Post-term Research Articles

The Role of the Family Support in the Quit Smoking Decision: A Systematic Literature Review

Cigarettes are still a source of health problems in Indonesia. Several non-communicable diseases, which are increasing in number, are mostly caused by smoking behavior. Diseases caused by smoking include prolonged cough, lung disease, pregnancy disorders, atherosclerosis infertility, and several types of cancer. The contribution of smoking to the occurrence of cardiovascular disease is also quite large. The role of the family in supporting the decision to stop smoking is very important. Families can provide the emotional and practical support needed to achieve smoking cessation goals. This study aims to disseminate research results related to the theme of the Role of the Family in Supporting the Decision to Stop Smoking. In addition, it also conducts an analysis of what family roles are needed to support smokers to quit. This research is a systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. Research is carried out systematically by following the correct research steps or protocols. A search for research articles relevant to the topic of this study was carried out using the keywords: role, family role, family, support, decision support, smoking, smoking cessation, family in decision support, and supporting smoking cessation decisions, which were obtained from Google Scholar and PubMed. In this Study the total of twenty one article were included and the several indicators in supporting smoking cessation included an environment that supports smoking cessation decisions, the role of the family in supporting smoking cessation decisions, enforcement of family rules, and barriers to quitting smoking.

Efficient administration of a combination of nifedipine and sildenafil citrate versus only nifedipine on clinical outcomes in women with threatened preterm labor: a systematic review and meta-analysis

BackgroundPreterm labor (PTL) is a common and serious pregnancy disorder that can cause long-term neurological issues in the infant. There are conflicting studies concerning whether sildenafil citrate (SC) reduces preterm labor complications. Therefore, the meta-analysis aimed to examine the clinical outcomes in women with threatened PTL who received nifedipine plus SC therapy versus only nifedipine.MethodsFor the original articles, six databases were searched using relevant keywords without restriction on time or language until January 13, 2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess the risk of bias in randomized and non-randomized studies, and GRADE determined the quality of our evidence. Meta-analysis of all data was carried out using Review Manager (RevMan) version 5.1.ResultsSeven studies with mixed quality were included in the meta-analysis. The study found that combining nifedipine and SC resulted in more prolongation of pregnancy (MD = 6.99, 95% CI: 5.32, 8.65, p < 0.00001), a lower rate of delivery in the 1st to 3rd days after hospitalization (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001), a higher birth weight (252.48 g vs. nifedipine alone, p = 0.02), and the risk ratio of admission to the neonatal intensive care unit (NICU) was significantly lower (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001) compared to nifidepine alone. The evidence was high for prolongation of pregnancy, delivery rate 24–72 h after admission, and NICU admission, but low for newborn birth weight.ConclusionsGiven the effectiveness of SC plus nifedipine in increased prolongation of pregnancy and birth weight, lower delivery in the 1st to 3rd days after hospitalization, and NICU admission, Gynecologists and obstetricians are suggested to consider this strategy for PTL management, although additional article rigor is required to improve the quality of the evidence.

RISK FACTORS, MATERNAL, AND PERINATAL OUTCOME OF FETAL MACROSOMIA

Objective: Macrosomia is characterized by a birth weight exceeding 4000 g, regardless of gestational age, or &gt;90th percentile for gestational age. This condition is linked to significant risks of maternal and neonatal morbidity and mortality. Globally, the prevalence of infants weighing ≥4000 g is estimated to be 9%. Various risk factors contribute to the development of fetal macrosomia, including a high pre-pregnancy body mass index (BMI), excessive weight gain during the antenatal period, high parity, male gender of the fetus, prolonged pregnancy, and maternal diabetes mellitus. Methods: A retrospective cross-sectional study was undertaken in the Department of Obstetrics and Gynecology at GIMSR Teaching Hospital, over a 5-year period from May 2018 to May 2023. The study encompassed all singleton pregnancies with a birth weight equal to or exceeding 4000 g, irrespective of the delivery method. Maternal and neonatal records for the study population were systematically collected, and data were documented. Results: Throughout the study duration, there were 167 cases where the birth weight equalled or exceeded 4,000 g. Most common maternal complication was prolonged labor and postpartum hemorrhage. Shoulder dystocia was seen in 2.9% of all deliveries and 10.8% of all vaginal deliveries. Most common neonatal complication was hypoglycemia. Conclusion: The prevalence of macrosomia in our study was 3.86%. Main risk factors identified in our study were male gender, pre pregnancy BMI &gt;25, previous macrosomic births, and excessive weight gain during pregnancy.

PERINATAL AND MATERNAL OUTCOME OF PREECLAMPSIA WITH SEVERITY FEATURE MANAGED EXPECTANTLY AT ST. PAUL’S HOSPITAL MILLENNIUM MEDICAL COLLEGE (SPHMMC), 2021, ADDIS ABABA, ETHIOPIA. A CROSS SECTIONAL STUDY

ABSTRACT Background Preeclampsia refers to the new onset of hypertension and proteinuria after 20 weeks of gestation in a previously normotensive woman. It is labeled as Preeclampsia with severe features when one of the severity signs occurs. Worldwide, Preeclampsia occurs in up to 7.5 percent of pregnancies and 10 - 15 % of direct maternal deaths are associated with preeclampsia and eclampsia. Majority of adverse maternal and perinatal outcome occur in Preeclampsia with severe features and when Preeclampsia occurs remote from term ( ). Objective The main objective of this study was to determine the maternal and perinatal outcome of Preeclampsia with severe features managed expectantly at SPHMMC in one year period. Materials and Methods: Facility based cross-sectional study was conducted. The study participants were selected consecutively by including all mothers admitted during the study period (January 2021 to December 2021 G.C.) with the diagnosis of Preeclampsia with severe features to SPHMMC that fulfill the inclusion criteria. Data taken was, the patients chart and a direct patient interview using pre-tested &amp; structured questionnaire. Collected data was entered in to Epi info version 7 &amp; analysis was made through SPSS version 25. Descriptive statistics, tables &amp; figures was used to describe the study finding. Result –the mean days of prolongation of pregnancy was 11.5 days with slight increment of maternal complication from expected proportion that completely resolved postpartum. The most common maternal complications were HELLP syndrome (15.1%) and abruptio placenta (7.2%). There were 21 perinatal deaths (08 still births and 13 neonatal deaths) that give perinatal mortality rates of 276 per 1000 live births. The rate of NICU admission was 66.7% and the neonatal survival to seventh day was 71.7%. Only 66(90.4%) of the women were a good candidate for expectant management. Magnesium sulphate and steroid (dexamethasone) at admission was given 100% but 8.2% of the mothers didn’t get magnesium sulphate during intra partum and post partum period. Conclusion / Recommendation - Proper selection of pregnant mothers with pre-eclampsia with severity feature and Close and frequent maternal and fetal surveillance during expectant management is associated with a good perinatal outcome without significant difference in maternal complication. Key Words: pre-eclampsia ,Perinatal outcome, maternal complication.

Membrane sweeping at term to promote spontaneous labor and reduce the likelihood of formal labor induction for prolonged pregnancy, in South Asia and the world: A meta-analysis.

Membrane sweeping promotes the spontaneous onset of labor, reducing the need for formal labor induction. In addition to the safety profile, membrane sweep is a cost-effective measure in a low-resource setting like South Asia. To the best of our knowledge, previous reviews and meta-analyses have not explored the timing and frequency of membrane sweeping or its association with the period of gestation (POG) and parity. Additionally, the results should be interpreted with caution due to the inclusion of older studies and the analyses conducted regardless of ethnicity in previous literature. We addressed these gray areas in the current study to fill the research gap. We searched PubMed, Google Scholar, Science Direct, and Cochrane Reviews. Study selection was performed using the semi-automated tool Rayyan. The selection criteria for this study encompassed the inclusion of randomized controlled trials (RCTs) published in English between January 2010 and May 2023, with accessible full-text articles. The focus was on low-risk pregnant women carrying a single fetus in a cephalic presentation at term (37-42weeks) gestation, confirmed by reliable methods. Essential data for relative risk (RR) and 95% confidence interval (CI) calculation must be present. The Cochrane risk-of-bias (RoB2) tool and funnel plots were used to assess bias. Review Manager (RevMan) 5.4 version was used for analysis. The Mantel-Haenszel statistics and random effects were used to calculate the overall effect of risk ratio with a 95% confidence interval. Study heterogeneity was calculated using the I2 statistic. Two subgroups were used in the analysis: South Asia and the rest of the world. A total of 13 RCTs with 2599 participants were analyzed. Overall, membrane sweep effectively reduced formal IOL with an effect size of 2.43 (95% CI: 1.51-3.91). It also promoted spontaneous labor with an effect size of 1.71 (95% CI: 1.15-2.55). In the South Asian subgroup, membrane sweeping significantly promoted the spontaneous onset of labor with an overall effect of 1.85 (95% CI: 1.37-2.51), and in the rest of the world subgroup, membrane sweeping significantly reduced formal labor induction with an overall effect of 1.93 (95% CI: 1.33-2.82). The pooled effects were significant in mulipara with a POG ≥40W in the South Asian subgroup. Membrane sweeping effectively reduces the need for formal labor induction and promotes spontaneous labor. This may be particularly relevant in South Asian populations where a disproportionate ethnic contribution to stillbirth rates is noted. Due to the limited number of RCTs addressing the factors and study methodology heterogeneity, we had limited data in some subgroup analyses. Therefore, we encourage more RCTs and meta-analyses on POG, parity, timing and frequency of membrane sweeping, and ethnic differences.

Use and Impact of Pessary, Cerclage, and Progesterone for the Secondary Prevention of Preterm Birth: Data from the German Neonatal Network.

To evaluate the use and effect of cervical stitch cerclage, pessary, and progesterone on pregnancy outcome in mothers of very low birth weight infants (VLBWI) born<32 weeks of gestation in the German Neonatal Network (GNN). The GNN is a population-based cohort study enrolling VLBWI since 2009. We included 575 neonates from 424 mothers into our analysis, who were born between 2015 and 2019, after prenatal intervention with cerclage, pessary, progesterone or a combination between 20/0 to 25/0 weeks of gestation to prevent preterm birth. Median intervention-to-birth interval was the primary endpoint. 231 of 424 pregnant women had a cerclage only (54.5%), 76 women a pessary only (17.9%), and 27 were prescribed progesterone only (15.3%). The most common combination treatment (>1 intervention group) was cerclage plus progesterone (n=27), followed by cerclage plus pessary (n=13). The median intervention-to-birth interval for the whole cohort was 24 days (IQR 19.0 days). The earlier the intervention was started, the longer the intervention-to-birth interval lasted: When started at 20 weeks, the interval was 34 days in contrast to 11.5 days, when started at 25 weeks. The >1 group was born at a significantly higher median GA with 27.0 weeks (IQR 2.9 weeks) and a higher median birth weight of 980 g (IQR 394 g) accordingly. We propose that the earliest possible start of intervention leads to the most efficient pregnancy prolongation.

The Prevalence of Endometriosis in Patients with Unexplained Infertility.

Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.

Associations between gestational weight gain under different guidelines and adverse birth outcomes: A secondary analysis of a randomized controlled trial in rural western China.

Several gestational weight gain (GWG) guidelines have been established based on monocenter or multicenter researches. We aimed to examine the associations between categories of GWG under the Institute of Medicine (IOM) recommendation guideline, the Chinese National Health Commission (NHC) guideline, and weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project and adverse birth outcomes. We used data from an antenatal micronutrient supplementation trial in rural western China between 2002 and 2006. Maternal weekly average GWG during the second and third trimesters was calculated and classified into inadequate, adequate and excessive GWG according to the IOM and NHC, respectively. Weight-gain-for-gestational-age z-scores derived from the INTERGROWTH-21st Project were grouped into three subgroups using two approaches: z-score percentile<25th, 25th to 75th, >75th and z-score <-1, -1 to 1, >1 SD. Infant birth weight and gestational age were measured using standard approaches. Generalized linear model with binomial family and logit link was applied to estimate the odds ratio (OR) and 95% confidential intervals (CI) for GWG categories and adverse birth outcomes. Among 1,239 women with normal weight (18.5 kg/m2 to 23.9 kg/m2) during early pregnancy, 18.0% and 34.2% were classified as adequate GWG according to IOM and NHC, respectively. Less than half of Chinese women reached optimal GWG by any recommendation guideline. According to NHC, excessive GWG showed a significant association with macrosomia (OR 3.75, 95% CI 1.03, 13.74), large-for-gestation-age (LGA) (OR 2.12, 95% CI 1.01, 4.45), and inadequate GWG was associated with post-term birth (OR 2.25, 95% CI 1.21, 4.16), compared with adequate GWG. Inappropriate GWG was associated with adverse birth outcomes even among women with normal weight during early pregnancy. The monitoring and interventions of weight status during pregnancy, especially for the second and third trimesters, are of great public health importance for optimal birth outcomes. Additionally, developing guideline of appropriate GWG ranges should account for the traits of regional population.

POSTTERM PREGNANCY: MATERNAL AND FETAL OUTCOMES

Postterm Pregnancy is one of the commonest obstetric conditions which associated with an increased risk of fetal and neonatal mortality and morbidity as well as an increased maternal morbidity. The aim of the present study is to determine the maternal and fetal outcomes of postterm pregnancy at Al-Sadaqa Teaching Hospital. A prospective case–control study was conducted at Al-Sadaqa Teaching Hospital, Aden from January 1st to December 31th 2020. Cases were considered postterm pregnancy (≥ 42 weeks) while control term pregnancy (37weeks - 41weeksand 6 days). Significant association between gestational age and the studied variables of postterm and term pregnancy were analyzed using appropriate statistical methods. A total of 185 cases of postterm pregnancy and 370 control group of term birth, the frequency of postterm pregnancy was (2.78%), we found statistically significant association between some of socio-demographic factors and postterm pregnancy, cesarean section was higher in postterm group (OR 2.80) with the indications were cephalopelvic disproportion (OR 12.38). Maternal complications were significantly association to postterm birth like prolonged labor (OR 12.99) and postpartum hemorrhage (OR 8.32). Regarding to fetal outcomes, Postterm pregnancy has showed a significant association with neonatal low Apgar score(p=0.000), Oligohydramnios (OR 42.24) asphyxia (OR 2.86), meconium aspiration (OR 9.41) and Perinatal death (p value 0.012). This study concluded that postterm pregnancy is associated with adverse maternal outcomes such as, prolonged labor and postpartum hemorrhage, and associated with adverse fetal outcomes like oligohydramnios, asphyxia and meconium aspiration syndrome. The outcome of prolonged pregnancy can be improved by proper counselling for follow up during pregnancy and proper monitoring and appropriate management during labor.

Hypoxic-ischaemic encephalopathy based on clinical signs and symptoms and associated factors among neonates, Southern Ethiopian public hospitals: a case-control study.

Hypoxic-ischaemic encephalopathy (HIE) is a severe condition that results from reduced oxygen supply and blood flow to the brain, leading to brain injury and potential long-term neurodevelopmental impairments. This study aimed to identify the maternal and neonatal factors associated with hypoxic-ischaemic encephalopathy among Neonates. The authors conducted a case-control study in 15 public hospitals with 515 neonates and mothers (175 cases and 340 controls). The authors used a questionnaire and clinical records created and managed by Kobo software to collect data. The authors diagnosed hypoxic-ischaemic encephalopathy (HIE) by clinical signs and symptoms. The authors used logistic regression to identify HIE factors. Hypoxic-ischaemic encephalopathy (HIE) was associated with maternal education, ultrasound checkup, gestational age, delivery mode, and labour duration. Illiterate mothers [adjusted odds ratio (AOR)= 1.913, 95% CI: 1.177, 3.109], no ultrasound checkup (AOR= 1.859, 95% CI: 1.073, 3.221), preterm (AOR= 4.467, 95% CI: 1.993, 10.012) or post-term birth (AOR= 2.903, 95% CI: 1.325, 2.903), caesarean section (AOR= 7.569, 95% CI: 4.169, 13.741), and prolonged labour (AOR= 3.591, 95% CI: 2.067, 6.238) increased the incidence of HIE. This study reveals the factors for hypoxic-ischaemic encephalopathy among neonates in Ethiopia. The authors found that neonates born to illiterate women, those who experienced prolonged labour, those whose mothers did not have ultrasound checkups during pregnancy, those delivered by caesarean section, and those born preterm, or post-term were more likely to develop hypoxic-ischaemic encephalopathy. These findings indicate that enhancing maternal education and healthcare services during pregnancy and delivery may positively reduce hypoxic-ischaemic encephalopathy among neonates.

Diagnostic options, physiopathology, risk factors and genetic causes of permanent congenital hypothyroidism: A narrative review.

In Permanent congenital hypothyroidism (PCH) is a lifelong condition characterized by a deficiency in thyroid hormone, leading to various neurodevelopmental complications. Early clinical signs are often nonspecific and easily overlooked, but newborn screening programs have improved early detection. This narrative review aims to provide insights comparatively transient and permanent PCH and also the diagnosis, risk factors, underlying pathophysiology, and genetic causes associated with PCH. Relevant studies were identified through a comprehensive search using the term 'Permanent congenital hypothyroidism' (Mesh) across scientific databases of electronic databases such as PubMed, Scopus, and Web of Science. Prompt initiation of thyroid hormone replacement therapy, particularly within the initial two weeks postpartum, crucially enhances neurocognitive development outcomes. Multiple predictive approaches, encompassing screening TSH levels, maternal thyroid history, and levothyroxine dosage per kilogram assessment, aid in identifying PCH. Recent studies have demonstrated a mounting prevalence of PCH, contributing significantly to the overall rise in CH incidence. Genetic factors, primarily DUOX2 and DUOXA2 mutations, alongside environmental influences such as post-term birth, low birth weight, and macrosomia, may induce PCH. Nonetheless, reliable markers for early PCH prediction upon diagnosis remain elusive, leading to delayed recognition post-ceasing levothyroxine treatment around age 3. Recent studies have observed an increased incidence of PCH, contributing substantially to the overall rise in cases of congenital hypothyroidism. Understanding the diagnostic options and genetic etiologies associated with PCH is crucial for the early identification and appropriate management.

A prospective observational study on efficacy and safety of extra amniotic saline infusion with transcervical foley’s catheter in induction of labour in post-dated pregnancy

A prospective observational study on efficacy and safety of extra amniotic saline infusion with transcervical foley’s catheter in induction of labour in post-dated pregnancy

Factors Influencing Induction of Labor Success in Riyadh, Saudi Arabia.

The physiological process by which the fetus and placenta are delivered from the uterus and pass through the vaginal canal for delivery is known as labor. Induction of labor involves deliberately initiating labor before it occurs naturally, using medical interventions or techniques to stimulate contractions and initiate the birthing process. This study aimed to investigate the factors that influence the success of labor induction procedures in Riyadh, Saudi Arabia, from January to April 2023. Subject and Methods. This retrospective chart review was conducted at the National Guard Hospital in Riyadh, Saudi Arabia. Data were collected from the patient chart of those who underwent labor induction from January to April 2023. The collected data were tabulated and cleaned in MS Excel. Final data were transferred to SPSS for subsequent data analysis. Five hundred and thirty-one pregnant women were analyzed. 52.7% were aged 30 years or below. The most common indication of IOL was post-dated pregnancy (26.2%). 62% were normal deliveries, indicative of IOL success, while 31.1% were cesarean deliveries, indicative of IOL failure. In univariate analysis, women with lower gravidity (≤3) and who had received Propess were associated with cesarean delivery. In a multivariate regression analysis, women who received Prostin and increased parity were identified as the significant independent predictors of IOL success. IOL's success was dependent primarily on increasing parity and Prostin administration. However, lower gravidity (≤3) and Propess medication could lead to operative procedures among pregnant women. Hence, it is necessary to carefully assess the condition of pregnant women before directing them to IOL.

Safety and efficacy of phosphodiesterase-5 (PDE-5) inhibitors in fetal growth restriction: a systematic literature review and meta-analysis.

Introduction: Fetal growth restriction (FGR) is associated with a higher risk of perinatal morbidity and mortality, as well as long-term health issues in newborns. Currently, there is no effective medicine for FGR. Phosphodiesterase-5 (PDE-5) inhibitors have been shown in pre-clinical studies to improve FGR. This study aimed to evaluate the latest evidence about the clinical outcomes and safety of PDE-5 inhibitors for the management of FGR. Methods: Eight databases (PubMed, Embase, Medline, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database and WangFang Database) were searched for English and Chinese articles published from the database inception to December 2023. Randomized controlled trials (RCTs) reporting the use of PDE-5 inhibitors in FGR were included. The quality of the RCTs was assessed using the Cochrane Risk of Bias Tool. Odds ratio and mean difference (MD) (95% confidence intervals) were pooled for meta-analysis. Results: From 253 retrieved publications, 16 studies involving 1,492 pregnant women met the inclusion criteria. Only sildenafil (15 RCTs) and tadalafil (1 RCT) were studied for FGR. Compared with the control group (placebo, no treatment, or other medication therapies), sildenafil increased birth weight, pregnancy prolongation and umbilical artery pulsatility indices. However, it also increased the risk of pulmonary hypertension in newborns, as well as headache and flushing/rash in mothers. There were no significant differences in gestation age, perinatal mortality or major neonatal morbidity, stillbirth, neonate death, infants admitted to neonatal intensive care unit, intraventricular hemorrhage and necrotizing enterocolitis in infants, as well as pregnancy hypertension and gastrointestinal side effects in mothers between the treatment and the control groups. Discussion: Sildenafil was the most investigated PDE-5 inhibitors for FGR. Current evidence suggests that sildenafil can improve birth weight and duration of pregnancy but at the same time increase the risk of neonatal pulmonary hypertension. It remains uncertain whether the benefits of sildenafil in FGR outweigh the risks and further high-quality RCTs are warranted. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=325909.

22 Vaginal progesterone for the prolongation of pregnancy after arrested pre-term labor-multicenter randomized controlled trial

22 Vaginal progesterone for the prolongation of pregnancy after arrested pre-term labor-multicenter randomized controlled trial

Investigating the Impact of Pregnancy-Induced Hypertension on Fetal Outcomes: A Comprehensive Study in Maternity Hospitals

Background: Hypertension in pregnancy is a major obstetric complication that poses a significant risk to maternal and fetal health, leading to increased morbidity and mortality. According to the World Health Organization, hypertensive disorders of pregnancy (HDP) claim the life of at least one woman every seven minutes. HDPs are associated with an increased risk of adverse fetal and neonatal outcomes, including preterm birth, intrauterine growth restriction (IUGR), perinatal mortality, and maternal morbidity and mortality. Prompt recognition and management of PIH are essential to mitigate these complications and ensure optimal maternal and fetal outcomes. Hence the study was undertaken to assess the impact of Pregnancy Induced Hypertension on fetal outcome among Antenatal mother with PIH at maternity hospital of Anand and Kheda district. Objectives: To assess the clinical presentation among mother with PIH at maternity hospital; To assess the impact of Pregnancy Induced Hypertension on fetal outcome. Methodology: A Prospective study was conducted at Dr. N. D. Desai hospital, Nadiad. Sample size was 30. Sample was selected by Consecutive Sampling Technique. The data regarding Demographic variable, Obstetric History, Classification of PIH, Blood pressure, Drug Received &amp; Fetal outcomes was collected using Structured Interview Scheduled. The result is computed by using descriptive and frequency and percentage using tables, graph etc. Data were analysed according to objectives of the study. Results: In present study, the incidence of gestational hypertension, pre-eclampsia, and eclampsia was 10%, 86.66%, and 3.33%, respectively. These conditions were more common in primipara. The symptoms of pregnancy-induced hypertension (PIH) included pedal edema (60%), vomiting (43.33%), blurry vision (6.66%), convulsions (3.33%), and dizziness (6.66%), as well as epigastric pain (16.66%) and lower abdominal pain (36.66%). Most mothers (83.33%) received antihypertensive medication. The study also found that fetal complications included preterm births (66.66%) and low birth weight (56.66%). Additionally, 63.33% of babies required NICU admission, and there were cases of post-term birth (3.33%), congenital abnormalities (3.33%), birth asphyxia (3.33%), and neonatal deaths (10%). Conclusion: Pregnancy-induced hypertension is a common and serious condition that can have devastating effects on both mothers and babies. To combat this, we need to raise awareness and take action at both community and hospital levels to reduce the risks and improve outcomes.

Neurological examination of healthy term infants at ages 6 and 10 weeks in Tshwane District.

Globally, there is a significant gap in detailed neurodevelopmental data for infants under 3 months, despite 6 weeks being identified a critical milestone for neuro-behavioural development. Normative values and optimal scores for healthy infants at 6 and 10 weeks postnatally are lacking in many settings. In South Africa, the statutory neurodevelopmental assessments at these ages exclude notable characteristics of central nervous system maturation and limit opportunities to collect data of early developmental progress. Our study aimed to assess developmental characteristics of healthy term infants aged 6 and 10 weeks using the Hammersmith Neonatal Neurological Examination (HNNE). A prospective longitudinal study was performed on 35 healthy term-born infants from low-risk pregnancies at 6 and 10 weeks' postnatal age in the Tshwane district. The statuses of infants' neurodevelopment in six domains were recorded using the HNNE. Optimality scores were derived from the raw scores of 34 items, using the 10th and 5th percentiles as cut-off points. Evidences of neurodevelopmental advancements, particularly in posture, muscle tone and visual behaviour between 6 and 10 weeks were illustrated, and total examination optimality scores of 29.5 in 91% and 31.5 in 94% of infants were recorded at 6 and 10 weeks, respectively. This article provides data on the neurodevelopment characteristics of infants at and between 6- and 10-weeks post term ages. The findings support the viewpoint to identify important milestone characteristics during early screening.

Експресія прогестеронових рецепторів при багатоплідній вагітності

Hormonal disorders, specifically progesterone insufficiency, constitute the primary cause of pregnancy loss. The role of progesterone insufficiency in the genesis of obstetric and gynecological losses is actively discussed worldwide. Progesterone and the quantity of its receptors play a crucial role in the maintenance and prolongation of pregnancy. The placenta, being the main site of progesterone synthesis, represents a significant source of information and serves as an essential diagnostic object. The obtained data during placental research are indispensable for understanding the etiopathogenic changes in pregnancy loss in the case of multiple pregnancies. Purpose - to analyze the immunohistochemical changes in the expression of progesterone receptors in placental structures of parturients with dichorionic diamniotic twins depending on the method of conception. Materials and methods. We conducted a clinical-statistical analysis of the course of pregnancy and childbirth in women with multiple pregnancies induced by assisted reproductive technologies (ART). To determine the expression of progesterone receptors, immunohistochemical research of placentas from women with dichorionic and diamniotic twins resulting from ART was carried out. Results.The study revealed that women with multiple pregnancies induced by ART had a complicated somatic and obstetric-gynecological history, which subsequently negatively influenced the outcomes and course of pregnancy. A complicated pregnancy not only affects the process of childbirth but also the timing of delivery, as premature births in multiple pregnancies occur twice as often as in singleton pregnancies. Immunohistochemical analysis of the placenta showed the highest quantity of progesterone receptors and their expression in the nuclei of decidual cells (50%) of the maternal structure of the placenta in women with dichorionic and diamniotic twins resulting from ART. Conclusions.The obtained data on the expression of progesterone receptors indicate an evident connection between structural interactions of the placenta and endometrium, which is a key component in the advisability of prescribing progesterone therapy for the prevention of obstetric and perinatal losses. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Prognostic Biomarkers of Pre-Eclampsia in Pregnant Women

Summary. According to various authors, the incidence of preeclampsia (PE) in pregnant women in our country ranges from 8 to 20% and does not tend to decrease. It has been shown that the pathogenesis of preeclampsia fits into the systemic inflammatory response syndrome with disturbances in the immune system and an imbalance in cytokine regulation. The aim of the study was to study pro-inflammatory (IL-1β, IL-6, IL-8) and anti-inflammatory (IL-4, IL-10) cytokines in women with preeclampsia of varying severity. Material and methods. We examined 76 pregnant women with PE aged from 24 to 36 years at a gestation period of 28–38 weeks. Of these, 42 developed PE (main group), and 34 women had no symptoms of PE (comparison group). 28 women with a physiological pregnancy formed the control group. The levels of pro- and anti-inflammatory cytokines (IL-1β, IL-6, IL-8, IL-4 and IL-10) in blood serum were studied by ELISA. Results. In pregnant women with PE upon admission to the hospital, the blood serum levels of IL-1β increased by 1.3 times (p &lt; 0.05), IL-8 by 7 times (p &lt; 0.001) and a decrease in the level of IL-4 by 2 times (p &lt; 0.001). And in pregnant women without signs of PE, these changes in cytokine synthesis were less pronounced (p &lt; 0.01). Conclusion. Maintaining a dynamic balance in the cytokine system plays an important role for the normal development of pregnancy. Th2-type cytokines promote normal trophoblast differentiation and its full invasion and, therefore, mediate the prolongation of physiological pregnancy. Switching to the synthesis of Th1-type cytokines and their enhanced production leads to disruption of trophoblast differentiation and invasion with the development of pregnancy pathology.

Unveiling sex bias and adverse neonatal outcomes in ultrasound estimation of gestational age: A population-based cohort study.

Gestational age estimation by second-trimester ultrasound biometry introduces systematic errors due to sex differences in early foetal growth, consequently increasing the risk of adverse neonatal outcomes. Ultrasound estimation earlier in pregnancy may reduce this bias. To investigate the distribution of sex ratio by gestational age and estimate the risk of adverse outcomes in male foetuses born early-term and female foetuses born post-term by first- and second-trimester ultrasound estimations. This population-based study compared two cohorts of births with gestational age based on first- and second-trimester ultrasound in the Medical Birth Registry of Norway between 2016 and 2020. We used a log-binomial regression model to estimate adjusted relative risk (RR) with 95% confidence interval (CI) for Apgar score <7 at 5 min, umbilical artery pH <7.05, neonatal intensive care unit (NICU) admission and respiratory morbidity in relation to foetal sex. The sex ratio at birth in gestational weeks 36-43 showed less male predominance in pregnancies estimated in first compared to second trimester. Any adverse outcome was registered in 627 of 4470 male infants born in gestational weeks 37-38 and 618 of 6406 females born ≥41 weeks. Male infants born in weeks 37-38 had lower risk of NICU admission (RR 0.76, 95% CI 0.58, 0.99), Apgar score <7 at 5 min (RR 0.63, 95% CI 0.28, 1.41) and respiratory morbidity (RR 0.68, 95% CI 0.37, 1.25) in first- compared to second-trimester estimations. Female infants estimated in first trimester born ≥41 weeks had lower risk of umbilical artery pH <7.05, NICU admissions and respiratory morbidity; however, CIs were wide. Early ultrasound estimation of gestational age may reduce the excess risk of adverse neonatal outcomes and highlight the role of foetal sex and the timing of ultrasound assessment in the clinical evaluation of preterm and post-term pregnancies.