Post-term Research Articles

Maternal and fetal outcomes among women with GDMA1 before and post-date

ObjectiveTo investigate adverse pregnancy outcomes in patients complicated with GDMA1 who delivered at term before or after 40 weeks of gestation. Study DesignA population-based cohort study including all women with GDMA1 during pregnancy was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. ResultsDuring the study period, 11,765 women with GDMA1 met the inclusion criteria.Of these, 1303 (11 %) delivered after 40 weeks (post-date, study group), while 10,462 (89 %) delivered at term before 40 weeks of gestation (before date, control group).Those who delivered after 40 weeks of gestation (the study group) had a significantly lower percent of cesarean deliveries (CD), higher rates of spontaneous vaginal deliveries and induction of labor in comparison to those who delivered before 40 weeks of gestation (the control group). The control group had significantly higher rates of preeclampsia and intrauterine growth restriction than the study group.Using a multivariable logistic regression model, delivery after 40 weeks was noted as an independent protective factor for CD (adjusted OR = 0.78, 95 %CI 0.66–0.92, p value = 0.001). Delivery after 41 + 0 weeks had a significantly higher rate of CD and LGA. ConclusionNo significant increase in adverse pregnancy outcomes at term post-date pregnancies complicated with GDMA1 was demonstrated. Furthermore, there was no increase in the rate of CD with the increase in gestational age until 41 weeks of gestation.

Maternal and pregnancy predictive risk factors for having a compensated maternal injury claim: a Swedish nationwide cohort study

To describe trends and identify maternal and pregnancy predictive risk factors for having a compensated claim for a maternal injury during delivery, as a proxy for having received suboptimal care. This nationwide retrospective cohort study included 1 754 869 births in Sweden between 2000 and 2016, including 4488 maternal injury claims filed with The National Swedish Patient Insurance Company (Löf), of which 1637 were compensated. Descriptive statistics on maternal and pregnancy characteristics, trends in filed/compensated claims over time, and distribution of compensated claims by clinical classification are presented. Characteristics associated with suboptimal care were identified using multivariable logistic regression, with mutual adjustment in the final model. Compensated claims were sorted into 14 clinical classifications (ICD-10 codes for main condition, injury, and causality). Overall, there was a two-fold increase in filed claims from 2000 to 2016, peaking in 2014. The rate of compensated claims only increased marginally, and 36.5% of filed claims were deemed avoidable. Perineal and pelvic floor injuries, as well as medical and diagnostic errors, were responsible for the majority of compensated claims. Women with a previous caesarean section, post term delivery, chronic or gestational disease, > 13 antenatal visits, or a multiple pregnancy had increased risk of having a compensated claim for a maternal injury during delivery. Understanding the risk factors for having a compensated maternal injury claim may guide health workers and maternity wards in improving the quality and organisation of care to reduce the risk of childbirth related injuries.

Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage

Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS. To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery. This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023. Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms. The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters. A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions. In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.

Association of maternal education, neighborhood deprivation, and racial segregation with gestational age at birth by maternal race/ethnicity and United States Census region in the ECHO cohorts.

In the United States, disparities in gestational age at birth by maternal race, ethnicity, and geography are theorized to be related, in part, to differences in individual- and neighborhood-level socioeconomic status (SES). Yet, few studies have examined their combined effects or whether associations vary by maternal race and ethnicity and United States Census region. We assembled data from 34 cohorts in the Environmental influences on Child Health Outcomes (ECHO) program representing 10,304 participants who delivered a liveborn, singleton infant from 2000 through 2019. We investigated the combined associations of maternal education level, neighborhood deprivation index (NDI), and Index of Concentration at the Extremes for racial residential segregation (ICERace) on gestational weeks at birth using linear regression and on gestational age at birth categories (preterm, early term, post-late term relative to full term) using multinomial logistic regression. After adjustment for NDI and ICERace, gestational weeks at birth was significantly lower among those with a high school diploma or less (-0.31 weeks, 95% CI: -0.44, -0.18), and some college (-0.30 weeks, 95% CI: -0.42, -0.18) relative to a master's degree or higher. Those with a high school diploma or less also had an increased odds of preterm (aOR 1.59, 95% CI: 1.20, 2.10) and early term birth (aOR 1.26, 95% CI: 1.05, 1.51). In adjusted models, NDI quartile and ICERace quartile were not associated with gestational weeks at birth. However, higher NDI quartile (most deprived) associated with an increased odds of early term and late term birth, and lower ICERace quartile (least racially privileged) associated with a decreased odds of late or post-term birth. When stratifying by region, gestational weeks at birth was lower among those with a high school education or less and some college only among those living in the Northeast or Midwest. When stratifying by race and ethnicity, gestational weeks at birth was lower among those with a high school education or less only for the non-Hispanic White category. In this study, maternal education was consistently associated with shorter duration of pregnancy and increased odds of preterm birth, including in models adjusted for NDI and ICERace.

Risk factors for prolonged pregnancy beyond 40 weeks

Prolonged and postterm pregnancy at the current stage is one of the urgent problems in the field of obstetrics and gynecology. It is due to both the high frequency of pathological processes during childbirth and in the context of pathological changes occurring with the fetus, which leads to an increase in perinatal mortality. Perinatal mortality rates, depending on literary sources, reach 19%, and neonatal morbidity can be up to 28%. All these complications are associated with poor resistance of the fetus to hypoxia due to increased maturity of brain structures and reduced oxygen supply due to dystrophic and involutional changes in the placenta. Therefore, studying the risk factors for prolonged pregnancy after 40 weeks becomes especially important.Therefore, postterm pregnancy should be considered as a pathological condition arising under the influence of various factors.Aim. To carry out a retrospective analysis of the records of childbirth with prolonged pregnancy for more than 40 weeks and to evaluate the risk factors for the occurrence of this pathology.Material and methods. In order to study the immediate and long-term consequences of the development of the prolongation of pregnancy for more than 40 weeks, we conducted a retrospective study of 100 pregnancy and childbirth cases for 2021-2022 at the Chernivtsi Regional Perinatal Center The standard method of mathematical analysis using Student's criteria, the standard and specialized computer program Libre Office Calc 7.0 was used for statistical processing of the obtained data.Results. In order to identify the risk factors of prolonged pregnancy, a comparative analysis of somatic, obstetrical and gynecological anamnesis, features of pregnancy in 100 women with prolonged and postterm pregnancies was carried out. As can be seen from the data presented in Table 1, no significant difference between the number of young first-borns in the groups was found. The share of young first-borns (up to 20 years old) is somewhat higher in prolonged pregnancies (28% versus 22% in late pregnancies). It is characteristic that there were 1.1 times more patients over 30 years of age in the postterm pregnancy group than in the prolonged pregnancy group (78% and 72%, respectively).Conclusions. The analysis of the somatic and obstetric and gynecological history, as well as the characteristics of the course of the current pregnancy, allows to determine the risk factors that indicate the possibility of the development of a delayed pregnancy.

Concurrent and predictive validity of the Alberta Infant Motor Scale and the Peabody Developmental Motor Scales-2 administered to infants born preterm in Norway

BackgroundThe correlation between the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scales-2 (PDMS-2) has not previously been assessed in Norwegian infants. Our purpose was to investigate the concurrent validity of the AIMS and the PDMS-2 in a group of high-risk infants, and to investigate the predictive validity of the two tests for atypical motor function at 24 months post term age (PTA).MethodsThis is a retrospective study of the AIMS and the PDMS-2 administered to infants born preterm with gestational age ≤ 32 weeks (n = 139) who had participated in a randomized controlled trial of early parent-administered physiotherapy. The infants’ motor development had been assessed using the AIMS and the PDMS-2 at 6- and 12-months. The primary outcome was PDMS-2 at 24-months PTA. To explore the correlation between the two tests we used Spearman’s rho. Bland Altman plots were used to detect if there were systematic differences between the measurements. Receiver-operating characteristics curves were used to calculate area under the curve as an estimate of diagnostic accuracy of the AIMS and the PDMS- with respect to motor outcome at 24 months.ResultsThe correlation between the AIMS and the PDMS-2 (total motor and locomotion subscale), at 6 months, was r = 0.44 and r = 0.76, and at 12 months r = 0.56 and r = 0.80 respectively. The predictive validity for atypical motor function at 24 months, assessed using the area under the curve at 6- and at 12- months, was for the AIMS 0.87 and 0.86, respectively, and for the PDMS-2 locomotion subscale 0.82 and 0.76 respectively.ConclusionThe correlation between the AIMS and the PDMS-2 locomotion subscale, at 6- and 12- months PTA, was good to excellent in a group of infants born preterm in Norway. And the AIMS and the locomotion subscale of the PDMS-2 were equally good predictors for atypical motor outcomes at 24 months PTA. These findings indicate that the AIMS and the locomotion subscale of the PDM-2, could be used interchangeable when assessing motor development in infants at 6- or 12 months of age.Trial registrationClinicalTrials.gov NCT01089296.

Early Life Factors and Polycystic Ovary Syndrome in a Swedish Birth Cohort.

Polycystic ovary syndrome (PCOS) is a medical condition with important consequences for women's well-being and reproductive outcomes. Although the etiology of PCOS is not fully understood, there is increasing evidence of both genetic and environmental determinants, including development in early life. We studied a population of 977,637 singleton women born in in Sweden between 1973 and 1995, followed sometime between the age 15 and 40. The incidence of PCOS was measured using hospital register data during 2001-2012, complemented with information about the women's, parents' and sisters' health and social characteristics from population and health care registers. Cox regression was used to study how PCOS is associated with intergenerational factors, and a range of early life characteristics. 11,594 women in the study sample were diagnosed with PCOS during the follow-up period. The hazard rate for PCOS was increased 3-fold (HR 2.98, 95% CI 2.43-3.64) if the index woman's mother had been diagnosed with PCOS, and with 1.5-fold (HR 1.51, 95% CI 1.39-1.63) if their mother had diabetes mellitus. We found associations of PCOS with lower (<7) one-minute Apgar score (HR 1.19, 95% CI 1.09-1.29) and with post-term birth (HR 1.19, 95% CI 1.13-1.26). Furthermore, heavy (10+ cigarettes/day) maternal smoking (HR 1.30, 95% CI 1.18-1.44) and maternal obesity (HR 1.90, 95% CI 1.62-2.36) were strongly associated with PCOS. This study finds support for the heritability and fetal origins of PCOS. Risk of PCOS could be reduced by further emphasizing the importance of maternal and early life health.

Assessing the role of agriculture-forestry-livestock nexus in improving farmers' food security in South Asia: A systematic literature review

CONTEXTThere is a growing consensus that agriculture, forestry, and livestock integration (agroforestry systems) could assist South Asia in combating food insecurity by expediting the transition towards sustainability. However, there is a dearth of a comprehensive synthesis of evidence demonstrating the actual relevance of this nexus to agroecological development and farmers' food security in South Asia—the majority of whom are smallholders with limited assets. OBJECTIVEThe main objective of this study is to evaluate the potentiality of the South Asian agroforestry systems- as a viable agroecological approach for ensuring farmers' food security: food availability, access, utilization, and stability. METHODSA systematic literature review was conducted following the guidelines provided by the “Preferred Reporting Items for Systematic reviews and Meta-Analyses” (PRISMA) to achieve the study objective. The Scopus and Web of Science Core Collection databases were used, along with Google Scholar as an additional database, to gather relevant articles for the review. RESULTS AND CONCLUSIONSAmong the 95 studies reviewed, only nine explicitly focused on food security, and none of them examined all four dimensions of food security simultaneously. Moreover, the skewed distribution of studies towards the Himalayan belt and a lack of quantitative measurement make it challenging to determine the extent to which agroforestry improved farmers' food security. However, the review identified several pathways, such as diversification of food options (n = 53), fodder supply (n = 57), income increase (n = 73) and diversification (n = 64), fuel wood supply (n = 59), fulfillment of medicinal needs (n = 30), and soil enrichment (n = 36), through which the integration of agriculture, forestry, and livestock could contribute to the food security. However, some studies found certain drawbacks, such as a decrease in agricultural crop yield (n = 29), breeding of pests and diseases (n = 10), and a longer gestation period (n = 9), which could threaten food and livelihood security. Nevertheless, evidence suggests that appropriate species selection and effective management practices can help mitigate these negative impacts. SIGNIFICANCEThe findings of this study will aid in the effective policy formulation to ensure food security by providing decision-makers and last-mile institutions with information on the benefits and drawbacks of the agricultural, forestry, and livestock nexus. Furthermore, the review findings would allow for cross-temporal and cross-spatial comparisons. Future research would benefit from the review approach used in this work as well as the identified research gaps.

Nifedipine versus magnesium sulfate in the management of preterm labour- A randomised controlled trial

Preterm labour is the leading cause of perinatal morbidity and mortality worldwide. Preterm birth accounts for 75% of neonatal deaths and 50% of long-term morbidity including respiratory disease and neuro-developmental impairment. The use of tocolysis in women in preterm labour aims to inhibit uterine contractions and reduce perinatal morbidity and mortality associated with early delivery.To study the effect and compare the efficacy of Nifedipine and Magnesium sulphate in management of preterm labour.: This randomized controlled trial was performed on 80 women with preterm labor between 28 and 37 weeks of gestation who were randomly assigned to receive either MgSO4 or nifedipine. All patients were checked for successful prolongation of pregnancy who had not been delivered at 48 hours [primary tocolytics effects] and more than 7 days [secondary tocolytics effects] after beginning the treatment and side effects of tocolysis.: From 80 patients, 40 received nifedipine and 40 received MgSO4. There were no differences in suppression of labor pain in 24 hours, 48 hours and 7 days between the two groups. Even though there were no statistically significant differences in one-minute and five-minute Apgar scores, neonatal respiratory distress syndrome between the groups neonates of MgSO4 group had more NICU admission which is significant (p value 0.049).: Oral nifedipine is as effective as magnesium sulfate with regard to inhibition of preterm labor.

Determinants of fetomaternal complication of instrumental vaginal delivery among women who gave childbirth in Southern Ethiopia: a facility-based cross-sectional study

BackgroundIn Ethiopia, one in five instrumental deliveries among women giving birth resulted in an unfavourable outcome. This study aimed to assess the determinants of feto-maternal complications of instrumental delivery in selected public hospitals of Gamo and Gofa zones, Southern Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 399 women attending selected public hospitals in the Gamo and Gofa zones. Data were collected using data extraction tools using a systematic random sampling technique. The collected data was entered into Epi-data version 3.1 and then analyzed using SPSS version 25. Logistic regression analysis was conducted to determine an association.ResultsOne hundred eighty-three (45.9%, n = 183/399) instrumental deliveries were found to be complicated. Primigravida women (AOR: 95% CI: 2.21 (1.35, 3.63), infant birth weight (AOR: 95% CI: 2.56 (1.37, 4.77), post-term pregnancy (AOR: 95% CI: 12.77 (2.92, 55.78), and maternal age (AOR: 95% CI: 7.00 (2.16, 22.64) were associated with fetomaternal complications in instrumental delivery among women who gave birth.Conclusions and recommendationA high proportion of women developed fetomaternal complications when compared to local studies. Promotion of antenatal care services, increasing women’s education and empowerment as well as working on capacity building of health care professionals through education and training is cost-effective to reduce the occurrence of fetomaternal complications.

Effect of grand multiparity on maternal, obstetric, fetal and neonatal results.

The aim of the study was to compare the incidence of antenatal and intrapartum complications and perinatal outcomes between grand multiparous women of the same age and socioeconomic status and nulliparous and multiparous women. A prospective case-control study was conducted at the Tertiary Center Gynecology and Obstetrics Clinic of the Eastern Anatolia Region between January 1, 2021, and January 1, 2023. It was compared with 149 grand multiparous, 724 multipara, and 258 nulliparous singleton pregnancies. The data were entered separately by two people and then compared. The delivery period, gestation period, maternal obstetric, and fetal and neonatal outcomes of the groups were compared. The frequency of postpartum hemorrhage, antepartum and postpartum anemia was significantly higher in grand multiparity patients than in other groups. Gestational hypertension, Gestational DM and Abortus imminent, and the frequency of preterm birth increases with parity. The frequency of hyperemesis gravidarum and preeclampsia was significantly higher in nulliparous pregnant women than in others. There was no difference between the groups in terms of premature rupture of membranes and post-term pregnancy. Among the neonatal outcomes, only the frequency of low birth weight was significantly higher in grand multiparous patients. The frequency of postpartum anemia, postpartum bleeding, gestational hypertension, gestational diabetes, and preterm pregnancy is higher in grand multiparity patients than in multiparous and nulliparous patients. Due to the increased risks with grand multiparity, pregnancy follow-up, and follow-up should be done within the risk factors of these patients in regions where grand multiparity is intense, and family planning practices should be increased.

Comparison of Maternal Labor-Related Complications and Neonatal Outcomes Following Elective Induction of Labor at 39 Weeks of Gestation vs Expectant Management: A Systematic Review and Meta-analysis

(Abstracted from JAMA Network Open 2023;6(5):e2313162) Induction of labor historically has been discouraged when there is no medical indication, such as for postterm pregnancies, suspected cases of poor fetal growth, prelabor rupture of membranes, or hypertension. This is because elective induction is associated with a higher risk of cesarean delivery (CD) and adverse birth outcomes than spontaneous labor.

Anterior uterocervical angle: is it an ultrasonographic screening tool that estimates the latent phase duration in post term pregnancies?

In recent years, in addition to cervical length measurement, a new ultrasonographic parameter has been defined as uterocervical angle (UCA), which can be used in the prediction of preterm labor. In this study,we evaluated the place of uterocervical angle in predicting the latent phase duration in postterm pregnancies. This prospective study consists of 90 pregnant women aged between 18 to 40 years who were hospitalized with a diagnose of late term pregnancy. Pregnant women with a latent phase duration of 1200 minutes or less were defined as Group 1. Patients with latent phase duration over 1200 minutes were defined as Group 2. All patients' age, BMI, smoke, cervical length measurements, uterocervical angle, latent and active phase of labor durations, length of the third stage and delivery types were compared. The UCA median value of group 1 was 120 (94-147), and group 2 was 99 (94-105) (p < 0.001). CL medians of Groups 1 and 2 were 29 (17-43) and 28 (27-41) respectively (p: 0.871). UCA (AUC: 0.917, p < 0.0001) significantly predicted prolonged latent phase duration. Optimal cut off value was obtained at the value of 105 degree (100% sensitivity, 75% specificity) for UCA. Kaplan-Meier survival analysis showed that duration of labor was significantly higher in a group with low UCA (p: 0.013). UCA can be a successful tool that can be used to predict duration of labor in cases of postterm pregnancies with medical induction.

NO donors on top of anti-hypertensive therapy reduces complications in chronic hypertensive pregnancies with hypodynamic circulation

ObjectivesChronic hypertension is associated with significant adverse maternal and fetal outcomes that appear to be often associated to a hypodynamic circulation. Treatment of hypertensive disorders of pregnancy tailored on maternal hemodynamics might reduce or mitigate these complications. Our purpose was to assess the hemodynamic modifications induced by the addition of NO donors and increased oral fluid intake on top of standard antihypertensive therapy in hypodynamic chronic hypertensive patients. We further evaluated if the possible hemodynamic modification induced by NO donors and increased oral fluid intake might be associated to a reduction of the severity and rate of complications vs. patients on antihypertensive standard treatment. Study DesignThis was a case-control study of 321 chronic hypertensive patients with a hypodynamic circulation at the echocardiographic evaluation at 24 weeks’ gestation. We included 160 controls (standard antihypertensive therapy) and 161 cases (standard therapy + NO donor patches + increased oral fluid intake). Student T test for paired and unpaired data, univariate logistic regression analysis, ROC curve analysis, and Cox Hazards Regression analysis were used as appropriate. ResultsAt enrollment the hemodynamic parameters were similar between the two groups. After 3–4 weeks stroke volume (77 ± 19 mL vs. 69 ± 19 mL; p < 0.001), and cardiac output (6.2 ± 1.7 L vs. 5.0 ± 1.6 L; p < 0.001) were higher and total peripheral vascular resistance (1465 ± 469 dyne·s·cm−5 vs. 1814 ± 524 dyne·s·cm−5; p < 0.001) was lower in the cases vs controls. Superimposed preeclampsia, preterm delivery before 34 weeks, abruptio placentae, HELLP Syndrome, fetal growth restriction, and perinatal death were more represented in the standard treatment group vs NO treated patients (81% vs 53%; p < 0.001). In particular, the standard treatment group showed 48% fetal growth restriction vs 34% in the NO treated group (p < 0.011). The Cox proportional-hazards regression showed a lower proportion of event-free pregnancies in controls on standard treatment (HR 2.6; 95% CI 2.0–3.5; p < 0.0001), and a prolongation of pregnancies in CH cases complicated by fetal growth restriction taking NO donors (HR 0.29; 95% CI 0.19–0.43; p = 0.0001). ConclusionsThe tailored treatment with NO donors and oral fluids of hypodynamic CH might have positive effects on the reduction or mitigations of adverse outcomes.

Association of Neonatal AKI with Gestational Age and Birth Weight in Tertiary Care Hospitals of Dhaka City, Bangladesh

Background: Acute kidney injury (AKI) is common in neonatal intensive care unit (NICU) and also in general neonatal ward (GNW) of two tertiary care hospitals (Dhaka Medical College and Sir Salimullah Medical College Mitford Hospital). Association of neonatal AKI with different birth weights (low birth weight, very low birth weight, extreme low birth weight) and gestational age (both term and preterm) has greater impact on AKI. Early detection and immediate management is life saving. Methodology: This prospective observational study carried out in NICU and GNW of DMCH &amp; SSMC Mitoford Hospital over a period of one year to find out the AKI cases within the first 28 days of life. Blood sample collected by plane test tube and send to the laboratory and serum creatinine levels were estimated by auto analyzer (PICTUS-400). AKI was leveled when serum creatinine &gt;1.5 times of medium values. Those AKI patients were evaluated in relation with gestational age &amp; birth weight. After counselling and taking informed written consent from legal guardians, three hundred neonates were enrolled in this study by purposive sampling. The data were collected in a pre-structured questionnaire and analysis by SPSS 22 software. Results: A total of 300 neonates were included in this study. Mean age of the neonates were 5.71±6.70 days (age range 1-28 days). Male were predominant (59.4%). Male and female ratio was 1.46:1. AKI developed in 23.7% neonates. Among them 53.5% was appropriate for gestational age (AGA), 36.6% had LBW and 9.9% had VLBW. Among preterm, term and post term 24.4%, 22.0% and 75.0% developed AKI respectively. Neonatal AKI also associated mostly with perinatal asphyxia (43.8%) and neonatal sepsis (35.21%). Conclusion: AKI developed in 23.7% neonates. AKI prevalence is same in gestational age and birth weight. Sir Salimullah Med Coll J 2023; 31: 73-78

Efficacy and Safety of Nifedipine as a Tocolytic Drug for the Treatment of Preterm Labour: Comparison with Levosalbutamol

Background: The rising prevalence of preterm birth is a significant public health concern. This study aimed to assess the efficacy and safety of the calcium channel blocker Nifedipine compared to the β2 agonist Levosalbutamol for inhibiting uterine contractions in early preterm labor, with a focus on maternal side effects and perinatal outcomes. Methods: A randomized clinical trial was conducted at Rajshahi Medical College Hospital over one year, involving pregnant women experiencing early preterm labor (24-36 weeks gestation, regular uterine contractions, cervical dilation 1-3 cm). a total N=66 patients were randomly assigned to receive either Nifedipine (Experimental group) or Levosalbutamol (Control group). Primary maternal outcomes included tocolysis, time to tocolysis, prolongation of pregnancy by ≥2 days, and delivery at term. Secondary perinatal outcomes included birth asphyxia, perinatal mortality, and the need for emergency NICU admission. Secondary maternal outcomes included side effects such as headache, hypotension, nausea/vomiting, and tachycardia. Results: Over 90% of patients in the Nifedipine group achieved tocolysis compared to 72.7% in the Levosalbutamol group (p = 0.054). Nifedipine achieved significantly faster tocolysis (8.7 hours vs. 29.3 hours, p &lt; 0.001). The Experimental group showed higher rates of arresting preterm labor for ≥2 days and lower rates of preterm delivery. Maternal side effects were lower for headache but higher for hypotension and nausea/vomiting in the Nifedipine group. Tachycardia occurred in the Control group but not the Experimental group. Both groups had low rates of birth asphyxia. Perinatal mortality was lower in the Experimental group, and NICU admission was less frequent. Conclusion: Nifedipine demonstrated superior efficacy over Levosalbutamol in terms of tocolysis, time to tocolysis, prolongation of pregnancy, delivery at term, with fewer maternal side effects and improved perinatal outcomes in pregnant women .....

Gestational Trophoblastic Disease with Coexisting Progressing Pregnancy: Personalised Treatment Modalities.

Gestational trophoblastic disease (GTD) coexisting with a steadily progressing pregnancy is an extremely rare condition presented in the literature as a single case or case series of successful delivery. The purpose of this study was to describe five cases of GTD and present possible management strategies for such patients. Clinical data of five pregnancies with coexisting GTD were identified within the Almazov National Medical Research Centre from 2018 to 2021. Three cases of multiple pregnancies with complete hydatidiform moles and two cases of singleton pregnancies with intraplacental choriocarcinoma and invasive hydatidiform moles were identified. Three pregnancies were prolonged and ended with preterm deliveries. Malignant transformation of the GTD accounted for 60% of the cases. The condition of newborns was based on the level of prematurity and functional immaturity, and in all cases, it was aggravated by anemia. GTD coexisting with progressing pregnancy is threatened by the risks of preterm delivery, miscarriage, hemorrhage, and disease progression and requires monitoring in a multidisciplinary clinic experienced in the management of patients with malignant tumors during pregnancy. In cases of prolonged pregnancy against the background of GTD, we suggest the following monitoring during pregnancy: pelvic, abdominal ultrasound/MRI (without contrast), prenatal invasive fetal karyotype testing in cases of singleton pregnancy, lung X-ray/CT with uterine shielding, weekly assessment of β-hCG levels, and dynamic monitoring of the fetus. The following postnatal monitoring should be performed: morphological examination of the placenta, weekly assessment of β-hCG levels up to normalization, then monthly assessment up to six months, and control of β-hCG level of the newborn.

Amnioreduction vs expectant management in pregnancies with moderate to severe polyhydramnios

The rate of polyhydramnios is higher in pregnancies complicated by congenital anomalies. These pregnancies have higher rates of peripartum complications. Amnioreduction is offered to relieve maternal symptoms such as dyspnea, abdominal and respiratory discomfort, and other issues like satiety. This study aimed to report the rates of amnioreduction and its associated complications in pregnancies with moderate to severe polyhydramnios secondary to fetal anomalies. We also sought to determine if amnioreduction provided additional benefits, including prolongation of pregnancy and a decrease in the rates of peripartum morbidities associated with moderate to severe polyhydramnios. This was a retrospective review of anomalous singleton pregnancies with moderate to severe polyhydramnios that were evaluated and delivered at a single center between 2013 and 2021. Peripartum outcomes were compared between pregnancies that underwent amnioreduction and those that were expectantly managed. Mann-Whitney U tests were used to compare continuous variables and Fisher's exact tests were used for categorical variables. A multiple regression model was created to understand the effects of amnioreduction on gestational age at delivery. A total of 218 singleton pregnancies met the inclusion criteria of moderate to severe polyhydramnios in the study period. Of those, 110 patients (50.5%) underwent amnioreduction and 108 patients (49.5%) opted for expectant management. A total of 147 procedures were performed at a median gestational age of 32.5 weeks and a median of 1900 mL of amniotic fluid was removed per procedure. Complications occurred in 10.9% (n=16) of procedures, including preterm delivery within 48 hours in 5.4% cases (n=8). The median amniotic fluid index was higher in the amnioreduction group than in the expectant group (38.9 cm vs 35.5 cm; P<.0001). Patients who underwent amnioreduction had an earlier median gestational age at delivery (36.3 weeks vs 37.0 weeks; P=.048), however, the rates of spontaneous preterm delivery were similar. A higher percentage of women in the amnioreduction group had vaginal delivery (49.4% vs 30.5%; P=.01) and lower rates of uterine atony (2.4% vs 13.7%; P=.006). In the multiple linear regression analysis, the gestational age at delivery positively correlated with gestational age at amnioreduction after controlling for amniotic fluid volume (P<.0001; 95% confidence interval, 0.34-0.71). In addition, the patients in the amnioreduction group were twice as likely to have a vaginal delivery (P=.02). Amnioreduction in the setting of moderate-severe polyhydramnios has a reasonably low rate of complications but does not provide any benefits in terms of prolonging the pregnancy. The procedure may increase the likelihood of vaginal delivery and lower the rates of uterine atony.

Tocolytic treatment and maternal characteristics, obstetric outcomes, and offspring childhood outcomes among births at and after 37 weeks of gestation: the Japan environment and children's study.

To evaluate differences in maternal characteristics and obstetric and offspring childhood outcomes between births at and after 37weeks of gestation (referred to as term and post-term births) according to the use of tocolytic treatment. Data for 63,409 women with singleton births at and after 37weeks of gestation were analyzed using data from the Japan Environment and Children's Study (JECS). We compared maternal characteristics, obstetric outcomes, and offspring childhood outcomes between term and post-term births exposed and not exposed to tocolytic treatment. Additionally, multivariable logistic regression models were used to calculate adjusted odds ratios for offspring childhood outcomes with significant between-group differences in the univariable analysis, with term and post-term births without tocolytic agents as the reference group. We observed differences in maternal characteristics and obstetric outcomes between term and post-term births exposed and not exposed to tocolytic treatment. The incidence of offspring childhood developmental disorders showed no significant between-group differences. However, participants exposed to tocolytic agents had higher incidence of offspring childhood allergic disorders. The adjusted odds ratio for any of the offspring childhood allergic disorders in term and post-term births with tocolytic agents was 1.08 (95% confidence interval, 1.03-1.13). This study found no significant difference in the incidence of offspring developmental disorders between term and post-term births exposed and not exposed to tocolytic treatment. However, tocolytic treatment was associated with differences in maternal characteristics and obstetric outcomes, along with a marginal increase in the incidence of childhood allergic disorders in offspring.

Obstetric Intervention and Perinatal Outcomes During the Coronavirus Disease 2019 (COVID-19) Pandemic.

To quantify pandemic-related changes in obstetric intervention and perinatal outcomes in the United States. We carried out a retrospective study of all live births and fetal deaths in the United States, 2015-2021, with data obtained from the natality, fetal death, and linked live birth-infant death files of the National Center for Health Statistics. Analyses were carried out among all singletons; singletons of patients with prepregnancy diabetes, prepregnancy hypertension, and hypertensive disorders of pregnancy; and twins. Outcomes of interest included preterm birth, preterm labor induction or preterm cesarean delivery, macrosomia, postterm birth, and perinatal death. Interrupted time series analyses were used to estimate changes in the prepandemic period (January 2015-February 2020), at pandemic onset (March 2020), and in the pandemic period (March 2020-December 2021). The study population included 26,604,392 live births and 155,214 stillbirths. The prepandemic period was characterized by temporal increases in preterm birth and preterm labor induction or cesarean delivery rates and temporal reductions in macrosomia, postterm birth, and perinatal mortality. Pandemic onset was associated with absolute decreases in preterm birth (decrease of 0.322/100 live births, 95% CI 0.506-0.139) and preterm labor induction or cesarean delivery (decrease of 0.190/100 live births, 95% CI 0.334-0.047) and absolute increases in macrosomia (increase of 0.046/100 live births), postterm birth (increase of 0.015/100 live births), and perinatal death (increase of 0.501/1,000 total births, 95% CI 0.220-0.783). These changes were larger in subpopulations at high risk (eg, among singletons of patients with prepregnancy diabetes). Among singletons of patients with prepregnancy diabetes, pandemic onset was associated with a decrease in preterm birth (decrease of 1.634/100 live births) and preterm labor induction or cesarean delivery (decrease of 1.521/100 live births) and increases in macrosomia (increase of 0.328/100 live births) and perinatal death (increase of 9.840/1,000 total births, 95% CI 3.933-15.75). Most changes were reversed in the months after pandemic onset. The onset of the coronavirus disease 2019 (COVID-19) pandemic was associated with a transient decrease in obstetric intervention (especially preterm labor induction or cesarean delivery) and a transient increase in perinatal mortality.