Prolonged Rupture Research Articles

Multidrug resistance pattern in bacteriological isolates of neonatal septicemia in NICU of a tertiary care center

Introduction: Multidrug resistance pathogens have been found to be an increasing cause of neonatal sepsis in developing country like India. The present study was conducted to study the multidrug resistant pattern in bacterial isolates of neonatal septicaemia in Neonatal intensive care unit (NICU) of a tertiary referral hospital, Northeastern part of U.P., India. Material and Methods: It was a prospective study in which blood culture sample was taken from 450 neonates who had clinical features of sepsis or had presence of risk factors (one major–prolonged rupture of membranes/evidence of chorioamnionitis, intrapartum fever, foul smelling liquor or two minor–febrile illness of mother 2 weeks prior to delivery, meconium stained liquor amnii, more than 3 vaginal examinations during labour, low birth weight or prematurity, prolonged labour, low Apgar score) over a period one year. Results: A total of 102 (22.7%) suspects were found to be positive for sepsis. In present study, among positive cases of neonatal sepsis, the prevalence of early onset was around three forth as compared to late onset sepsis. Among all gram positive and gram negative isolates Klebseilla pneumoniae was found to be maximum followed by Grp B streptococcus. Out of total isolates only five isolates were MDR, whereas 4 MRSA and 17 ESBL. Conclusion: Presence of Multidrug resistant isolates as well an increasing rate of ESBL producers among neonates noted in this study is alarming. Thus regular monitoring of susceptibility profile of bacterial pathogen is the need of the hour to treat and curtail the increasing trend of neonatal septicemia. Keywords: Neonatal sepsis, Antibiotic susceptibility, Klebseilla pneumoniae Grp B streptococcus.

Umbilical Cord Blood Culture in General in the Diagnosis of Sageis Newborns

Worldwide neonatal sepsis is among the most frequent causes of neonatal death. Various studies have tried to establish the relationship between prevalence of neonatal septicemia risk factors and bacteriological profiling, low birth weight, prematurity, etc. Current study was aimed to compare early onset of neonatal sepsis (EONS) among primigravida and multigravida mothers using umbilical cord blood (UCB) and peripheral venous blood (PVB) samples. It was also aimed to establish the utilization of umbilical cord blood culture (UCBC) in comparison to peripheral venous blood culture (PVBC) in identifying EONS. In present study the blood samples were collected from high risk neonates for the clinical blood culture and screening. Among the 75 neonates in the study, 24 (32.0%) were observed to have sepsis screen positive. Study of high risk neonates umbilical cord blood culture (UCBC) positivity was 17.3% while Peripheral Venous blood culture positivity was 5.3%. Moreover, in this study all risk factors like Prematurity, Low birth weights, Premature rupture of membrane, and birth asphyxia were significantly (p<0.05) associated with UCBC growth/positivity. Low birth weight (86%) was mostly reported in the high risk neonates with other associated sepsis factors. Similarly maternal fever and prolonged rupture of membrane was highly significantly (p<0.01) associated with UCBC positivity. Gram negative bacterias were more commonly found, such as Pseudomonas (5.3%), followed by E. coli (4%), and Klebsiella (2.7%) and gram positive Streptococcus sp. (2.7%), etc. From our analysis it can be said that the UCBC has strong diagnostic outcomes as compared to the PVBC for etiological evaluation of bacterial sepsis in neonates at high risk.

Intra-amniotic Infection

Intra-amniotic Infection

A double blind randomized controlled trial using copper impregnated maternity sanitary towels to reduce perineal wound infection

To investigate the effect of copper impregnated sanitary towels on the infection rate following vaginal delivery (VD). Single center double blind randomized controlled trial. Women aged 18 or over who had a sutured second-degree tear or episiotomy following VD. All women were randomized to receive either a copper-oxide impregnated sanitary towel (study group) or a non-copper sanitary towel (control group). The primary study outcome was the incidence of wound infection within a 30-day period from VD, assessed via telephone questionnaire. Secondary outcomes were length of hospital stay and risk factors of infection. 450 women were enrolled in the study of whom 225 were randomized to the copper impregnated sanitary towel (study group) and 225 to the non-copper sanitary towel (control group) group. Follow-up rate was 98.2%. A total of 102 women (23.1%) developed an infection within 30 days following VD, 19 in the study group (8.6%) and 83 (37.4%) in the control group (P=<0.001, absolute risk reduction (ARR) of 28.8%). The incidence of superficial/deep and organ/space infections was significantly lower in the study group (7.7% vs. 30.2%, P=<0.001 and 4.6% vs. 31.5%, P=<0.001 respectively) with an ARR of 22.5% and 27.0% respectively. Multivariable analysis reported Asian ethnicity and prolonged rupture of membranes as significant risk factors; for the development of infection (OR 1.91, P=0.03 and OR=1.97, P=0.04 respectively). This is the first study to demonstrate a significant reduction in infection rate following VD with the use of copper impregnated sanitary towels.

Early-onset sepsis in term infants admitted to neonatal intensive care units (2011-2016).

ObjectivesInvestigate characteristics of term infants culture-evaluated for early-onset sepsis (EOS) in neonatal intensive care units (NICUs), frequencies of organisms causing EOS, and factors associated with EOS.Study designUsing a cohort design, we identified term infants evaluated for EOS with blood, cerebrospinal fluid, or urine cultures in 326 NICUs (2011–2016). Using multivariable logistic regression, we investigated the association between EOS and demographic characteristics.ResultsOf 142,410 infants, 1197 (0.8%) had EOS, most commonly caused by group B Streptococcus (GBS; 40.6%). Lower EOS risk was associated with low Apgar score, Cesarean delivery, small for gestational age, prenatal antibiotic exposure, and positive or unknown maternal GBS screening result. Increased risk was associated with prolonged rupture of membranes, maternal age <19 years, vasopressor treatment, and ventilator support.Conclusion(s)GBS was the most frequent cause of EOS. Early risk factor recognition may help daily management of term infants in NICUs.

Timing of induction for term prelabor rupture of membranes and intravenous antibiotics

Induction of labor usually within 24 hours is recommended for term prelabor rupture of membranes. It is still unclear when within the 24 hours induction of labor for term prelabor rupture of membranes should be initiated. Antibiotic prophylaxis for group B Streptococcus is usually recommended for prolonged prelabor rupture of membranes. The aim of our study was to evaluate whether induction of labor at ≤6 hours from prelabor rupture of membranes with intravenous oxytocin in singleton pregnancies at ≥37 weeks' gestation without regular uterine contractions reduces the administration of intravenous antibiotic agents. This was a retrospective cohort study including all women with prelabor rupture of membranes at ≥37 weeks' gestation and without regular uterine contractions in which labor was induced using intravenous oxytocin. Women were divided into 2 groups according to the timing of induction (≤6 hours vs >6 hours after prelabor rupture of membranes). A total of 166 women with term prelabor rupture of membranes were included, 53 of whom (31.9%) were induced within 6 hours of prelabor rupture of membranes and 113 (68.1%) were induced after 6 hours. There were no differences in demographic characteristics and risk factors for term prelabor rupture of membranes between the 2 groups. Women who underwent induction of labor at ≤6 hours were significantly less exposed to intravenous antibiotic prophylaxis compared with women induced at >6 hours (36% vs 80.5%, respectively; odds ratio, 0.14; 95% confidence interval, 0.07-0.28). Furthermore, for women induced within 6 hours after prelabor rupture of membranes, the chances of delivering at <12 or <24 hours were increased, nonreassuring cardiotocogram significantly less common, and hospital stay significantly shorter. No differences were found in regard to neonatal outcomes. Induction of labor at ≤6 hours with intravenous oxytocin after term prelabor rupture of membranes is significantly associated with lesser use of antibiotic agents, shorter latency to delivery, lower incidence of nonreassuring cardiotocogram, and shorter hospital stay than induction of labor at >6 hours after prelabor rupture of membranes.

An observational study on clinical and bacteriological profile of new-borns with early onset sepsis

Background: Neonatal sepsis related mortality is preventable with timely recognition, rational antimicrobial therapy and aggressive supportive care. The objective of this study was to study the maternal and neonatal risk factors in new-borns with early onset sepsis and to ascertain commonest pathogen responsible.Methods: This study was done in the neonatal intensive care unit tertiary care hospital, Thrissur. Data collected after clinical examination and from the records of new-borns diagnosed with early onset sepsis were analyzed. All neonates suspected to have sepsis had a septic screen to corroborate the diagnosis. Blood culture was performed in all cases of suspected sepsis prior to starting antibiotics. The risk factors for sepsis, both maternal and neonatal were analysed. Their clinical features and bacteriological profile were studied. Data analysis was done using their mean±standard deviation (SD), percentage analysis, chi-square test or fischer’s test.Results: Fifty newborns with diagnosed early onset sepsis (EOS) were studied. Results suggest that maternal screening is prudent, interventions like vaginal examination were causative of sepsis than meconium stained liquor or prolonged rupture of membranes. A coincidental finding suggests that sepsis is more common in males and term babies. Blood culture showed predominant pathogen to be Klebsiella.Conclusions: Among the maternal factors, increased frequency of vaginal examination was most prevalent in the study group. Prematurity and asphyxia were not strong pre-runners for sepsis. EOS cases presenting with respiratory distress were 50%. Fever and tachycardia were the next common clinical features. The cases yielded blood culture positive were 20% and Klebsiella pneumonia (40%) was the commonest organism isolated.

Evaluation of suspected neonatal herpes simplex virus infection in preterm versus term newborns in the neonatal intensive care unit.

While national guidelines are available for the evaluation and management of term infants at risk for herpes simplex virus (HSV) infection, such guidelines are lacking for preterm infants. We sought to determine the risk factors and clinical characteristics of preterm vs. term infants who were evaluated and treated empirically for HSV infection in the neonatal intensive care unit (NICU). In a retrospective cohort study, medical records of all infants who were admitted to our NICU (2009-2016) and who were evaluated and empirically treated for HSV were reviewed for mothers' and infants' demographics, clinical characteristics, and laboratory findings. During the study period 4.2% (103/2,471) of all preterm infants, and 6.0% (112/1,865) of all term infants were evaluated and treated empirically for neonatal HSV. Among all infants who were evaluated and treated for HSV, 5.5% (12/215) had neonatal HSV disease, of whom 83.3% (10/12) were preterm infants. In comparison to term, preterm infants were more likely to be evaluated and treated, if they had a maternal history of HSV [OR 2.51 (95% CI: 1.41-4.48)], prolonged rupture of membranes [2.64 (1.221-5.73)], leukopenia [3.65 (1.94-6.87)] and thrombocytopenia [2.25 (0.85-5.89)]. HSV disease was associated with a higher mortality compared to those without disease [25% (3/12) vs. 4.4% (9/203) respectively; p = <0.05]. Preterm infants evaluated and empirically treated for HSV have a higher burden of HSV infection than term infants. HSV should be considered in the management of preterm infant with a maternal history of HSV, prolonged rupture of membranes, and thrombocytopenia.

Indications and Clinical Profile of Neonatal Admissions: A Cross-Sectional Descriptive Analysis from a Single Academic Center in Jordan.

PurposeTo review the indications and clinical profile of neonatal admissions at King Abdullah University Hospital in Jordan.Materials and MethodsWe conducted a cross-sectional review of all neonates admitted to the neonatal intensive care unit between September 2016 and September 2018. Collected data include demographic characteristics, indications for admission, morbidities and mortality, and discharge outcomes. Findings were reported among term and preterm infants.ResultsA total of 1444 infants were admitted during the study period of whom 1332 (92.2%) were inborn and 612 (42.4%) were term neonates. Of the 832 preterm infants, 545 were late preterm (34–36 6/7 gestation) and 125 had very low birth weight (˂ 1500 grams); 925 (64%) were born by cesarean section. Respiratory failure of the newborn (41.2%) and prematurity (33.3%) were the main indications for admission among the whole cohort. Maternal prolonged premature rupture of membranes (PROM) was observed in nearly half the admissions of term infants. Hypoxic ischemic encephalopathy (3.2% vs 0.7%, p 0.01) and congenital anomalies (5% vs 1.2%, p 0.03) were more common in term infants. The rate of bronchopulmonary dysplasia was 39% among <28-week and 28% among <32-week premature infants. Sepsis was encountered in 59 infants. The overall mortality rate was 3.8%. Prematurity was the main predisposing factor for mortality (Adjusted OR: 9.9, 95% CI: 3.5, 27.6).ConclusionThe majority of neonatal admissions at our institution are term and late preterm infants delivered by cesarean section. Prematurity, respiratory failure of the newborn, and suspected sepsis due to maternal PROM are the leading causes of admission. The mortality rate is within WHO target to achieve Sustainable Development Goal 3. Population-based studies are needed to make better conclusions that represent the whole Jordanian population. A revisit for the indications of cesarean deliveries may help to improve the neonatal outcomes.

Can neonatal pneumothorax be successfully managed in regional Australia?

There is a lack of data reflecting the trend of neonatal pneumothorax in regional Australia. The aim of this study is to review the incidence and characteristics of neonates diagnosed with pneumothorax in Central Queensland, analyse outcomes in terms of the ability of local hospitals to manage this condition, and describe predictors for severe disease requiring transfer to a tertiary centre. Thus the role of regional health services in managing this condition will be reviewed. This was a retrospective observational study of all neonates born between 1 January 2008 and 31 December 2015 coded by hospital records with a diagnosis of neonatal pneumothorax in Central Queensland. Data for sex and birth gestation for all Central Queensland births of the same period were also obtained. Descriptive statistics were calculated for birth weight and gestation, and Apgar scores. Frequencies were calculated for sex, length of admission, age of diagnosis and risk factors including meconium aspiration syndrome (MAS), prolonged rupture of membranes (PROM) and positive pressure ventilation (PPV). The primary outcome measure was successful treatment at a Central Queensland hospital versus requirement for transfer to tertiary hospital or death prior to transfer. Statistical significance was calculated for binary and continuous variables. During the study period, there were 31 cases of pneumothorax amongst 17 640 deliveries recorded by three Central Queensland hospitals, with a significant bias towards males (84%) amongst pneumothorax cases (p<0.001). Median gestational age was comparable between the Central Queensland population and the pneumothorax cohort. Diagnosis of pneumothorax was usually made within 48 hours of birth (87.1%). PPV was present in two-thirds of the pneumothorax cohort whilst MAS and PROM were less common. No significant relationship was found between type of pneumothorax and gender, birth weight, MAS, PROM, caesarean section or PPV. The majority of cases were successfully treated locally (67.7%) and with oxygen alone (64.5%). Other treatment modalities included surfactant use, thoracocentesis, chest tube insertion and PPV. Patients with bilateral pneumothorax or pneumomediastinum had poorer outcomes (p=0.04). Overall local outcomes were good, with only one perinatal death prior to discharge or transfer. Neonatal pneumothorax is effectively managed in the regional hospitals studied in keeping with contributions of regional paediatricians and rural generalists. Compared with unilateral pneumothorax, bilateral pneumothorax or pneumomediastinum were associated with transfer to tertiary centre. There were no clear predictors for bilateral pneumothorax.

Maternal Fetal Health

Maternal Fetal Health

Maternal Risk Factors, Clinical Profile and Short-Term Outcome of Pre-Term Low Birth Weight Babies

Background: Preterm Low Birth Weight babies carry relatively higher risk of perinatal and neonatal mortality, retarded growth and development subsequently. In this study, some maternal risk factors were investigated as it seems to be important to study these factors on regional basis.&#x0D; Objective: To find out the maternal risk factors, clinical profile and short term outcome of pre-term low birth weight neonates by gestational age, birth weight, Occipitofrontal Circumference, length, different presentation (asphyxia, hypothermia, feeding difficulties, signs of infection) on admission and the morbidity and mortality of preterm LBW.&#x0D; Materials and Methods: A descriptive type of cross sectional study was done in neonatal ward of Jalalabad Ragib Rabeya Medical College Hospital, Sylhet from May, 2015 to April, 2016. Hundred cases were selected from neonatal ward and 100 controls were selected from obstetrics ward.&#x0D; Results: Among 100 pre-term LBW neonates, 52 were male and 48 were female. Only 22% mother took regular antenatal check up in case group and 55% in control group. Mean gestational age of neonates were 33.3±2.1 weeks. Important risk factors were primi parity (58% in cases vs 34% in control), hypertension (19% vs 5%), pre-eclampsia (26% vs 12%), prolonged rupture of membrane (33% vs 7%), APH (22% vs 0%), acute infection (8% vs 1%), multiple birth (17% vs 2%). Common clinical presentations were prematurity and LBW. Commonest morbidity was feeding problem (70%). The overall survival rate was 87%. Most common cause of death was septicemia (30%).&#x0D; Conclusion: all the identified risk factors were significantly higher in pre-term LBW babies than those of control.&#x0D; KYAMC Journal Vol. 11, No.-2, July 2020, Page 77-82

Early-Onset Neonatal E. coli Sepsis in Term Infants in the Absence of Antenatal or Intrapartum Risk Factors for Infection

Early-onset neonatal sepsis (EONS), an important cause of neonatal morbidity and mortality, is usually due to ascending infection from maternal genital tract or infected amniotic fluid. The most common organism is group B streptococcus (GBS), followed by Esc herichia coli (E. coli). Risk factors include maternal GBS colonization, chorioamnionitis, prolonged membrane rupture, prematurity, and intrapartum maternal pyrexia. The presentation of EONS can be varied, ranging from temperature instability to profound hypotension. We present two cases of E. coli EONS in term infants presenting as respiratory distress, without risk factors for infection. The first case is a 34-year-old female, with history of one previous caesarean section (CS), who underwent a repeat CS at 37+1 week’s gestation for obstetric cholestasis. Investigations performed on the second day of neonatal life in view of persistent respiratory distress, revealed E. coli bacteremia, complicated by septic shock. The mother developed fever on the first post-operative day due to E. coli bacteremia. The second case is a 31-year-old GBS negative primigravida with gestational diabetes, who underwent an induction of labor at 38+ 3 weeks. She had a forceps delivery for fetal distress six hours after membrane rupture. On the second day of life, the neonate had retractions and poor feeding, and blood cultures grew E. coli. There were no risk factors for EONS. The neonate rapidly deteriorated and despite extracorporeal membrane oxygenation, passed away on the seventh day of life. These cases illustrate the importance of E. coli as a cause of EONS and the need for a high index of suspicion due to the subtle presentation. Prompt recognition and treatment are important even in the absence of risk factors, as there is potential for rapid deterioration if treatment is delayed. In the presence of definite risk factors, broad-spectrum antibiotics should be considered for E. coli and GBS.

Determinants of neonatal mortality at neonatal intensive care unit in Northeast Ethiopia: unmatched case-control study

BackgroundGlobally, in 2016, about 38% and 3% of all neonatal death were recorded in sub-Saharan Africa and Ethiopia, respectively. In the same year, 47 neonates out of 1000 live births were not surviving in the first 28 days of age in the Amhara region, Ethiopia. Despite the highest burden of neonatal death in the region, specific or the proximate determinants of neonatal death in the neonatal intensive care unit were not well identified.ObjectiveThis study aimed to identify the determinants of neonatal mortality at neonatal intensive care unit in Dessie Referral Hospital, Northeast Ethiopia.MethodsAn institution-based unmatched case-control study was conducted on neonates admitted to the neonatal intensive care unit of Dessie Referral Hospital, from January 1, 2016, to December 30, 2017. A total of 390 charts (130 cases and 260 controls) were selected by simple random sampling technique. The data were abstracted from the facility-based data abstraction form. A binary logistic regression analysis was fitted to identify the determinants of neonatal mortality.ResultsPregnancy-induced hypertension (AOR = 4.57; 95% CI 1.45–14.43), prolonged rupture of membrane (AOR = 2.04; 95% CI 1.13–3.68), very low birth weight (AOR = 7.00; 95% CI 2.10–23.35), and low birth weight (AOR = 2.12; 95% CI 1.10–4.20) were identified factors. Moreover, respiratory distress syndrome (AOR = 3.61; 95% CI 1.10–12.04), perinatal asphyxia (AOR = 2.27; 95% CI 1.18–4.39), meconium aspiration syndrome (AOR = 2.35; 95% CI 1.12–4.97), and infection (AOR = 2.26; 95% CI 1.34–3.82) were also significantly associated with neonatal death.ConclusionsPregnancy-induced hypertension, prolonged rupture of membrane, low birth weight, respiratory distress syndrome, perinatal asphyxia, meconium aspiration syndrome, and infections were the major determinants of neonatal mortality. Therefore, special attention will be given to small and sick babies. Moreover, early anticipation of complications and management of mothers who had pregnancy-induced hypertension and prolonged rupture of the membrane would save neonates.

The impact of cesarean section on neonatal outcomes at a university-based tertiary hospital in Jordan

BackgroundOver the past two decades, there has been a steady rise in the rate of Cesarean section delivery globally. As a result, short-term and long-term maternal and neonatal complications are rising. The objective of this study is to determine the rate and indications for Cesarean section at King Abdullah University Hospital (KAUH) in Jordan and to assess the resulting neonatal outcomes.MethodsA retrospective chart review was conducted for all women and neonates delivered by Cesarean section during the period January 2016 to July 2017 at KAUH tertiary academic center. Collected data include demographic characteristics, indication for delivery, and neonatal outcomes such as NICU admission, respiratory complications, sepsis, mortality, and length of hospitalization.ResultsTwo thousand five hundred ninety-five Cesarean section deliveries were performed over 18 months representing a rate of 50.5% of all deliveries. Sixty percent were scheduled procedures. Seventy-two percent were performed at full term gestation. The most common indication was previously scarred uterus (42.8%) followed by fetal distress (15.5%). The rate of admission to the neonatal ICU was 30% (800/2595). After multilogistic conditional regression analysis, the factors associated with increased risk of neonatal ICU admission were found to include grandmultiparity (Adjusted OR 1.46), gestational diabetes (Adjusted OR 1.92), maternal employment (Adjusted OR 1.84), prolonged rupture of membranes (Adjusted OR 5), fetal distress (Adjusted OR 1.84), prematurity (Adjusted OR 43.78), low birth weight (Adjusted OR 42), high order multiple gestation (Adjusted OR 9.58) and low 5-min APGAR score (Adjusted OR 10). Among the babies electively delivered at early term (37–38.6 weeks), 16% were admitted to the NICU for a median length of stay of 4 days (IQR 2, 8). The most common diagnoses for admitted term neonates were transient tachypnea of newborns and respiratory distress syndrome.ConclusionsCS deliveries account for more than half the number of deliveries at our institution and almost one third of the delivered babies are admitted to the NICU. Together with the resulting maternal and neonatal consequences, this carries a major burden on the newborns, health care facilities, and involved families. Local strategies and policies should be established and implemented to improve the outcome of births.

Risk Factors Associated with Early and Late-onset of Neonatal Sepsis in Duhok City

Backgrounds and objectives: Neonatal sepsis refers to bacterial, fungal, protozoan infections or any viral agents or pathogens which inter to the newborns bloodstream after the birth. Neonatal Sepsis is the main reason of deaths in non-developed countries. There is an overall prevalence of 54.67% in Iraq. The present study intends to explore the demographic and clinical affecting factors of early and late onset of neonatal sepsis of a sample population in Duhok city. The predictors of neonatal sepsis diagnosis were determined accordingly.Methods: This cross-sectional study shows 110 neonates who were diagnosed with early or late onset of neonatal sepsis. A paediatrician diagnosed the patients through physical and clinical assessment.Results: The prevalence of early and late onset of neonatal sepsis was 52.73% and 47.7%, respectively. The Apgar scores of less than seven and more than seven were risk factors for early and late-onset of neonatal sepsis, prolonged rupture of the membranes greater than18 hours and multiple gestations are common in patients with early onset of neonatal sepsis.Conclusions: The study showed that the early onset of neonatal sepsis or late-onset of neonatal sepsis was associated with Apgar score and prolonged rupture of the membranes.

Antepartum Hemorrhage and Outcome of Very Low Birth Weight, Very Preterm Infants: A Population-Based Study.

We aimed to determine the independent effect of maternal antepartum hemorrhage (APH) on mortality and major neonatal morbidities among very low birth weight (VLBW), very preterm infants. A population-based cohort study of VLBW singleton infants born at 24 to 31 weeks of gestation between 1995 and 2016 was performed. Infants born with the following pregnancy associated complications were excluded: maternal hypertensive disorders, prolonged rupture of membranes, amnionitis, maternal diabetes, and small for gestational age. APH included hemorrhage due to either placenta previa or placental abruption. Univariate and multivariable logistic regression analyses were performed to assess the effect of maternal APH on mortality and major neonatal morbidities. The initial cohort included 33,627 VLBW infants. Following exclusions, the final study population comprised 6,235 infants of whom 2,006 (32.2%) were born following APH and 4,229 (67.8%) without APH. In the APH versus no APH group, there were higher rates of extreme prematurity (24-27 weeks of gestation; 51.6% vs. 45.3%, p < 0.0001), mortality (20.2 vs. 18.5%, p = 0.011), bronchopulmonary dysplasia (BPD, 16.1 vs. 13.0%, p = 0.004) and death or adverse neurologic outcome (37.4 vs. 34.5%, p = 0.03). In the multivariable analyses, APH was associated with significantly increased odds ratio (OR) for BPD in the extremely preterm infants (OR: 1.31, 95% confidence interval: 1.05-1.65). The OR's for mortality, adverse neurological outcomes, and death or adverse neurological outcome were not significantly increased in the APH group. Among singleton, very preterm VLBW infants, maternal APH was associated with increased odds for BPD only in extremely premature infants, but was not associated with excess mortality or adverse neonatal neurological outcomes. · Outcome of very low birth weight infants born after antepartum hemorrhage (APH) was assessed.. · APH was not associated with higher infant mortality.. · APH was not associated with adverse neurological outcome.. · APH was associated with increased bronchopulmonary dysplasia in extremely preterm infants..

Determinants of Intrauterine Fetal Death among Unbooked Paturients at the University of Port Harcourt Teaching Hospital, Southern Nigeria

Background: Intrauterine fetal death (IUFD) is one of the most important problem in reproductive health, especially in developing countries. Unbooked pregnant women are more likely to suffer IUFD.&#x0D; Objectives: To determine the prevalence and risk factors of intrauterine fetal death among unbooked paturients at the University of Port Harcourt Teaching Hospital. &#x0D; Materials and Methods: A retrospective study of 344 unbooked women with intrauterine fetal death who presented at the labour ward of the University of Port Harcourt Teaching Hospital between January 1, 2011 and December 31, 2015. Data was obtained from their case / theater records and ward registers, encoded into a spreadsheet and analyzed using SPSS 22.0. Results were presented as means, rates and proportions. Associations between variables were assessed using students t-test and Pearson’s correlation. Differences were considered statistically significant at P &lt; 0.05.&#x0D; Results: There were 12,421 deliveries during the study period: 10,136 (81.6%) received antenatal care while 2,285 (18.4%) did not. There was a total of 1,313 perinatal deaths, giving a perinatal mortality rate of 60.9/1000 births in unbooked patients and 18.4/1000 births in booked patients (P &lt;0.01). Majority 149 (43.3%) of the IUFD occurred below 37 weeks and 123 (35.8%) at term. IUFD occurred prior to presentation in 320 (93%), of which most were referred from traditional birth attendants and religious institutions. Hypertensive disorders, abruptio placentae, obstructed labour, prolonged pregnancy, and prolonged rupture of membranes were the most common complications associated with IUFD.&#x0D; Conclusion: Pregnant women should be encouraged to register for antenatal care and deliver in health facilities with skilled attendants.

Clinical profile of patients with post-caesarean wound infection: experience of Patan Hospital, Nepal

Introduction: Would infection following caesarean delivery adds physical, psychological, and health burden to individual and health care system. This hospital based study aim to determine the rate of infection, the risk factors, pathogens and antibiotic sensitivity.&#x0D; Method: A prospective study was carried out to analyze the wound infection in women following caesarean delivery in the Department of Obstetrics and Gynecology, Patan Hospital, Nepal, between January 2018 to December 2018. The study was approved from the institutional review committee. Clinicodemographic data during perinatal period of caesarean delivery were descriptive analyzed in relation to wound infection.&#x0D; Result: Wound infection occurred in 102 (3.1%)of 3285 caesarean section (of total 7131 deliveries during the study period. The caesarean SSI rate was 3.1%, all were incisional SSI (84 superficial and 18 deep) and there were no organ-space SSI. Majority (81.3%) SSI cases were detected in emergency LSCS. Coagulase Negative Staphylococci was the most common organism isolated from wound swab. Routine postoperative antibiotics did not have a major impact in reducing wound infection rate. Multiple per vaginal examinations, prolonged rupture of membrane and staples for skin closure were more commonly associated with SSI.&#x0D; Conclusion: Reduction in caesarean rate is the major key factor for decreasing the post caesarean wound infection. Protocol should be developed and strictly implemented by all the health care professionals in order to minimize and prevent the infection rate after caesarean section.

Neonatal outcome comparisons between preterm infants with or without early pulmonary hypertension following prolonged preterm premature rupture of membranes before 25 gestational weeks in Korean Neonatal Network

Objective To determine the outcomes of very low birth weight infants (VLBWIs) following maternal mid-trimester prolonged preterm premature rupture of membranes (PPROM) and subsequent early pulmonary hypertension (PH). Design Prospective cohort study. Setting A nationwide web-based registry of VLBWIs from 67 neonatal intensive care units. Patients VLBWIs registered on the Korean Neonatal Network and born between 23 and 34 gestational weeks. Methods VLBWIs exposed to maternal PPROM prior to 25 gestational weeks and lasting ≥7 days (PPROM25, n = 402) were matched 1:1 with infants not exposed or exposed within 24 h to PPROM (CON, n = 402), using propensity score matching. The PPROM25 group was subdivided into PPROM25 groups with or without early PH, defined as exposure to inhaled nitric oxide or other pulmonary vasodilators to treat PH within 3 days of life. Clinical variables and major outcomes were compared, and risk factors for mortality and morbidities were analyzed. Results Of 1790 infants with maternal PPROM, the PPROM25 group comprised 402 (22.5%) infants. Survival rates were similar between the CON and PPROM25 groups (71.6% vs 74.4%); however, the incidence of bronchopulmonary dysplasia (BPD) differed (47.8% and 60.2%, p < .05). Infants in the PPROM25 group with early PH had higher mortality (55.6%) and more severe intraventricular hemorrhage (IVH) (31.7%) than infants in the PPROM25 group without early PH (21.9% and 14.3%, respectively; p < .05). In multivariate analysis, lower 5 min Apgar score and the presence of oligohydramnios increased the risk of development of early PH. The presence of PPROM25 was founded to be a significant risk factor for BPD and early PH in relation to mortality and severe IVH, respectively. Conclusions In VLBWIs, prolonged exposure to maternal mid-trimester PPROM increased the risk of BPD. Subsequent early PH immediately after birth increased mortality and severe IVH, thus, requires special attention.