Post-term Research Articles

Study Effect of Esomeprazole on the Treatment of Preeclampsia in Pregnant Women: A Double-Blind Clinical Trial Study

Background: Preeclampsia is one of the most serious complications of pregnancy, leading to various maternal and fetal complications. Objectives: This study aimed to determine the effect of oral esomeprazole in the treatment of preeclampsia in pregnant mothers. Methods: In this double-blind clinical trial, we compared oral esomeprazole with a placebo. The study population included 120 pregnant women with preeclampsia (60 in the esomeprazole 40 mg group and 60 in the placebo group) who were referred to Ba'ath Hospital in Sanandaj in 2023. Patient care and follow-up were conducted from the time of diagnosis of preeclampsia and inclusion in the study groups until delivery and the final condition of the baby. The outcomes investigated included prolongation of pregnancy and maternal, fetal, and neonatal outcomes. Results: The average delivery time in the esomeprazole group was 37.3 ± 1.2 weeks, compared to 37.5 ± 1.7 weeks in the placebo group, with no statistically significant difference (P = 0.75). The frequency of maternal outcomes, such as eclampsia, pulmonary edema, hemolysis, placental abruption, renal failure, hepatic hematoma, ascites, thromboembolism, and maternal death, was not statistically different between the esomeprazole and placebo groups, and no severe complications were observed in either group. Similarly, fetal outcomes, including intrauterine growth restriction (IUGR) and changes in fetal heart rate patterns, did not significantly differ between groups, with no instances of fetal or neonatal death observed. Additionally, neonatal outcomes, such as Apgar scores below 7, NICU admissions, mechanical ventilation, and other severe neonatal complications, were not significantly different between the two groups (P > 0.05). Although the esomeprazole group showed a lower frequency of adverse maternal, fetal, and neonatal outcomes compared to the placebo group, these differences were not statistically significant. Conclusions: The frequency of adverse maternal, fetal, and neonatal outcomes was lower in the esomeprazole group than in the placebo group for most variables, but the differences were not statistically significant. Therefore, it cannot be concluded with certainty that esomeprazole is ineffective in preventing or controlling preeclampsia.

Factors Associated with Cesarean Section in Primiparous Women at the Bernard Kouchner Communal Medical Centre in Coronthie, Conakry, Guinea

<i>Objective</i>: to analyse the factors associated with Caesarean section in primiparous women. <i>Methods</i>: This was a 12-month (1 January to 31 December 2022) retrospective case-control study conducted at the Bernard Kouchner Communal Medical Centre (CMC) in Coronthie. Correctly completed records of primiparous women with a singleton pregnancy were included, with a live foetus in cephalic presentation having been delivered (by Caesarean section or vaginal delivery) from 28 weeks' gestation with a weight ≥ 1000 g. The "cases" consisted of records from primiparous women who had undergone caesarean section. The "controls" were composed by matching each "case" with the record of a patient who had undergone vaginal delivery, according to the order in the delivery register. Socio-demographic, clinical and obstetric characteristics were analysed and compared. A univariate analysis comparing cases to controls and a multivariate analysis looking for an association between maternal determinants were performed. <i>Results</i>: The prevalence of caesarean section in primiparous women was 31%. The average age of primiparous women was 24 ± 5 years. The 20-24 age group was the most represented in both groups, with 35% of caesareans and 42% of vaginal deliveries. The factors significantly associated with caesarean section in primiparous women were advanced maternal age (OR=1.13 CI=1.07-1.20), prolonged pregnancy (OR=25.1 CI =3.23 - 5.40), arterial hypertension (OR=4.98 CI= 2.24 -11.6), premature rupture of membranes (OR= 4.25 CI: 2.27 - 8.05), haemorrhagic complications (OR=8.56 CI=3.05 - 26.6), foetal distress (OR=68.4 CI=18.3 - 45.1) and macrosomia (OR=12.7 CI= 4.83 - 38.6). <i>Conclusion</i>: correct antenatal care and delivery by qualified personnel could help prevent some of these factors and thus reduce the caesarean section rate among primiparous women in our health facility.

Trends in gestational age at live birth in Scotland from 2005 to 2019: a population-based study

Background Gestation at birth is associated with short and long-term outcomes. This study used high quality, national, administrative data to examine trends in gestation at birth in Scotland. Methods This observational study used maternity hospital discharge records for 2005 to 2019 to determine trends in the percentage of live births that were preterm (<37 weeks gestation), term (37–41 weeks), and post-term (≥42 weeks), overall and by maternal age and deprivation category. Preterm births were further examined by category of preterm birth (moderate to late [32–36 weeks]; very [28–31 weeks]; extremely [<28 weeks] preterm), and onset of labour (spontaneous; provider-initiated). Singleton and multiple births were examined separately. Aggregate logistic regression was used to estimate the annual change in the odds of a birth being in a specified gestational category. Results The percentage of singleton births in Scotland that were preterm decreased from 2005 (6.5%, 3,361/51,665) to 2010 (5.8%, 3268/56344), then increased to 2019 (7.2%, 3,408/47,507). The percentage of singleton births that were spontaneous moderate to late, very, and extremely preterm all increased between 2010 and 2019. The percentage of singleton births that were provider-initiated moderate to late preterm also increased between 2010 and 2019, however provider-initiated very or extremely preterm birth decreased. The percentage of singleton births that were preterm increased over time across all maternal age and deprivation categories, with increases greatest in groups at highest baseline risk. The percentage of singleton births that were post-term increased from 2005 to 2009, then decreased to 2019. Conclusions There has been an increase in spontaneous preterm birth from 2010 to 2019, which is not fully explained by changes in maternal age or deprivation. Further research to examine the contribution of other, preventable, risk factors is warranted. Trends in provider-initiated preterm birth, and post-term birth, are likely to reflect changing clinical practice.

Current possibilities and prospects of tocolytic therapy

The urgency of the problem of preterm birth (PB) is because of its high prevalence and neonatal mortality. The effects of PB on the fetus are often fatal, and PB accounts for 70% of neonatal mortality and 36% of infant mortality. Severe neurological deficits (e.g., cerebral palsy, epilepsy, intraventricular hemorrhages, retinopathy, blindness, hearing loss, delayed neuropsychiatric and motor development) occur in 68% of surviving premature infants. Additionally, children born prematurely have a high risk for purulent septic diseases. The metabolic consequences of prematurity cause diseases such as metabolic syndrome and hypertension. Thus, tocolytic therapy is a crucial therapeutic measure in obstetrics. However, most known and actively used tocolytic drugs induce insufficient effect for long-term prolongation of pregnancy or have serious side effects. Currently, there is a search for new tocolytics to obtain safe, adequate, and long-term effects. This review examines promising and relevant drugs that may be used in routine obstetric practice. Scientific articles, meta-analyses, and systematic reviews from the databases PubMed, Embase, Web of Science, and Google Scholar, and RSCI were analyzed. For the analysis, publications in English and posted no more than 5 years before the study was conducted were selected, except for fundamental works with a longer publication period.

Ultrasound assessment of embryo cardiac function as a predictive criterion of adverse pregnancy outcome

Purpose to evaluate the value of the embryo/fetus heart rate (HR) in early pregnancy assessed by ultrasound for the formation of a group at high risk of adverse pregnancy outcomes.Materials and methods. A retrospective analysis of ultrasound examinations of 1073 pregnant women at 5+0–10+6 weeks was carried out. The embryo/fetus heart rate was compared with the gestational age calculated by the crown rump length (CRL) and the date of the last menstruation period (LMP). Retrospectively, all examined pregnant women were divided into two groups: group 1—with intrauterine embryo death before 14 weeks of pregnancy (n = 107); group 2—with prolongation of pregnancy until the second trimester (n = 966). When analyzing the data array using a decision tree, the embryo heart rate was assessed at various stages of pregnancy by LMP, CRL, and regardless of the exact period of pregnancy.Results. Analysis of heart rate values at different stages of pregnancy by LMP showed significant differences in heart rate between groups, the cases of later embryo loss characterized by lover heart rate values. There were no significant differences in heart rate between the groups at different stages of pregnancy by CRL (significant differences were obtained only at 8+0–9+6 weeks). Cut-off values of embryo heart rate for prediction of adverse pregnancy outcomes have been proposed for different stages of pregnancy, as well as a universal cut-off for the entire embryonic period.Conclusion. The proposed cut-off values of embryo heart rate for different stages of pregnancy, calculated by LMP, may be used for timely prediction of adverse pregnancy outcomes. When the exact gestational age is unknown, a universal heart rate cut-off value of <116 bpm may be used. All proposed HR cut-off values were characterized by high specificity, but none of them by high sensitivity. A sensitivity of HR cut-off values can be increased by the use in combination with other ultrasound and clinical signs of adverse pregnancy outcome.

Effect of continuity of team midwifery care on maternal and neonatal outcomes: a quasi-experimental study in Iran

Midwife-led continuity of care models have been linked to better clinical outcomes in certain developed countries. However, there is a paucity of research on these models in developing nations. This quasi-experimental study was conducted on primiparous women who referred to one private midwifery center and two public hospitals in Ahvaz, Iran to evaluate the effect of team midwifery care on maternal and neonatal outcomes of pregnant women in Iran. Two hundred women were allocated either into the experimental (n = 100) or control (n = 100) groups. Women in the experimental group, received team midwifery care, while women in the control group, received routine care. Data were collected using a demographic questionnaire, Mackey questionnaire, and a checklist. Women in the team midwifery care group experienced significantly higher rates of normal vaginal birth and exclusive breastfeeding compared to women in the control group. No statistically significant difference was observed between the two groups in terms of the rate of induction of labor and postpartum hemorrhage. The duration of labor was longer in the team midwifery care compared to the control group. Women in the team midwifery care group had a significantly higher rate of exclusive breastfeeding at six weeks postpartum compared to the control group (80 vs. 61%, p = 0.001). After excluding women with ruptured membranes and prolonged pregnancies, neonates in the intervention group had significantly higher first- and fifth-minute Apgar scores (p < 0.0001), and a lower rate of admission to intensive care unit in the intervention group compared to the control group (1 vs. 9%, p = 0.04). Also, women in the team midwifery group had skin-to-skin contact significantly earlier than those in the control group (33.87 ± 66.26 min vs. 111.98 ± 247.31 min, p = 0.578). Given the positive impact of continuous team midwifery care on maternal and neonatal outcomes, its implementation in maternity care systems, particularly in countries like Iran with high cesarean section rates, is strongly recommended.

Rumor Detection With Hierarchical Representation on Bipartite Ad Hoc Event Trees.

The rapid growth of social media has caused tremendous effects on information propagation, raising extreme challenges in detecting rumors. Existing rumor detection methods typically exploit the reposting propagation of a rumor candidate for detection by regarding all reposts to a rumor candidate as a temporal sequence and learning semantics representations of the repost sequence. However, extracting informative support from the topological structure of propagation and the influence of reposting authors for debunking rumors is crucial, which generally has not been well addressed by existing methods. In this article, we organize a claim post in circulation as an ad hoc event tree, extract event elements, and convert it into bipartite ad hoc event trees in terms of both posts and authors, i.e., author tree and post tree. Accordingly, we propose a novel rumor detection model with hierarchical representation on the bipartite ad hoc event trees called BAET. Specifically, we introduce word embedding and feature encoder for the author and post tree, respectively, and design a root-aware attention module to perform node representation. Then we adopt the tree-like RNN model to capture the structural correlations and propose a tree-aware attention module to learn tree representation for the author tree and post tree, respectively. Extensive experimental results on two public Twitter datasets demonstrate the effectiveness of BAET in exploring and exploiting the rumor propagation structure and the superior detection performance of BAET over state-of-the-art baseline methods.

A STUDY ON MATERNAL AND FETAL OUTCOME IN OLIGOHYDRAMNIOS

Background: Amniotic fluid provides a protected milieu for growing fetus, cushioning the fetus against mechanical and biological injury. It also supplies nutrients and facilitates growth and movement.Oligohydramnios is defined as Amniotic fluid index (AFI) less than 5 cm, or deep vertical pocket &lt; 21. It occurs in 1–5% pregnancies at term, with the incidence increasing in postdate pregnancies to 11%.2 Maternal conditions associated with decreased AFV ( amniotic fluid volume)include post-dated pregnancy, preterm premature rupture of membranes (PPROM), hypertension, autoimmune disorders and maternal medication like prostaglandin synthetase inhibitors. Fetal factors: Which influence AFV are essentially related to fetal growth (intrauterine growth restriction) and fetal anomalies, particularly of the renal tract. The most commonly associated renal anomalies with oligohydramnios include bilateral renal agenesis, multicystic dysplastic kidneys, bladder outlet obstruction and infantile polycystic kidney disease.The aim of this study is to evaluate the etiological risk factors of oligohydramnios and to know the clinical significance and mode of delivery and maternal and perinatal outcome. Methods: This was a retrospective study conducted on 100 cases in Basaveshwar Medical and Teaching Hospital attached to MahadevappaRampure Medical college, Kalaburagi from 1-8-2023 to 1-6-2024.All cases coming to Basaveshwar medical and teaching hospital with oligohydramnios were included in the study after fulfilling inclusion and exclusion criteria Results: Of the 100 cases in the present study,40 cases were in 25-30 years accounting for 40% of cases with maximum number of cases in this age group.56 cases were primigravida accounting for 56% of cases with majority of cases being primigravida and 44 cases were multigravida accounting for 44% of cases.The number of cases with preterm rupture of membranes were 21 ( 21%), cases with Intra uterine growth restriction were 15 (15%). 6 cases (6%) had congenital anamolies. The number of cases withpost dated pregnancy were 22 (22%), Pregnancy induced hypertension cases were 28 (28%). Cases with autoimmune diseases were 1 (1%) and 7 cases (7%) were idiopathic.The most important cause for oligohydramnios was pregnancy induced hypertension and post-dated pregnancy. 13 of the cases had spontaneous onset of labouri.e 13% cases, 28 cases (28%) were induced and 59 cases underwent cesarean section accounting for 59% of all cases.In the present study, total of 19 cases underwent cesarean section because of fetal distress accounting for 19% of cases with the most common indication for cesarean section.11 cases (11%) underwent LSCS due to IUGR, ,4 cases (4%) underwent cesarean section because of non-progression of labour, 2 cases(2%) underwent LSCS because of malpresentation/malposition, 9 cases (9%) had cephalopelvic disproportion, 2 cases (2%) refused for induction of labour and 12 cases (12%) were previous LSCS.Among the 100 cases studied ,there were 8 cases (8%) with meconium aspiration syndrome, 5 cases (5%) had respiratory distress, 6 cases (6%) had low birth weight, 6 cases (6%) with congenital anomalies, 21 cases (21%)had NICU admissions, 4 cases (4%) were still born and 2 cases(2%) had intrauterine fetal death Conclusion: Oligohydramnios is associated with fetal distress, meconium aspiration syndrome ,respiratory distress syndrome ,increased NICU admissions, low birth weight, perinatal mortality, morbidity and increased maternal morbidity due to increased cesarean section rates.Oligohydramnios requires intense fetal monitoring with proper antenatal and intrapartum care.Hence, AFI can be used as a primary tool in fetal surveillance in antenatal and intrapartum period and can help in categorization of fetus into high risk and low risk .One can have favourable outcome with good antenatal and intrapartum care

Factors Associated With Meconium-Stained Amniotic Fluid Among Postdated Women In Kirkuk Province, Iraq

Background: Meconium-stained amniotic fluid (MSAF), also known as green-stained amniotic fluid, has long been associated with the risk of miscarriage. MSAF is becoming more prevalent as a woman gets older and reaches a peak of 15% around delivery time. Studies indicated that MSAF affects 7–9% of all term births. Objectives: The main aim of this study is to identify whether the prolongation of pregnancy beyond the expected date of delivery has negative effects on the health of both mothers and the neonate. To identify the risk factors related to meconium-stained amniotic fluid among postdated deliveries. Additionally, to identify the risk factors related to MSAF among postdated deliveries. Methodology: The study was carried out over six months in the hospitals in the Kirkuk province region of Iraq. The constructed questionnaire (Using the interviewing technique) was used for data collection. Statistical significance was defined as a P value of less than or equal to 0.05. Results: The study results reveal that the mean age is 28.36 ± 6.52. Concerning residence, most reported that they have been living in urban areas. Regarding the client's educational qualifications, more than half read and write. The gestational age for less than half is 37-40 weeks. Regarding the occurrence of MSAF, the study found a significant association between gestational age, educational qualifications of the mothers, and their residency. Conclusion: MSAF is among the risk factors that jeopardize the life of the mother and the baby during pregnancy and after delivery. The study revealed significant findings among some demographic data such as the mother's gestational age and the area of residency along with the women's educational qualifications with MSAF. The study recommended that extra attention and care be provided to the rural areas which have a crucial role in the prevention of such problems.

Maternal and fetal outcome of postdated pregnancy; A cross sectional study

Background: Postdated pregnancy refers to a pregnancy that extends beyond the expected date of delivery, which is 280 days. When a pregnancy surpasses 42 weeks (more than 294 days), it is termed as post-term pregnancy. Postdated pregnancy is one of the most common obstetric problems associated with increased maternal and foetal morbidity, and mortality. Gestational age is among the most important determinants of perinatal outcomes, but studies have focused more on preterm births (&lt;37 completed gestational weeks) and less on the understanding and prevention of post term births. Objectives: To assess the maternal and fetal outcome of postdated pregnancy. Material and Methods: Present observational descriptive cross sectional study was conducted for the period of 1 year from 1st April 2023 to 31st March 2024. Total 150 postdated pregnant women included in present study as per predefined after satisfying the inclusion and exclusion criteria. Results: During study period out of total deliveries 110 were postdated deliveries. Out of them 46.36% and 28.18% were of 21-25 years and 26-30 years of age respectively. The mean age of all participants was 25.51 ± 4.58 years. A statistically significant association was found between the gestational age of postdated women and their mode of delivery. Out of 110 postdated women, 68.18% and 31.81% had vaginal and caesarean deliveries, respectively. Conclusion: Adverse maternal and fetal outcomes of post-dated pregnancy should be anticipated and counseling of women at risk of post-term pregnancy and timely management for its prevention is recommended

Local inflammatory factors in pregnant women with various methods of cervical insufficiency treatment

the reasons for the formation of cervical insufficiency are considred to be different from violation of the ratio of connective tissue elements due to its genetic characteristics to hormonal imbalance, and the predominance of pro-inflammatory factors of the immune system. A special attention is devoted to clinical situations, when cervical insufficiency was diagnosed in terms 22-24 weeks, the treatment means an alternative between emergency cerclage and obstetric pessary. The gaol of study – to compare dynamic of vaginal microbiota and local cervical immune factors by use of different cervical insufficiency treatment methods. Materials and methods. 81 pregnant with cervical insufficiency, diagnosed in term 22-24 weeks were observed, 47 pregnant treated by cerclage procedure (group A), and 34 were fitted with an obstetric pessary (group B). 30 healthy pregnant women in the period of 22 weeks formed group C. In all patients before treatment and every two weeks after it microscopy of vaginal discharges according to Hay/Ison criteria and evaluation of cervical cytokines were performed. Results. The balance by obstetric pessary use of type I and type III by Hay-Ison criteria being similar before treatment with pregnancy prolongation is changing dramatically to the prevalence of bacterial vaginosis be use of obstetric pessary – from 30,3% and 21,2% in 2 weeks to 25,0% and 41,7% in 6 weeks, by cerclage – from 43,5% and 14,9% in 2 weeks to 30,3% and 17,5% in 6 weeks. Patients with cervical insufficiency have increased concentration of IL-6 and IL-10, but by use of obstetrical pessary additionally growth of IL-8 from 42,3 pg/ml in 2 weeks to 187,6 pg/ml in 6 weeks is registered as well as decreasing of SLPI from 1,5 μg/ml to 0,6 μg/ml. Both changes show progression of inflammation and are associated with worth pregnancy outcomes. In the same time, cerclage is assocated with growth of SLPI from 1,9 μg/ml to 4,3 μμg/ml, what is a marker of adequate immune reaction by pregnancy. There is a difference between the groups of cerclage and obstetric pessary in dynamic of microbiota changes - a tendency to increasing of laboratory criteria of bacterial vaginosis frequency in group of obstetric pessary in 2 weeks becomes significant in 4 and more in 6 weeks comparing with group of cerclage. Proper to cervical insufficiency high concentration of proinflammatory IL-6 and IL-10 by use of obstetrical pessary is complicated by increasing of IL-8 and decreasing of SLPI, what means an activation of cervical inflammation, by cerclage – a increasing of SLPI is observed, what is favourable for pregnancy.

Factors Associated with Post-term Birth and its Relationship to Neonatal Mortality in Japan: An Analysis of National Data From 2017 to 2022.

Prior research has not yet examined the relationship between post-term birth and neonatal mortality in Japan, along with factors associated with post-term birth. We investigated these associations utilizing nationwide birth data from Japan. Birth and mortality data were obtained from the Vital Statistics of Japan for the years 2017 to 2022. The post-term birth rate was calculated by birth characteristics, and the neonatal mortality rates for post-term and term births were computed. Additionally, log-binomial regression analysis was employed to explore the associations between post-term birth and neonatal mortality, as well as between various characteristics and post-term birth. The characteristics considered included infant sex, maternal age group, parity, maternal nationality, maternal marital status, and household occupation. This study analyzed data from 4,698,905 singleton infants born at 37 weeks of gestational age or later. Regression analysis revealed that post-term birth was positively associated with neonatal mortality. The adjusted risk ratio for neonatal mortality in post-term compared to term births was 8.07 (95% confidence interval, 5.06 to 12.86). Factors positively associated with post-term birth included female infant sex, older maternal age, primiparity, non-Japanese maternal nationality, unmarried status, and various household occupations, including farmer, full-time worker at a smaller company, other type of worker, and unemployed. Younger maternal age was inversely associated with post-term birth. In Japan, post-term birth represents a risk factor for neonatal mortality. Additionally, sociodemographic characteristics, such as maternal marital status, nationality, and parity were found to be predictors of post-term birth.

The prevalence of pulmonary artery hypertension in neonates with meconium aspiration syndrome: a prospective study

Background: Meconium aspiration syndrome (MAS) is one of the most common causes of respiratory distress in the term and post term newborns. Meconium staining of amniotic fluid occurs in 10-15% of all deliveries, amongst which 5% of babies develop MAS. Pulmonary artery hypertension (PAH) and pneumothorax are severe complications of MAS and these contribute significantly to mortality and morbidity in the affected babies. The objective was to study the prevalence, risk factors and outcome of PAH in neonates with meconium aspiration syndrome. Methods: This prospective observational study included 250 newborns with MAS who were screened for the development of PAH by echocardiography during hospital stay. The prevalence, risk factors and outcome of PAH were determined. Results: The prevalence of PAH and PPHN among meconium aspiration syndrome was 45% and 29% respectively. Low Apgar score at birth and presence of thick meconium were identified as the risk factors for progression to PAH. The outcome of newborns with PPHN was poor. Conclusion: There is a high prevalence of PAH in babies born with MAS and those progressing to PPHN have a poorer outcome.

Association between postterm birth and adverse growth outcomes in children aged 3-6 years: A national retrospective cohort study.

Gestational age significantly influences children's growth and development. Yet, the effect of postterm birth (gestation beyond 42 weeks) on children's growth outcomes remains underexplored. This study aimed to assess the impact of postterm birth on adverse growth outcomes in children using a nationally representative sample from China. A retrospective cohort study was conducted in China from 1 April 2018, to 31 December 2019. The final analysis included 141,002 children aged 3-6 years from 551 cities. Postterm birth was defined as children with postterm birth at a gestational age of 42 weeks or more. Obesity, overweight and thinness were assessed using body mass index-for-age (BMI-for-age) z-scores, based on the World Health Organization (WHO) Child Growth Standards. Generalised additive models were employed to investigate the non-linear relationship between maternal gestational age and BMI-for-age z scores. Poisson regression models and subgroup analyses with forest plots were performed to examine the associations between postterm birth and the risks of obesity, overweight and thinness in children. We included 141,002 mother-child pairs, of whom 7314 (5.2%) children were classified as postterm births. There exists a non-linear relationship between gestational age and BMI-for-age z scores. Children born postterm exhibited a 46% increased risk of obesity, a 27% increased risk of combined overweight/obesity and a 13% increased risk of thinness. Similar associations were observed in most cases when further sensitivity and subgroup analysis were conducted. Postterm birth was associated with elevated risks of obesity, overweight and thinness in children aged 3-6 years, independent of sex. These findings underscore the importance of further research across diverse populations to understand the implications of postterm births on child health outcomes.

Cesarian section and long-term outcomes for cownose rays (Rhinoptera bonasus).

Cownose rays (Rhinoptera bonasus) are schooling rays commonly displayed in large groups in public aquariums. They are long-lived, have an annual reproductive cycle, and readily breed in managed care with most pregnancies culminating with the unaided and successful birth of a single neonate. Occasionally, females are observed to have prolonged pregnancies or suffer dystocia during parturition and intervention via a cesarian section (C-section) is required to deliver the neonate. Monthly reproductive monitoring at Ripley's Aquarium of the Smokies using ultrasound to stage pregnancies allows for the prediction of anticipated due dates and guides the decision to assist with delivery. Recognizing when to assist birth and best practices for performing C-section are important for the reproductive health, sustainability, and longevity of this species in managed care. This report describes a surgical technique for C-section in cownose rays and includes short-term complications and long-term outcomes for females.

Hormonal profiles and biomarkers leading to parturition in cattle.

This study aimed to understand the physiological mechanisms regulating parturition and to identify potential biomarkers to predict onset of birth. Additionally, we compared hormone profiles between cows with shorter and longer gestation lengths. Twenty-eight days before due date until 3d postpartum, cows (n = 18) were blood sampled daily. Circulating concentrations were measured for progesterone (P4) and estradiol (E2) by RIA, testosterone, prostaglandin F2α metabolite (PGFM), cortisol, pregnancy-specific protein B (PSPB) by ELISA and lactate concentrations by colorimetric assay. At end of gestation, P4 decreased from d-14 to d-4 (from 3.6 to 1.4ng/mL), most likely from rapid loss of placental P4 production (64% of decline in 24h). A second rapid decrease in P4 to undetectable concentrations was observed from d-2 to parturition (from 1.4 to 0.1ng/ml; most likely luteal origin) corresponding to increase in PGFM from d-2 to parturition (249.7 to 2868.4pg/mL). Estradiol and PSPB increased ~8-fold from ~13d before parturition with acute rise in E2 but not PSPB (45% vs 13% in first 24h). Testosterone decreased slightly during the same period. Cortisol and lactate increased only at calving. Comparison of cows with shorter vs longer gestation, when data were normalized to parturition day, a difference was detected in circulating E2 and PGFM patterns, but not P4 and PSPB. Thus, the first significant hormonal changes associated with parturition begin at d-14 with E2 and PSPB as two clear biomarkers of impending parturition. Cows with shorter and longer gestation had hormonal differences indicative of identifiable earlier placental maturation.

The Effectiveness of Birthing Ball Gymnastics on Primigravida Maternity Gestational Age

One of the riskiest pregnancy conditions is post-term pregnancy, which is defined as a gestational age greater than the estimated day of delivery (HPL). This is because difficulties may arise for both the mother and the fetus, particularly when birthing is imminent. Birthing ball gymnastics is one complementary therapy that can help labor commence at full gestational age (term). The aim of the research was to evaluate the impact of birthing ball gymnastics on the gestational age of moms who were primigravidae. The study's quasi-experimental design, which included a treatment group and a control group, was randomized post-test only. The Midwife Independent Practice Place (TPMB) Sidoarjo served as the research site for five months, starting in February 2023 and ending in June 2023. Purposive sampling procedures were used in the study to collect samples from participants who satisfied the inclusion criteria. This resulted in the collection of 30 samples, 15 of which were treatment groups and 15 of which were control groups. Birthing ball exercises and birthing ball gymnastics are provided twice a week for 20 minutes to the treatment group starting at 32 weeks gestation. The control group, on the other hand, had no birthing ball gymnastics instruction and was assessed right away. Utilizing the chi square statistical test to analyze the data, the study's results (p value (0.000) &lt; 0.05) indicated that birthing ball gymnastics was effective in reducing primigravida maternity mothers' gestational age at the Midwife Independent Practice Place (TPMB) in Sidoarjo. In order to prevent the delivery process with post-term gestational age, it is envisaged that the installation of birthing ball gymnastics can be carried out in healthcare facilities such as hospitals, clinics, or Midwife Independent Practice Places (TPMD) for primigravida pregnant women.

Foeto–Maternal outcomes of pregnancies beyond 41 weeks of gestation after induced or spontaneous labour

ObjectiveIt has been suggested that induction of labour before 42 weeks of pregnancy prevents foetal complications. To evaluate the maternal and foetal outcomes of induced and spontaneous labour beyond gestational week 41 + 0. Study designWe conducted a register-based nationwide cohort study that included pregnant women who were delivered in Sweden in 2016–2021. Women were classified into two groups: induction of labour (IOL) or spontaneous onset of labour (SOL). Maternal and foetal outcomes after IOL in gestational week 41 were compared with SOL in gestational week 41 and 42. ResultsComparison between the IOL (n = 23,772) and SOL (n = 62,611) groups in gestational weeks 41 showed that various parameters were higher in the IOL group: caesarean deliveries (12.3 % and 4.6 %, P < 0.001), vacuum extraction (8.7 % and 6.9 %, P < 0.001), blood loss of > 1000 ml during labour (11 % vs 8.3 %, P < 0.001). The risks were remained significant even after adjusting for potential confounders (caesarean delivery: aOR 2.36; 95 % CI, 2.23–2.50, vacuum delivery: aOR 1.09; 95 % CI, 1.03–1.16, P = 0.002, and blood loss of >1000 ml: aOR 1.25; 95 % CI 1.18–1.31). The proportions of stillbirths (0.07 % and 0.18, P < 0.001), and newborns with apgar scores < 4 at five minutes (0.4 % vs 0.3 %, P < 0.001), were also higher in the IOL group. The risk of stillbirth after IOL in gestational week 41 was increased relative to SOL in the same week and remained high after adjusting for potential confounders (aOR 1.75; 95 % CI 1.07–2.80, P = 0.025).The IOL group in gestational weeks 41 comprised a higher proportion of caesarean deliveries (12.3 % and 8.5 %, P < 0.001), but a lower (8.7 % and 9.7 %, P = 0.006) proportion of deliveries by vacuum extraction than the SOL group (n = 4548) in week 42. ConclusionsInducing labour at gestational week 41 in women with prolonged pregnancies may have adverse effects on foetal and maternal outcomes compared to those who experience spontaneous labour onset at the same gestational age. The risk of negative foetal outcomes after induction at week 41 appears similar to that in women who give birth after spontaneous labour at week 42.

Altered Placental Morphology Associated with Stillbirth in A Mouse Model of Prolonged Pregnancy

Altered Placental Morphology Associated with Stillbirth in A Mouse Model of Prolonged Pregnancy

Proportion and Associated Factors of Adverse Birth Outcomes Among Women Who Gave Birth at Debre Markos General Hospital, East Gojjam Zone, Ethiopia, 2022: A Cross-Sectional Study

Background: Adverse birth outcomes are a common public health problem in the developing world, including Ethiopia. There are several indices of adverse birth outcomes, such as stillbirth, preterm birth, low birth weight, small for gestational age and congenital anomalies. Objective: This study aimed to determine the proportion and associated factors of adverse birth outcomes among women who gave birth at Debre Markos General Hospital. Methods: A health facility-based cross-sectional study was conducted from July 1 to August 1/2022 on laboring women who attended Debre Markos General Hospital. A total of 337 study participants were selected using a systematic sampling method. Data were collected through interviews with a structured questionnaire. Epi Data version 3.1 was used for data entry and analyzed using Statical Package for Social Sciences software. Bivariable and multivariable logistic regression analyses were employed; a P value of less than 0.05 was considered a statistically significant factor. Result: The overall proportion of this study showed that 26.1% of women had adverse birth outcomes; 7.7% stillbirths and 9.2% each preterm and low birth weights. Rural residence, no antenatal care, antepartum hemorrhage, pregnancy-induced hypertension, illiteracy, post term pregnancy, birth interval less than two years, and age less than 20 years were independently associated with adverse birth outcomes. Conclusion: In this study, the overall proportion of adverse birth outcomes was low compared to previous studies. Residence, no antenatal care follow-up, antepartum hemorrhage, pregnancy-induced hypertension, post term pregnancy, birth interval less than two years, illiteracy, and age less than 20 years were associated with adverse birth outcomes.