Post-term Research Articles

Pre- and Post-Sexual Maturity Liver-specific ERα Knockout Does Not Impact Hepatic Mitochondrial Function.

Compared with males, premenopausal women and female rodents are protected against hepatic steatosis and present with higher functioning mitochondria (greater hepatic mitochondrial respiration and reduced H2O2 emission). Despite evidence that estrogen action mediates female protection against steatosis, mechanisms remain unknown. Here we validated a mouse model with inducible reduction of liver estrogen receptor alpha (ERα) (LERKO) via adeno-associated virus (AAV) Cre. We phenotyped the liver health and mitochondrial function of LERKO mice (n = 10-12 per group) on a short-term high-fat diet (HFD), and then tested whether timing of LERKO induction at 2 timepoints (sexually immature: 4 weeks old [n = 11 per group] vs sexually mature: 8-10 weeks old [n = 8 per group]) would impact HFD-induced outcomes. We opted for an inducible LERKO model due to known estrogen-mediated developmental programming, and we reported both receptor and tissue specificity with our model. Control mice were ERαfl/fl receiving AAV with green fluorescent protein (GFP) only. Results show that there were no differences in body weight/composition or hepatic steatosis in LERKO mice with either short-term (4-week) or chronic (8-week) high-fat feeding. Similarly, LERKO genotype nor timing of LERKO induction (pre vs post sexual maturity) did not alter hepatic mitochondrial O2 and H2O2 flux, coupling, or OXPHOS protein. Transcriptomic analysis showed that hepatic gene expression in LERKO was significantly influenced by developmental stage. Together, these studies suggest that hepatic ERα is not required in female protection against HFD-induced hepatic steatosis nor does it mediate sexual dimorphism in liver mitochondria function.

The Use of Off-label and Unlicensed Drugs for Neonates: A Report from a Teaching Hospital in Baghdad

Background: Neonates who are admitted to hospitals will need various drugs. The use of unlicensed or off-label drugs without scientific evidence makes this exposure unsafe. Aim of study: We aimed to assess the use of drugs for neonates based on the British National Formulary for Children and IBM Micromedex Neofax. Patients and methods: This is a descriptive study which reviewed the clinical files of enrolled neonates who have stayed in the hospital for more than 24 hours and received at least one drug. It was conducted in the neonatal care unit of the Children Welfare Teaching Hospital/ Medical City Complex in Baghdad during the period from 1st of January to 30th of June/2018. The data was entered on a predesigned format and analyzed by using the appropriate statistical methods. Results: A total number of 1079 neonates were admitted to the NCU during the study period, of whom 967 were included in the current study with 597 (61.7%) males and 370 (38.3%) females. There were 424 (43.8%) preterm, 496 (51.3%) term and post term neonates, and 47 (4.9%) neonates with unknown gestational age. Different classes of drugs were used with a total of 56 drugs, of which 33.9% were unlicensed and 66.1% were off-label. Accordingly, 42.5% of the neonates received unlicensed drugs and almost all patients received at least one off-label drug. Major risk factors for such use include mechanical ventilation, male sex and prolonged hospitalization. Conclusions: In hospitalized neonates, drugs were more frequently prescribed as an off-label rather than unlicensed. Almost all neonates were exposed to off-label formulations.

Longer duration of gestation in term singletons is associated with better infant neurodevelopment

BackgroundLonger gestation at term and post-term age is associated with increased perinatal mortality. Nonetheless, recent neuroimaging studies indicated that longer gestation is also associated with better functioning of the child's brain. Aimsto assess whether longer gestation in term and post-term (in short: term) singletons is associated with better infant neurodevelopment. Study designcross-sectional observational study. SubjectsParticipants were all singleton term infants (n = 1563) aged 2–18 months of the IMP-SINDA project that collected normative data for the Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). The group was representative of the Dutch population. Outcome measuresTotal IMP score was the primary outcome. Secondary outcomes were atypical total IMP scores (scores <15th percentile) and SINDA's neurological and developmental scores. ResultsDuration of gestation had a quadratic relationship with IMP and SINDA developmental scores. IMP scores were lowest at a gestation of 38·5 weeks, SINDA developmental scores at 38·7 weeks. Next, both scores increased with increasing duration of gestation. Infants born at 41–42 weeks had significantly less often atypical IMP scores (adjusted OR [95 % CI]: 0·571 [0·341–0·957] and atypical SINDA developmental scores (adjusted OR: 0·366 [0·195–0·688]) than infants born at 39–40 weeks. Duration of gestation was not associated with SINDA's neurological score. ConclusionsIn term singleton infants representative of the Dutch population longer gestation is associated with better infant neurodevelopment scores suggesting better neural network efficiency. Longer gestation in term infants is not associated with atypical neurological scores.

Progestogen maintenance therapy for prolongation of pregnancy after an episode of preterm labour: A systematic review and meta-analysis.

Evidence for progestogen maintenance therapy after an episode of preterm labour (PTL) is contradictory. To assess effectiveness of progestogen maintenance therapy after an episode of PTL. An electronic search in Central Cochrane, Ovid Embase, Ovid Medline and clinical trial databases was performed. Randomised controlled trials (RCT) investigating women between 16+0 and 37+0 weeks of gestation with an episode of PTL who were treated with progestogen maintenance therapy compared with a control group. Systematic review and meta-analysis were conducted. The primary outcome was latency time in days. Secondary neonatal and maternal outcomes are consistent with the core outcome set for preterm birth studies. Studies were extensively assessed for data trustworthiness (integrity) and risk of bias. Thirteen RCT (1722 women) were included. Progestogen maintenance therapy demonstrated a longer latency time of 4.32 days compared with controls (mean difference [MD] 4.32, 95% CI 0.40-8.24) and neonates were born with a higher birthweight (MD 124.25 g, 95% CI 8.99-239.51). No differences were found for other perinatal outcomes. However, when analysing studies with low risk of bias only (five RCT, 591 women), a significantly longer latency time could not be shown (MD 2.44 days; 95% CI -4.55 to 9.42). Progestogen maintenance therapy after PTL might have a modest effect on prolongation of latency time. When analysing low risk of bias studies only, this effect was not demonstrated. Validation through further research, preferably by an individual patient data meta-analysis is highly recommended.

Maternal and Fetal Outcome between Dated and Post-dated Pregnancy: A Comparative Study Conducted in a Tertiary Care Hospital

This prospective observational comparative study was conducted in department of Obstetrics and Gynaecology (OBGyn) of Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka. It was carried out from April 2019 to September 2019. The objectives was to compare the feto-maternal outcome of postdated pregnancy (40+1- 41+6 weeks) with pregnancy at term(37-40 weeks). Pregnant women admitted in ShSMCH with or without labour pain were considered as study population. Following ethical clearance from the local ethical committee and written informed consent, 59 cases of post-dated pregnancy (case) and 59 cases of term pregnancy (control) were included inthis study. Cases and control were selected by random sampling method according to inclusion and exclusion criteria. Inclusion criteria were: 1) Patients who have excellent EDD(dated by early ultrasonogram) , 2) Patients having regular menstrual cycle prior to present pregnancy and can remember exact LMP, 3) Postdated pregnancy as case and pregnancy at term as control. Exclusion criteria were: 1) Patients with eclampsia, systemic hypertension, heart disease, diabetes mellitus and renal disease, 2) Patients with multiple gestation and any congenital anomaly, 3) Pregnancy occurred during lactational amenorrhoea, 4) Pregnancy with veneral disease, 5) pregnancy with blood group incompatibility. Data were collected with a pre-designed structured questionnaire. A full assessment were done by history[age, occupation, menstrual and obstetric history, medical, surgical and family history, antenatal care(ANC)], physical examination (general, abdominal and vaginal) and ultrasonogram (USG) to assess gestational age and liquor volume. After proper counselling, induction of labour given to patients without labour pain and fetal distress. Mode of delivery, post-delivery maternal and fetal outcome and complication were recorded.This study showed that maximum number of patients in term pregnancy (control) belonged to age group (21-30 years) [control 71.2%, case 62.7%] and in post-dated pregnancy (case) belonged to &gt;30 years [control 15.5%, case 23.7%]. In both groups, maximum number of women were housewives, control 48(81.4%), case 46(78%) and service-holder 11(18.6%) in control, 13 (22%) in case. In control group 36 (61%) were primi-gravida and 23 (39%) were multi-gravida. In case group 29(49.2%) were primi-gravida, 30(50.8%) multi-gravida. Family history of post-dated pregnancy were present in 14(23.7%) of control group and 13(22%) of case group. Most of the women of both control (93.2%) and case (89.8%) received regular ANC. Large fetus were seen in 6(10.2%) of control and 9(15.3%) of case group. Vertex was common presenting feature in both control (94.9%) and case (88.1%). Liquor volume was adequate in maximum number of women of both control (69.5%) and case (62.7%) group. Uterine irritability was present in 16(27.1%) of control and 17 (28.8%) of case group. Associated complication, such as CPD and elderly primi were present in 10 (16.9%) of control and 9 (15.3%) of case group. Induction of labour was required in 33(55.9%)of control and 41 (69.5%) of case group. Normal vaginal delivery was achieved in 41 (69.5%) of control and in 33 (55.9%) of case group women. LSCS required in 18 (30.5%) of control and 25 (42.4%) of case group women. Cause of LSCS is fetal distressin (54.5%) of control and (42.4%) of case group. Post-operative complication were more in case (16.9%), versus (3.4%) in control. Fetal complication were more in case group (22%), versus control (6.8%) regarding birth asphyxia, RDS, neonatal jaundice, neonatal septicemia, meconium aspiration syndrome, macrosomia and neonatal death. So this study showed that maternal and fetal perinatal morbidiy were quite high in post-dated pregnancy. There is scope for further improvement of clinical care practices of post-dated pregnant womenwith acceptable maternal and fetal outcome. J Shaheed Suhrawardy Med Coll 2021; 13(2): 130-136

The impact of cerclage placement on gestational length in women with premature cervical shortening.

Cervical insufficiency (CI) is a condition consistent with painless cervical dilatation that can lead to preterm delivery. Cervical cerclage is a procedure in which cervical suture is performed for preventing preterm labor in several indications. Late emergency cerclage is technically more challenging compared to elective cerclage, performed earlier during pregnancy, prior to cervical changes. Pregnancy outcomes with emergency cerclage were found to be improved in previous reports, but there is still inconclusive data. To assess the effectiveness and safety of emergency cerclage vs. conservative management with progesterone and/or bed resting, in preventing preterm birth and improving neonatal outcomes in women with clinically evident cervical insufficiency. This is a retrospective cohort study conducted on all women diagnosed with cervical insufficiency between the 16th and 24th gestational week who met the inclusion criteria, from January 2012 to December 2018. Obstetric and neonatal outcomes: time from diagnosis to delivery, duration of pregnancy, birth weight and Apgar score, were compared between women who underwent cerclage and those who treated conservatively. Twenty eight women underwent emergency cerclage (cerclage group) and 194 managed with a conservative therapy, progesterone and/or bed rest (control group). Time from diagnosis to delivery 13 weeks vs. 8weeks and birth weight 2,418 g vs. 1914 g were significantly higher in the first cohort. Average pregnancy duration was three weeks longer in the cerclage group, but that was not significant. No complications occurred in the cerclage group and no difference in mode of delivery were found. Emergency cerclage is an effective and safe procedure in preventing preterm birth and prolongation of pregnancy, in women with cervical insufficiency in the late second trimester.

A Case of Pregnant Uterus Perforation During Laparoscopy

RELEVANCE Pregnant uterus perforation during laparoscopy is a rare complication, accompanied by a higher risk of infection and miscarriage. Clinical management of pregnancy and its outcome have practical interest and need discussion.AIM To provide a clinical case of pregnant uterus perforation during laparoscopy.MATERIAL AND METHODS Patient L., 34 years old, with a tumor of the right ovary and 21–22 weeks of pregnancy. Result The article describes a clinical case of independent childbirth on time after pregnant uterus perforation during laparoscopy with removing a significant volume of amniotic fluid in a 21–22 weeks pregnant woman.CONCLUSION The prolongation of pregnancy and independent childbirth on time after uterus perforation with a gestation period of 21 or 22 weeks is possible in case of timely diagnosis of the complication, careful restoration of uterine integrity and rational management of the postoperative period.

A RETROSPECTIVE STUDY OF PREVALENCE AND MAJOR INDICATIONS OF CESAREAN SECTION IN A TERTIARY CARE HOSPITAL IN INDIA

According to the World Health Organisation (WHO), a caesarean section is a surgical procedure that can save the life of a woman and her baby when undertaken for medical reasons. Thus, the procedure should only be used in complicated pregnancies. However, C-sections have gradually become common in developing countries, and it is already quite common in the developed countries for a long time. A number of obstetric complications such as dystocia, foetal distress, breech births, post-term pregnancy, multiple pregnancy, and pregnancy-induced hypertension are recognized as reasonable motives behind caesarean section deliveries. Approximately 18.5 million caesarean births have been recorded each year globally, accounting for 19.1% of total births, which is beyond the cut-off recommended by the World Health Organization (WHO). In India, the rate of caesarean section delivery is dramatically increased from 3% in 1992–93 to 17% in 2015–16. In terms of regional variations, south Indian states have recorded substantially higher levels of caesarean deliveries in comparison to north India. Despite several studies that have investigated the factors contributing to caesarean section delivery, systematic evidence is still lacking towards understanding the determining factors and formulating effective policies to address the increasing rate of caesarean section deliveries in India. With this backdrop, this study attempts to observe the major indications and prevalence of caesarean section among pregnant women in a tertiary care hospital in India

Prolongation of Pregnancy in Patients with HELLP Syndrome Using Methylprednisolone: A Retrospective Multicentric Analysis.

Immediate delivery is an established concept for preventing life-threatening complications in mothers with HELLP syndrome; however, it is associated with preterm births. Cases of HELLP syndrome diagnosed at the university hospitals of Halle and Magdeburg (Germany) were analyzed retrospectively. Each patient of the treatment group was administered 64 mg of methylprednisolone (MP) intravenously for 10 days, with the dosage being reduced by 50% every other day in patients from Halle (n = 65). Almost immediate delivery was performed in the control groups (n = 45, Halle; n = 28, Magdeburg). Pregnancies in the treatment group were prolonged by 4 days (median 1-55 days). The platelet counts increased from 76,060 ± 22,900/μL to 117,430 ± 39,065/μL in the MP group compared with an increase from 66,500 ± 25,852/μL to 83,430 ± 34,608/μL in control group 1 and from 78,890 ± 19,100/μL to 131,080 ± 50,900/µL in control group 2 (p < 0.001). Severe neonatal complications were significantly reduced in the treatment group (p < 0.05): sepsis, 9.25% vs. 24%; ventilation, 44.6% vs. 46.5%; and infant death, 1.6% vs. 8.6%. In a selected collective of patients with HELLP syndrome, prolongation of pregnancy using MP treatment improved maternal and neonatal outcomes.

Recurrence of post-term pregnancy and associated factors among women who delivered at Kilimanjaro Christian Medical Centre in northern Tanzania: A retrospective cohort study.

Post-term pregnancy is a health problem of clinical importance and; tends to recur in subsequent pregnancies. Maternal age, height, and male fetal sex are risk factors associated with Post-term pregnancy. The study aimed to determine the recurrence risk of post-term pregnancy and associated factors among women delivered at KCMC referral hospital. This retrospective cohort study used KCMC zonal referral hospital medical birth registry cohort data for 43472 women delivered between 2000 and 2018. Data were analyzed using STATA version 15 software. Log-binomial regression with robust variance estimator determined the factors associated recurrence of post-term pregnancy adjusted for other factors. A total of 43472 women were analyzed. The proportion of post-term pregnancy was 11.4%, and the recurrence was 14.8%. The recurrence risk of post-term pregnancy was increased when a woman had a history of previous post-term pregnancy (aRR: 1.75; 95%CI: 1.44, 2.11). Advanced maternal age, i.e., ≥35years (aRR: 0.80; 95%CI: 0.65, 0.99), having secondary and higher education (aRR: 0.8; 95%CI: 0.66, 0.97), and being employed (aRR: 0.68; 95%CI: 0.55, 0.84) decreased the recurrence risk of post-term pregnancy. Women with recurrence of post-term pregnancy had a higher risk of delivering newborns weighed ≥4000gm (aRR: 5.05; 95% CI: 2.80, 9.09). Post-term pregnancy is associated with recurrence risk in subsequent pregnancies. A history of previous post-term pregnancy is associated risk factor and these women are at increased risk of delivering newborns weighed ≥4000gm. Clinical counselling of women at risk of post-term pregnancy and timely management is recommended to prevent adverse neonatal and maternal outcomes.

CLINICAL PROFILE OF POLYCYTHEMIA IN SMALL FOR GESTATIONAL AGE NEONATES ADMITTED TO THE NEONATAL INTENSIVE CARE UNIT OF A TERTIARY CARE HOSPITAL

Background:-Polycythemia is the principal cause of hyperviscosity of blood in neonates and is associated with serious, sometimes life threatening complication of the brain, heart, kidney, lungs and intestines. The incidence is high in small for gestational age neonates. To assess the incidence, clinical prole of Aim:- polycythemia among Inborn small for gestational age newborns admitted in the Neonatal Intensive Care Unit of Jorhat Medical College and Hospital. Objectives:-To determine the incidence of polycythemia among small for gestational babies admitted in the Neonatal Intensive Care Unit of Jorhat Medical College &amp; Hospital, and to assess the pattern of clinical manifestations and complications attributable to polycythemia. Method:-130 consecutive small for gestational age inborn babies admitted into the NICU of Jorhat Medical College and Hospital, Jorhat during the period of 1 year from May 2021 to April 2022 were screened for polycythemia at 2 - 4 hours of postnatal age using venous hematocrit. The newborns were considered polycythemic if the venous hematocrit was ≥65%. The incidence of polycythemia in small for gestational age was 31.5% Results:- (41 out of 130 babies). Among the 130 small for gestational age babies, 57 were preterm,49 were term and 24 were post term. The incidence of polycythemia was 29.2%in preterm, 36.7 % in term and 24.3% in post term babies. Among the polycythemic babies, icterus(70.7%) was the commonest clinical manifestation followed by lethargy (60.9%) and tachypnoea (36.5%).Hyperbilirubinemia (70.7%) was the commonest laboratory abnormality followed by thrombocytopenia(63.4%), hypokalemia (17.07%) , hypernatraemia (9.7%), hypoglycaemia (7.3%) , hypocalcemia (7.3%), hyperkalemia (4.8%) and hyponatremia (2.4%).39 babies underwent partial exchange transfusion with normal saline for correction of polycythemia. There was improvement in clinical features and hematocrit levels following partial exchange transfusion. Two asymptomatic babies did not undergo partial exchange transfusion and were managed conservatively. Conclusion:-Polycythemia is a silent clinical condition which if unrecognized can result in signicant morbidity in neonates. As incidence is high in small for gestational age newborns, these babies must be actively screened for its timely detection and management in order to prevent complications attributable to polycythemia-hyperviscosity syndrome. Key words:- Neonatal polycythemia, small for gestational age, Hematocrit, Partial exchange transfusion

Study of Postdatism with Respect to Fetomaternal Outcome at A Tertiary Care Hospital

OBJECTIVES This study aims to know our setup’s fetomaternal pregnancy complications that extend beyond 40 weeks of gestation. METHODOLOGY This is a prospective cross-sectional study of 390 patients with uncomplicated postdated pregnancies fulfilling the inclusion and exclusion criteria admitted to the department of Obstetrics and Gynecology (both in spontaneous labour and induced patient) at Hayatabad Medical Complex, a tertiary care hospital in Peshawar, KPK from July 2020 to June 2021.RESULTS Out of 390 patients, a majority (72.30 %) were in the age group of 20 – 35 years. Most of them (50.51%) presented at gestation 40+1 – 40+6 weeks. The majority (57.69%) were multigravida, and most (93.07%) were un-booked. Most delivered vaginally (80.51%), and 19.48% had C/section (including both emergency and elective). The most common indication for C/section was fetal distress (44.73%), followed by C/section on demand (18.42%). The majority&gt;90% had Apgar score greater than seven at 5 minutes which was gestation dependent. Overall perinatal mortality was 4.07% which was also gestation dependent ranging from 0.5% at 40+1 – 40+6 weeks to 2.30% at and beyond 42 weeks of gestation. Neonatal morbidity in the form of Birth asphyxia, Meconium Aspiration Syndrome (MAS), Shoulder Dystocia and NICU admission also showed an increasing tendency with increasing gestation beyond 40 weeks. Maternal morbidity in the form of PPH, perineal tears 3°/4° and endometritis also showed a similar increasing trend with increasing gestation beyond 40 weeks. CONCLUSION Pregnancy continuing beyond 40 weeks has a definite risk to the fetus.

Failed induction of labor in term nulliparous women with an unfavorable cervix: Comparison of cervical ripening by two forms of vaginal prostaglandins (slow-release pessary and vaginal gel).

To compare the rate of failed induction after cervical ripening by two forms of vaginal prostaglandins. This two-year retrospective study (January 1, 2016, through December 31, 2017) in two tertiary maternity units included nulliparous women with a singleton fetus in cephalic presentation and an unfavorable cervix requiring labor induction for prolonged pregnancy. The principal endpoint was the rate of failed induction, defined by the performance of a cesarean delivery before 6 cm of dilation. Cervical ripening was initiated by prostaglandins for 24h, using a slow-release pessary (unit A) or a vaginal gel (unit B). The care protocol of the two groups after the first 24h were similar. The women's individual characteristics were compared between the two units. The rates of failed induction were then compared between the two units, first by univariate and then by multivariable analysis adjusted for the characteristics that differed significantly between the units. Among the 17,217 women delivered in the two maternity units during the study period, 178 met our inclusion criteria (125 in unit A (slow-release pessary) and 53 in unit B (vaginal gel)). The rate of failed induction was similar: 21.6% in unit A (slow-release pessary) and 17.0% in unit B (vaginal gel) (P=0.48). The multivariate analysis did not show any difference about failed induction, time from the onset of induction to delivery, and vaginal delivery rate within 24h. The rate of failed induction of labor did not differ between slow-release pessary and vaginal gel.

Biomechanisms of cervical remodeling and current approaches to maturity assessment

The cervical remodeling process is unique and consists of softening, ripening, dilation at fetal birth, and repair to the original state, which is a dense long tubular structure. In this review, the problem of impaired cervical remodeling is discussed in both preterm birth and delayed transformation, which leads to the unpreparedness of the cervix for childbirth and prolongation of pregnancy. Histological, immunological and structural dynamic changes in the cervix begin long before delivery and are noted as early as the first trimester of gestation. There are a few ways to assess the maturity of the cervix. In the second and third trimester, in order to predict preterm birth, these are ultrasound cervicometry and a cervical phosphorylated insulin-like growth factor binding protein-1 test. At full term, in order to determine its readiness for delivery, this is a palpation assessment. Inadequate assessment of the cervical characteristics is one of the factors of untimely prevention of preterm birth, and at full term leads to inappropriate choice of method of preparation for labor. It is necessary to develop new approaches to the comprehensive assessment of the cervix, using existing methods, and to discover new ways to assess its maturity.&#x0D; In this review, the problem of cervical maturation diagnosis is considered based on literature data from such databases as PubMed, ResearchGate, and Google Scholar, as well as from electronic resources of the M. Gorky Scientific Library (St. Petersburg State University, Russia). This review analyzes data on molecular, biochemical and histophysiological processes occurring during cervical maturation at all stages of gestation.&#x0D; It is generally accepted that the main role in cervical changes at all stages of gestation is played by: collagen fiber restructuring / desorganization, decreased concentrations of collagen and elastin, high molecular weight hylauronic acid cleavage, increased aquaparin level and tissue hydrophilicity, increased cervical vascularization, as well as changes in glycosaminoglycan and matrix metalloproteinase content. Palpatory technique and ultrasound cervicometry are the most common methods of determining the cervical length, which have insufficient sensitivity, probably because they do not cover all pathogenetic pathways of remodeling and cannot assess all cervical characteristics. Improvement of efficiency is possible through the introduction of combined techniques and the use of promising methods such as elastography, ultrasound diagnosis of the cervix with Doppler assessment of its vessels, determination of a disintegrin and metalloprotease with thrombospondin-like repeats-1 and placental 1-microglobulin in cervical secretion, and relaxin in maternal blood.&#x0D; Understanding the molecular, biochemical and histophysiological processes that occur during cervical remodeling is crucial for predicting preterm birth, diagnosing isthmic-cervical insufficiency, understanding the lack of timely cervical readiness, and choosing tactics the method of preinduction and induction of labor if necessary. The lack of clinical methods and their lack of objectivity require a combined approach and the search for new prognostic markers of cervical maturation.

Meconium Aspiration Syndrome: Analysis of Case Report

Introduction: The first stool of a newborn child is meconium. Meconium is a sticky material composed of denuded intestinal epithelium cells, bile acid, amniotic fluid, swallowed lanugo hair, digestive enzymes, water and mucus. Post-term infants are more likely to have meconium-stained amniotic fluid (MSAF). Meconium aspiration syndrome, a leading cause of severe illness and death in newborns, occurs in about 5 per cent to 10 per cent of births. Case study: A newborn male baby was admitted to the Neonatal Care Unit with the chief complaints of Term, vacuum extraction and thick MSAF and Respiratory Distress skin colour was found to be dark green in the chest and dorsal limb of the body. Breath sound was found to be abnormal with grunting sounds on examination with a stethoscope. The patient’s Clinical symptoms include the appearance of skin colour, and breath sound and Chest radiography shows the diagnosis of Meconium Aspiration Syndrome (MAS). The patient was treated with O2 through nasal continuous positive airway pressure, fluid management was based on daily body weight and antibiotics like ampicillin and gentamicin was administered at the time of admission. The Patients caretaker was advised to Kangaroo mother care and direct breastfeeding. Conclusion: Over the years, medication and care for newborns with meconium aspiration have evolved and changed. Prophylactic antibiotic therapy in MAS does not change the prognosis of patients. In newborns with extreme and recurrent hypoxemia caused by MAS, extracorporeal membrane oxygenation (ECMO) has been utilised as a last-resort therapy. Nevertheless, there are still several techniques for preventing and treating meconium aspiration syndrome; therefore research should continue to diminish illness and death caused by Meconium aspiration syndrome.

Association between gestational weight gain and preterm birth and post-term birth: a longitudinal study from the National Vital Statistics System database

BackgroundTo evaluate the association between gestational weight gain (GWG) and preterm birth and post-term birth.MethodsThis longitudinal-based research studied singleton pregnant women from the National Vital Statistics System (NVSS) (2019). Total GWG (kg) was converted to gestational age-standardized z scores. The z-scores of GWG were divided into four categories according to the quartile of GWG, and the quantile 2 interval was used as the reference for the analysis. Univariate and multivariate logistic regression analyses were performed to investigate the association between GWG and preterm birth, post-term birth, and total adverse outcome (preterm birth + post-term birth). Subgroup analysis stratified by pre-pregnancy body mass index (BMI) was used to estimate associations between z-scores and outcomes.ResultsOf the 3,100,122 women, preterm birth occurred in 9.45% (292,857) population, with post-term birth accounting for 4.54% (140,851). The results demonstrated that low GWG z-score [odds ratio (OR): 1.04, 95% confidence interval (CI): 1.03 to 1.05, P < 0.001], and higher GWG z-scores (quantile 3: OR: 1.42, 95% CI: 1.41 to 1.44, P < 0.001; quantile 4: OR: 2.79, 95% CI: 2.76 to 2.82, P < 0.001) were positively associated with preterm birth. Low GWG z-score (OR: 1.18, 95% CI: 1.16 to 1.19, P < 0.001) was positively associated with an increased risk of post-term birth. However, higher GWG z-scores (quantile 3: OR: 0.84, 95% CI: 0.83 to 0.85, P < 0.001; quantile 4: 0.59, 95% CI: 0.58 to 0.60, P < 0.001) was associated with a decreased risk of post-term birth. In addition, low GWG z-score and higher GWG z-scores were related to total adverse outcome. A subgroup analysis demonstrated that pre-pregnancy BMI, low GWG z-score was associated with a decreased risk of preterm birth among BMI-obesity women (OR: 0.96, 95% CI: 0.94 to 0.98, P < 0.001).ConclusionOur result suggests that the management of GWG may be an important strategy to reduce the number of preterm birth and post-term birth.

Comparison of the Effectiveness of Oral Progesterone and Micronized Progesterone Pessary in Reducing the Spontaneous Preterm Birth Incidences

Objective: The purpose of this study is to compare the effectiveness of oral progesterone and micronized progesterone pessary in reducing the spontaneous preterm births incidence. Study Design: Randomized controlled trial Place and Duration: Gynaecology and Obstetrics Department of Combined Military Hospital, Peshawar from January 2021 to December 2021. Methods: Total 112 pregnant females were presented in this study. Included females were aged between 18-45 years. After taking informed written consent, detailed demographics of enrolled cases included age, BMI, parity and gestational age was recorded. Females were divided in two groups. Group I received oral progesterone in 56 females and group II received micronized progesterone pessary. Post-operative outcomes among both groups were assessed. SPSS 23.0 was used to analyze all data. Results: Among 112 cases, 35 (31.3%) had age 18-25 years, 45 (40.2%) females had age 26-35 years and 32 (28.6%) cases had age 36-45 years. 64 (57.1%) patients had BMI &lt;25kg/m2 and 48 (42.9%) cases had BMI &gt;25kg/m2. Mean parity in group I was 2.5±1.23 and in group II parity was 1.72±3.16. Mean gestational age of the patients in group I was 33.16±10.42 weeks and in group II mean gestational age was 34.17±8.23 weeks. Frequency of c-section in both groups were higher as compared to vaginal delivery with p value &lt;0.003. Mean time of prolongation of pregnancy in group I was 18.22±6.33 days and in group II mean time was 30.7±5.47 days. We found that micronized progesterone cyclogest pessary was effective in terms of reducing NICU admissions, maternal systemic complications, preterm C-section, tocolysis use, side effects, intraventricular haemorrhage and perinatal mortality as compared to oral progesterone. Conclusion: Preventive micronized progesterone pessary was found to be more effective than oral progesterone (dydrogesterone) in reducing premature birth among women at high-risk of premature delivery. Keywords: Oral Progesterone, Micronized Progesterone Pessary, Preterm Birth, Side Effects

Impaired pulmonary function mediates the impact of preterm birth on later-life stroke: a 2-step, multivariable Mendelian randomization study.

Observational studies have suggested an association between preterm birth and stroke in late adulthood, but it remains unclear whether the association is causal. The purpose of this study was to evaluate the causal effects of gestational age on stroke and to determine the pathophysiological mechanisms underlying the causal associations. Two-sample Mendelian randomization (MR) was performed to assess the causal effects of fetal gestational duration, early preterm birth (EPB), preterm birth, or postterm birth on stroke and its subtypes. Two-step Mendelian randomization (TSMR) and multivariable Mendelian randomization (MVMR) were additionally used to determine the role of common stroke risk factors, including cardiovascular diseases, hypertension, pulmonary impairment, inflammation, and metabolic diseases, in mediating the causal associations between gestational age and stroke and its subtypes. Genetically predicted EPB increased the risk of cardioembolic stroke (CES; odds ratio [OR], 1.115; 95% confidence interval [CI], 1.036 to 1.200; p=0.004) and large artery stroke (LAS; OR, 1.131; 95% CI, 1.031 to 1.241; p=0.009). The TSMR results showed that EPB was associated with a lower forced expiratory volume in the first second and forced vital capacity ratio (FEV1/FVC) (β=-0.020; 95% CI, -0.035 to -0.005; p=0.009), which increased the risk of CES and LAS. Further MVMR analysis showed that the associations between EPB and stroke disappeared after adjustment for FEV1/FVC. Our data demonstrate that EPB is causally associated with an elevated risk of CES and LAS, and that pulmonary dysfunction mediates the causal impact of EPB on CES and LAS.

Urban-rural differences in the pregnancy-related adverse outcome

BackgroundLittle is known about potential urban-rural differences in adverse pregnancy outcomes. The purpose of this study is to look into the urban-rural differences in the trend of adverse maternal and...

Pattern of weight gain in pregnant women and effect on maternal and neonatal outcome in Abuja, Nigeria: A longitudinal multicentre study

Background: Normal pregnancy is usually associated with weight gain. Abnormal weight gain in pregnancy could result in adverse neonatal and maternal outcome. Studies related to this in Nigeria are limited.Objective: The aim was to evaluate the pattern of weight gain in pregnancy and the feto-maternal outcome among women with different body mass indices attending antenatal clinic in the Federal capital territory (FCT).Study design: This was a longitudinal, multicentre study.Materials and Methods: Two hundred and twenty participants were recruited from 6 general hospitals in the FCT. Their body mass indices were calculated and they were categorized as underweight, normal weight, overweight and obese accordingly. They were followed up till 2 weeks postpartum. Maternal outcome sought included gestational hypertension, gestational diabetes and mode of delivery, postpartum haemorrhage, retained placenta and perineal injury. Neonatal outcomes included macrosomia, low birth weight, neonatal hypoglycaemia, shoulder dystocia, stillbirth and admission into special care baby unit (SCBU).Result: The mean age of participants was 28.8 years ±4.7 with parities ranging from 0-8. The majority of them (39%) were overweight. While most of the women (118, 56.2%) had normal weight gain (NWG) in pregnancy, 15(7.1%) had low weight gain (LWG) and 77(36.6%) had high weight gain (HWG). Most (95%) of the HWG was among the overweight and obese women. There was a higher induction rate and postpartum haemorrhage among HWG women and postdate among the obese group. There was no difference in neonatal outcome among the groups.Conclusion: This study demonstrated that HWG and LWG have more adverse pregnancy outcomes than NWG. Younger women (20-24years) with normal BMI at booking tend to gain suboptimal weight in pregnancy. HWG in pregnancy was commoner among overweight and obese women with increased induction of labour and postpartum haemorrhage among them. Post-date pregnancy was higher among the obese group. There was no difference in neonatal outcomes among the groups.