Outcome In High Risk Pregnancies Research Articles

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.

ROLE OF MODIFIED BIOPHYSICAL PROFILE IN PREDICTING PERINATAL OUTCOME IN HIGH RISK PREGNANCY

Background: In order to achieve the target of having a healthy mother and healthy baby there is a need to identify pregnant woman with high risk factors.Ante natal foetal monitoring is aimed at identifying foetus that are at high risk of suffering from intrauterine hypoxia. Aims and Objectives: To evaluate the role of modified biophysical profile in predicting perinatal outcome in high risk pregnant women Material and methods: This is a hospital based observational study in the department of Obstetrics and Gynaecology , Victoria Government Hospital , Visakhapatnam, from January 2022 to May 2022.A total of 96 high risk pregnant women were included in this study. Inclusion criteria was Singleton pregnancy ,risk factors like[pre eclampsia,gestational hypertension,diabetes mellitus,anemia,past dates,post cesarian section.breech,bad obstetric history and pre term,Exclusion criteria was multifetal gestation,intrauterine death,fetal anomalies. Detailed history was taken and relavent investigations were sent. Results: 16.9% of cases had meconium stained liquor (normal CTG and AFI), 36% with meconium stained liquor had normal AFI but abnormal CTG, 40% with meconium stained liquor had abnormal AFI but normal CTG, 50% with meconium stained liquor had abnormal AFI and abnormal CTG 0% of babies had perinatal death when AFI and CTG was normal, 100% of babies had perinatal death when AFI and CTG was abnormal Conclusion: Modified bio physical profile is a easy ,time saving and cost effective procedure and can used as a test of antepartum fetal surveillance in order to predict perinatal outcome in high risk pregnancy.

The Role of Cardiotocography in Monitoring Fetal Condition During Labour in High Risk Pregnancy and Its Correlation with Perinatal Outcome

Background: Cardiotocography (CTG) is considered to be a non-invasive prenatal screening technique. It is used to monitor fetal condition during labor. Objectives: this study aimed to evaluate the role of Cardiotocography as a screening tool during labor in high risk pregnancy for determining perinatal outcomes. Methods: In this cross-sectional study, Cardiotocography was performed randomly on 200 pregnant women with risk factors (postdate, oligohydronomia, Pregnancy-induced hypertension, diabetes mellitus, anemia, intrauterine growth retardation, Antepartum hemorrhage, and pre-labor rupture of membrane who attended the labor ward of Duhok Teaching Hospital of Obstetrics and Gynecology from 20 October 2019 to 15 February 2020 and the results of CTG were categorized a reactive and non-reactive cardiotocography tracing groups and the perinatal outcomes were correlated with cardiotocography results. Results: In this study, the mean age of patients was 27.41±6.09 years; ranged 18-42 years. There was no significant difference in the mean age of the patients (27.48±6.17 vs. 27.33±6.05 years), gravida (2.49±1.73 vs. 2.10±1.53) and gestational age (39.85±1.40 vs. 39.84±1.41weeks) between patients with reactive and non-reactive cardiotocography tracing, respectively. Patients with reactive cardiotocography were significantly more likely to have live babies (1.52±1.77 vs. 0.54±0.67) and no dead babies was recorded between reactive and non-reactive cardiotocography groups. The rate of caesarean section was significantly higher in patients with non-reactive cardiotocography (64.4% vs. 38.4%) and for bloody liquor (7.9% vs. 2.0%). It was also observed that low Apgar score 0-4 in first minute (12.9% vs. 4.0%) and 5-7 Apgar score in five minutes (34.7% vs. 9.1%) and admission to neonatal intensive care unit were significantly higher in patients with non-reactive than in those with reactive cardiotocography (59.4% vs. 26.3%), respectively. Conclusions: This study showed that cardiotocography is a useful technique to determine perinatal outcomes in high-risk pregnancies.

Role of cerebro-placental ratio in prediction of perinatal outcome in high-risk Pregnancies with intrauterine growth restriction

Background: Antenatal surveillance using Doppler ultrasound velocimetry of the uteroplacental umbilical and fetus arteries has been commonplace. The cerebroplacental ratio has been investigated as a way to predict newborn outcomes. Aim and objectives: In this research, we wanted to see whether the cerebro-placental ratio may help predict perinatal outcomes in high-risk gestation with intrauterine growth restriction. Subjects and methods: This was case-control research done at Al-Hussein University Hospital's Department of Obstetrics and Gynecology; The obstetric color Doppler investigation might be examined in two groups of 100 high-risk pregnant wome: Group Ⅰ - study group: 50 high risk pregnant women with IUGR and Group Ⅱ - control group: 50 high risk pregnant women without IUGR. Results: CPR achieved significance at cutoff point of 1.03 for predicting IUGR with sensitivity of 87.2% and specificity of 71.6% with PPV 83% and NPV 79%. Conclusion: Intrauterine growth restriction in high-risk gestations, the cerebral-placental ratio has a significant prognostic value for perinatal outcome.

Value of shear-wave elastography and cerebral–placental–uterine ratio in women diagnosed with preeclampsia and fetal growth restriction in prediction of adverse perinatal outcomes

Purpose The aim of this study was to measure placental stiffness with shear-wave elastography technique and to evaluate the relationship with cerebral–placental–uterine ratio (CPUR) and adverse perinatal outcomes in patient groups diagnosed with preeclampsia (PE) and fetal growth restriction (FGR) in the second and third trimesters compared to the control group. Materials and methods This prospective cross-sectional study was conducted at our hospital between March 2019 and March 2020. The study groups were divided into three groups: PE, FGR, and low risk pregnancy (LRP) group. The study population had singleton pregnancies and the placental site was at the anterior wall. Both shear-wave elasticity (SWE) and shear-wave velocity (SWV) were measured in the placenta during pregnancy. CPUR was calculated for each group. Results A total of 147 patients were included in this study. The mean SWE (kilopascals) values in the PE group were significantly higher than in the FGR and controls (difference of means = 3.67, 9.45; 95% CI (1.23–6.1, 7–11.8); p < .05), respectively. The mean SWV values were significantly higher in PE and FGR groups than controls (p < .05). CPUR showed correlation with central maternal surface of placenta (p: .02, r: −0.184), central fetal surface of placenta (p < .001, r: −0.288), peripheral maternal surface of placenta (p: .002, r: −0.252), and peripheral fetal surface of placenta SWE values (p: .03, r: −0.181). NICU admission was correlated with central fetal surface of placenta SWE values (p: .002, r: 0.258). Conclusion In conclusion, we demonstrated increased placental stiffness in both the PE and the FGR group. Also, this difference was found to be more prominent in preeclampsia. This technique seems useful for assessment of placental function and may strengthen the utility of Doppler parameters for predicting adverse perinatal outcomes in high-risk pregnancies.

Analysis of Prenatal and Intrapartum ECG and Delivery Outcome of High-risk Pregnancy

Analysis of Prenatal and Intrapartum ECG and Delivery Outcome of High-risk Pregnancy