Delivery Of Placenta Research Articles

Assessment of Uterine Contraction and Atonic Bleeding during the Third Stage of Labor Using Shear Wave Elastography.

This study aimed to clarify the relationship between fluctuations in uterine stiffness during the third stage of labor and blood loss upon placenta delivery using shear wave elastography. This prospective cohort study enrolled consecutive singleton pregnant women above 37 weeks of gestation who delivered infants transvaginally at a single perinatal center. Shear wave velocities (SWV) were continuously measured during the third stage of transvaginal labor using transabdominal ultrasound and these values were compared between groups with large (≥500 g) and small amounts of bleeding during this stage. In total, 8 cases of large bleeding and 47 cases of small bleeding were compared. The large amount of bleeding group had a significantly lower median of minimum SWV values (0.97 [0.52-1.01] m/s than the small amount of bleeding group (1.25 [1.04-1.48] m/s p = 0.02). However, no significant differences were observed between the two groups in terms of median, mean, and maximum SWV values. The time from delivery of the infant to placental delivery was significantly longer in the large amount of bleeding group (median time: 370.5 s vs. 274 s, p < 0.05). Ultrasound quantification of uterine stiffness using shear wave elastography demonstrated that uterine contractions may influence the biological hemostasis of the uterus during the third stage of labor. Baseline uterine stiffness was weak and a longer duration of placental separation might be associated with cases of large amounts of bleeding during this stage.

Prevention of Maternal Complication with Ayurveda Regime

Maternal health revolves around the health and wellness of pregnant women at the time they give birth and during child rising. Ayurveda considers food to be the best source of nourishment as well as medication for the pregnant woman. The nine monthly diets are singularly unique to Ayurveda. The food taken by a pregnant woman (Aahar Ras) nourishes and helps the growth of the foetus (Garbha Vriddhi), nourishes the mother's own body (Swa-Sharir Pushti) and nourishes the breasts by which the breast milk formed (Stanyaya). Postpartum period is an important phase of transition in women’s life following childbirth. This period is also known as puerperium, starts following the expulsion of the placenta. Mortality and morbidity of mother are most challenging problems of our country. In our day-to-day life we see many mothers complaining of increase in their physical problems like back-ache, anaemia and many other infections after puerperium. Lady after delivery of placenta is called as Sutika (puerperal woman), Sutikakala (duration of puerperium) is the period following childbirth during which all body tissues revert back approximately to a pre-pregnant state. For better health attainment after delivery every postnatal woman should be encouraged to follow Sutika Paricharya as per Ayurveda classics.

Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth

BackgroundTo support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics.MethodsThe data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women’s needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability.ResultsTwo hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important.ConclusionsSome items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.

Analysis of Cesarean Section using Robsons classification at Teaching Hospital of Eastern Nepal

Introduction: Cesarean section is an operative procedure for delivery of fetus and placenta by making an incision over abdomen and uterus after period of viability. Aims: The aim of study is to analyze rate of cesarean section and perform an analysis based on Robsons ten group classification. Methods: A cross sectional study was conducted at Department of Obstetrics and Gynecology of a teaching hospital of eastern Nepal, over a period of one year from October 2022 to September 2023. All details regarding demography, obstetric history, medical history, labor status, indication of cesarean section, etc. were collected. Then all pregnant ladies were assigned to one of Robsons ten group classification systems and recorded into labor confinement book. The statistical analysis was performed using Statistical Package for Social Sciences version 21. Descriptive statistical tools were used to express the results. All tests were done with a significance level of 5% (p-value &lt;0.05) and 95% confidence Interval. Results: The overall rate of cesarean section was 1,829(46.93%). Majority 1323(72.30%) were in age group 20-30 years. Maximum 1,629(89.10%) delivered at&gt;37 weeks of gestation. Majority 789(43.10%) of cases had lower segment cesarean section because of previous cesarean delivery. According to Robsons classification system, Group 5 has highest cesarean section rate 725 (39.60%) followed by Group 2(A+B), 334(18.21%). Conclusion: Implementing Robsons Ten Group Classification System at our setting has helped us to identify major contributor of overall cesarean section rate. Group 5 was at top followed by group 2. Thus with adequate trial of labor after cesarean, proper labor monitoring and judicious use of induction protocol can significantly reduce rate of cesarean section.

Evaluation of IUD Insertion During CS In 100 Patient. A Prospective Study

Background: The application of an IUD to the female after placenta delivery during a caesarean section had several benefits since the female was under anesthetic, which reduced the need for additional manipulation and pain, and the female at the time of delivery had a strong desire for family planning. IUDs placed postpartum experienced numerous disengagements, including bleeding and displacement. Objectives: To evaluate the efficacy of post placental IUD insertion during cesarean section in 100 patients. Patient and methods: A prospective study was conducted at obstetrics and gynecology department of Damanhur Medical National Institute in the period from March 2022 to March 2023. Group I: included 52 women who agreed to insert immediate post placental IUD at the cesarean delivery. Group II: included 48 women as control group. The type of IUD used was cupper-T IUD, both groups were assessed as regard to time of cesarean section (CS), amount of postoperative bleeding, postoperative pain, occurrence of infection, any displacement of IUDs, failure of contraception and patients’ satisfaction. Results: In both groups, the demographic information was comparable. The medical histories of the investigated patients and the control group did not differ significantly according to our research. The study group's caesarean procedure took a little longer to complete. There were no appreciable differences between the two groups in terms of infection, puerperal hemorrhage, or IUD displacement. Both groups' satisfaction levels were displayed as either pain or displacement. In the research and control groups, the expulsion rates were 3.92% and 0.00%, respectively. Conclusion: Based on our research, we draw the conclusion that IUD insertion during CS is safe and effective, avoiding the reasons why it can be challenging to insert an IUD after puerperium and having a low expulsion rate; so, it can be considered a standard procedure.

Effect of Tranexamic Acid in Prevention of Post-Partum Haemorrhage: A Prospective Observational Study

Background: Treatment of Post partum haemorrhage relies primarily on uterotonics, but early use of Tranexamic Acid (TXA) has become part of several recommended algorithms. Recent data has demonstrated that Tranexamic Acid (TXA), an antifibrinolytic agent, reduces death due to bleeding when used as a treatment for PPH. This study was conducted with an objective to see the role of tranexamic acid along with uterotonic agent (oxytocin) in prevention of postpartum hemorrhage. Materials and Methods: The present prospective observational study carried out at the Maternal and Child Health (MCH) wing Department of a rural tertiary care hospital and medical college situated in the central India during January 2021 to December 2022. A total sample size of 1640 patients attending labour room for vaginal birth or caesarean section in 3rd stage of labour were included in the study. Total 1640 women were further divided into two groups, Group A (receiving both tranexamic acid along with oxytocin) and Group B (receiving only oxytocin). Blood loss in each group was measured by visual method and Gravimetric (measurement by weight) method. They were followed till delivery; maternal and neonatal outcome was studied. Statistical analysis was done by using SPSS 27.0 version and GraphPad Prism 7.0 version and p&lt;0.05 considered as level of significance. Results: The majority of patients in Group A and Group B were between 26-30 years of age group. There was no significant difference between the groups in terms of maternal age, gestational age, gravida and booking status. The mean foetal birth weight among Group A was 2421.28 ± 626.91 and Group B was 2381.38 ± 721.20 with no significant difference between the groups. There was significant reduction in blood loss in study group A as compared to control group in both vaginal and LSCS birth with statistically significant difference. Conclusion: Tranexamic acid injection, an antifibrinolytic agent when given prophylactically after delivery of placenta along with oxytocin appears to reduce the blood loss during normal labour as well as caesarean sections effectively.

A comparison of the effect of placental extraction from exteriorized versus non-exteriorized uterus on blood loss during caesarean section in Nigerian women.

The purpose of this study was to determine the effect of placenta extraction from exteriorized uterus versus placenta extraction from non- exteriorized uterus on blood loss during caesarean section (CS). It was a randomized control study in which 98 women undergoing caesarean section were allocated randomly to either the placental delivery from exteriorized uterus or placental delivery from non-exteriorized uterus. The main outcome measure was intraoperative blood loss, and Intention to treat analysis was used. More participants in the non-exteriorized placenta removal group had blood loss ≥500mls (P-value <0.001). Logistic regression showed about 5times likelihood of having blood loss of 500mls or more in the non-exteriorized group (P< 0.001; OR: 5.67; 95%CI: 2.38-13.40). The mean estimated blood loss was 54.1mL less in exteriorized placenta removal group (476.12±160.86 versus 530.20±145.18; P-value = 0.084). The mean changes in haemoglobin concentration in exteriorized and non-exteriorized groups were 0.68±0.19g/dL and 0.74±0.20g/dL; P = 0.131) respectively. This study showed statistically significant difference in blood loss of 500mls or more in the placenta delivery from non-exteriorized compared to the exteriorized group. However, there was no significant difference in the mean blood loss, duration of surgery, and change in haemoglobin between the two groups.

Comparations Controlled Cord Traction and Manual Removal of Placenta in Caesarean Section: Prospective Study of Somali Pregnant Women

Aim: This study sought to examine the intraoperative and postoperative outcomes of Controlled cord traction and manual removal of the placenta in the third stage of labour during the caesarean section. Methods: We prospectively enrolled pregnancies who were admitted to the clinic of the Department of obstetrics and Gynaecology for caesarean section (Pfannenstiel method) in addition to providing sociodemographic data (age, body mass index) and clinical data (haemoglobin, total operative time, removed placenta total time, postpartum haemorrhage, need to blood transfusion, hospital stay, intensive care unit (ICU) admission, postoperative eating and drinking time, and intrabdominal blood). Results: Of 196 participating women, 98 performed controlled cord traction removal of the placenta, and 98 performed manual removal. The controlled cord traction removal of the placenta group and the manual removal of the placenta group had similar blood loss (haemoglobin drop) and postpartum haemorrhage (p&gt;0.05). In the controlled cord traction removal of placenta group, significant intra-operative findings were shorter removal of placenta time (18.7±10.6 vs 28.6±13.1 second, p=0.0001), shorter total operative time (36.3±10.7 vs 41.8±11.4, p=0.003) and lower prevalence of presenting intrabdominal blood (12.2% vs 26.7%, p=0.021). Significant postoperative findings were earlier eating time ( 15.0±7.3 vs 19.6±14.4 hours, p=0.011) and lower incidence of endometritis ( 1% vs 4.1%, p=0.042) compared with the manual removal of placenta. Conclusion: The umbilical cord traction maneuverer for the placenta delivery had more advantages than the manual removal maneuverer. This technique should be recommended during the third stage of labour during the caesarean section.

PHYSIOLOGICAL BASED CORD CLAMPING- AN ARCHAIC STEP RELEARNED CLINICAL STUDY AT A TERTIARY CARE CENTRE.

Objective: To study maternal and perinatal outcomes in physiological based cord clamping in third stage of labour. Method: We conducted prospective observational study, in the Department of Obstetrics and Gynecology of Govt. Medical college &amp; hospital, Aurangabad for 2 years to study physiological based cord clamping which is a method of deferred cord clamping until natural delivery of placenta. The placenta was allowed to deliver physiologically without any cord traction or cord pull, encouraging mothers own uterine contractions and taking help of gravity. Oxytocin was given intramuscularly to the mother only after complete placental delivery. Results: Out of 200 women most of them belong to age group 21-25 years (41.5%) with mean age of 24.78 ± 6.72 years. 47.5% were from upper lower class, 53.5% were G2 followed by 26.5% were primigravida's. About 72% women's GA was ranging between 37-40 weeks. In 89.5% women the time required for 3rd stage of labour ranged between 5-10 minutes while in 99% women's placenta expelled in &lt;15 minutes. In our study 75% of women had outstanding experience after PCC. Among 200 neonates who delivered vaginally, had birth weight 2.5-3 kg (71%). majority of neonates had APGAR score ≥7 at 1 min were 97.50%, at 5 minute (100%) and 10 minute (100%) had Apgar score ≥7. It was observed that majority of neonates had heart rate 121-140 bpm at 1 minute (91.5%) and 5 minutes. (96%). Also, it was observed that mean temperature at 5 minutes was 98.32 ±1.08 F. Only 1.5% required NICU admission for neonatal jaundice. No case of hypothermia seen.

Annotation and Identification of Phytochemicals from Eleusine indica Using High-Performance Liquid Chromatography Tandem Mass Spectrometry: Databases-Driven Approach.

Eleusine indica (L.) Gaertn is a perennial herb belonging to the Poaceae family. As the only species of Eleusine found abundantly in Malaysia, it is locally known as "rumput sambau" and has been traditionally used to treat various ailments including pain relief from vaginal bleeding, hastening the placenta delivery after childbirth, asthma, hemorrhoids, urinary infection, fever, and as a tonic for flu-related symptoms. A diverse array of biological activities have been reported for the plant, such as antimicrobial, cytotoxic, anticonvulsant, anti-inflammatory, analgesic, antipyretic, and hepatoprotective action. Despite many reports on its traditional uses and biological activities, limited chemical databases are available for the plant. Thus, the aims of this study were to annotate and identify the phytochemical constituents in the methanolic extract of E. indica through tandem LCMS-based analysis techniques using MZmine, GNPS, Compound Discoverer, and SIRIUS platforms. This technique managed to identify a total of 65 phytochemicals in the extract, comprising primary and secondary metabolites, and was verified by the isolation of one of the identified phytochemicals. The structural elucidation mainly using 1D and 2D NMR as well as comparison with values in the literature confirms the isolated phytochemical to be a 3-OH anomer of loliolide, a benzofuran-type of compound, which consequently increases the level of confidence in the applied technique. The research describes a useful method for the fast and simultaneous identification of phytochemicals in E. indica, contributing to the study of the chemical properties of the genus and family.

Efficacy of Preoperative Intravenous Tranexamic Acid Before Cesarean Section in Placenta Previa: A Randomized Double Blind Control Trial

Background: Placenta previa is a common cause of postpartum hemorrhage (PPH) that contributes substantively to maternal morbidity and mortality rates. Tranexamic acid is an antifibrinolytic drug that is useful for the treatment of PPH. The recommendation from many guidelines is to start giving tranexamic acid as soon as PPH is diagnosed to reduce postpartum blood loss. Furthermore, some studies report the beneficial use of tranexamic acid given as a prophylactic before Cesarean section to decrease intraoperative blood loss and prevent PPH. To the authors’ knowledge, in high-risk obstetrics case such as placenta previa, there was insufficient data to support recommendations of the use of tranexamic acid for prevent PPH. Objective: To evaluate the efficacy of supplementary intravenous tranexamic acid before cesarean section versus prophylactic intravenous oxytocin after placenta delivery alone to decrease intraoperative blood loss and prevent PPH in placenta previa. Material and Methods: The present study conducted a double blinded placebo control trial comparing adjunct 1 g tranexamic acid given intravenously before skin incision with prophylactic intravenous oxytocin after placenta delivery alone before cesarean section for placenta previa. The study recruited 60 women who were diagnosed with placenta previa at gestational age (GA) of more than 28 completed weeks undergoing emergency cesarean section due to active bleeding or scheduled for elective cesarean section at 37 completed weeks at Chonburi Hospital between July 2021 and July 2022. The primary outcome was intraoperative blood loss. Results: Sixty diagnosed placenta previa women were recruited, with 30 patients per group. Group I patients were given 1 g tranexamic acid and Group II were given a placebo of 100 ml NSS before skin incision. Both groups received intravenous oxytocin 20 units after placenta delivery. The main outcome showed that preoperative tranexamic acid intravenous reduced intraoperative blood loss significantly compared with the placebo at 349.5 ml (range of 168 to 2,200) versus 619 ml (range of 288 to 3,243), p&lt;0.001. The secondary outcome showed a significant decrease in the incidence of PPH at 4 (13.33%) versus 10 (33.33%), p=0.030 and decreased in the incidence of blood transfusion of more than one unit from 5 (16.67%) versus 13 (43.33%), p=0.047. Conclusion: Prophylactic supplementary 1 g tranexamic acid intravenously before cesarean section to prophylactic intravenous oxytocin after placental delivery was found to effectively reduce intraoperative blood loss and PPH. Keywords: Tranexamic acid; Preoperative; Placenta previa; Intraoperative blood loss; Cesarean section

COMPARISON OF MEAN DURATION OF 3RD STAGE OF LABOUR IN PATIENTS TREATED WITH AND WITHOUT INTRAUMBILICAL VEIN INJECTION OF OXYTOCIN

Background: Active management of 3rd stage of labor is done routinely to enhance the process of the placental delivery and decrease the duration of 3rd stage of labor so as to minimize the risk of postpartum hemorrhage. A recent study concluded that intraumbilical administration of oxytocin shortened the duration of 3rd stage of labor significantly as compared to control group and suggested its use in routine practice for its role in the reduction in the risk of postpartum hemorrhage.&#x0D; OBjectives: The objective of this study was to compare the mean duration of 3rd stage of labor in patients treated with and without intraumbilical vein injection of oxytocin.&#x0D; Methods: It was a randomized controlled trial conducted at Department of Obstetrics &amp; Gynecology, Government Teaching Hospital, Shahdara from 15/01/2022 to 14/07/2022.This study involved 60 pregnant women undergoing vaginal delivery which were further divided into two groups. After clamping and cutting of umbilical cord, in addition to routine management of 3rd stage of labor, women in Group-An also received intraumbilical oxytocin while the women in Group-B were taken as controls and only routine management of 3rd stage of labor was performed. The outcome variable was mean duration of 3rd stage of labor which was recorded in minutes from delivery of baby till delivery of placenta and was compared between the groups. A written informed consent was taken from each patient.&#x0D; Results: The mean age of the patients was 27.2±4.3 years while the mean parity was 2.85±1.83. There were 22 (36.7%) primiparas, 21 (35.0%) multiparas and 17 (28.3%) grand multiparas. The mean BMI of the patients was 27.5±3.9 Kg/m2 and 19 (31.7%) patients were obese. The mean duration of 3rd stage of labor was significantly shorter in women receiving intraumbilical oxytocin as compared to controls (4.33±1.52 vs. 9.40±2.77 minutes; p-value&lt;0.001). Similar difference was observed between the groups across various subgroups based on patient’s age, parity and BMI.&#x0D; Conclusion: Intraumbilical administration of oxytocin significantly reduced the mean duration of 3rd stage of labor which along with anticipated reduction in the risk of postpartum hemorrhage calls for the preferred use of intraumbilical oxytocin in the active management of 3rd stage of labor in future

Skin-to-Skin Contact in the Third Stage of Labor and Postpartum Hemorrhage Prevention: A Scoping Review.

Literature supports numerous benefits of skin-to-skin contact for neonatal adaptation to extrauterine life and bonding/attachment, but few studies explore the effects of skin-to-skin contact on maternal outcomes. This review aims to map the evidence on skin-to-skin contact in the third stage of labor for postpartum hemorrhage prevention. Scoping review, which covered stages recommended by the Institute Joanna Briggs, including studies from the PubMed, EMBASE, CINAHL, LILACS, Web of Science, and Scopus databases, using the descriptors "Postpartum hemorrhage", "Labor stages, third", "Prevention" and "Kangaroo care/Skin-to-skin". 100 publications on the subject found, 13 articles met the inclusion criteria, with 10,169 dyads were assessed in all studies. Publications from 2008 to 2021 were mostly written in English and designed as a randomized controlled trial. Skin-to-skin contact was effective and significant in: reducing the duration of the third stage of labor; placenta delivery; uterine contractility and physiological involution; absence of atony, decreasing blood loss with lower rates of erythrocyte and hemoglobin drop; reducing the need for synthetic oxytocin and/or ergometrine to control bleeding; and reducing changing pads per period and length of stay. Skin-to-skin contact was considered an effective, low-cost, and safe strategy, with positive effects already established in the literature for infants and extremely favorable results in postpartum hemorrhage prevention cases, being highly recommended in assistance for the dyad. Open Science Framework Registry ( https://osf.io/n3685 ).

Pre-eclampsia.

Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disabilityand cardiovascular and metabolic disease later in life. Pre-eclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.

The effect of tranexamic acid on blood loss after vaginal delivery and caesarian section

PPH is most common cause of maternal death, contributing to approximately 35% of maternal death all over the world. WHO (2017) recommended that tranexamic acid should be considered as a standard comprehensive PPH treatment package and must be used in all cases of PPH regardless of the cause of PPH.To evaluate the effectiveness and safety of intravenous Tranexamic acid (TA) for reduction of postpartum blood loss after vaginal delivery and LSCS and to record any adverse effects following its administration.This study was conducted as a randomized, double blind, placebo controlled trial on females at high risk of PPH and delivered vaginally or via LSCS at our Institute. All the participants were randomly categorized into two groups study group (tranexamic acid) and control group. The two groups were compared with respect to efficacy (amount of blood loss and incidence of PPH) and safety (vitals and side effects). Mean blood loss from the delivery of placenta to the end of delivery and from end of delivery to 2 hours postpartum was significantly lower in study group as compared to control group (p&amp;#60;0.05). Incidence of PPH was significantly higher in control group (p&amp;#60;0.05). There was no statistically difference in the vital at the time of delivery between two groups (p&amp;#62;0.05). Most common side effect due to tranexamic acid in study group was nausea (16%) followed by vomiting and diarrhea in 9% and 1% respectively. Tranexamic acid is an effective drug that can be used safely for prophylactic management of PPH regardless of its cause. This antifibrinolytic agent significantly reduce blood loss and incidence of PPH irrespective of type of delivery. Though, the drug is associated with minor side effects such as nausea, vomiting and diarrhea, it was not associated with major complications, thromboembolic phenomenon and maternal or perinatal morbidity and mortality.

Oxytocin before versus after placenta delivery for postpartum hemorrhage prevention: meta-analysis of randomized controlled trials

Oxytocin before versus after placenta delivery for postpartum hemorrhage prevention: meta-analysis of randomized controlled trials

Maternal and Placental DNA Methylation Changes Associated with the Pathogenesis of Gestational Diabetes Mellitus.

Gestational diabetes mellitus (GDM) is an important metabolic complication of pregnancy, which affects the future health of both the mother and the newborn. The pathogenesis of GDM is not completely clear, but what is clear is that with the development and growth of the placenta, GDM onset and blood glucose is difficult to control, while gestational diabetes patients' blood glucose drops and reaches normal after placenta delivery. This may be associated with placental secretion of insulin-like growth factor, adipokines, tumor necrosis factor-α, cytokines and insulin resistance. Therefore, endocrine secretion of placenta plays a key role in the pathogenesis of GDM. The influence of DNA methylation of these molecules and pathway-related genes on gene expression is also closely related to the pathogenesis of GDM. Here, this review attempts to clarify the pathogenesis of GDM and the related maternal and placental DNA methylation changes and how they affect metabolic pathways.

How effective is antenatal care in preparing mothers for newborn care? An exploratory survey of lactating women in a rural Nigerian district

BackgroundNeonatal death rates are high in sub-Saharan Africa and the majority of these deaths are preventable. Antenatal care (ANC) is a good channel for the reduction of neonatal deaths. This study aimed to assess newborn care practices among lactating women in Nigeria and determine their relationship with ANC attendance. MethodologyThis was a cross-sectional survey involving 241 lactating mothers selected using the cluster sampling method. A structured interviewer-administered questionnaire was employed to obtain data. The Chi-square test was used to assess the associations between categorical variables. Logistic regression was used to determine the predictors of umbilical cord care, thermal care, and neonatal vaccination status. Good cord care was defined as having minimum of three appropriate practices concerning the use of clean instruments to tie the cord, use of clean instruments to cut the cord, and application of chlorhexidine, 70% alcohol, saltwater, or nothing on the cord), Results were presented as odds ratios (ORs). P < 0.05 was taken as statistically significant. ResultsThe mean age of participants was 29.0 ± 5.5 years. Most participants reported that sterile instruments were used to cut their baby's umbilical cords; that their babies were dried immediately after placenta delivery and that their babies were fully vaccinated (91.0%, 90.5%, and 85.1% respectively). ANC visits (aOR = 8.0, p = 0.02) and place of delivery (aOR = 10.6, p = 0.01) were significantly associated with good umbilical cord care practices. However, none of the participants' sociodemographic characteristics were significantly associated with newborn thermal care and vaccination status. ConclusionThe prevailing antenatal care services are ineffective in preparing mothers for newborn care. Place and frequency of ANC have positive associations with umbilical cord care. There is a need to implement quality ANC that will enhance maternal and neonatal outcomes and implement innovative interventions to enhance ANC attendance. The WHO positive pregnancy experience model should be implemented.

Efficacy and safety of perrectal 400 microgram misoprostol versus intravenous 200 microgram methylergometrine in the management of third stage of labor for prevention of postpartum haemorrhage

Background: Objective: Postpartum haemorrhage (PPH) is a major cause of mortality and morbidity during childbirth, especially in developing countries. Misoprostol is a cheap, safe, widely available, and stable at room temperature, does not required any intravenous accesses and having few mild side effects. In resource-poor countries with limited facilities, misoprostol may be one of the important interventions to prevent PPH. We aimed to assess the effectiveness of perrectal low dose misoprostol for the prevention of PPH. Method: We designed a prospective randomized control trial, single centre study. 138 indoor low risk pregnant women with gestational age at least 37 weeks who anticipated vaginal delivery were randomly assigned to perrectal 400 microgram misoprostol (n = 71) or intravenous 200 microgram (n = 67) methylergometrine after delivery of baby and placenta. The primary outcome was incidence of PPH (estimated blood loss &gt;500 ml after delivery of baby and placenta). Results: In this study out of 138 low risk pregnancy, no women developed PPH, no patient required additional dose of oxytocin, no patient required any form of transfusion.

PPIUCD in private sector

PPIUCD is preferably inserted within 10 minutes of placenta delivery, intracaesarean, or 48 hours of delivery. In India, 65 percent of women have unmet family planning needs. The goal of this prospective study was to assess the acceptability, safety, and expulsion rate of Cu T 380 after 6 weeks of insertion. The research was conducted at St. Stephen's Hospital in Delhi, a tertiary care facility, in the Department of Obstetrics and Gynecology. For a year, 150 patients of various ages were implanted with PPIUCD. Patients were monitored for 6 weeks to assess- 1) Expulsion rate 2) Safety within Within 6 weeks of insertion, there was no evidence of abdominal pain, foul-smelling vaginal discharge, bleeding, or perforation. 3). Removal reasons In our study, we found that the overall complication rate was 9.29 percent, with infection rate 0.7 percent, prolonged lochia rate 2.1 percent, persistent bleeding rate 3.6 percent, and pain abdomen 1.4 percent. The study's removal rate was 5.0 percent. The rate of expulsion was 2.86 percent. The satisfaction rate was 80%. Based on the findings of this study, we believe that postpartum IUCD should be widely used as a contraceptive.