Poor Perinatal Outcome Research Articles

Predictors of Hydrops Fetalis Infants by Mode of Delivery

BACKGROUND: Hydrops fetalis is a fetal condition associated with higher perinatal and neonatal mortality and morbidity. The overall survival rate from the diagnosis is today estimated to be 27% despite advanced intrauterine and neonatal care. Factors that contribute to poor perinatal and neonatal outcomes have been identified; however, little is known about the existing specific predictor tool of perinatal outcome by mode of delivery. 
 OBJECTIVE: the study aimed to determine whether cesarean section does improve the perinatal outcomes of hydrops fetalis infants.
 STUDY DESIGN: This was a retrospective cohort study that retrieved 102 medical records of pregnancies complicated by hydrops fetalis. For all those women, the transabdominal ultrasound was performed during pregnancy as part of the standard diagnostic modality of intrauterine hydrops fetalis. All pregnant women’s and their newborn’s medical records were retrieved and reviewed to collect information related to the outcomes as per the mode of delivery either by cesarean section or vaginal delivery. Based on the severity of fetal disease as described by obstetric ultrasound findings, pregnant women were divided into 4 groups: mild, moderate, moderately severe, and severe hydrops fetalis. The significance of the obtained data was set at two-tailed p<0.05. The chi-squared test was used to compare categorical between groups based on outcomes. Fisher’s exact test or Monte Carlo correction was used for chi-squared analysis when more than 20% of the cells had an expected count <5. The odds ratio and 95% confidence interval for perinatal adverse outcomes were calculated using logistic regression.
 RESULTS: The incidence of hydrops fetalis was estimated to be 1.1% in this cohort study. The non-immune hydrops fetalis was the common type, accounting for 75.6% of all cases. Perinatal mortality occurred in 55.9% and the 7-day survival was estimated at 44.1%. The mortality rate was 66.1% in non-immune hydrops fetalis. There was a statistically significant association between the mode of delivery and the overall survival (pv-0.04). However, survival was increased in class I and class II (55.0%), while survival was equally observed in classes III and IV (22.5%). There was a statistically significant association between the class and survival (pv <.001). Birth weight of ≥3000 grams was associated with reduced poor perinatal outcomes at 0.3% (pv-0.02, 95% CI=0.14 -0.85). Similarly, admission to the newborn unit was associated with reduced mortality by 2.5% (pv-0.04, 95% CI=1.0 - 6.4).
 CONCLUSION: Cesarean section delivery does not improve the perinatal outcomes of hydrops fetalis newborns and it should be considered only for maternal concerns. The predictor tool of perinatal outcomes of hydrops fetalis infant per mode of delivery is a useful tool to assist in decision-making and predict the perinatal outcome of hydrops fetalis per mode of delivery.
 

Correlation between oligohydramnios and anaemia in the third trimester of pregnancy: A study in a tertiary care hospital in Pakistan.

Maintaining normal amniotic fluid index and normal hemoglobin level is crucial for normal fetal development. Their reduction can lead to maternal and fetal morbidity in the form of operative delivery and poor perinatal outcome such as, low birth weight. There is an association between oligohydramnios and anaemia, although there is scarcity on this correlation in literature. Early detection of oligohydramnios can improve maternal and perinatal outcome. This study aimed to investigate the association between oligohydramnios and anaemia during the third trimester of pregnancy. This retrospective cohort study was conducted at NESCOM Hospital, Pakistan. The study spanned from August 1, 2021, to July 31, 2022. The study included 109 pregnant individuals with oligohydramnios, resulting in an incidence of 22% among the total of 551 deliveries during the study period. The average age of participants was 29.75 years. The average gestational age was 33.52 weeks, with a range of 28 to 38 weeks. The analysis indicated that 44.03% of cases with oligohydramnios were associated with anaemia, followed by idiopathic causes (41.28%). Pearson's correlation revealed a significant association between oligohydramnios and anaemia (r = 0.307, p = 0.001), supporting the hypothesis of a potential interconnection between these two conditions. Regarding delivery outcomes, 81.6% underwent cesarean section, emphasizing the need for careful management in cases of oligohydramnios and anaemia. Neonatal outcomes indicated that 1.8% and 44.5% of neonates were extremely low birth weight and low birth weight, respectively. This study provides empirical evidence supporting a significant association between oligohydramnios and anaemia in the third trimester.

Poor perinatal outcome in a woman with severe pre-eclampsia and asymptomatic COVID-19

There is currently little known about the complex interaction between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and pregnancy. Past data from MERS-CoV and SARS-CoV-1 indicated that infection was associated with an adverse neonatal outcome. A 20-year-old primigravida presented at 23 weeks gestation and was found to have severe pre-eclampsia complicated by HELLP syndrome (haemolysis, elevated liver enzymes, low platelets) and acute fatty liver of pregnancy (AFLP). She had no respiratory symptoms and only one documented elevated body temperature from the referring facility. She was subsequently found to be COVID-19 positive. Within several hours of admission, she had an intrauterine demise. Following delivery, her condition steadily improved. COVID-19 may worsen pre-eclampsia leading to an adverse outcome. Obstetricians should be aware of the possible negative impact of COVID-19 on hypertensive disorders of pregnancy and the need for further research on this complex relationship.

Prenatal care utilization and perinatal outcomes among pregnant adolescents in Mexico, 2008-2019.

To describe utilization of prenatal care and outcomes of low birth weight and preterm birth among adolescent births in Mexico. We used birth certificate data and included live births to individuals 10-24 years, 2008-2019. Our outcomes were binary measures of adequate prenatal care, low birth weight, and preterm birth. We compared adolescents (10-14 years, 15-16, and 17-19) to those 20-24 years. We included individual-, clinical-, and municipality-level variables, used multivariable logistic regression, and calculated adjusted predicted probabilities. We also tested whether receipt of prenatal care moderated the relationship of age with preterm birth and low birth weight. We included a total of 12 106 710 births to women 10-24 years. The adjusted predicted probability of adequate prenatal care increased with age: 56.07% (95% CI 55.82-56.31%) adjusted probability among adolescents 10-14 years compared with 65.51% (95% CI 65.48%-65.55%) among individuals 20-24 years. Receipt of adequate prenatal care in part mitigated disparities in preterm birth and low birthweight across all age groups: 7.30% (95% CI 7.17%-7.43%) adjusted probability of delivering a preterm infant among those 10-14 years who received adequate prenatal care compared with 9.37% (95% CI 9.20%-9.53%) among those 10-14 years without adequate prenatal care. In Mexico, adolescent pregnancies are associated with inadequate prenatal care as well as higher odds of preterm delivery and low birth weight. Youngest adolescents (10-14 years) have the highest probability of adverse outcomes. Adequate prenatal care may help partially mitigate disparities in poor perinatal outcomes.

Association of high pre-pregnancy body mass index with adverse maternal and perinatal outcomes.

Obesity is an epidemic of the 21st century with its rates doubling in both developed and developing countries. It raises concerns for both maternal and fetal well-being and needs altered care throughout pregnancy and in postnatal period. Raised BMI prior to conception is associated with adverse feto-maternal outcomes. Limited data is available about its association with adverse maternofetal outcome in this region of the world. Our objective was to find out association of high pre-pregnancy BMI with adverse maternal and perinatal outcomes. This cohort study of 390 patients was conducted in Gynae department of Lady Reading Hospital Peshawar. Study duration was from June 2021 to March 2022. Patients enrolled in third trimester of gestation (≥ 37 weeks) were divided into two groups based on BMI i.e., Group-A with BMI <25 and Group-B with BMI ≥ 25. Both groups were followed until their delivery and discharge. The mean age of 390 women was 28.2 ± 4.8 years. There was statistically significant association between raised pre pregnancy BMI and maternal risks like postpartum hemorrhage (p-0.0001), genital tract (p-0.0002) and perineal trauma (p-0.04). Neonatal risks significantly associated with high pre-pregnancy BMI were macrosomia (p-0.0001), and one minute APGAR score of < 8/10(p- 0.01). Both groups had no statistically significant difference for different modes of delivery i.e normal vaginal/ instrumental delivery and cesarean section (P-value 0.9). Maternal pre-conception BMI of ≥ 25 leads to poor maternal and perinatal outcomes.

To study women at risk of PIH (Primi &amp; Multi) by colour doppler velocimetry of uterine arteries

The aim of the study is to study women at risk of PIH (Primi &amp; Multi) by Colour Doppler velocimetry of uterine arteries. Pregnant women attending the antenatal clinics, screened for possible participation in the present study after explaining the nature of the study. A patient was diagnosed to have PIH if there was a rise in systolic pressure of at least 30 mmHg or a diastolic of at least 15 mmHg over the previously known blood pressure or an absolute rise in the blood pressure of at least 140/90 mmHg was taken to diagnose women as a case of PIH. Out of the 100 cases, maximum 35 cases (35%) were low risk primigravidae, followed by cases with history of PIH (15%), obesity (14%), Anemia (10%),Essential hypertension (7%), IUGR (7%),Which constitute 53%. Rest of the cases was family history of hypertension (6%), oligohydromnios (5%) and Twin (1%).Maximum cases i.e. 40% were illiterate, 28% cases were educated up to primary school and only 20% were educated up to middle school and above. Total 60% cases were literate. 77.2% babies were alive, Abortion were 5.3% and 16.76% cases were with poor perinatal outcome. Study shows that 22% cases showed abnormal waveform in colour Doppler, out of which 90.90% developed PIH, while 78% cases were with normal waveform out of which only 10.25% developed PIH later. For prediction of IUGR out of 22% of abnormal waveform 86.36 developed IUGR and out of 78% of normal waveform 20.51% developed IUGR. We conclude that a women with high risk factor (nulliparity and others) having abnormal uterine artery waveforms between 16-28 weeks of gestation (presence of diastolic notch with/without high resistance) are at higher risk of development of PIH (90.90%) and IUGR (95%). An important aspect is the high negative predictive value for PIH (89.74%) and IUGR (78.66%) which helps to detect those patient who will not develop PIH and IUGR early positive prediction enables, one to take preventive measures early thus improving both maternal and perinatal prognosis.

Perinatal outcome of women presenting with reduced fetal movements

Background and objectives: Reduced fetal movement is a reason for concern in both mothers and clinicians. The objective of this study was to assess the pregnancy characteristics and perinatal outcomes in women with decreased fetal movements. Methods: A case-control study was conducted on 489 pregnant women in Maternity Teaching Hospital, Erbil city from October 2021 to December 2022. They were assigned into two groups, cases consisting of 244 women with a perception of reduced fetal movements and a control group including 245 women with good fetal movements. perinatal outcome was compared between the two groups. Results: The majority (59.5%) of the study participants were term pregnancies (? 37weeks). Among women with RFM, 32.4% were nulliparous and 59% were multiparous comparing to control group (26.9% and 63.7%, respectively). A higher proportion of women with reduced fetal movements had gestational diabetes (34%), and preeclampsia (40.2%), compared to women of Group II with the rate of 15.5% and 21.2% respectively. The rate of cesarean section was significantly higher among cases than controls (45% vs. 24.9%, respectively). The rate of abnormal Doppler among Group I women was higher than in Group II women (26.2% versus 2.9%). Significantly higher rate of neonates in Group I had low APGAR score. Conclusions: Perception of reduced fetal movements is a reason for woman to contact their healthcare providers. The poor perinatal outcome is more evident in women with reduced fetal movements.

Preeclampsia and its determinants in Ethiopia: A systematic review and meta-analysis.

Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia. To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model. Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia. When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.

Pregnancy outcomes following antenatal screening for intrahepatic cholestasis of pregnancy (ICP)

ObjectiveTo evaluate the maternal and perinatal outcomes following antenatal screening for ICP using a retrospective approach. Materials and methodsA retrospective study was conducted at the second affiliated hospital of Chongqing Medical University, Chongqing, China, from 2012 to 2017. Pregnant women registered for antenatal in our hospital were screened for ICP. The pregnant women with detailed delivery record and presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. MethodThe pregnant women with detailed delivery records presenting with the diagnosis of ICP based on TBA level ≥10 mmol/L and abnormal liver enzymes were included in the study. 1410 pregnant women were enrolled in this study. We selected 940 pregnant women without the diagnosis of ICP as our control and 470 pregnant women diagnosed with ICP as our case study. Data collection and sampling in the control group was done using microsoft excel (version 16.61) random number generator. ResultsThe mean age of the pregnant women and the gestational age at the time of diagnosis of ICP were 29.01 ± 4.3 years and 31.90 ± 8.83 weeks, respectively. It was found that a significant number of patients with ICP had a preterm birth and low birth weight (LBW), n = 151 (32.5%) P < 0.001 and n = 70 (14.9%) P < 0.001, respectively. A significant number of patients in the case group had a history of liver disease and gall bladder disease, p < 0.001 and p = 0.005, respectively, and a higher rate of GDM p < 0.001. Despite treatment, high TBA titer among ICP patients was associated with preterm delivery. ConclusionICP in pregnancy leads to complications and poor perinatal outcomes. Fetal outcomes depend on the TBA levels; therefore, early diagnosis of ICP through routine screening followed by treatment is recommended in high-risk persons/areas.

Behavioural outcomes of children born with intrauterine growth restriction: protocol for a systematic review and meta-analysis

IntroductionIntrauterine growth restriction (IUGR) is a pregnancy condition, which is associated with poor perinatal outcomes and long-term neurodevelopmental impairment. Several studies also investigated the impact of IUGR on child behaviour...

Engaging Czech-Slovak Roma women in the co-creation of an antenatal care information resource

Abstract Background Czech-Slovak Roma women in the UK suffer barriers to antenatal care such as stigma contributing to reduced engagement with health services. There is a scarcity of research and intervention studies with this population. This study aims to co-create an antenatal care community information resource with a group of these women through participatory research. Women's stories of their pregnancy journeys would be able to provide an understanding of their maternity needs, to inform design considerations for a prototype of an antenatal care information resource. Objectives 1. To understand Roma women's needs in pregnancy, childbirth, and maternity services through storytelling 2. To share with women publicly available antenatal information resources such as pregnancy apps 3. To co-create a low-resolution paper prototype of an antenatal care information resource that meets their needs Research activities 1. Six two-hour workshops with 6-8 women supported by a peer researcher and an interpreter. 2. Two workshops focused on the co-creation of an antenatal information resource. 3. Design-based participatory methods and thematic analysis, culminating in a community event and webinar for public and professional stakeholders. Findings The women's pregnancy journeys covered several topics such as unplanned pregnancies, nausea and vomiting, pregnancy loss and birth trauma. Through all these, the main message they wished to convey was the need for women in the community to overcome the stigma of seeking help for their mental health. Our information resource developed using a co-creative participatory approach, signposts Roma women to reliable information and healthcare provision potentially reducing poor maternal and perinatal health outcomes. This study could be replicated in other marginalized newly arrived groups of migrant women to facilitate timely uptake of antenatal and mental health support services. Key messages • Czech-Slovak Roma women face stigma in seeking help for their mental health during pregnancy. • Roma women can be supported to overcome stigma through design-based participatory research.

Placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity and healthy pregnancies.

Malaria and preeclampsia are leading causes of maternal morbidity and mortality in sub-Saharan Africa. They contribute significantly to poor perinatal outcomes like low neonatal weight by causing considerable placental morphological changes that impair placental function. Previous studies have described the effects of either condition on the placental structure but the structure of the placenta in malaria-preeclampsia comorbidity is largely understudied despite its high burden. This study aimed to compare the placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity versus those with healthy pregnancies. We conducted a retrospective cohort study among 24 women with malaria-preeclampsia comorbidity and 24 women with healthy pregnancies at a County Hospital in Western Kenya. Neonatal weights, gross and histo-morphometric placental characteristics were compared among the two groups. There was a significant reduction in neonatal weights (P<0.001), placental weights (P = 0.028), cord length (P<0.001), and cord diameter (P<0.001) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. There was also a significant reduction in villous maturity (P = 0.016) and villous volume density (P = 0.012) with increased villous vascularity (P<0.007) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. Placental villous maturity and villous volume density are significantly reduced in patients with malaria-preeclampsia comorbidity with a compensatory increase in villous vascularity. This leads to impaired placental function that contributes to lower neonatal weights.

Role of Lactate Dehydrogenase and Lymphocyte Count as Predictors of Poor Perinatal Outcomes in COVID-19-Infected Pregnancies Requiring Hospitalization and Delivery: A Retrospective Cohort Study

Role of Lactate Dehydrogenase and Lymphocyte Count as Predictors of Poor Perinatal Outcomes in COVID-19-Infected Pregnancies Requiring Hospitalization and Delivery: A Retrospective Cohort Study

Umbilical Cord Diseases Affecting Obstetric and Perinatal Outcomes.

(1) The aim of this article is to describe the physiopathology underlying umbilical cord diseases and their relationship with obstetric and perinatal outcomes. (2) Methods: Multicenter case series of umbilical cord diseases with illustrations from contributing institutions are presented. (3) Results: Clinical presentations of prenatal ultrasound findings, clinical prenatal features and postnatal outcomes are described. (4) Conclusions: Analysis of our series presents and discusses how umbilical cord diseases are associated with a wide variety of obstetric complications leading to a higher risk of poor perinatal outcomes in pregnancies. Knowing the physiopathology, prenatal clinical presentations and outcomes related to umbilical diseases allow for better prenatal counseling and management to potentially avoid severe obstetric and perinatal complications.

Perinatal outcome of maternal deaths at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa, January 2014 - June 2019.

Maternal death is a tragic event. Of maternal deaths worldwide, 99% occur in low- and middle-income countries. Perinatal outcome is related to maternal wellbeing. Maternal death has a negative impact on fetal and neonatal outcome in the short and long term. To determine the perinatal outcomes of pregnancies that ended in a maternal death at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, South Africa, over a 5-year period, to describe the causes of maternal death, and to determine the stillbirth rate (SBR) and early neonatal death (ENND) rate in this population. This was a retrospective cross-sectional study of maternal deaths in women with a viable pregnancy from January 2014 to June 2019 at CHBAH. All maternal deaths with gestation >26 weeks or fetal weight >500 g were included in the study. Information on demographics, booking status, antenatal care, pregnancy outcome, and fetal and neonatal outcome was extracted from maternal and neonatal files. Of a total of 183 maternal deaths during the study period, 147 were included in the study. The institutional maternal mortality ratio was 135 deaths per 100 000 live births. Hypertension was the main direct cause of death (36.5%; n=27/74), followed by pregnancy related sepsis (27.4%; n=21/74) and obstetric haemorrhage (20.6%; n=15/74). Non-pregnancy-related infections, of which 91.4% were HIV and HIV-related complications, comprised 47.9% (n=35/73) of indirect causes of death, followed by medical and surgical disorders. Of a total of 151 babies, including two sets of twins and one set of triplets, 137 were delivered and 14 were undelivered at the time of maternal death. Ninety-one babies (61.9%) were born alive and 51 (34.6%) were stillbirths. Of the 91 liveborn infants, 6 (6.5%) had an ENND. Of the 51 stillbirths, 14 (27.5%) were undelivered and 11 (21.6%) were delivered by perimortem caesarean section. The SBR was 347 per 1 000 maternal deaths and the ENND rate 66 per 1 000 live births. The perinatal mortality rate (PMR) was 388 per 1 000 maternal deaths, which is 12 times higher than the PMR per 1 000 live births for the general population. Women who experience maternal death have babies with very poor perinatal outcomes, with a very high SBR, ENND rate and PMR. The health of the mother has a direct and significant effect on fetal and neonatal outcomes.

Exploring the impacts of a nuchal cord on perinatal outcomes in vaginal delivery

Objectives: To investigate the frequency of cord entanglement and neonatal outcomes in vaginal deliveries. Methods: A total of 24,623 patients who had vaginal delivery at at Kayseri City Hospital between July 2018 and January 2023 were included in the study. The incidence of nuchal cord was determined in the study group. The characteristics and perinatal outcomes of groups with and without nuchal cord were compared. Chi-square test was used for statistical evaluation. A p value less than 0.05 was considered significant in the evaluation. Results: The rate of cord entanglement in the neck at birth was 15.7%. There was no statistically significant difference between the infant weights, genders, maternal ages, hospitalization rates in the neonatal intensive care unit, and apgar scores at the 1st and 5th minutes of the babies included in the study. We detected amniotic fluid with meconium in 506 (13.1%) patients with a nuchal cord and 270 (1.3%) without a nuchal cord, and the difference was found to be significant. Conclusions: There is no significant relationship between vaginal deliveries with the nuchal cord and poor perinatal outcomes, except for meconium amniotic fluid. For this reason, pregnant women diagnosed with nuchal cord in the third trimester can deliver vaginally, but they should be carefully monitored in terms of meconium and related complications. However, neonates with nuchal cord do not have significantly longer neonatal hospital stays, and thus the adverse effects of nuchal cord may be transient.

Kesesuaian Peningkatan Berat Badan Selama Kehamilan Berhubungan dengan Luaran Kehamilan

Globally, 53% of pregnant women experience unsuitable weight gain with WHO recommendations. This condition is associated with poor perinatal outcomes. Study investigates pregnancy weight gain's impact on outcomes. This study design was observational with a retrospective cohort approach. The sample size was obtained based on the difference formula of two proportions, namely, 142 mothers giving birth. Consecutive sampling technique according to inclusion criteria (mothers giving birth, willing to be respondents, complete medical record status) and exclusion extraction, namely having a history of comorbidities and/or complications The form record is used to collect data. Data analysis with SPSS 25 used the exact Fisher, Mann-Whitney, and chi-square tests. The results showed that 74% of pregnant women experienced weight gain not according to recommendations with 86.5% experienced inadequate weight gain. Appropriateness of weight gain during pregnancy was related to birth weight (p=0.024), birth length (p=0.009), amniotic fluid condition (p=0.000), and Apgar score (p=0.002). Pregnancy outcomes in the form of type of delivery (p=0.426), gestational age (p=0.84), and length of gestation (p=0.0583) were not related. Examination of pre-pregnancy BMI and education about recommendations for weight gain during pregnancy have been important since the first ANC contact.

Umbilical Artery Thrombosis After Selective Termination in Dichorionic Diamniotic Twin Pregnancy: A Case Report.

Umbilical artery thrombosis is a rare complication associated with poor perinatal outcomes. The incidence of umbilical artery thrombosis in pregnancy is estimated from 0.0025% to 0.045%. Prenatal screening and diagnosis of umbilical artery thrombosis is usually performed by ultrasonography. Up to now, no treatment consensus has been achieved. We present a case of dichorionic diamniotic twin pregnancy complicated with selective termination of one twin with lymphoid cystic tumor at 14 weeks and 2 days of gestation and the alive twin occurred single umbilical artery thrombosis at 35 weeks and 6 days of gestation. The emergency cesarean section was performed after emergency admission. A healthy male baby was delivered weighing 2690g with Apgar scores of 10 and 10 at 1 and 5 minutes, respectively, whereas the dead fetus weighed 10 g. Thrombosis was observed throughout one of the umbilical artery of the alive fetus. The woman and the infant are followed up closely and both in good condition. The number and morphology of umbilical arteries should be carefully observed during pregnancy. Individualized management of umbilical artery thrombosis should be based on clinical conditions. Timely termination of pregnancy if necessary could be suitable to improve adverse pregnancy outcomes.

A Prospective Study of Social Needs Associated with Mental Health among Postpartum Patients Living in Underserved Communities.

Given the rising rates of maternal morbidity and mortality in the United States and the contribution of mental illness, especially among individuals living in underresourced communities, the objective was to evaluate the prevalence of unmet health-related social needs and their impact on perinatal mental health outcomes. This was a prospective observational study of postpartum patients residing within regions with increased rates of poor perinatal outcomes and sociodemographic disparities. Patients were enrolled in a multidisciplinary public health initiative "extending Maternal Care After Pregnancy (eMCAP)" between October 1, 2020 and October 31, 2021. Unmet health-related social needs were assessed at delivery. Symptoms of postpartum depression and anxiety were evaluated at 1 month postpartum utilizing the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder-7 (GAD7) screening tools, respectively. Mean EPDS and GAD7 scores and odds of screening positive (scoring ≥ 10) were compared among individuals with and without unmet health-related social needs with p < 0.05 considered significant. Of participants enrolled in eMCAP, 603 completed at least one EPDS or GAD7 at 1 month. Most had at least one social need, most commonly dependence on social programs for food (n = 413/603; 68%). Individuals lacking transportation to medical (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.2-13.32) and nonmedical appointments (OR: 4.17, 95% CI: 1.08-16.03) had significantly higher odds of screening positive on EPDS while participants lacking transportation to medical appointments (OR: 2.73, 95% CI: 0.97-7.70) had significantly higher odds of screening positive on GAD7. Among postpartum individuals in underserved communities, social needs correlate with higher depression and anxiety screening scores. This highlights the need to address social needs to improve maternal mental health. · Social needs are prevalent among underserved patients.. · Needs can be assessed in a structured or freeform manner.. · Unmet needs correlate with poor mental health outcomes.. · Similar needs correlate with depression and anxiety..

Prevalence of meconium-stained amniotic fluid in SARS COVID-19 positive pregnant mothers and its manifestations in newborns

Background: This study is being conducted to find out whether coronavirus disease 2019 (COVID-19) is associated with an increased incidence of MSAF in COVID-positive pregnant women. Finding implications for operative delivery and perinatal outcome. The evidence will help in managing COVID-positive women in pregnancy. Methods: This prospective observational study was conducted from July 1, 2020 to October 20, 2020 at Rajarajeswari Medical College and Hospital, Bangalore. A total 38 newborns born to SARS-COVID-19 infected mothers were included. Data collected from pregnant women, patient records, birth registries, operating room/delivery room records and NICU registries. Results: The clinical characteristics of 38 mothers and their newborns were analyzed. The mode of delivery was normal vaginal delivery (NVD) in most (N=21) cases. All newborns tested negative for SARS-CoV-2. 18 babies required only routine newborn care, and 20 babies required neonatal intensive care unit (NICU) admission at birth for management of meconium-stained amniotic fluid (MSAF)(11pregnancies), prematurity (3 cases), dyspnea (6 cases), stage 2/3 hypoxic ischemic encephalopathy (HIE) (2 cases), and Jaundice (9 cases). 18 of 38 stable babies held mother's side and breastfeeding started, with no signs and symptoms attributed to SARS-CoV-2. Conclusions: In our study, the prevalence of MSAF is higher (28%) in COVID-19 Positive mothers, resulting in low APGAR scores and poor perinatal outcomes. Vigilant intrapartum care is recommended to reduce the risk of poor neonatal outcomes. No newborns developed signs and symptoms of SARS-CoV-2 infection during rooming-in, breastfeeding and during admissions at neonatal intensive care unit (NICU).