Post-term Research Articles

DHA, nutrient intake, and maternal characteristics as predictors of pregnancy outcomes in a randomised clinical trial of DHA supplementation

To investigate the relationships among docosahexaenoic acid (DHA) intake, nutrient intake, and maternal characteristics on pregnancy outcomes in a phase III randomised clinical trial designed to determine the effect of a DHA dose of 1000mg/day compared to 200mg/day on early preterm birth (<34 weeks gestation). A secondary aim of the phase III randomised trial was to explore the relationships among pregnancy outcomes (maternal red blood cell phospholipid (RBC-PL) DHA at delivery, preterm birth, gestational age at delivery, labor type, birth anthropometric measures, low birth weight, gestational diabetes, pre-eclampsia, and admission to a neonatal intensive care unit) in participants (n=1100). We used Bayesian multiple imputation and linear and logistic regression models to conduct an analysis of five general classes of predictor variables collected during the trial: a) DHA intake, b) nutrient intake from food and supplements, c) environmental exposure to tobacco and alcohol, d) maternal demographics, and e) maternal medical history. DHA supplementation lowered the risk of preterm birth and NICU admission, and increased gestation and birth weight as observed in the primary analysis. Higher maternal RBC-PL-DHA at delivery was associated with DHA supplementation and formal education of a bachelor's degree or higher. DHA supplementation and maternal age were associated with a higher risk of gestational diabetes. Total vitamin A intake was associated with longer gestation, while fructose and intake of the long chain omega-6 fatty acid, arachidonic acid, were associated with shorter gestation. Risk of preterm birth was associated with a history of low birth weight, preterm birth, pre-eclampsia, and NICU admission. Bayesian models provide a comprehensive approach to relationships among DHA intake, nutrient intake, maternal characteristics, and pregnancy outcomes. We observed previously unreported relationships between gestation duration and fructose, vitamin A, and arachidonic acid that could be the basis for future research. ClinicalTrials.gov (NCT02626299); December 10, 2015.

Glucocorticoids shorten and speed up the misoprostol-induced labour in postdate pregnancy.

Glucocorticoids shorten and speed up the misoprostol-induced labour in postdate pregnancy.

Frequency of obesity and in pregnancy and fetal outcome in normal weight, over weight and obese pregnant females

ABSTRACT&#x0D; Background: Obesity is now a major public health PROBLEM especially among women of reproductive age. This happening has a major impact on pregnancy outcomes, according to latest reports. Especially, during pregnancy and childbirth, obese women are more at risk of fetomaternal complications than women with a normal body mass index (BMI). Objective: To determine the frequency of normal weight, over weight and obese women presenting for antenatal care and to compare the outcome in normal weight, over weight and obese pregnant females. Patients and Methods Descriptive Case series study conducted from 29th October 2022 to 29 April 2022 .200 subjects meeting the inclusion criteria were enrolled in the study after informed consent. BMI was recorded and weight category assigned. All these women were followed-up till 37 weeks of gestation and till delivery. The indications for Caesarian section in any pregnancy were post-dates pregnancy (gestational age at more than 41 weeks), reduced fetal movements, fetal growth restriction, and term pre-labour rupture of membranes more than 24 hours. Main outcome variable: Fetal outcome was accessed using C-section, macrosomia and admission of neonate to NICU. Results: Frequency of weight of the patients was classified as 34%(n=68) were normal, 40.5%(n=81) were over-weight and 25.5%(n=51) were obese, comparison of outcome in normal weight, over weight and obese pregnant females shows that of 8 cases of macrosomia, 1 in normal and overweight while 6 cases in obese, of 61 cases of C-section 13 in normal, 15 in overweight and 33 were obese, NICU admission cases were 27, out of which 7 in normal, 6 in overweight and 14 were in obese group, p value 0.80.Conclusion: We concluded that on comparison for the outcome in normal weight, over weight and obese pregnant females, obese and overweight females are higher at the risk of macrosocia, cesarean birth and NICU admission of the neonate.

Ultrasonographic Measurement of Fetal Adrenal Gland Size for the Prediction of Success of Induction of Labor Among Primigravida Beyond 40Weeks Gestation.

As the pregnancy advances beyond term, the risk of perinatal morbidity and mortality increases. Hence to prevent these complications associated with postterm pregnancy, induction of labor is done, as per our institution protocol between 40 and 41weeks of gestation. Induction has its own drawback, so it is essential to identify the women with high chances of failure of induction of labor, to prevent the morbidities associated with induction failure. To study the role of ultrasonographic fetal adrenal gland enlargement for the prediction of success of labor induction among primigravida beyond 40weeks gestation. Low-risk primigravidas beyond 40weeks gestation, scheduled for induction of labor, were enrolled for the study. Fetal adrenal gland dimensions were measured by using abdominal probe Philips HD 7XE and general electronics logiq P6 pro or any ultrasound machine equipped with 7.5-10MHz linear array probe and 3.5-5MHz curved array probe. The fetal adrenal gland length, width and ratio were statistically significant between the successful versus failed induction groups. The cutoff fetal zone ratio > 0.36 for the prediction of successful induction of labor had 90% sensitivity, 89% specificity, 93% PPV and 75% NPV. Fetal zone enlargement (fetal zone ratio > 0.36) is a strong predictor of successful induction of labor as compared to TVL and Bishop's score. It can be used for screening the women, who are destined for induction failure, so that adverse effects of induction of labor can be avoided.

The Evaluation of Obstetric Outcome of Postdated Pregnancy

Background: Postdated pregnancy is one of the commonest obstetric conditions. Pregnancy is called term when it lies between 37 weeks to 40 weeks from the last menstrual period. If the pregnancy exceeds 40 weeks it is called as postdated pregnancy.&#x0D; Methods: From January to June 2022, researchers from the Research institute Dhaka Medical College and Hospital, carried out this prospective observational study. We surveyed 100 participants for this research. After carefully evaluating the woman and the fetus, induction of labor was conducted after the due date had passed. Intact membrane, cephalic presentation, singleton pregnancies, and a low Bishop score in post-dated pregnancies were also requirements for participation. Women with absolute contraindications to induction of labor, such as a contracted pelvis, placenta previa, unexplained vaginal hemorrhage, breech presentation, or a history of caesarean section, were not included in the analysis.&#x0D; Results: During the study Sixty percent of the population is comprised of young adults ages 21 to 30. There were 42% in the oxytocin group, 38% in the ARM + oxytocin group, and 14% in the misoprostol group. There were 30% unsuccessful deliveries with oxytocin drip, 25% with ARM + Oxytocin drip, and 14% with misoprostol. The vast majority of births occurred naturally via the cervix, whereas around 33% required a caesarean section and 10% required the use of forceps. The fetal distress rate was 13%, while the cervix conditions were poor in 5%. 75% of the newborns were very fine.&#x0D; Conclusion: Timely labor is closely connected with positive birth outcomes. It is critical to make a correct diagnosis of postdatism. With the right advice and constant monitoring from medical professionals, postpartum depression in mothers may be alleviated. Many hospitals around the country resort to caesarean sections to end post-dated pregnancies because of technological limitations in foetal monitoring and oxytocin titration. Inducing labor seems to be safe for both mother and child when a full-term cervix and favorable fetal presentation are present.

Fetal middle cerebral artery Doppler in post term pregnancy: a predicting factor for induction of labor outcome

Fetal middle cerebral artery Doppler in post term pregnancy: a predicting factor for induction of labor outcome

OP10_3. Maternal circulating serum AMYLOID A1 in post-date pregnancies and placenta-associated biomarkers

OP10_3. Maternal circulating serum AMYLOID A1 in post-date pregnancies and placenta-associated biomarkers

What influences women's experiences of childbirth in Flanders? – A quantitative cross-sectional analysis of the Babies Born Better survey

ObjectiveLabour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium. DesignA cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders. Participants1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018. FindingsThe majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362–0.817) and post term birth (OR 0.664, 95% CI 0.462–0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 – 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 – 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218–0.463), an instrumental birth (OR 0.318, 95% CI 0.218–0.463) or a planned- (OR 0.349, 95% CI 0.205–0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109–0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth. Key conclusionsThe majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences. Implications for practiceWomen's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

Exposures during pregnancy and at birth are associated with the risk of offspring eating disorders.

Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses. A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found. Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED. We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.

Outpatient Cervical Ripening With Misoprostol to Prevent Post-Term Pregnancy: A Double-Blind Randomized Clinical Trial

Outpatient use of misoprostol is assessed in a few studies and usually in low doses and vaginal routes. This study aimed to evaluate cervical ripening by outpatient administration of misoprostol to prevent post-term pregnancy. This randomized clinical trial study was performed on 140 patients that were randomly allocated into two groups: 25 μg sublingual SL (group A) and 50 μg PO misoprostol (group B). The patients were primigravid with a gestational age of 40 weeks, with an amniotic fluid index (AFI) of ≥5 cm, a reactive non-stress test (NST) with no evident uterine contraction, Bishop Score of &lt;8, and no notable past medical history. Patients who had a normal vaginal delivery before 41 weeks were considered successful delivery. Maternal age, the number of misoprostol doses, vaginal examination, type of interventions before delivery, the indication of hospitalization, delivery route, the indication of cesarean section, delivery complications, and neonatal outcomes were compared using SPSS software. P&lt;0.05 was considered statistically significant. group A had mean age of 23.27±4.03 years and Group B had a mean age of 24.61±5.46 years with no significant difference (P=0.223). The number of misoprostol doses (P=0.001), extra misoprostol, and oxytocin application were significantly lower in group B (P=0.003). Maternal and neonatal complications showed no significant difference between the two groups (P&gt;0.05). Outpatient cervical ripening with misoprostol appears to be an optimal method. More prospective studies with higher sample sizes are required to ensure its safety for routine recommendations for cervical ripening to prevent post-term pregnancy.

Propranolol and Misoprostol versus Misoprostol Alone for Induction of Labour in Primigravidas

Background Induction of labor is indicated when risks to maternal or fetal health out weight benefits of continuing the pregnancy. One of the most common reasons for labor induction is postterm pregnancy (ie,&amp;gt; 41 weeks of gestation). Objectives The aim of the study is to compare propranolol and misoprostol versus misoprostol alone for induction of labour in primigravidas. Patients and Methods This study included one hundred and twenty eight pregnant fullterm primigravida women, they were divided randomly into two equal groups. In both group, every patient received 25 microgram of misoprostol vaginally under aseptic prequations then every 6 hours with maximum 4 doses until efficient uterine contractions is reached three or more in 10 minutes each lasting for 45 seconds for induction of labor. Then after 30 minutes patients in group A received oral propranolol 20 mg and patients in group B received oral placebo in the form of sugary tablets, then womens monitored for fetal and maternal wellbeing and progress of labor. Results In this study, all the parturients were primigravid, it was highly considered to recruit parturient of almost similar conditions. The mean age of women included in the study was (23.3+/4.1) and the mean gestational age of the parturient was range (38 – 42) weeks. The mean pre induction Bishop score was range (2-6), we select only women with Bishop score of 6 or less considering the fact that the main goal for using medication for induction of labor was the reppening of an unfaverable cervix. There was no statistical difference between both groups as regards initial basic characteristics. There was no statically significant difference between propranolol and placebo research group regarding birth weight, apgar score at 1 and 5 minutes and NICU administration and patients satisfaction. Conclusion From the previous results regarding the propranolol effectiveness and safety, it dose not seem to negatively influence the fetus as apgar score at 1 and 5 minutes and the need for NICU admission were not influenced by its administration. And on the other hand, propranolol was significant in reduction the time latent phase and therefore the total duration of labor. Taking in mind this significant results it seems that propranolol might become a useful obestetrical tool for induction of labor in the future.

Role of Mesh in the Reinforcement of the Primary Repair of Large Hiatal Hernia

Abstract Background The incidence of hiatal hernias increases with age. Approximately 55%-60% of individuals over the age of 50 have a hiatal hernia. However, only about 9% have symptoms, and it depends on the type and competency of the lower esophageal sphincter. Aim of the Work In our study, an objective observational study was made regarding post operative short term mesh related complications possible to develop in patients underwent hiatal repair of large hiatal hernia with mesh rienforcement. Patients and Methods An observational cohort (retrospective and prospective) study regarding the post operative mesh related complications in patients who underwent Large diaphragmatic hernia repair with mesh application. The study was conducted at Ain Shams University Hospitals, Al-Demerdash, Department of General surgery. Approval of the research ethics Committee of medicine and general surgery department at faculty of medicine, Ain Shams University as well as a written informed consent from all participants was obtained. The study was conducted on 15 patients over a period of six months, starting from date of approval of the protocol by the faculty and the university committee at 10/7/2021. Results Five patients (33.3%) complained about dysphagia postoperatively. In one case, the symptoms declined spontaneously within 6 months was grade 1. Another patient successfully underwent esophageal dilatation of a stenosis 2 months postoperatively was grade 2. Up to this date, two patients (13.3%) still report mild dysphagia but maintain normal body weight were grade 3. Three cases report persistent intraabdominal discomfort without weight loss described as bloating. Two patients experienced heartburn, while another patient reported respiratory compromise in the form dyspnea due to already huge hiatal defect with lung collapse present preoperatively. Conclusion Laparoscopic large hiatal/paraesophageal hernia repair with prosthetic meshes as well as laparoscopic antireflux surgery with prosthetic hiatal closure are safe and effective procedures to prevent hiatal hernia recurrence and/or postoperative intrathoracic wrap migration, with low complication rates and mesh fixation is indicated in patients with large hiatal hernial defect &amp;gt; 5 cm.

Prediction and Prevention of Preterm Birth: Secondary Analysis of a Randomized Intervention Trial.

Our objective was to evaluate whether pregnancy is prolonged by the use of a proteomics-based maternal serum screening test followed by treatment interventions. This is a secondary analysis of the PREVENT-PTB randomized trial comparing screening with the PreTRM test versus no screening. The primary trial analysis found no significant between-group difference in the preterm birth rate. Rather than considering a dichotomous outcome (preterm versus term), we treated gestational age at birth as a continuous variable using survival analysis. We also evaluated between-group difference in NICU length of stay and duration of respiratory support. Results indicated that pregnancy was significantly prolonged in subjects screened with the PreTRM test compared to controls (adjusted hazard ratio 0.53, 95% confidence interval 0.36-0.78, p < 0.01). Newborns of screened subjects had significantly shorter NICU stays but no significant decrease in duration of respiratory support. In the PreTRM screen-positive group, interventions that were associated with pregnancy prolongation included care management and low-dose aspirin but not 17-hydroxyprogesterone caproate. We conclude that screening with the PreTRM test followed by interventions for screen-positive pregnancies may prolong pregnancy and reduce NICU LOS, but these observations need to be confirmed by additional research.

Association between socioeconomic status with pregnancy and neonatal outcomes: An international multicenter cohort.

Previous evidence examining the association between socioeconomic status and pregnancy complications are conflicted and often limited to using area-based measures of socioeconomic status. In this study, we aimed to examine the association between individual-level socioeconomic factors and a wide range of adverse pregnancy and neonatal outcomes using data from the IMPROvED birth cohort conducted in Sweden, the Netherlands and Republic of Ireland. The study cohort consisted of women who participated in the IMPROvED birth cohort between 2013 and 2017. Data on socioeconomic factors were self-reported and obtained at 15 weeks' gestation, and included level of education, employment status, relationship status, and income. Data on pregnancy and neonatal outcomes included gestational hypertension, pre-eclampsia, gestational diabetes mellitus, emergency cesarean section, preterm birth, post term delivery, small for gestational age and Apgar score at 1 min. These data were obtained within 72 h following delivery and confirmed using medical records. Multivariable logistic regression examined the association between each socioeconomic variable and each outcome separately adjusting for maternal age, maternal body mass index, maternal smoking, maternal alcohol consumption and cohort center. We also examined the effect of exposure to any ≥2 risk factors compared to none. A total of 2879 participants were included. Adjusted results suggested that those with less than third level of education had an increased odds of gestational hypertension (OR: 1.74, 95% CI: 1.23-2.46), while those on a middle level of income had a reduced odds of emergency cesarean section (OR: 0.59, 95% CI: 0.42-0.84). No significant associations were observed between socioeconomic variables and neonatal outcomes. Exposure to any ≥2 socioeconomic risk factors was associated with an increased risk of preterm birth (OR: 1.75, 95% CI: 1.06-2.89). We did not find strong evidence of associations between individual-level socioeconomic factors and pregnancy and neonatal outcomes in high-income settings overall, with only few significant associations observed among pregnancy outcomes.

Comparison of calving and revenue-generating qualities in beef-sired male and female progeny from dairy cows

Although interest in beef-on-dairy breeding strategies is intensifying, little is actually known of the performance differences between beef-sired male and female progeny of dairy cows. The objective was therefore to use a large cross-sectional database of up to 1,389,670 animals to investigate if performance differences existed between male and female progeny generated from beef-on-dairy matings; the focus was on characteristics of interest to both the dairy producer (i.e., gestation length, calving performance, perinatal mortality, and calf sale value) and the beef producer (i.e., slaughter-related traits). While statistical differences existed between both sexes, the observed differences were not always biologically large, with some favoring females (e.g., calving traits and age at slaughter) and some favoring males (i.e., carcass weight). Beef-sired male calves had, on average, a 0.8 d longer gestation than their female counterparts; the sex difference in dairy-sired calves was, on average, 1.1 d, with the advantage to females. The odds of a difficult calving was 2.2 times greater for beef-sired male calves relative to beef-sired female calves; this translated to a difference in predicted probability of dystocia between the sexes of 1.8 percentage units. Male beef-sired calves sold at auctions <42 d of age were worth, on average, €32.40 more than beef-sired female calves. Focusing just on beef-sired progeny, relative to heifer carcasses (mean weight of 280.0 kg), the carcasses of steers (mean weight of 336.9 kg) and bulls (mean weight of 335.4) were 55.4 to 56.9 kg heavier. Based on a 15-point conformation scale, the carcasses of bulls were 1 unit superior to heifers, with the carcasses of the latter being 0.06 units better than steers. Heifers were slaughtered, on average, 79.1 d younger than steers although heifers were slaughtered, on average, 93.8 d older than bulls, the latter generally being finished on a more intensive diet relative to steers and heifers in Ireland. In conclusion, many benefits exist for beef-sired heifer calves in that they had, on average, shorter gestations with less expected assistance required at calving and, although their calf value was less and their carcasses were lighter than their male counterparts, they were slaughtered several months younger than steers.

Users' Concerns About Endometriosis on Social Media: Sentiment Analysis and Topic Modeling Study.

Endometriosis is a debilitating and difficult-to-diagnose gynecological disease. Owing to limited information and awareness, women often rely on social media platforms as a support system to engage in discussions regarding their disease-related concerns. This study aimed to apply computational techniques to social media posts to identify discussion topics about endometriosis and to identify themes that require more attention from health care professionals and researchers. We also aimed to explore whether, amid the challenging nature of the disease, there are themes within the endometriosis community that gather posts with positive sentiments. We retrospectively extracted posts from the subreddits r/Endo and r/endometriosis from January 2011 to April 2022. We analyzed 45,693 Reddit posts using sentiment analysis and topic modeling-based methods in machine learning. Since 2011, the number of posts and comments has increased steadily. The posts were categorized into 11 categories, and the highest number of posts were related to either asking for information (Question); sharing the experiences (Rant/Vent); or diagnosing and treating endometriosis, especially surgery (Surgery related). Sentiment analysis revealed that 92.09% (42,077/45,693) of posts were associated with negative sentiments, only 2.3% (1053/45,693) expressed positive feelings, and there were no categories with more positive than negative posts. Topic modeling revealed 27 major topics, and the most popular topics were Surgery, Questions/Advice, Diagnosis, and Pain. The Survey/Research topic, which brought together most research-related posts, was the last in terms of posts. Our study shows that posts on social media platforms can provide insights into the concerns of women with endometriosis symptoms. The analysis of the posts confirmed that women with endometriosis have to face negative emotions and pain daily. The large number of posts related to asking questions shows that women do not receive sufficient information from physicians and need community support to cope with the disease. Health care professionals should pay more attention to the symptoms and diagnosis of endometriosis, discuss these topics with patients to reduce their dissatisfaction with doctors, and contribute more to the overall well-being of women with endometriosis. Researchers should also become more involved in social media and share new science-based knowledge regarding endometriosis.

The Effect of Garlic Tablet for Preventing Preterm Labor: A Randomized Clinical Trial

Background: One of the important causes of neonatal mortality and morbidity is preterm birth. There is little evidence about the role of garlic in preventing preterm labor. Objectives: This study aimed to investigate the role of garlic tablets in preventing premature birth. Methods: This is a double-blind clinical trial. Five hundred and thirty-seven singleton pregnant women in the 16th to 26th week of pregnancy with a history of threatened preterm delivery (delivery before the 37th week of pregnancy) were included in this study. The participants were randomly divided into intervention (n = 272) and control groups (n = 265). The intervention group received garlic tablets (500 mg/day) every 24 hours for 10 weeks and 250 mg intramuscular progesterone every week until 36 weeks or delivery time. The control group received placebo tablets plus 250 mg intramuscular progesterone (every week until 36 weeks). The primary outcome was the incidence of Preterm delivery (gestational age &lt; 37 weeks). Quantitative variables were expressed as frequency and percentage and compared using the chi-square or Fisher exact test with a small sample size. Numerical data were presented as mean and standard deviation. We used the Kolmogorov-Smirnov test to determine the normality of the data distribution. After that, the relationships of continuous variables with normal distribution were investigated using the independent t student test, and continuous variables without normal distribution were investigated with the non-parametric Mann-Whitney test. Multivariate logistic regression analysis estimated different variables' interaction and confounding effects. Results: Four hundred and forty-five had term delivery (82.9%), and 92 (17.1%) had preterm delivery. Seventeen participants in the intervention group (6.3%) and 75 (28.3%) in the control group had preterm delivery (P &lt; 0.001). By considering preterm labor as dependent and other independent variables, the study group (intervention or control) was the only predictor of preterm labor (OR-3.6, CI: 95%: 1.98 - 6.5, P &lt; 0.001). Conclusions: The results showed that the combined treatment of oral garlic tablets and intramuscular progesterone significantly prolonged pregnancy or improved outcomes. Garlic tablets seem to be effective in preventing preterm birth.

Successful post-term pregnancy in scared bicornuate uterus: case report

Pregnancies in the bicornuate uterus are usually considered high-risk because of their association with poor reproductive outcomes such as recurrent pregnancy loss, cervical insufficiency, low birthweight, preterm birth, malpresentation, cesarean delivery, and uterine rupture. The objective of the report was to show that patients with a scared bicornuate uterus at post-term could have successful pregnancy outcomes. We are presenting a 28-year-old gravida III para II lady with a bicornuate scared uterus at post-term. She has a history of early third-trimester pregnancy loss, and her second pregnancy was delivered via cesarean section. In her first pregnancy, the patient's uterus was not identified as bicornuate. However, an ultrasound during her second pregnancy revealed that she had a bicornuate uterus, which led to the diagnosis. At term, the lady had a successful cesarean section. Lastly, for the current post-term pregnancy she had no prenatal check-up. Even though this, she was coming at the latent first stage of labor and an emergency cesarean section was done.Conclusion Successful outcomes could be achieved in patients with the bicornuate uterus at post-term gestation.

Cerebroplacental versus Umbilicocerebral Ratio-Analyzing the Predictive Value Regarding Adverse Perinatal Outcomes in Low- and High-Risk Fetuses at Term.

Background and Objectives: The aim of this study was to investigate the prediction of adverse perinatal outcomes using the cerebroplacental (CPR) and umbilicocerebral (UCR) ratios in different cohorts of singleton pregnancies. Materials and Methods: In this retrospective cohort study, we established our own Multiple of Median (MoM) for CPR and UCR. The predictive value for both ratios was studied in the following outcome parameters: emergency cesarean delivery, operative intervention (OI), OI due to fetal distress, 5-min Apgar < 7, admission to neonatal intensive care unit, and composite adverse perinatal outcome. The performance of the ratios was assessed in the following cohorts: total cohort (delivery ≥ 37 + 0 weeks gestation, all birth weight centiles), low-risk cohort (delivery ≥ 37 + 0 weeks gestation, birth weight ≥ 10. centile), prolonged pregnancy cohort (delivery ≥ 41 + 0 weeks gestation, birth weight ≥ 10. centile) and small-for-gestational-age fetuses (delivery ≥ 37 + 0 weeks gestation, birth weight < 10. centile). The underlying reference values for MoM were estimated using quantile regression depending on gestational age. Prediction performance was evaluated using logistic regression models assessing the corresponding Brier score, combining discriminatory power and calibration. Results: Overall, 3326 cases were included. Across all cohorts, in the case of a significant association between a studied outcome parameter and CPR, there was an association with UCR, respectively. The Brier score showed only minimal differences for both ratios. Conclusions: Our study provides further evidence regarding predictive values of CPR and UCR. The results of our study suggest that reversal of CPR to UCR does not improve the prediction of adverse perinatal outcomes.

Twice-Weekly Versus Once-Weekly Membrane Sweeping in the Prevention of Post-Term Pregnancy: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Membrane sweeping is considered a simple and effective method for initiating spontaneous onset of labor. Despite the widely accepted membrane sweeping use to prevent post-term birth, the optimal frequency has not been estimated. We aimed to assess the effectiveness and safety of twice-weekly versus once-weekly membrane sweeping in post-term pregnancy prevention. Four different databases were searched for available clinical trials from inception to October 2022. We selected randomized controlled trials (RCTs) that compared twice-weekly membrane sweeping in intervention group versus once-weekly membrane sweeping in control group among pregnant women with singleton pregnancy at ≥ 39 gestational weeks. Our primary outcomes were the rate of spontaneous onset of labor and the requirement for formal methods of labor induction. Our secondary outcomes were sweeping to delivery interval in days, gestational age at delivery in weeks, Bishop score at admission, chorioamnionitis, and premature rupture of membranes. Three RCTs (596 patients) were included. Twice-weekly membrane sweeping was associated with significant increase in the rate of spontaneous onset of labor and significant decline in labor induction rate in comparison with once-weekly group. Duration from sweeping to delivery was significantly shorter among the twice-weekly group (p<0.001). Furthermore, gestational age at delivery was significantly earlier in the twice-weekly group. A significantly higher Bishop score at admission was observed in the twice-weekly group (p=0.02). There were no significant differences across both groups in chorioamnionitis and premature rupture of membranes. In conclusion, twice-weekly membrane sweeping is more effective in preventing post-maturity pregnancy than once-weekly sweeping without added adverse events.