Optimum Timing Of Delivery Research Articles

Outcome predictors and patient progress following delivery in pregnant and postpartum patients with severe COVID-19 pneumonitis in intensive care units in Israel (OB-COVICU): a nationwide cohort study

A key unresolved controversy in severe COVID-19 pneumonitis in pregnancy is the optimum timing of delivery and whether delivery improves or worsens maternal outcomes. We aimed to assess clinical data on every intensive care unit (ICU) day for pregnant and postpartum women admitted to the ICU with COVID-19, with a particular focus on the days preceding and following delivery. In this multicentre, nationwide, prospective and retrospective cohort study, we evaluated all pregnant women who were admitted to an ICU in Israel with severe COVID-19 pneumonitis from the 13th week of gestation to the 1st week postpartum. We excluded pregnant patients in which the ICU admission was unrelated to severe COVID-19 pneumonitis. We assessed maternal and neonatal outcomes and longitudinal clinical and laboratory ICU data. The primary overall outcome was maternal outcome (worst of the following: no invasive positive pressure ventilation [IPPV], use of IPPV, use of extracorporeal membrane oxygenation [ECMO], or death). The primary longitudinal outcome was Sequential Organ Failure Assessment (SOFA) score, and the secondary longitudinal outcome was the novel PORCH (positive end-expiratory pressure [PEEP], oxygenation, respiratory support, chest x-ray, haemodynamic support) score. Patients were classified into four groups: no-delivery (pregnant at admission and no delivery during the ICU stay), postpartum (ICU admission ≥1 day after delivery), delivery-critical (pregnant at admission and receiving or at high risk of requiring IPPV at the time of delivery), or delivery-non-critical (pregnant at admission and not critically ill at the time of delivery). From Feb 1, 2020, to Jan 31, 2022, 84 patients were analysed: 34 patients in the no-delivery group, four in postpartum, 32 in delivery-critical, and 14 in delivery-non-critical. The delivery-critical and postpartum groups had worse outcomes than the other groups: 26 (81%) of 32 patients in the delivery-critical group and four (100%) of four patients in the postpartum group required IPPV; 12 (38%) and three (75%) patients required ECMO, and one (3%) and two (50%) patients died, respectively. The delivery-non-critical and no-delivery groups had far better outcomes than other groups: six (18%) of 34 patients and two (14%) of 14 patients required IPPV, respectively; no patients required ECMO or died. Oxygen saturation (SpO2), SpO2 to fraction of inspired oxygen (FiO2) ratio (S/F ratio), partial pressure of arterial oxygen to FiO2 ratio (P/F ratio), ROX index (S/F ratio divided by respiratory rate), and SOFA and PORCH scores were all highly predictive for adverse maternal outcome (p<0·0001). The delivery-critical group deteriorated on the day of delivery, continued to deteriorate throughout the ICU stay, and took longer to recover (ICU duration, Mantel-Cox p<0·0001), whereas the delivery-non-critical group improved rapidly following delivery. The day of delivery was a significant covariate for PORCH (p<0·0001) but not SOFA (p=0·09) scores. In patients who underwent delivery during their ICU stay, maternal outcome deteriorated following delivery among those defined as critical compared with non-critical patients, who improved following delivery. Interventional delivery should be considered for maternal indications before patients deteriorate and require mechanical ventilation. None.

A clinical study of perinatal and maternal morbidity and mortality in gestational hypertension, preeclampsia and eclampsia

In India, hypertensive disorders complicating pregnancy are common and continue to be responsible for the largest proportion of perinatal deaths resulting from prematurity and IUGR and are major contributors to perinatal and maternal morbidity and mortality.&#x0D; The aim: The present study is undertaken to analyse the cases of preeclampsia and eclampsia, including consequences concerning preterm delivery, IUGR, IUD and stillbirth and for the evaluation of a safe motherhood program at the population level.&#x0D; Materials and methods: The present study was conducted on 105 selected cases from the census (sample of 12,589 patients) of pregnancy-induced hypertension (gestational hypertension, preeclampsia and eclampsia).&#x0D; Results: Hypertensive cases complicating pregnancy of the foetal deliveries conducted during the study period, out of which Gestational hypertension (GTN) cases reported were 44. Preeclampsia (PE) cases were 39, severe preeclampsia (SPE) were 1 and Eclampsia cases were 21. Labetalol alone was used in 62 cases, and 44 babies were born without any complications. As an anticonvulsant magnesium sulphate (MgSO4, 7H2O) was used in all cases of imminent eclampsia and eclampsia (MgSO4 PRITCHARD Regime) in a total number of 38 cases. Preterm / prematurity was the most common cause of perinatal death. The total number of NICU admissions was 42 (40 %).&#x0D; Conclusions: The early use of anti-hypertensive drugs, the optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome. Early transfer to a specialist centre is important, and the referral centres should be well-equipped to treat critically ill patients.

MATERNAL MORBIDITY AND MORTALITY IN HYPERTENSIVE DISORDER COMPLICATING PREGNANCY

Introduction- hypertensive disorders complicating pregnancy is one of the extensively researched subjects in obstetrics. The pathology should be understood and involvement of multiorgan dysfunction should be taken into account Objectives- To analyse the cases of hypertensive disorder complicating pregnancy and its maternal outcome in patients admitted in government general hospital, Guntur. Methods- A total number of 250 cases of hypertensive disorder complicating pregnancy(gestational hypertension,preeclampsia, eclampsia) admitted to GGH , Guntur from august 2020-July 2021 Selection of cases- both booked and referred and all patients who were diagnosed hypertension complicating pregnancy. Results- Hypertensive cases complicating pregnancy accounted for 9.4% of deliveries.out of which gestational hypertension cases accounted for 3%,preeclampsia accounted for 5.7%,and eclampsia 0.7%.In this study, maximum cases were seen between age groups 20-30 in primigravida belonging to low socioeconomic strata. majority of patients detected to have high blood pressures at 32-36weeks of gestation,and a mean gestational age of 35 weeks.haemolysis,elevated liver enzymes,low platelet count syndrome is the most common maternal complication and intrauterine growth restriction is the most common fetal complication.22 cases followed by abruptio placentae, acute renal failure,postpartum haemorrhage and postpartum eclampsia.Maternal mortality occurred in 2 cases. ConclusionEarly use of antihypertensive drugs, optimum timing of delivery, strict fluid balance, and anticonvulsants in cases of eclampsia will help to achieve a successful outcome.Training and continuing medical education of attending staff and the structuring management protocols relevant to local needs are also an important part in the case of hypertension complicating pregnancy

Fetal Growth Restriction - Diagnostic Work-up, Management and Delivery.

Fetal or intrauterine growth restriction (FGR/IUGR) affects approximately 5 – 8% of all pregnancies and refers to a fetus not exploiting its genetically determined growth potential. Not only a major cause of perinatal morbidity and mortality, it also predisposes these fetuses to the development of chronic disorders in later life. Apart from the timely diagnosis and identification of the causes of FGR, the obstetric challenge primarily entails continued antenatal management with optimum timing of delivery. In order to minimise premature birth morbidity, intensive fetal monitoring aims to prolong the pregnancy and at the same time intervene, i.e. deliver, before the fetus is threatened or harmed. It is important to note that early-onset FGR (< 32 + 0 weeks of gestation [wks]) should be assessed differently than late-onset FGR (≥ 32 + 0 wks). In early-onset FGR progressive deterioration is reflected in abnormal venous Doppler parameters, while in late-onset FGR this manifests primarily in abnormal cerebral Doppler ultrasound. According to our current understanding, the “optimum” approach for monitoring and timing of delivery in early-onset FGR combines computerized CTG with the ductus venosus Doppler, while in late-onset FGR assessment of the cerebral Doppler parameters becomes more important.

Risk of stillbirth at term and optimum timing of delivery in uncomplicated south Asian singleton pregnancies.

Aims of this study were to compare the perinatal mortality rate and the prospective risk of stillbirth for each given gestational age and to ascertain whether it is safe to continue the pregnancy beyond 40 weeks of gestational age and induce labour at 41 weeks in low risk singleton pregnancies. This was a retrospective study. The perinatal mortality and prospective risk were calculated per 1000 total births and 1000 ongoing pregnancies respectively in well dated singleton pregnancies. 38+0 to 39+6 gestational age was taken as the reference. A total of 12,595 deliveries after 28 weeks of gestation were included. The risk of stillbirth at 38+0 to 39+6 weeks was 1.43 (95% CI, 0.9 to 2.4) per 1000 on going pregnancies. The perinatal mortality rate at 38+0 to 39+6 weeks was 2.9 (95% CI, 1.9 to 4.5) per 1000 total births. The perinatal mortality rate decreased throughout gestation and it was lowest at 40+0 - 41+6. In contrast, risk of stillbirth increased with advancing gestation and peaked at 40+0 - 41+6 (2.57, 95% CI, 1.4 to 4.7). However, risk of stillbirth at 40+0 - 41+6 was not statistically different from 38+0 to 39+6 (OR 1.79, 95% CI, 0.80 to 3.98). To prevent one stillbirth, 886 pregnancies should be induced at 38+0 to 39+6. Risk of stillbirth is more informative than perinatal mortality at term. Frequent antenatal fetal surveillance should be adopted towards term in order to identify high risk pregnancies. Elective delivery before 40 weeks in low risk pregnancies is not justified.

115: Optimum timing of delivery for monochorionic twins: evidence from the prospective multicenter ESPRiT study

Society for Maternal-Fetal Medicine: 2011 31st Annual MeetingThe Pregnancy Meeting, Society for Maternal-Fetal Medicine: 2011 31st Annual Meeting

Sonicaid FetalCare: fetal heart rate analysis

Advances in technology over the past 30 years enable us to assess fetal health using safe and non-invasive ultrasound techniques. One such technique is fetal heart rate monitoring, and in pregnancies where there is fetal compromise the fetal heart rate contains crucial information with regard to the optimum timing of delivery. The features of the fetal heart rate are well understood, but numerous studies have shown that expert assessment of traces is prone to inconsistency. In addition, when junior or inexperienced staff review traces important features may not be noticed, with the danger that critical decisions are delayed. Computer analysis of the fetal heart rate using Sonicaid FetalCare or the care analysis built into Sonicaid fetal monitors is therefore a welcome and much-needed way of standardizing interpretation to the highest standards. Such analysis captures an enormous amount of clinical experience and in effect brings it to the bedside.