and after delivery, monitoring and preparation should be intensified for affected gravidas to avoid serious complications of preeclampsia. In severe cases, delivery of the fetus and the placenta is the ultimate solution to treat preeclampsia. The current review is a summary of recent advances regarding the knowledge of preeclampsia. However, the detailed etiology, pathophysiology, and effect of preeclampsia seem complicated, and further research to address the primary etiology and pathophysiology underlying the clinical manifestations and outcomes is warranted.

Long-term quality of life after obstetric intensive care unit admission: A cross-sectional cohort study.

To assess the long-term quality of life (QoL) after obstetric Intensive Care Unit (ICU) admission. Cross-sectional survey study. Tertiary care centre. Women admitted to the level 3 ICU during pregnancy or ≤6 weeks postpartum, between 2000 and 2015. Quality of life measures were compared with the population reference values. Associations with baseline ICU parameters were assessed with multivariable linear regression. Patient-reported outcome and experience measures (PROMs/PREMs) were described. Quality of life according to the Linear Analogous Scale (LAS), the Satisfaction with Life Scale (SWLS) and the SF-36 questionnaire; PROMs/PREMs using the Pregnancy and Childbirth outcome set of the International Consortium for Health Outcomes Measurement. Of all 265 obstetric ICU admissions, 230 were eligible and 94 (41%) were included (median follow-up time 14 years). The LAS (75.7 versus 78.7, p=0.077) and SWLS (25.2 versus 26, p=0.176) sum scores were not different from the population reference values. The SF-36 subdomains bodily pain (55.3 versus 73.9), general health (58.2 versus 73.9) and vitality (56.9 versus 69.1) were lower than the reference values (all p < 0.001). PROMs/PREMs were low in 46.2% for pain, 15.1% for depression, 11.8% for satisfaction with care and 52.7% for healthcare responsiveness. An indirect obstetric ICU admission diagnosis was independently associated with a reduced physical health score (B -1.7, 95% confidence interval [CI] -3.4 to -0.1) and severe neonatal morbidity with a reduced mental health score (B -6.6, 95% CI -11.3 to -1.8). Obstetric ICU admission is associated with reductions in long-term physical health QoL and in some patients with mental health QoL. We suggest multidisciplinary rehabilitation and long-term psychosocial support.

Knowledge, attitude, and skills of partograph utilization among health workers: a systematic review

Partograph is a simple tool that World Health Organization (WHO) has recommended utilizing during labor monitoring. The ability of health workers in the obstetric unit to interpret clinical data from partograph to detect abnormal labor monitoring is influenced by their knowledge, attitude, and skills. We undertook a systematic review to determine the knowledge, attitude, and skill of partograph among health workers in the obstetric unit. We use the standard of PRISMA guidelines. Different online databases were used for this review: PubMed, ScienceDirect, Scopus, and Google Scholar. We found 16 of 1.957 articles from the selection process which meet the eligibility criteria. Overall, the partograph utilization was low due to a lack of knowledge, poor attitude, and poor skills of health workers. This influences how health workers interpret clinical data from partograph to detect abnormal labor progress. Therefore, on-the-job training and supportive supervision are needed to improve the knowledge, attitude, and skills of health workers in the obstetric unit.

Developing the midwifery Unit Self-Assessment (MUSA) Framework: A mixed methods study in six European midwifery units

ObjectiveEvidence indicates that midwifery units are associated with improved health outcomes and experiences; however, there are barriers to their development and scale-up. Guidelines are crucial to their implementation, ensuring that they are developed and integrated sustainably and safely. This study aimed to evaluate and explore the use of a self-assessment tool and improvement process for midwifery units in Europe. MethodsA mixed methods study was conducted with six midwifery units located in Europe. Quantitative and qualitative data were collected and analysed concurrently, and each informed the other, making the approach both interactive and iterative. The six midwifery units were invited to complete the self-assessment tool, the responses of which were analysed descriptively, and implement an improvement process into practice. Interviews were conducted with midwives using the tool and analysed thematically. ResultsFindings indicate benefits and potential feasibility of an improvement process for midwifery units, and suggest that the self-assessment tool is a generative and reflexive practice for midwives. However, issues were identified around limitations of the tool, structural barriers and professional autonomy. Midwifery units require a framework to guide and support their implementation, improvement and scale-up. ConclusionResults highlight the need for more consideration of how macro-level barriers, encompassing social, legal and political dimensions of maternity care, factor locally in the implementation and scale-up of midwifery units. More research is needed to evaluate the feasibility and outcomes of implementing a self-assessment and improvement framework in midwifery units across Europe.

The Midwifery Unit Self-Assessment (MUSA) Toolkit: embedding stakeholder engagement and co-production of improvement plans in European midwifery units

Background:For women with straightforward pregnancies midwifery units (MUs) are associated with improved maternal outcomes and experiences, similar neonatal outcomes, and lower costs than obstetric units. There is growing interest and promotion of MUs and midwifery-led care among European health policymakers and healthcare systems, and units are being developed and opened in countries for the first time or are increasing in number. To support this implementation, it is crucial that practice guidelines and improvement frameworks are in place, in order to ensure that MUs are and remain well-functioning. Aims and objectives:This project focused on the stakeholder engagement and collaboration with MUs to implement the Midwifery Unit Self-Assessment (MUSA) Tool in European MUs. A rapid participatory appraisal was conducted with midwives and stakeholders from European MUs to explore the clarity and usability of the tool, to understand how it helps MUs identifying areas for further improvement, and to identify the degree of support maternity services need in this process. Key conclusions:Engagement and co-production principles used in the case studies were perceived as empowering by all stakeholders. A fresh-eye view from the external facilitators on dynamics within the MU and its relationship with the obstetric unit was highly valued. However, micro-, meso- and macro-levels of organisational change and their associated stakeholders need to be further represented in the MUSA-Tool. The improvement plans generated from it should also reflect these micro-, meso- and macro-level considerations in order to identify the key actors for further implementation and integration of MUs into European health services.

A three-year audit of pregnancy outcomes in women with pulmonary hypertension admitted to the high-risk obstetric unit at Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal, South Africa.

The aim of this study was to describe the profile and outcomes of pregnancies in women with pulmonary hypertension in South Africa. A retrospective study was undertaken at a state-subsidised hospital. Data were analysed using SPSS. Descriptive statistics were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. A p-value less than 0.05 was considered statistically significant. Of a cohort of 185 women, 86.3% had pulmonary hypertension secondary to left heart disease. The median age of the cohort was 28 years (interquartile range 23-33) with 37.8% being HIV infected and 59% having mild pulmonary hypertension. Frequencies of deaths, intensive care unit admissions and cardiac failure events increased with increasing severity of pulmonary hypertension (p < 0.001). Women with more severe pulmonary hypertension had higher rates of preterm births (p < 0.001). Adverse pregnancy outcomes were concentrated in women with moderate-to-severe pulmonary hypertension.

Inequities in Inpatient Obstetrics Pain Management and Evaluation: Age, Race, Mental Health, and Obesity.

To evaluate disparities of pain management among patients giving birth in inpatient Obstetrics units based on age, race, BMI, and mental health diagnoses. A retrospective cohort study was performed and included all individuals giving birth at a tertiary-care institution in 2019. Patient-reported pain scores, and inpatient narcotic administration and dosing for pain control were collected. Models were adjusted for race, age, BMI, and diagnoses of anxiety, depression, opioid use disorder, and/or schizophrenia. 4788 Individuals met the inclusion criteria. A higher proportion of African American patients reported severe pain (n = 233/607, 38.4%) and received narcotics (n = 653/1141, 57.2%) compared to patients of other races. Despite controlling for several possible confounders, African American patients (OR 1.55, 95% CI 1.08-2.22), patients with increased BMI (OR 1.02, 95% CI 1.01-1.03), and patients with a mental health diagnosis (OR 2.33, 95% CI 1.32-4.12) were more likely to have worse pain at rest. Older patients were more likely to be administered narcotics (n = 447/757, 59.0%) compared to younger patients (patients aged 18-26: n = 577/1257, 52.3%; patients aged 27-35: n = 1451/2774, 52.3%; p < 0.001), despite younger patients being more likely to have severe pain (OR 1.50; 95% CI 1.20-1.86; p = 0.001). Patients who are Non-Hispanic African American and patients with obesity and mental health diagnoses experience inequities in postpartum pain management. Pain is complex and multifactorial and can be impacted by cultural, social, environmental factors and more. Further studies on factors that influence pain perception and management in inpatient obstetrics units are needed.

Maternal and perinatal outcome of Ramadan fasting in women with gestational diabetes.

To compare maternal and perinatal outcome of Ramadan fasting during pregnancy in women with/without gestational diabetes. This prospective case-control study was conducted at Department of Obstetrics & Gynecology Unit 1 Ruth PKM Civil Hospital & Dow Medical College and Holy Family Hospital, Karachi during 1st April to 31st July, 2022. In this study normoglycemic pregnant women and those identified as gestational diabetes (n=52) on oral glucose tolerance test, who fasted during Ramadan were included. Women, on diet control or diet plus metformin were included in the study. Study questionnaire included demographic details, days of fasting, self-reported hypoglycemic episodes. Maternal outcomes included preterm birth, pregnancy induced hypertension. Perinatal outcome included hyperbilirubinemia, hypoglycemia, weight of placenta, and apgar score. Eighty two women were included in the study, gestational diabetes (n=57) and normoglycemic (n=25). Average days of fasting were 16 ±9.0 days (range 5-30). Women with GDM were older (28.6 vs. 26.0 years, p-value=0.034), had raised levels of HbA1c (5.5 vs. 5.1, p-value=0.004), mean FBS (102.8 vs. 84.6 mg/dl, p-value <0.001), mean RBS (135.3 vs. 106.4 mg/dl, p-value <0.001) and had higher BMI at delivery (31.0 vs. 26.6 kg/m2, p-value=0.004). HbA1c (p-value=0.016) and head circumference of baby (p-value=0.038) were found lower in the group who fasted for more than 20 days among normoglycemic pregnant women. No other maternal and neonatal outcomes were found to be significantly affected by Ramadan fasting among pregnant women with/without GDM. Gestational diabetes do not affect maternal and perinatal outcome among pregnant women.

A mixed method, phase 2 clinical evaluation of a novel device to treat postpartum haemorrhage

BackgroundWe evaluated the safety, efficacy, and acceptability of a new device designed to facilitate uterine compression in women with postpartum haemorrhage (PPH). MethodsA prospective, phase two clinical device trial with concurrent qualitative study, conducted in a UK consultant obstetric unit. The device was used in addition to standard care in women unresponsive to initial oxytocin therapy. The primary effectiveness outcome was additional blood loss of over 1000mls, whilst safety was assessed through adverse events. Interviews assessed device feasibility and acceptability, and were analysed using framework analysis. ResultsWe recruited 57 women with clinical PPH after vaginal birth; 67% were primiparous and 47% had undergone operative birth. All but two (96%) had atony as a cause of the haemorrhage; in addition, 30% also had bleeding from lacerations and 11% had retained tissue.After device use, only one woman had additional blood loss over 1000mls, although 3 women (7%) needed a Bakri balloon and 14% received a blood transfusion. All but one clinician felt that the device was easy to use. Clinicians stated that the device assisted management in 85% of cases. All 56 women who responded stated that if they bled in a future birth they would want the device to be used again.There were no serious adverse events related to the device. However, 3 events were judged as ‘possibly’ being caused by the device − 2 minor vaginal grazes and one postnatal episiotomy infection and breakdown. Lax vaginal tissue complicated the use of the device in three women. In 47 interviews, participants, birth partners, clinician users and attending midwives viewed the device positively. Clinicians found it useful as a way of stopping blood loss and as an aid to diagnose the source of bleeding. ConclusionsThe PPH Butterfly may provide a rapid, acceptable and effective treatment for postpartum haemorrhage. Clinical Trial Registration prospective with ISRCTN15452399 11/09/2017 (www.isrctn.com/ISRCTN15452399).

Assessment of Obstetrics and Gynaecological referred Cases and their Outcomes to Isra Tertiary Care Hospital

Objective: To assess, the type of obstetrics and gynaecological cases referred to tertiary care hospitals.Study Design: Descriptive cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Obstetrics and Gynecology Unit 2 of Isra University Hospital Hyderabad, Pakistan from May 2022 to July 2022.Materials and Methods: The patients who were referred to the Department of Obstetrics and GynaecologyUnit 2 at Isra University Hospital during the study duration from various primary, secondary, tertiary, andprivate hospitals for any obstetric or gynaecological emergency were the primary source of data. Theconfidentiality of each patient was carefully respected. This study evaluated the prevalence of various obstetricand gynaecological conditions for which patients were usually referred to Isra University Hospital within thestudy duration as well as the management options provided to these patients.Results: The bulk of referrals (71%) were for gynaecological cases, according to the results of our study. Patients under 20 years of age comprised 31% of the total. The majority of patients (20%) were multipara and in their third trimester (18%). Vesicovaginal fistula (VVF) was the most common gynaecological reason for referral(27%) and the least were ectopic pregnancy and UV prolapse 9% each. Placenta previa (13%), was the mostcommon obstetric referral in our study and at least 2% were placental abruption, preterm labour, and preeclampsia. Furthermore, 24% of VVF patients were successfully managed transvaginal while only 4% weremanaged transabdominal. All gynaecological malignancies were treated with total abdominal hysterectomywith bilateral salpingo-oophorectomy and omentectomy. Laparotomies were done for ectopic pregnanciesand 5 patients of UV Prolapse underwent vaginal hysterectomy whereas only 1 had pessary insertion. Amongstobstetric cases 7% cases of placenta previa/accreta had Cesarean section, 4% had Cesarean section along withbladder repair and 2% of cases necessitated myometrial excision. Compression sutures were the mostfrequently used form of treatment (5%) for postpartum hemorrhage patients, followed by hysterectomy (4%)and medical management (2%). Preterm labour was monitored, whereas placental abruption and preeclampsiarequired caesarean procedures.Conclusion: The majority of patients both gynaecological and obstetric referred to Isra Tertiary Care Hospitalthroughout a 3 months period had either an urgent need for treatment or a serious condition that necessitateda specialist's expertise and the availability of the appropriate resources. Therefore, it can be concluded thatthere is a critical need to upgrade our health system infrastructure, particularly in the area of maternal and child health care, in order to make it simple to provide timely and appropriate management to a variety of health conditions and lower the likelihood of any mishaps involving the mother or the fetus. Additionally, this will also benefit patients by avoiding unnecessary travel from distant regions and helps reduce the burden on tertiary care health system.&#x0D; &#x0D; &#x0D;

Diagnostic capabilities of transperineal ultrasound (TPUS) to evaluate anal sphincter defect post obstetric anal sphincter injury (OASIS)? A systematic review

IntroductionEndoanal ultrasound (3D-EAUS) is the gold standard imaging investigation for evaluating the anal sphincter; unfortunately, it is not universally available in most obstetric units. This study aims to appraise the ability of transperineal ultrasound (TPUS) compared with 3D-EAUS as the gold standard to identify anal sphincter defects after primary repair of OASIS.MethodsA systematic search of major databases to identify diagnostic accuracy of 3D-TPUS in evaluating anal sphincter defects. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were designed for this systematic review. The risk of bias and applicability concerns were assessed using the QUADAS-2 tool. Our eligibility criteria are patients with a history of primary repair of anal sphincter injuries (OASIS). They were followed up after the primary repair to detect the anal sphincter defect using 3D-TPUS vs. 3D-EAUS as a gold standard.ResultsTwo eligible observational studies were included and assessed for risk of bias using the QUADAS-2 tool and showed a low risk of bias and a low risk of concerns. 3D-TPUS had various sensitivity to detect external anal sphincter defects in two studies; meanwhile, the specificity was around 67–70%. For detecting the internal anal sphincter defects, 3D-TPUS had low sensitivity but high specificity (93–94%).Conclusion3D-TPUS had various sensitivity to detect external anal sphincter defects and low sensitivity to detect internal anal sphincter defects. On the other hand, 3D-TPUS had low specificity for detecting external anal sphincter defects and high specificity for detecting internal anal sphincter defects.

Maternal and paternal postpartum early mood and bonding

ABSTRACT Background Whereas the maternal ‘blues’ has been widely researched, comparatively less is known about the “highs” following childbirth, and the relation between mothers and fathers’ mood in this early period. We aimed to investigate the association between maternal ‘blues’ and ‘highs’ with paternal postpartum mood (here described as ‘lows’ and ‘highs’) in the early postpartum and their associations with the quality of child bonding. Methods Women and their cohabitating male partners, fathers of the index child (N = 98 couples), attending an obstetric hospital unit completed questionnaires on mood, bonding and socio-demographics between the 3rd and the 5th postpartum day. We used generalised estimating equations to analyse the data. Results The ‘blues’ scores were higher in mothers, whereas ‘highs’ and bonding were higher in fathers. Maternal ‘blues’ were significantly correlated with paternal ‘lows’ (rs = .23, p < .05) and maternal ‘highs’ were also associated with paternal ‘highs’ (rs = .22, p < .05). Parental ‘highs’ were significantly associated with better baby bonding (B = .13, p = .02). Conclusions Our study demonstrates moderate associations between both ‘blues/lows’ and ‘highs’ in mothers and fathers shortly after the birth of the child. Associations between mood, particularly ‘highs’, and bonding were similar for mothers and fathers. Greater consideration of ‘blues/lows’ and ‘highs’ in both parents is needed to promote adjustment in the postpartum period.

Healthcare workers affected by COVID-19 in a midwife obstetric unit in Johannesburg, South Africa

Background/Aims COVID-19 was first identified in China in December 2019 and was declared a pandemic in March 2020. South Africa reported its first case on 5 March 2020, and by December 2021, the country was battling a fourth wave of COVID-19 infections. This study assessed the impact of COVID-19 infections among healthcare workers in a midwives' obstetric unit in Soweto, South Africa, during the peak of the first wave. Methods Healthcare workers from the unit who were infected with or affected by COVID-19 were interviewed. Data were collected on demographics, presenting symptoms, the need for hospital admission in those who tested positive and the perceived source of infection. Qualitative data were collected on perceptions of testing negative or positive and the impact of testing positive. Results A total of 18 healthcare workers were interviewed, with the majority being midwives (61.1%), or advanced midwives (27.8%). Of the 15 included in quantitative analysis, 53% tested positive for COVID-19, with three (37.5%) requiring hospital admission, but there were no deaths. Of the staff who tested positive, 87.5% thought they became infected at work. None reported managing a patient with confirmed COVID-19. As a result of the high number of staff that tested positive for COVID-19 in the unit, there were staff shortages and anxiety about testing positive. Conclusions There was a high rate of COVID-19 infections in the unit, with the majority thought to have been acquired at work. This created anxiety among staff and had an impact on workload. The COVID-19 pandemic had a devastating impact on healthcare workers globally, and the effects are likely to be felt for years to come.