Outcome In High Risk Pregnancies Research Articles

Efficacy of L-Arginine for Preventing Preeclampsia and Improving Maternal and Neonatal Outcomes in High-Risk Pregnancies: A Systematic Review and Meta-Analysis.

Preeclampsia (PE) remains a significant cause of maternal and neonatal morbidity and mortality, particularly in high-risk pregnancies. The present study aims to assess the efficacy of L-arginine supplementation in preventing PE and improving maternal and neonatal outcomes in high-risk pregnancies. We searched international databases (ISI, PubMed, Scopus, and Embase) and extracted studies that evaluated the efficacy of L-arginine for preventing PE and improving maternal and neonatal outcomes in high-risk pregnancies. The data collected were analysed utilising the random-effects model in Stata (version 15). Out of the collected studies, 10 met the eligibility criteria, comprising a total sample size of 1165 subjects (586 cases and 584 controls). The mean age of the cases was 28 ± 5.05 years, while that of the controls was 27.32 ± 4.58 years. The results revealed that L-arginine was more effective in reducing the incidence of PE than placebo [odds ratio (OR)=0.36, 95% confidence interval (CI): 0.17, 0.77]. Also, the results showed no statistically significant difference between the two groups in systolic blood pressure (SBP; standard mean difference (SMD): -0.35, 95% CI: -91, 21) and diastolic blood pressure (DBP; SMD: -0.50, 95% CI: -1.08, 0.07). There was a statistically significant difference in neonatal birth weight between the two groups (SMD: -0.16, 95% CI: -31, -0.01). No statistically significant difference existed between the two groups in terms of gestational age (SMD: 0.6, 95% CI: -0.06, 0.18). Furthermore, there was no significant difference between the two groups in the APGAR score at one minute (SMD: 0.40, 95% CI: -0.02, 0.82). Our findings revealed that L-arginine supplementation during pregnancy reduced the incidence of PE in high-risk pregnancies. However, it does not significantly improve maternal and neonatal outcomes.

Comparative study of fetal doppler versus non stress test as predictor of perinatal outcome in high risk pregnancy between 36 to 42 weeks

Pregnancy is a unique physiologically event in a women’s life. The main aim of the study was to compare the efficacy of the Doppler velocimetry versus non stress test in relation to perinatal outcome in high risk pregnancies between 36 to 42 weeks.This comparative prospective study was carried out on 200 antenatal patients between 36-42 weeks of pregnancy in Department of Obstetrics & Gynaecology Smt Kashibai Navle Medical College and Hospital a tertiary care center from December 2016 to July 2018.All cases were divided into four groups based on NST and Doppler velocimetry of umbilical artery. Abnormal Doppler studies were found in 12% women. 14% had abnormal NST. Apgar score < 7 at 5 minutes were in 19 fetuses, out of these 15 had abnormal Doppler velocimetry. Average birth weight was low in Group D (1.2kg), where both the tests were abnormal. NICU admissions were 5% in Group A and 100% in Group B and D, where Doppler was abnormal. Mean gestational age was also low in group D. Highest perinatal mortality and neonatal morbidity was seen in women with abnormal umbilical artery Doppler. 6 neonatal deaths occur in Group D and 1 in Group B. In the present study, umbilical artery sensitivity for predicting perinatal morbidity and mortality is 46.1, specificity is 94, PPV is 93 and NPV is 54.Highest percentage of perinatal complications and perinatal deaths were seen in groups with abnormal Doppler velocimetry. Group D had the worst perinatal outcome.

Utilizing Modified Coopland's Scoring System to Identify and Predict the Outcome of High-Risk Pregnancies in Resource-Limited Settings: A Retrospective Review.

Introduction A high-risk pregnancy is associated with adverse maternal and foetal outcomes. Women with high-risk pregnancies are at a greater risk of developing antepartum haemorrhage, miscarriages, and the need for surgical interventions. Neonatal complications include preterm births, low birth weight (LBW), intra-uterine deaths and an increased need for NICU admission. The utilisation of low-cost scoring tools for identifying high-risk women can aid in early diagnosis and timely implementation of therapeutic interventions. Objective The retrospective record-based study sought to calculate the proportion of high-risk pregnancies using modified Coopland's scoring system and compare the maternal and foetal outcomes among high-risk pregnancies. Methods The study retrospectively analysed the records of antenatal women in their third trimester from the years December 2018 to December 2021. Each record was then numerically assessed according to the modified Coopland's scoring system and categorised according to the risk status. Maternal and neonatal outcomes were then compared across the risk groups. Results The data included 300 cases over a three-year period.According to modifiedCoopland's scoring system, we found that the overall proportion of high-risk pregnancies was 18.3%. Adverse maternal and fetal outcomes were increased in high-risk pregnancy groups when compared to low-risk pregnancies, miscarriages (31.6% vs 15.8%) and antepartum haemorrhage (55.6% vs 11.1%). Babies born to high-risk mothers had a higher chance of developing LBW status (52.0%) and respiratory distress (45.5%) when compared to those born to low-risk mothers: 8.0% and 13.6%, respectively. Conclusion A notable portion of pregnant women were classified as high-risk using modified Coopland's scoring tool and would benefit from targeted obstetric care.

Role of umbilical artery and fetal middle cerebral artery doppler study in prediction of pregnancy outcome in high-risk pregnancies

Role of umbilical artery and fetal middle cerebral artery doppler study in prediction of pregnancy outcome in high-risk pregnancies

Severe Pre-Eclamptia Resulting In Abruptio Placentae, Stillbirth and Disseminated Intravascular Coagulopathy in Antenatal Clinic Defauter Woman in Calabar, South-South Nigeria

This case report examines a poignant instance of severe preeclampsia in a 26 year old with a history of recurrent pregnancy loss and however, a prior vaginal delivery. The patient presented at 29 weeks gestation with acute lower abdominal pain with associated abruptio placentae, resulting in a stillbirth and disseminated intravascular coagulopathy (DIC). The intricate interplay of obstetric history and clinical management reveals the challenges in navigating such complex scenarios. The patient's obstetric history of recurrent miscarriages and a vaginal delivery with perineal tear signals a predisposition to adverse outcomes. The acute presentation of abruptio placentae underscores the imperative for heightened vigilance in pregnant women even in the absence of antenatal complaints. Successful resuscitation involved correcting shock, transfusing three units of blood and addressing hemorrhagic DIC. Tranexamic acid, pentazocine, normal saline, misoprostol and oxytocin were employed to stabilize the patient, highlighting the necessity of a comprehensive and multidisciplinary approach. This case serves as a stark reminder of the unpredictable nature of severe preeclampsia and emphasizes on the critical importance of early detection and intervention. Future research endeavors should focus on refining risk stratification models and exploring innovative interventions to enhance maternal and fetal outcomes in high-risk pregnancies.

Occurrence of ultrasonographic assessed placental abnormalities, treatments, pregnancy outcome, and subsequent fertility on a large warmblood stud farm: A retrospective field study

Little is known about the incidence and outcome of high-risk pregnancies in equine practice and clinical studies on spontaneous occurring placentitis cases and treatments are missing. Therefore, the aims of this retrospective field study were to (1) describe the incidence and severity of ultrasonographic assessed placental abnormalities (UPA) in 4,192 pregnancies on a large commercial warmblood stud farm in 2017 – 2019 and (2) characterize these UPA cases and their pregnancy outcome. UPA severity (Placental abnormality score (PSc) 1-3; low to high), nine treatment regimens (TM1-9) used in UPA cases and treatment duration as well as subsequent fertility were analyzed in the group of UPA mares.The proportion of pregnancies affected by UPA was 4.2 % (n=177/4192). Placental abnormality severity was scored as PSc1 (51.4 %), PSc2 (32.8 %) and PSc3 (15.8 %).The generalized mixed model revealed PSc was affected by mare age and mare status (own pregnancy (OP) or embryo transfer recipient (ER)) (P=0.035) with ER mares having increased PSc compared with mares having their own pregnancy. Abortion occurred in 17/177 (9.6 %) UPA pregnancies.Overall, at the end of the next season, 61.1 % of UPA mares were pregnant, 32.0 % barren, and 6.9 % open (n=175). Pregnancy was established in 62/91(68.1 %) of mares with PSc1, 31/58 (53.4 %) with PSc2 and 14/26 (53.8 %) with PSc3. Most pregnancies were achieved in the first 81/107 (75.7 %) or second 18/107 (16.8 %) inseminated cycle.In conclusion, early detection and treatment of ultrasonographic assessed placental abnormalities can save high-risk pregnancies in > 90 % of cases with a satisfying subsequent fertility.

Perinatal Outcomes of High Risk Pregnancies: Experience of a Tertiary Care Hospital

High Risk Pregnancy (HRP) denotes a condition where the mother, the fetus, or both are predisposed to complications during the gestation period, at birth, or postnatally, which is affected by several factors. Objective: To analyze the perinatal outcomes of high-risk pregnancies, focusing on the experience of a tertiary care hospital. Methods: A longitudinal study over two years, from October 1, 2020, to December 31, 2022, was conducted on 213 high-risk pregnant women, via purposive sampling, who attended the antenatal clinic Liaquat University Hospital, Hyderabad and Jamshoro. After obtaining informed written consent, interviews were conducted with the participants to collect data about their sociodemographic, obstetric, and gynecological histories. Perinatal outcomes were evaluated on the 8th day post-delivery, during which details concerning maternal and fetal complications in terms of morbidity and mortality, were documented. Results: Rh-negative pregnancy was found to be the most high-risk factor with 24.4% (52) of the cases, followed by teenage pregnancy at 12.2% (26), and short stature at 10.9% (23). Additionally, severe anemia was found in 21 women (9.8%), Pregnancy Induced Hypertension (PIH) in 18 women (8.6%), and obesity was also seen in 18 women (8.6%). Other noted risk factors included grand multigravida in 13 women (6.1%), thyroid disorder 4.9% (10), twin pregnancy 3.7% (8) and congenital fetal anomaly, polyhydramnios, oligohydramnios each with 2.4% (5). Conclusions: This study significantly contributes to the body of knowledge on high-risk pregnancies and their outcomes.

Enoxaparin-induced cutaneous panniculitis in a pregnant female

Low-molecular-weight heparins (LMWHs) are currently used as an antithrombotic prophylactic therapy during pregnancy and in post-surgery patients. The safety of various drugs in pregnancy has always been a matter of concern. Enoxaparin, being associated with low fetal and neonatal complications, is used extensively to improve the outcomes in high-risk pregnancies. The duration of treatment with LMWH in pregnancy is generally long; hence, strict monitoring of side effects should be done. We report a case of a 25-year-old pregnant female who experienced painful, erythematous skin necrosis and panniculitis after prophylactic administration of enoxaparin at multiple sites subcutaneously.

Enhancing Maternal and Neonatal Outcomes in High-Risk Pregnancies: The Efficacy of Staged Nursing and Nutritional Interventions

Considering the escalating prevalence of high-risk pregnancies encountered in clinical settings, the imperative to safeguard the well-being and survival of both high-risk pregnant women and their babies represents a hotspot of clinical research. This study investigated the clinical effects of an innovative care model for high-risk pregnancies, specifically a combination of staged nursing and nutritional interventions, on maternal nutritional status. Initially, 96 pregnant women were assigned randomly into two groups: a control group receiving routine care and a research group benefiting from the combined approach of staged nursing and nutritional interventions. Comparative analysis revealed that the research group experienced a significant reduction in labor duration and a decrease in the incidence of adverse pregnancy outcomes, thereby highlighting the efficacy of this combined approach in enhancing the safety of childbirth for high-risk pregnancies. Additionally, the research group exhibited more significant improvements in nutritional status than the control group, further endorsing the combined approach as a more effective and reliable safeguard for the health of high-risk pregnant women. Therefore, the implementation of staged nursing in conjunction with nutritional interventions is advocated for use during childbirth in high-risk pregnancies.

Prenatal ultrasound screening and pregnancy outcomes in HIV-positive women in Germany: results from a retrospective single-center study at the Charité-Universitätsmedizin Berlin.

The aim of this study was to investigate the rate of Mother-to-child-transmission (MTCT) in women living with HIV (WLWH) in a tertiary care institution. Furthermore, we aimed to assess prenatal ultrasound screening for fetal anomalies and outcomes in high-risk pregnancies due to maternal HIV infection." In this single-center study, retrospective data related to pregnancy and childbirth were collected from 420 WLWH. All data were evaluated descriptively. From January 2014 to December 2020, a total number of 420 pregnant WLWH delivered 428 newborns. 415 (98.8%) were receiving antiretroviral therapy (ART) and 88.8% had a viral load of < 50 cop/ml prior delivery. 46 (11%) of the newborns were born prematurely. Low birth weight < 2500g occurred in 38 (9.1%) of the children. 219 (52.1%) caesarean sections (CS) were performed. The most frequent indication for an elective CS was a previous CS (70.2%). 8 severe malformations were detected using first and second trimester ultrasound. In one child, MTCT was detected postpartum, resulting in an HIV transmission rate of 0.2% in the presented cohort. The low rate of vertical HIV-transmission in our cohort of 0.2% is the result of interdisciplinary prenatal care and high experience of healthcare providers in treatment of WLWH. Despite high ART coverage and adherence, good maternal immune system and very low vertical HIV transmission rate, maternal HIV infection remains a challenge in obstetric care. First and second ultrasound screening should be a part of prenatal care for HIV-infected women and should also be offered to HIV-negative women. A reduction of the rate of unnecessary elective caesarean deliveries in WLWH is necessary to reduce complications in subsequent pregnancies.

Effects of anti-Xa activity monitoring on the outcome of high-risk pregnancies treated with a prophylactic dose of low-molecular-weight heparin.

To evaluate if anti-Xa level monitoring and dose adjustment in women using a prophylactic dose of enoxaparin can decrease placenta-mediated pregnancy complications. This retrospective observational cohort study included pregnant women receiving enoxaparin prophylaxis, who were followed at the Thrombosis and Hemostasis Outpatient clinic between 2010 and 2017. The dose was adjusted according to enoxaparin anti-Xa levels in the study group or the weight of individuals in the control group. Of 585 women surveyed, 110 met the inclusion criteria; 63 of them were included in the study group and 47 in the control group. Mean starting dose was 46 versus 43 mg (p = .25), mean final dose was 52 mg versus 45 mg (p = .03) and dose adjustment was required in 37% versus 11% (p = .002) in the study and control groups, respectively. Twenty-eight percent of anti-Xa measurements in the second trimester were beneath the prophylactic threshold, compared to 11% and 16% in the first and third trimesters, respectively (p = .02). Labors ended with live birth in 91% versus 94% of cases (p = .5), 85% versus 68% of pregnancies were term (p = .05), 11% versus 23% of newborns were low birth weight (p = .1) and placenta-mediated pregnancy complications were documented in 9% versus 19%, (p = .17) in the study group relative to controls, respectively. The most prominent decrease in anti-Xa levels was observed in the second trimester. Monitored women had significantly more term deliveries and demonstrated a trend toward higher birth weight and fewer placenta-mediated pregnancy complications. Larger studies are needed to confirm improved pregnancy outcome in monitored women.

Comparative Analysis of Neonatal Effects in Pregnant Women with Cardiovascular Risk versus Low-Risk Pregnant Women.

Cardiovascular diseases are a leading cause of mortality and morbidity worldwide. Pregnancy imposes unique physiological changes on a woman's cardiovascular system. A cohort of 68 participants, comprising 30 pregnant women with cardiovascular risk and 38 without cardiovascular risk, was recruited for this study. These participants were prospectively followed during their pregnancies from 2020 to 2022 at the Obstetrics and Gynecology Department of the "Pius Brînzeu" Emergency County Clinical Hospital in Timişoara, Romania. All women included in this study underwent cesarean section deliveries at the same medical facility. Data regarding the gestational weeks at delivery, birth weight, and Apgar scores assessed by neonatologists were collected for each participant. Statistical analyses were performed to compare the neonatal effects between the two groups. The results of this study revealed significant differences between the groups in terms of Apgar scores (p = 0.0055), gestational weeks (p = 0.0471), and baby birth weight (p = 0.0392). The findings underscore the importance of considering maternal cardiovascular health as a potential determinant of neonatal outcomes. Further research is needed to elucidate the underlying mechanisms and develop strategies for optimizing neonatal outcomes in high-risk pregnancies.

Placentitis occurrence, treatments, pregnancy outcome and subsequent fertility on a large warmblood stud farm: a retrospective field study

Little is known about the incidence and outcome of high-risk pregnancies including placentitis. Common placentitis treatments combine antibiotics, non-steroidal anti-inflammatory drugs and progestins. However, clinical studies on spontaneous placentitis cases and treatments are missing. Therefore, the aim of this retrospective field study was to describe the occurrence and severity of placentitis, the abortion rate after placentitis diagnosis (based on udder development, combined-thickness-of-uterus-and-placenta and fetal fluid echogenicity) and treatment during pregnancy (2017-2019) on one warmblood stud farm. Furthermore gestational, placental and foal characteristics were analyzed to determine their association with the severity of placentitis, which was scored (Placentitis score (PSc) 1-3; low to high). Pregnancy day of diagnosis (PDD), placentitis treatment and subsequent fertility were recorded as well as the effects of mare's age and status (own pregnancy (OP) or embryo transfer recipient (ER)). Statistical analyses were conducted to analyze potential associations and significant effects on PSc using a Chi-Square test and a generalized linear mixed model. The proportion of pregnancies affected by placentitis was 4.2% (n=177/4192) occurring in 164 mares (3-24 years; Mean±SD= 11.8±5.10). After clinical diagnosis (PDD 256.7±50.4 days) mares were treated with one of nine different treatments (TM 1-9). Abortion occurred in 17/177 (9.6 %) pregnancies diagnosed with placentitis. The remainingplacentitis pregnancies were further characterized by decreased gestational length (330.1±10.04 days), foal birth weight (54.3±7.09 kg), foal height (103.6±4.28 cm) and placental weight (6.3±1.9 kg). Placentitis severity was scored as PSc1 (51.4%), PSc2 (32.8%) and PSc3 (15.8%). PSc was affected by mare's status (P=0.034) with ER mares having increased PSc compared with mares having their own pregnancy. PSc significantly influenced the choice of TM (χ² (16) = 161.4, P<0.0001) and duration of treatment (PSc1: 19.1a ±23.5 days, PSc2: 51.8b ±33.3 days, PSc3: 65.1b ±43.8 days). Mares with PSc1 were most commonly treated with TM1 (Ceftiofur+Flunixin; 37.4%) and TM8 (TrimSulfa+Flunixin; 33.0%). PSc2 mares predominantly received TM2 (Ceftiofur+Flunixin for 7d, followed by TrimSulfa+Altrenogest; 51.7%) and animals showing PSc3 were treated with TM5 (TrimSulfa+Altrenogest+Clenbuterol+Pentoxifylline) and TM3 (Ceftiofur+Flunixin for 7 d, followed by TrimSulfa+Altrenogest+Clenbuterol+Pentoxifylline) (both 28.6%). Overall, at the end of the next season, 61.1% of placentitis mares were pregnant, 32.0% barren, and 6.9% open (n=175). Pregnancy was established in 62/91(68.1%) of mares with PSc1, 31/58(53.4%) with PSc2 and 14/26(53.8%) with PSc3. Most pregnancies were achieved in the first 81/107(75.7%) or second 18/107(16.8%) inseminated cycle. In conclusion, early detection and treatment of placentitis can save high-risk pregnancies in > 90% of cases and mares show a satisfying subsequent fertility.

Comparison of ductus venosus Doppler and cerebroplacental ratio for the prediction of adverse perinatal outcome in high-risk pregnancies before and after 34 weeks.

The objective of the study was to compare the accuracy of the ductus venosus pulsatility index (DV PI) with that of the cerebroplacental ratio (CPR) for the prediction of adverse perinatal outcome at two gestational ages: <34 and ≥34 weeks' gestation. This was a retrospective study of 169 high-risk pregnancies (72 < 34 and 97 ≥ 34 weeks) that underwent an ultrasound examination of CPR, DV Doppler and estimated fetal weight at 22-40 weeks. The CPR and DV PI were converted into multiples of the median, and the estimated fetal weight into centiles according to local references. Adverse perinatal outcome was defined as a composite of abnormal cardiotocogram, intrapartum pH requiring cesarean delivery, 5' Apgar score <7, neonatal pH <7.10 and admission to neonatal intensive care unit. Values were plotted according to the interval to labor to evaluate progression of abnormal Doppler values, and their accuracy was evaluated at both gestational periods, alone and combined with clinical data, by means of univariable and multivariable models, using the Akaike information criteria (AIC) and the area under the curve (AUC). Prior to 34 weeks' gestation, DV PI was the latest parameter to become abnormal. However, it was a poor predictor of adverse perinatal outcome (AUC 0.56, 95% CI: 0.40-0.71, AIC 76.2, p > 0.05), and did not improve the predictive accuracy of CPR for adverse perinatal outcome (AUC 0.88, 95% CI: 0.79-0.97, AIC 52.9, p < 0.0001). After 34 weeks' gestation, the chronology of the DV PI and CPR anomalies overlapped, but again DV PI was a poor predictor for adverse perinatal outcome (AUC 0.62, 95% CI: 0.49-0.74, AIC 120.6, p > 0.05), that did not improve the CPR ability to predict adverse perinatal outcome (AUC 0.80, 95% CI: 0.67-0.92, AIC 106.8, p < 0.0001). The predictive accuracy of CPR prior to 34 weeks persisted when the gestational age at delivery was included in the model (AUC 0.91, 95% CI: 0.81-1.00, AIC 46.3, p < 0.0001, vs AUC 0.86, 95% CI: 0.72-1, AIC 56.1, p < 0.0001), and therefore was not determined by prematurity. CPR predicts adverse perinatal outcome better than DV PI, regardless of gestational age. Larger prospective studies are needed to delineate the role of ultrasound tools of fetal wellbeing assessment in predicting and preventing adverse perinatal outcome.

Comparison of modified biophysical profile and doppler ultrasonography studies in predicting perinatal outcome in high-risk pregnancies

In order to improve perinatal outcomes and reduce mother and foetal morbidity and mortality especially in high-risk pregnancies, there is an immense need to do thorough antepartum surveillance test. Aims and Objectives: To compare modified biophysical profile (MBPP) and Doppler studies results for prediction of perinatal outcome and to evaluate the association between the mode of delivery and abnormal Doppler and MBPP.Methodology: This is a prospective observational and comparative study. High-risk term patients were taken in this study, following which MBPP and Doppler studies were performed within 48 to 72 hours of delivery.The study population were divided as follows and perinatal outcome was assessed:A-Normal MBPP and normal Doppler velocimetryB-Normal MBPP and abnormal Doppler velocimetryC-Abnormal MBPP and normal Doppler velocimetryD-Abnormal MBPP and abnormal Doppler velocimetry.Results: The high-risk factor for the greatest number of patients, which accounted for 39.33% of patients, was pregnancy-induced hypertension. Age was less than 25 years in 88 patients (55%). 67 patients were primigravida (44.7%), LSCS was the mode of termination of pregnancy in 127 (84.7%) patients.Greatest prenatal complications occurred in individuals who had abnormal MBPP and Doppler, with a significant P value of < 0.05., Subsequently followed by MBPP, which had a significantly higher NPV than Doppler studies (63.64% vs. 59.41%), which makes it helpful for identifying healthy new-borns.Conclusion: In our study, it was determined that better prediction of adverse perinatal outcome was observed when both Doppler studies and MBPP was done in combination followed by MBPP.

MODIFIED BIOPHYSICAL PROFILE IN HIGH RISK PREGNANCY AND ITS FETAL OUTCOME

Background: High risk pregnancies are at increased risk of maternal and neonatal morbidity and mortality. Modied biophysical prole (MBPP) is one of the best method used in antepartum fetal surveillance which comprises of Non stress test (NST) and Amniotic uid index (AFI). Our main aim is to evaluate the efcacy of modied biophysical prole in predicting perinatal outcome in high risk pregnancy &amp; to prevent perinatal morbidity &amp; mortality by intervention done in time. Methods: A prospective cohort study was conducted in our hospital from February 2021 to January 2022. In this study 200 high risk pregnant women with term pregnancy, attending the antenatal outpatient clinic or admitted in the ward were evaluated with the modied biophysical prole consisting of NST recording for 20 minutes, followed by ultrasound assessment of amniotic uid volume, using four quadrant technique. Results:Among 200 high risk pregnant women, Modied biophysical prole in high risk pregnancy showed amniotic uid index &lt; 5 in 4.5% cases, 26 % cases had AFI 6 to 8 and 69.5 % cases had AFI 8 to 24 ; CTG showed 23 % cases were found to have non-reactive &amp; 77% cases were reactive. When AFI &amp; CTG was combined, non-reactive CTG is more among cases with AFI &lt; 5 and it was statistically signicant (P Value =0.05). The rate of LSCS, Neonatal resuscitation and Admission was increased when there was abnormal MBPP. Conclusion: Modied biophysical prole is the best method for antepartum fetal surveillance. It can be used to predict perinatal outcome and provide timely intervention in high risk pregnancies

Assessment of Obstetric Doppler Ultrasound in High-Risk Pregnancy and Its Perinatal Outcome

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality &amp; morbidity. It accounts for a sizeable number of future unhealthy children, which is a significant burden to parents and society. IUGR can be minimized to some extent by timely &amp; accurate detection of IUGR. Aims and objectives: To evaluate various waveforms of the umbilical artery, middle cerebral artery, ductus venosus, and cerebroplacental ratio as a predictor of adverse pregnancy outcomes in high-risk pregnancies. Materials and Methods: Eightywomen with a gestational age of 24 to 36 weeks were studied in the department of Radiodiagnosis of SAMC &amp; PGI, Indore, Madhya Pradesh, from April 2021 to September 2022. Subjects were divided into non-complicated pregnancy [Appropriate for gestational age (AGA); n=40) and high-risk pregnancy [Small for gestational age (SGA); n=40; ≥18 years of age, with or without risk factors]. All underwent Doppler interrogation of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus between 24-36 weeks of gestation. Results: Elevated head circumference (HC)/ abdominal circumference (AC) ratio, elevated femur length (FL)/AC ratio, presence of oligohydramnios without ruptured membrane, and advanced placental grade was more frequently observed among SGA babies. In this series, among the various risk factors, hypertension was a significant risk factor for IUGR, which other workers also accepted. Pulsatility index (PI), resistive index (RI) and systolic/diastolic (SD) ratio of uterine &amp; umbilical arteries was significantly raised in SGA babies compared to AGA babies. In contrast, middle cerebral artery (MCA)'s PI, RI, and SD ratios were significantly lower in SGA babies than in AGA babies. Uterine artery early Diastolic Notch was seen in 11 cases &amp; all of them delivered SGA babies. Hypertension was present in 8 of these 11 cases. Absent Diastolic Flow was detected in only one case, and the foetus ......

Frequency of third trimester umbilical artery Doppler for improving neonatal outcomes in high-risk pregnancies: a randomized trial.

Umbilical artery Doppler ultrasonography is useful for high-risk prenatal surveillance. However, according to a systematic review and meta-analysis by the Cochrane pregnancy and childbirth group, the optimal frequency with which such surveillance should occur remains unclear. In the current study, we aimed to investigate whether performing umbilical artery Doppler on a weekly basis enables earlier detection of changes in utero-placental blood flow than the recommended bi-weekly (i.e., fortnightly) regimen and its impact on perinatal outcomes. This randomized controlled study included 292 high-risk pregnant women in their third trimester who attended the Ain Shams University Maternity Hospital in Egypt from January 2018 to September 2019. The women were randomly assigned to two groups to undergo either bi-weekly or once-weekly umbilical artery Doppler ultrasound. In the primary analysis performed according to the intention-to-treat basis, we observed no difference in the primary outcome of fetal admission to the neonatal intensive care unit (NICU) within the first 24 hours (risk difference, -2.63; 95% confidence interval, -12.92 to 7.65). Furthermore, no significant differences in secondary outcomes were observed (apart from stillbirth). Weekly umbilical artery Doppler is not superior to bi-weekly surveillance in preventing admission to the NICU and most other studied outcomes. Therefore, the bi-weekly regiment may be more convenient for women and more cost-effective for health care organizations (trial registration: NCT03584763 at clinicaltrials.gov).

Clinico-epidemiological profile of women with high-risk pregnancy utilizing antenatal services in a rural primary health center in India

Objective: Early detection and effective management of high-risk pregnancies can substantially contribute to the reduction of adverse maternal and fetal outcomes. This study aimed to determine the prevalence and clinical profile of women with high-risk pregnancies in rural areas who utilize antenatal services in a primary health center (PHC). Materials and Methods: A retrospective analysis was carried out over a six-month period by reviewing the mother and child protection cards maintained at the PHC's Maternal and Child Health Center. During the study period, 950 pregnant women were registered, of whom 793 were included in the study based on the completeness of the records. Data analysis was performed using the licensed Statistical Package for the Social Sciences (SPSS) software version 21.0. Results: The prevalence of high-risk pregnancy among the antenatal women was 272 (34.3%) with 95% CI [31.1-37.7]. Of the 272 women, 240 (88.2%) had a single high-risk factor, while 32 (11.8%) had more than one high-risk factor. The major factor contributing to high-risk pregnancy was hypothyroidism (43.7% with 95% CI [37.9-49.6]), followed by a previous lower segment Caesarean section (LSCS) (19.1%). Conclusion: The study found that the prevalence of high-risk pregnancies was 34.3% in this rural setting. The majority of high-risk pregnancies were due to hypothyroidism, followed by more than one previous LSCS or abortion. Further research is required to track high-risk pregnancy outcomes and investigate the newborn thyroid profile of women with hypothyroidism.

Neonatal Outcome in High Risk Pregnancies Based on Umbilical Arterial Blood Gas Analysis

The purpose of this study is to evaluate the correlation between umbilical arterial blood gas and short term outcome of the neonates born. This prospective observational cohort study was carried out at Department of Paediatrics, MLB Medical College, Jhansi on 120 term neonates delivered by caesarean sections or normal vaginal delivery of high risk mother based on Neonatal Resuscitation Program (NRP) between July 2017 to July 2018. All neonates were divided into two groups: 1) Group I (52 cases) consists of neonates with umbilical cord pH less than 7.2, whereas Group II (68 cases) consists of neonates with umbilical cord pH more than 7.2. Male babies and LSCS delivery were higher in both groups. The most common risk factors in mother are anemia (26%) and MSL (23%). All the cases were full term babies and have normal birth weight. Mean PO2 level was 11±6 and in group II it was 14±8. Mean PCO2 in group I was 63.7±13.7 while in group II it was 52.1±7.9. Mean bicarbonate was 21.36±3.54 and in group II it was found to be 24.13±3.25. On statistical analysis difference between pH, PCO2, PO2, BE and bicarbonate was significant. In group I, neonates required resuscitation in 57.69% (30 out of 52 cases), but in group II, only (10.29) (7 out of 68) cases required resuscitation. In group I, 48.07% (25 of 52) newborns were admitted to the NICU, whereas 5.88% (4 of 68) neonates in group II were admitted to the NICU. Encephalopathy is observed in 15 instances (28.85%) in Group I, but only 4 cases (5.88%) in Group II. HIE symptoms were frequently seen in the initial hours or days following delivery. Convulsion occurred in 11 instances (21.15.0%) in Group I, but only 3 cases (4.41%) in Group II. Convulsive disorders as sign of moderate encephalopathy had been presented more in neonates who had acidosis in 24 to 48 hours after birth. In group I, 26 cases (50.0%) had delayed in attaining oral feed until an hour, but in group II, only 4 cases (5.88%) cases had delay in attaining oral feed until an hour. The statistical association between delayed attainment of full meal and infant pH is significant. HIE is significantly higher in group 1. The average hospitals stay among academic newborns in Group I was 3.9613.199 days. The length of hospital stray in academic newborns exhibited an inverse connection with umbilical cord pH. In group II, the average length of hospital stay is 2.151.479 days. When compared to group II, group I experienced a considerably longer hospital stay. At 1 and 5 minutes of birth, a new-born with cord blood pH &lt;7.2 had an APGAR score of 5.60±1.963 and 7.88±1.437, whereas a baby with cord blood pH &gt;7.2 had an APGAR score of 8.70±0.964 and 8.70±0.964. According to statistical study, the APGAR score is significantly related to the pH of the cord blood. Umbilical cord blood ABG has been conducted as a definitive factor for fetus evaluation. The pH of umbilical cord blood is the best current criteria for diagnosing foetal hypoxemia during labour and determining appropriate postnatal care decisions.