Incidence Of Preterm Labor Research Articles

Outcome of Preterm Labour in SSMC Mitford Hospital, Dhaka.

Introduction: : Preterm birth as a consequence of preterm labour is the major clinical problem associated with perinatal mortality, serious neonatal morbidity and moderate to severe childhood disability and two-thirds of all perinatal deaths. Moreover, preterm labour comprises a large number of low birth weight babies. Global incidence of preterm labour is 5-10% of all births. The aim of this study was to determine the clinical profile and to find out pregnancy outcomes of preterm labour. Materials & Methods: This cross-sectional study was conducted in Sir Salimullah Medical College Mitford Hospital, Dhaka from January 2005 to December 2005. A total 103 gravid women who got admitted with established premature labour pain were included as study patients. Preterm labour associated with severe pre-eclampsia, eclampsia, antepartum haemorrhage and intrauterine fetal death were excluded. Data were collected in a pre-designed questionnaire and analyzed by SPSS software. Results: Incidence of preterm labour was found 6.3%. Among maternal morbidities, puerperal sepsis found to be highest (14.56%) followed by UTI (7.77%), PPH (6.80%), wound infection (5.83%) and retained placenta (3.88%). This study found perinatal mortality 32.0% and morbidity 49.5% of which RDS contributed highest (24.27%) followed by neonatal jaundice (11.65%), septicemia (8.73%), neonatal convulsion (2.91%) and umbilical sepsis (1.94%). Conclusion: Preterm labor followed by preterm birth significantly contributes to maternal morbidity and perinatal morbidity and mortality. Medicine Today 2021 Vol.33(2): 143-146

Course of labor and condition of the newborn in women affected by benign ovarian tumors

Annotation. According to various estimations, the incidence of adnexal neoplasms during pregnancy makes up from 0.19% to 8.8%. Most of cases are diagnosed in the first trimester and their incidence gradually decreases as the period of pregnancy grows. Depending on their size and location, ovarian tumors may be related to an adverse obstetrical result caused by mechanical influence. They increase the risk of abortion (from 0 to 6%), preterm labor (from 5.8% to 10.4%) and mechanical impediment to labor. Aim – studying the peculiarities of the course of labor and the condition of the newborn of women affected by benign ovarian tumors. We have conducted a complex examination of 67 pregnant women with benign ovarian tumors and tumor-like growths found before pregnancy or in the first trimester of gestation (basic group) and 50 women presenting no ovarian neoplasms or any other severe gynecological or somatic pathology (reference group). To identify the risk factors, the basic group was divided into 2 subgroups. The condition of fetuses was assessed with the use of automated cardiotocography analysis based on the Dawes/Redman criteria, with the calculation of the short-term variability (STV). The mean and standard deviation (M ± m) were evaluated at a significance level of p <0.05. Categorical variables are presented as the absolute number of cases in the group and the frequency in percent – n (%). Tests for differences between independent samples in the case of quantitative variables were performed using Student’s t test, the Mann-Whitney rank test, and in the case of categorical variables using Fisher’s exact test. The obtained results suggest that the course of labor in women affected by benign ovarian neoplasms is characterized by an increased incidence of complications. A significant difference has been established in the incidence of cesarean sections (35.8% vs 8.0% in the reference group, р<0.05), preterm labor (28.4% vs. 6.0%, р<0.05), fetal distress (19.4% vs. 8.0%, р<0.05) and preterm rupture of membranes (17.9% vs. 6.0%, р<0.05). The incidence of almost all complications of labor in Subgroup 1 significantly exceeds the figures from the reference group and the incidence of preterm labor and fetal distress is also higher in comparison with Subgroup 2. The presence of extragenital pathology is a well-known risk factor for perinatal complications, which is also confirmed by our research. A high level of comorbidity of benign ovarian neoplasms with various extragenital diseases also accounts to a certain degree for gestational complications. Thus, pregnancy in women affected by ovarian tumors implies an increased risk of obstetrical and perinatal complications, in particular, threats of miscarriage and preterm labor. The studies of this issue lack systematization, are often controversial and fragmentary. There has been practically no research on the risk factors for such complications and the ways of their prognostication and prevention.

Evaluation of Sonographic Measurement of Umbilical Cord Coiling Index in the Second Trimester and Its Correlation to Perinatal Outcome

The umbilical cord represents a unique lifeline between the fetus and mother and contains two arteries and one vein wrapped up in Wharton’s jelly with moderate twists. Umbilical coiling abnormalities can result in fetal growth restriction, fetal distress, or intrauterine fetal death. Hypocoiled umbilical cords are associated with intrauterine fetal death (IUFD), fetal growth restriction, fetal distress, low Apgar scores, fetal congenital anomalies, and abnormal insertion of the umbilical cord. Hypercoiled umbilical cords are associated with IUFD, fetal distress, asphyxia, fetal congenital anomalies, and the presence of a single umbilical artery. The aim of this work is to determine if the umbilical Cord coiling index measurement during second trimester ultrasound scan can predict perinatal outcome. Seventy eight healthy uncomplicated pregnant women who regularly attended the antenatal care clinic for antenatal care and to do anomaly ultrasound scan on her baby in 2nd trimester. All participants were informed about the aims and the procedures of the study and signed an informed consent form prior to beginning. Regular antenatal cThe umbilical cord represents a unique lifeline between the fetus andmother and contains two arteries and one vein wrapped up in Wharton’s jelly with moderate twists. Umbilical coiling abnormalities canresult in fetal growth restriction, fetal distress, or intrauterine fetal death. Hypocoiled umbilical cords are associated with intrauterine fetal death (IUFD), fetal growth restriction, fetal distress, low Apgar scores, fetal congenital anomalies, and abnormal insertion of the umbilical cord. Hypercoiled umbilical cords are associated with IUFD, fetal distress, asphyxia, fetal congenital anomalies, and the presence of a single umbilical artery. The aim of this work is to determine if the umbilical Cord coiling index measurement during second trimester ultrasound scan can predict perinatal outcome. Seventy eight healthy uncomplicated pregnant women who regularly attended the antenatal care clinic for antenatal care and to do anomaly ultrasound scan on her baby in 2nd trimester. All participants were informed about the aims and the procedures of the study and signed an informed consent form prior to beginning. Regular antenatal care visit was done every two weeks till delivery with assessment of perinatal outcomes regarding: gestational age at delivery, fetal monitoring by CTG, method of delivery, meconium staining amniotic fluid or not, examination by apgar score at 1stand 5th minute, birth weight, admission to NICU or not and perinatal death. According to umbilical cord index, of total 78 pregnant women who completed the study 62 (79.2%) were having normal UC coiling, 10 of cases (12.8%) were having hypocoiling and 6 (7.7%) were having hypercoiling. Our results showed that hypo- and hyper-coiling were associated with increased incidence of preterm labor (32-36 weeks) “22.2%and 40% respectively” while normo-coiling was associated with lesser incidence “2%”. Both hypocoiling “10%” and hypercoiling “16.7%”groups showed higher incidence of IUGR when compared with the normocoiling group “1.6%”. APGAR score at minute one was significantly lower in the both hypocoiling and hypercoiling groups than the normocoiling group with p- value: 0.005. While at minute five, there was no significant difference between the three groups of the study. Conclusion: The abnormal umbilical coiling index “< 10th percentile or > 90th percentile” is associated with adverse perinatal outcomes. Therefore, early evaluation on Umbilical cord Index in the 2nd trimester can identify fetuses who are at risk and thus help in further management.are visit was done every two weeks till delivery with assessment of perinatal outcomes regarding: gestational age at delivery, fetal monitoring by CTG, method of delivery, meconium staining amniotic fluid or not, examination by apgar score at 1stand 5th minute, birth weight, admission to NICU or not and perinatal death. According to umbilical cord index, of total 78 pregnant women who completed the study 62 (79.2%) were having normal UC coiling, 10 of cases (12.8%) were having hypocoiling and 6 (7.7%) were having hypercoiling. Our results showed that hypo- and hyper-coiling were associated with increased incidence of preterm labor (32-36 weeks) “22.2%and 40% respectively” while normo-coiling was associated with lesser incidence “2%”. Both hypocoiling “10%” and hypercoiling “16.7%”groups showed higher incidence of IUGR when compared with the normocoiling group “1.6%”. APGAR score at minute one was significantly lower in the both hypocoiling and hypercoiling groups than the normocoiling group with p- value: 0.005. While at minute five, there was no significant difference between the three groups of the study. Conclusion: The abnormal umbilical coiling index “< 10th percentile or > 90th percentile” is associated with adverse perinatal outcomes. Therefore, early evaluation on Umbilical cord Index in the 2nd trimester can identify fetuses who are at risk and thus help in further management.

English

BACKGROUND Antepartum haemorrhage of unknown origin (APHUO) being a diagnosis of exclusion, is a rare condition which poses dilemma in the management of pregnancy in terms of timing and mode of delivery. The purpose of this study was to evaluate antenatal factors associated with APHUO, clinical presentation and analyse its impact on pregnancy and its outcome. METHODS This is a retrospective study conducted over a period of two years in a tertiary care hospital. Pregnancy outcomes were compared between 41 cases who had APHUO versus 39 controls who never had history of bleeding in their antepartum period. Bleeding pattern, incidence of preterm labour, intra partum and postpartum complications, mode of delivery, birth weight, APGAR (appearance, pulse, grimace, activity, and respiration) score of the baby and neo-natal intensive care unit (NICU) admission were analysed. RESULTS Patients with APHUO had subclinical abruption and increased risk of preterm delivery. Intrapartum and postpartum complications were similar among both the groups. The average birth weight was much lesser in the study group, but the cause was attributed to prematurity. These findings were consistent with the previous studies. CONCLUSIONS APHUO is associated with subclinical abruption and increased risk of preterm labour. Hence the patient should be counselled for delivery at a tertiary care center with adequate neonatal care. Greater incidence of NICU admission and low birth weight were attributed to prematurity among the study group. Induction of labour at term in this group is of questionable value unless there is an associated obstetric indication. KEY WORDS APHUO, Preterm Labour, Sub Clinical Abruption, Low Birth Weight

Incidence, associated risk factors, and the ideal mode of delivery following preterm labour between 24 to 28 weeks of gestation in a low resource setting.

Preterm labour, between 24 to 28 weeks of gestation, remains prevalent in low resource settings. There is evidence of improved survival after 24 weeks though the ideal mode of delivery remains unclear. There are no clear management protocols to guide patient management. We sought to determine the incidence of preterm labour occurring between 24 to 28 weeks, its associated risk factors and the preferred mode of delivery in a low resource setting with the aim of streamlining patient care. Between February 2020 and September 2020, we prospectively followed 392 women with preterm labour between 24 to 28 weeks of gestation and their newborns from admission to discharge at Kawempe National Referral hospital in Kampala, Uganda. The primary outcome was perinatal mortality associated with the different modes of delivery. Secondary outcomes included neonatal and maternal infections, admission to the Neonatal Special Care Unit (SCU), need for neonatal resuscitation, preterm birth and maternal death. Chi-square test was used to assess the association between perinatal mortality and categorical variables such as parity, mode of delivery, employment status, age, antepartum hemorrhage, digital vaginal examination, and admission to Special Care unit. Multivariate logistic regression was used to assess the association between comparative outcomes of the different modes of delivery and maternal and neonatal risk factors. The incidence of preterm labour among women who delivered preterm babies between 24 to 28 weeks was 68.9% 95% CI 64.2-73.4). Preterm deliveries between 24 to 28 weeks contributed 20% of the all preterm deliveries and 2.5% of the total hospital deliveries. Preterm labour was independently associated with gravidity (p-value = 0.038), whether labour was medically induced (p-value <0.001), number of digital examinations (p-value <0.001), history of vaginal bleeding prior to onset of labour (p-value < 0.001), whether tocolytics were given (p-value < 0.001), whether an obstetric ultrasound scan was done (p-value <0.001 and number of babies carried (p-value < 0.001). At multivariate analysis; multiple pregnancy OR 15.45 (2.00-119.53), p-value < 0.001, presence of fever prior to admission OR 4.03 (95% CI .23-13.23), p-value = 0.002 and duration of drainage of liquor OR 0.16 (0.03-0.87), p-value = 0.034 were independently associated with preterm labour. The perinatal mortality rate in our study was 778 per 1000 live births. Of the 392 participants, 359 (91.5%), had vaginal delivery, 29 (7.3%) underwent Caesarean delivery and 4 (1%) had assisted vaginal delivery. Caesarean delivery was protective against perinatal mortality compared to vaginal delivery OR = 0.36, 95% CI 0.14-0.82, p-value = 0.017). The other protective factors included receiving antenatal corticosteroids OR = 0.57, 95% CI 0.33-0.98, p-value = 0.040, Doing 3-4 digital exams per day, OR = 0.41, 95% 0.18-0.91, p-value = 0.028) and hospital stay of > 7 days, p value = 0.001. Vaginal delivery was associated with maternal infections, postpartum hemorrhage, and admission to the Special Care Unit. Caesarean delivery is the preferred mode of delivery for preterm deliveries between 24 to 28 weeks of gestation especially when labour is not established in low resource settings. It is associated with lesser adverse pregnancy outcomes when compared to vaginal delivery for remote gestation ages.

Varicella Infection During Pregnancy- Maternal and Fetal Outcome; Case Series and Analysis in a Tertiary Centre in South India!

Background: This is a retrospective study undertaken to analyse the maternal and fetal outcome of varicella infection during pregnancy. Methods: This is a retrospective observational study done in Kerala Institute of Medical Sciences, Trivandrum, a tertiary care hospital in South India. Sixty nine women infected with chickenpox during pregnancy from January 2009 to February 2018 (9 years) were taken for the study. Results: The incidence of chickenpox during pregnancy in our study was 33.7 in 10000 pregnancies. There were no spontaneous miscarriages. The incidence of congenital anomalies was 7.2% and when compared to the overall obstetric population of the nine year study period in which the incidence was 6.5 %, there was no statistical significance (p- 0.99). The incidence of preterm labour was 4.7% and when compared to the overall obstetric population in which the incidence was 15 %, there was a statistically significant less incidence (p- 0.035). The incidence of polyhydramnios was 4.7% and when compared to the overall obstetric population in which the incidence was 1%, there was a statistically significant increased incidence (p - 0.018). The incidence of fetal growth restriction was 13% and when compared to the overall obstetric population in which the incidence was 12.4%, there was no statistically significant difference (p- 0.963) Conclusions: The maternal and fetal complications with chickenpox infection during pregnancy were more when infected in the first trimester. Early treatment, screening and followup will reduce the maternal and fetal morbidity

Differences of Ampicillin and Cefazolin Effects in Reducing hs-CRP Level in Premature Rupture of Membranes

Background: Premature rupture of membranes (PROM) is a rupture of amniotic sac before delivery. PROM is associated with an increased incidence of preterm labor and infection. The use of prophylactic antibiotic may reduce the risks of infection. High-sensitivity C-reactive protein (hs-CRP) is an acute-phase reactant protein that is associated with PROM. How much effect of prophylactic antibiotic to hs-CRP level remains unclear.Objective: To compare the reduction in hs-CRP levels in premature rupture of membranes before and after given ampicillin or cefazolin.Methods: The design of this study was true experimental design (pre and post-test) conducted at Dr. Kariadi General Hospital Medical Center Semarang and Kartini General Hospital Jepara from September 2019 to January 2020. Study samples are pregnant women with premature rupture of membranes that came to the Emergency Department and Maternity Ward Dr. Kariadi General Hospital Medical Center Semarang and Kartini General Hospital Jepara. Samples were divided into two groups, a group treated with ampicillin and the other with cefazolin therapy. All samples were subjected to a hs-CRP examination. Statistical analysis was performed by Mann-Whitney and Wilcoxon.Results: There are no significant differences in the age variable (28.8 ± 6.54 vs 29.1 ± 5.93), gestational age (36.3 ± 2.55 vs 36.3 ± 2.90), and parity (2,2 ± 0.99 vs 2.47 ± 1.19) in the ampicillin and cefazolin groups (p&gt; 0.05). In this study, 37.1% patients have a history of PROM while 62.9%. had no history of PROM. Reduction in hs-CRP levels after administration of ampicillin and cefazolin was significant (4.4 ± 2.65 mg/L vs 6.3 ± 4.43 mg/L, respectively, p = 0.03). The difference in the decrease in hs-CRP levels before and after given ampicillin and cefazolin was significant (p = 0.0001). Conclusion: There is a decrease in hs-CRP levels after the administration of ampicillin or cefazolin in PROM, whereas cefazolin induced higher reduction in hs-CRP levels. Ampicillin can still be used as a first-line prophylactic antibiotic in primary healthcare facilities.

Late preterm births and associated neonatal outcomes in a tertiary care center-A prospective observational study.

Background: Prematurity is one of the leading causes of morbidity and mortality among newborns. The incidence of preterm deliveries especially the late preterm births have unfortunately gone up in the last decade. Late preterm births are associated with increased neonatal complications compared to term births. This study makes an effort to find out the relevant maternal and fetal factors associated with late preterm births. This study also assesses the maternal and neonatal outcomes associated with late preterm births. Methods: This prospective observational study was conducted at Maternal and Child Health Unit of Shri B M Patil Medical College Hospital Vijayapur, Karnataka over a period of 1 year. 200 late preterm births and 200 term births were enrolled in the study. During the study period, all neonates delivered in the hospital were divided into two groups as late preterm group and term group. Maternal and neonatal data was collected in predefined structured proforma. Results: The mother's mean age in the late preterm group was 24.34 ± 4.07 years, and among the term group was 25.24 ± 4.54 years, which was not statistically significant (P=0.857). The obstetric risk factors observed for late preterm births were inadequate antenatal care (39%), premature rupture of membranes (31%), hypertensive disease of pregnancy (24.5%), previous preterm delivery (21%), and maternal anemia (13%). When two or more factors were found, late preterm labor incidence was 32.6% in this study. 14.5% late preterm's needed resuscitation (P=0.003), 45% late preterm neonates had difficulty establishing feeding at birth (P<0.001), 34% late preterm’s had respiratory distress at birth (P<0.001), 12% had hypoxic-ischemic encephalopathy (Stage2/3) (0.003), 35% had early-onset sepsis (P<0.001), 28% had jaundice (P<0.001), 24% had hypoglycemia (P<0.001), 41% had hypothermia (P<0.001), 13.5% had HSPDA (P<0.006). The duration of hospital stay was significantly more in late preterm neonates (8.7 ± 1.6 days) as compared to term neonates (3.9 ± 1.1 days) with a pvalue of <0.05. Most important is the mortality, which was significantly more among late preterm neonates (18%) than term neonates (6%) with a p-value of 0.011. Conclusion: Maternal risk factors such as preterm premature rupture of membrane, inadequate antenatal care, hypertensive disorders of pregnancy, and maternal anemia were associated with late preterm births. Since late preterm birth is an independent risk factor for neonatal morbidity and mortality compared to term neonates, knowing maternal and perinatal risk factors is essential. Early identification and management of these risk factors reduces the neonatal morbidities and mortalities.

Vaginal progesterone in prevention of preterm labour

Introduction: Preterm birth, defined as childbirth occurring at less than 37 completed weeks or 259days of gestation since the first day of a woman’s last menstrual period, is one of the leading causesof neonatal morbidity and mortality. Across 184 countries, the rate of preterm birth ranges from 5%to 18% of babies born. Out of 27 million babies born every year (2018 data ) in India, 3.5 millionbabies born are premature. Recent literature review has shown that the use of Progesterone reducesrisk of preterm birth. But there is little information available regarding the role of Progesterone inpreventing preterm labour. Objectives: Primary objective of the study is to find out the incidence ofpreterm labour among pregnant women taking vaginal progesterone. Secondary objective istoassess the safety and efficacy of progesterone in feto-maternal outcome. Methods: This is a crosssectional study where100 prescriptions from IPD of Dept of O&amp;G, VIMSAR, Burla of women who hadrecently undergone labour with singleton gestation and with previous history of preterm labour wereanalysed. Incidence of preterm labour among those taking and not taking vaginal progesterone werecompared. Results: There was decreased incidence of preterm labour as there is prolongation meanGestational age by 9.383 weeks among pregnant women taking vaginal progesterone. Conclusions:In the present study, women taking vaginal progesterone had significantly lowered incidencepreterm birth rate.

A study of perinatal morbidity and mortality in preterm delivery

To determine the incidence of preterm labour and also to determine the incidence and various cause of Morbidity and Mortality in the perinatal period. A prospective study of patients in preterm labour (delivered &amp;#62; 28 weeks and prior to 37 completed weeks) admitted to the obstetrics department of JSS Hospital Mysore Karnataka. Which is tertiary teaching hospital. The study was conducted between February 2012 to January 2014. Total number of deliveries during the period were 3209 out of which the number of preterm deliveries were 241 which fulfilled our study criteria. Immediately. Following delivery, the following features of baby noted like Sex, weight, APGAR score at 1 and 5-minute, immediate complications, congenital Anomaly, birth injury, gestational age, as assessed by the paediatrician based on modified Ballard scoring. Babies and mother followed up for a period of 7 days. Baby examined for the detection of any complication which were managed accordingly.During the study the various risk facters associated with preterm labour were also determined in detail and the correlation of the risk factors to antenatal care, maternal age, parity, presentation and lie, mode of delivery, indication of caesarean sections was studied in detail. So, this study we studied the behavioural pattern of the mother and baby towards preterm labour in detail. The data collected as mentioned above were analysed using appropriate statistical methods. The total number of preterm deliveries were 241 out of the total number of 3269 deliveries in the period of 2 years of the study. Therefore, the incidence of preterm labour was 7.4%. Out of which the total number of preterm spontaneous labour cases were180 (74.7%) and total number of elective preterm delivery were 61 (25.3%). The total number of mortalities during the perinatal period was 82 which accounts of perinatal mortality of 30%. Out of which the total number of stillbirths were 28 (34%) and total number of early neonatal deaths were 54 (66%).To conclude it was seen that preterm labour was associated with high occurrence of perinatal morbidity and mortality. The main causes were found due to birth asphyxia, respiratory distress syndrome and septicaemia. Preterm labour was more common in primigravida with preterm premature rupture of membrane as triggering factors. Preterm babies were born with number of physiological handicaps and thus predisposed to a large number of pathological conditions which needs anticipation and prompt treatment. Thus, timely identification of the risk factors and prompt treatment would help to bring down the incidence of preterm labour and hence its perinatal mishap. And lastly improvement of health care services and good neonatal intensive care unit are the cornerstone in the management of preterm births.

Cardiac disease in pregnancy – A retrospective study

Objectives: To evaluate the maternal and perinatal outcomes in patients with cardiac disease in pregnancy. Materials and Methods: Medical records of 185 women with heart disease who delivered at ?28 weeks of gestation from January 2011 to December 2015 at JSS Hospital, Mysuru, were studied. Results: The prevalence of heart disease in pregnancy was 1.76%. There were 77 (41.6%) women with congenital heart disease and 72 (38.9%) with rheumatic heart disease. 61.6% of the women were from rural background, and 38.4% were from the urban areas. Isolated mitral stenosis was the most common defect in those with rheumatic heart disease; and atrial septal defect was the most common congenital lesion seen. 80% of women remained NYHA class I throughout pregnancy. 53 women who underwent corrective procedures prior to, or during pregnancy had a good outcome. The maternal mortality rate was 1.4%. 44 % of women were primigravidas. The incidence of pre term labor was 15%. Vaginal delivery was preferred, and the second stage of labor was cut short with either outlet forceps or the vaccum cup. LSCS under regional anesthesia for obstetric indications was well tolerated. 31% of newborns were of low birth weight (

The Association of Cervical Length, Bacterial Vaginosis, Urinary Tract Infection and Premature Rupture of Membranes to The Imminent Preterm Labour

Background: Research conducted at the Central General Hospital (RSUP) Dr. Kariadi Semarang in 2013 stated that out of 1,719 deliveries, 82 (5%) were preterm labor cases. Although there are many predictors for predicting imminent preterm labour, the complete prediction and prevention have not been established. Prevention of preterm labor through screening is the key to antenatal care. Good early prediction on a premature labor will provide adequate antenatal surveillance and special interventions.Objective: to analyze the relationship between cervical length, bacterial vaginosis, urinary tract infections, and premature rupture of membranes with the incidence of preterm labor.Methods: It is an observational analytic study in the form of the design of cross sectional with subject of pregnant women who experienced imminent preterm labour at gestational age 28-34 weeks and were treated at the ward of Obstetrics Gynecology Hospital Dr. Kariadi Semarang and network hospital during the study period (n=112). Subjects were assessed for the clinical risk (BV, premature rupture of the membrane, urinary tract infection) and sonography (cervical length). Statistical analysis was performed with paired t-test for normally distributed data and Mann Whitney if otherwise. Analysis of the relationship between variables and the incidence of preterm labor was carried out by the X 2 testResults: From 112 subjects, it was found that the Prevalence Ratio (PR) for cervical length, bacterial vaginosis, urinary tract infections and premature rupture of membranes to the incidence of imminent preterm labor was 2.2;2.32;1.99 and 2.36 respectively. From the multivariate analysis, it was found that bacterial vaginosis and premature rupture of membranes were the most influencing factors for the incidence of imminent premature labor with Odd Ratios of 6.497 and 21.362, respectively.Conclusion: There is a relationship between cervical length (≤25 mm ), bacterial vaginosis, urinary tract infections and premature rupture of membranes in the incidence of preterm labor.

Differences of maternal leukocyte count in premature rupture of membranes and preterm premature rupture of membranes

Background: Premature rupture of membranes (PROM) is rupture of membranes amniotic membrane prior to the labor. PROM is associated with an increased incidence of preterm labor and infection.Aim: To compare maternal leukocyte count in premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM)Methods: This cross-sectional design was conducted at Dr. Kariadi General Hospital Medical Center and Kartini General Hospital Jepara from September 2019 to January 2020. The study sample was pregnant women with premature rupture of membranes that came to Emergency Department. Samples were divided into two groups, PROM and PPROM. All samples were subjected to leukocyte count examination.Results: This study has a total of 40 samples, with 20 samples each. In PROM, 8 (40%) leukocytosis and 12 (60%) were normal, while in PPROM 7 (35%) leukocytosis and 13 (65%) were normal. There were no significant differences in maternal leukocyte levels in PROM and PPROM (p=0.229).Conclusion: There were no significant differences in maternal leukocyte levels in PROM and PPROM.

Analisis Faktor Sosiodemografi Kejadian Persalinan Preterm di RSUP Dr. Mohammad Hoesin Palembang Tahun 2019

Preterm labor is delivery that occurs less than 37 weeks or 259 days after gestation or birth weight of the fetus of less than 2,500 grams. Sociodemographic factors influence the implementation of preterm labor. This study aims to determine the relationship between sociodemographic factors including age, occupation, education, maternal smoking and alcohol habits on the incidence of preterm labor at Dr. Mohammad Hoesin Central Hospital Palembang in 2019. This research is a quantitative study using a cross sectional design with a sample size of 317 respondents with a systematic random sampling technique. Data collection was done by viewing and recording maternal data in medical records, on variables of maternal age, maternal occupation, smoking habits, drinking alcohol habits and preterm labor using a checklist designed by the researcher. This research was conducted at Dr. Mohammad Hoesin Central Hospital Palembang from July to August 2020. Data were analyzed using the chi square test. The results of the analysis showed that there was a relationship between maternal occupation and the incidence of preterm labor (p value = 0.045 &lt;0.05) with an OR value of 0.528, meaning that working mothers had a 0.528 times more risk of experiencing preterm labor than non-working mothers. Simple logistic regression analysis concluded that working mothers had a risk of experiencing preterm labor by 63,94%. Of the five sociodemographic factors measured in this study, maternal occupational factors have a relationship between incidence of preterm labor. These results can be used as a basis for information on promotional measures and to prevent the incidence of preterm labor.

COMMON PREGNANCY COMPLICATIONS IN RELATION TO VITAMIN D DEFICIENCY

Background: Maternal vitamin D deficiency is a widespread public health problem as the prevalence of inadequate and deficient vitamin D status in pregnant women ranges from 5 to 84% globally. Objective: To assess risk factors for vitamin D deficiency and investigate the relation between maternal vitamin D level, and development of gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, and preterm labor. Patients and methods: Our prospective observational study included 100 pregnant women divided into 2 equal groups: group A had insufficient vitamin d level and group B had sufficient vitamin D level in serum with no risk factors. Vitamin D levels were measured on the MiniVidas (Biomerieux, France). Results: The incidence of preterm labor was 22%. There was a statistically significant association between hypovitaminosis D and preterm labor. There was no significant association between hypovitaminosis D and gestational diabetes mellitus, gestational hypertension and intrauterine growth retardation. Conclusion: There was an association between hypovitaminosis D in pregnancy and preterm deliveries, No association between vitamin D deficiency and common pregnancy complications as gestational diabetes, gestational hypertension and intra uterine growth retardation.

COMMON PREGNANCY COMPLICATIONS IN RELATION TO VITAMIN D DEFICIENCY

Background: Maternal vitamin D deficiency is a widespread public health problem as the prevalence of inadequate and deficient vitamin D status in pregnant women ranges from 5 to 84% globally. Objective: To assess risk factors for vitamin D deficiency and investigate the relation between maternal vitamin D level, and development of gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, and preterm labor. Patients and methods: Our prospective observational study included 100 pregnant women divided into 2 equal groups: group A had insufficient vitamin d level and group B had sufficient vitamin D level in serum with no risk factors. Vitamin D levels were measured on the MiniVidas (Biomerieux, France). Results: The incidence of preterm labor was 22%. There was a statistically significant association between hypovitaminosis D and preterm labor. There was no significant association between hypovitaminosis D and gestational diabetes mellitus, gestational hypertension and intrauterine growth retardation. Conclusion: There was an association between hypovitaminosis D in pregnancy and preterm deliveries, No association between vitamin D deficiency and common pregnancy complications as gestational diabetes, gestational hypertension and intra uterine growth retardation.

Use of Remifentanil for Open in utero Fetal Myelomeningocele Repair Maintains Uterine Relaxation with Reduced Volatile Anesthetic Concentration

Introduction: Open fetal repair of myelomeningocele (MMC) is an option for prenatally diagnosed spina bifida. Historically, high-dose volatile anesthetic was used for uterine relaxation but is associated with fetal cardiovascular depression. We examined the impact of administering a supplemental remifentanil infusion on the concentration of inhaled anesthetic required for intraoperative uterine relaxation. Methods: We retrospectively analyzed 22 consecutive patients who underwent open fetal MMC repair with desflurane anesthesia from 2014 to 2018. The anesthetic protocol was modified to include high-dose opioid with remifentanil in 2016. We examined intraoperative end-tidal desflurane concentrations, vasopressor use, incidence of umbilical artery Doppler abnormalities, and incidence of preterm labor and delivery. Results: Patients (n = 11) who received desflurane and remifentanil (Des/Remi) were compared to patients (n = 11) who received desflurane (Des) alone. Intraoperatively, the maximum end-tidal desflurane required to maintain uterine relaxation was lower in the Des/Remi group (7.9 ± 2.2% vs. 13.1 ± 1.2%, p < 0.001). The mean phenylephrine infusion rate was also lower in the Des/Remi group (36 ± 14 vs. 53 ± 10 mcg/min, p = 0.004). Discussion: Use of opioid with supplemental remifentanil was associated with lower volatile anesthetic dosing and decreased vasopressor use; fetal outcomes were not different. Remifentanil may allow for less volatile anesthetic use while maintaining adequate uterine relaxation.

Role of Ultrasonographic Evaluation of Cervical Features and Myometrial Thickness in Prediction of Preterm Birth

Background: Spontaneous preterm birth is the leading cause of neonatal mortality as more than one million die because of pre-term birth. Premature neonates who survive have significantly higher risk of developing serious complications such as cardiovascular, respiratory dysfunction, motor and intellectual deficiencies. Objective: The aim of our study is to evaluate the role of ultrasonographic measurement of myometrial thickness, cervical length, presence of funneling and cervical position in prediction of preterm labor. Study Design: Our prospective observational study included a sample of 100 pregnant women divided into 2 groups, group A (50 pregnant women who had previous preterm labor) and group B (50 low risk pregnant women).The myometrium thickness was measured by transabdominal ultrasound at 4 different sites low anterior, mid anterior, fundal and posterior. Transvaginal ultrasound was performed to assess cervical length, presence of funneling and cervical position. Results: The incidence of preterm labor was 18%. There was a statistically significant association between the presence of positive history of previous abortion and the risk of preterm birth. The cervical length measured at 20-24 weeks was significantly shorter in spontaneous preterm birth women in comparison to women who delivered at full term. Conclusion: At 20-24 weeks of gestation, transvaginal cervical length measurement is the best predictor. A posterior uterine thickness ≤6.0 (mm) had highest diagnostic characteristics in predicting preterm delivery among risky group. Cervical position was found insignificant in prediction of preterm birth. Keywords: Cervical length, preterm birth, myometrial thickness, cervical position.

Study on Effect of Magnesium Sulfate as Tocolytic Agent

We face many problems in diagnosis, monitoring and adopting treatment policy.There are very limited studies about preterm labour prevention in our country and few national data are available about the incidence of preterm labour. Acute tocolysis prevents preterm labor for 48 hours, which is the critical period for antenatal steroid administration or maternal transfer to perinatal centers to improve neonatal outcomes. This prospective study was conducted. To determine the effectiveness of magnesium sulfate as tocolytic agent in preterm labour to arrest the premature onset of labour. A total of 90 primigravid and multigravid with preterm labour was included in this study at 250 Beded General Hospital Tangail from January 2012 to December 2015. The mean age of the respondents was 24.13±4.67 year. The mean systolic and diastolic blood pressure were 122.47±12.64 and 71.67±12.67 mm of Hg respectively. Gestational age did not influence on the outcome of treatment with Tocolytic regime. Out of 90 pregnant women, 70% were anemic, 53.3% had vaginal bleeding and 76.7% had abdominal pain. Among 90 respondents only 6 women had premature rupture of membrane and about 40% had inadequate amniotic fluid. The three treatment regime (Antibiotic+ Tocolytic+ steroid) was found indifferent in terms of affectivity. Preterm labour is not a very uncommon pregnancy-related complication. This study evaluates, the effect of magnesium sulphate as tocolytic agent. Bangladesh Med J. 2020 May; 49(2) : 25-29

Faktor Risiko Kelahiran Prematur di RSUD Dr. M. Soewandhi Surabaya pada Tahun 2017

Pendahuluan: Persalinan prematur adalah salah satu penyebab terbesar dari kematian neonatal yang ditentukan oleh berbagai faktor risiko. Tujuan: Mengetahui pengaruh usia ibu, paritas, riwayat persalinan prematur, kehamilan ganda dan komplikasi kehamilan terhadap kejadian persalinan prematur. Metode: Penelitian dilakukan dengan metode kasus kontrol secara retrospektif dengan data dari rekam medis ibu yang melakukan persalinan di RSUD Dr. M. Soewandhi pada tahun 2017. Hasil: Analisis menunjukkan hubungan yang signifikan antara usia ibu (p = 0,004), riwayat persalinan preterm (p = 0,006) dan komplikasi kehamilan (p &lt;0,001) dengan kejadian persalinan preterm. Berdasarkan analisis multivariat, ibu berusia &lt;20 dan&gt; 35 tahun berisiko 3,510 (95% CI 1,481-8,230) kali, dan ibu yang mengalami komplikasi kehamilan berisiko 5,203 (95% CI 2,248-12,040) kali mengalami persalinan prematur.Kesimpulan: Faktor usia ibu dan komplikasi kehamilan merupakan faktor-faktor yang dapat meningkatkan risiko persalinan premature. Faktor-faktor ini perlu diberikan perhatian khusus saat menilai kehamilan sehingga persalinan prematur dapat dicegah.