Rate Of Fetal Distress Research Articles

Dose Sildenafil Citrate Reduce the Incidence of Emergency Cesarean Section and Fetal Distress During Labor? A Randomized Double-Blinded Clinical Trial.

Fetal distress (FD) is one of the most frequent causes of emergency cesarean section (CS) due to the insufficient uteroplacental blood supply during labor. There is a theory that Sildenafil citrate (SC) may improve the uteroplacental blood supply and decrease fetal hypoxia and FD. In a randomized double-blinded clinical trial, a total of 208 low-risk subjects who met our stringent inclusion criteria were randomly assigned into two groups: the Sildenafil citrate group (n=104) and the placebo group (n=104). These participants were referred to our referral gynecology and obstetrics department for delivery between July 2022 to September 2022. The SC group received oral SC at a dose of 50 mg every 6 hr, up to a maximum of three times. The final maternal-fetal-neonatal results were recorded and all data were analyzed using SPSS version 23. The mean age of mothers was 28.98±5.6 years and 120 cases were primigravid (57.7%). Out of a total of 208 pregnant subjects, 168 subjects delivered through normal vaginal delivery (80.8%) and 40 cases underwent emergency CS (19.2%). The number of NVD in Sildenafil group was significantly more than placebo group (87.5% vs. 74%) and SC decreased the rate of emergency CS to 87.5% (RR=2.46%, 95%CI 1.19-5.08). Also, SC decreased the rate of FD to 53.8% (RR=2.83%, 95%CI of 1-8.24). The results showed that SC can effectively decrease the rate of emergency CS and FD during labor.

Clinical effects of Cook® cervical ripening balloon on promoting cervical dilation for early termination of pregnancy in high-risk parturients.

We aimed to evaluate the clinical effects of oxytocin, misopros-tol, controlled-release dinoprostone suppository, and Cook® cervical ripening balloon on early termination of pregnancy in high-risk parturients. Four hun-dred high-risk full-term parturients not in labor who were unsuitable for await-ing delivery and treated from May 2018 to July 2020 were divided into groups I-IV with a random number table (n=100). They received labor induction by oxytocin, misoprostol, controlled-release dinoprostone suppository, and Cook® cervical ripening balloon, respectively. The general data, cervical ripening ef-fect, delivery outcome, delivery time, adverse reactions, and neonatal condi-tions were compared. The time from the beginning of labor induction to labor and duration of the first, third, and total stages of labor were shorter in group II-IV than in group I (p<0.05). The incidence rates of excessive uterine contrac-tion in groups II and III were higher than those of groups I and IV, and the inci-dence rates of fetal distress in groups I-III exceeded that of group IV (p<0.05). The neonatal Apgar scores of groups III and IV were higher than those of groups I and II (p<0.05). Cook® cervical ripening can promote cervical maturation and shorten the labor induction time and stage of labor.

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.
 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.
 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.
 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.

Cervical Osmotic Dilators versus Dinoprostone for Cervical Ripening during Labor Induction: A Systematic Review and Meta-analysis of 14 Controlled Trials.

This study aimed to conduct a systematic review and meta-analysis of all randomized and nonrandomized controlled trials (RCTs and NCTs, respectively) that explored the maternal-neonatal outcomes of cervical osmotic dilators versus dinoprostone in promoting cervical ripening during labor induction. Six major databases were screened until August 27, 2022. The quality of included studies was evaluated. The data were summarized as mean difference or risk ratio (RR) with 95% confidence interval (CI) in a random-effects model. Overall, 14 studies with 15 arms were analyzed (n = 2,380 patients). Ten and four studies were RCTs and NCTs, respectively. The overall quality for RCTs varied (low risk n = 2, unclear risk n = 7, and high risk n = 1), whereas all NCTs had good quality (n = 4). For the primary endpoints, there was no significant difference between both groups regarding the rate of normal vaginal delivery (RR = 1.04, 95% CI: 0.95-1.14, p = 0.41) and rate of cesarean delivery (RR = 1.04, 95% CI: 0.93-1.17, p = 0.51). Additionally, there was no significant difference between both groups regarding the mean change in Bishop score and mean time from intervention to delivery. The rate of uterine hyperstimulation was significantly lower in the cervical osmotic dilator group. For the neonatal outcomes, during cervical ripening, the rate of fetal distress was significantly lower in the cervical osmotic dilator group. There was no significant difference between both groups regarding the mean Apgar scores, rate of meconium-stained amniotic fluid, rate of umbilical cord metabolic acidosis, rate of neonatal infection, and rate of neonatal intensive care unit admission. During labor induction, cervical ripening with cervical osmotic dilators and dinoprostone had comparable maternal-neonatal outcomes. Cervical osmotic dilators had low risk of uterine hyperstimulation compared with dinoprostone. Overall, cervical osmotic dilators might be more preferred over dinoprostone in view of their analogous cervical ripening effects, comparable maternal-neonatal outcomes, and lack of drug-related adverse events. · This is the first analysis of cervical osmotic dilators versus PGE2 for cervical ripening during labor.. · There was no difference between both arms regarding the rates of normal vaginal/cesarean deliveries.. · There was no difference between both arms regarding the rates of neonatal adverse events.. · Cervical osmotic dilators had significant lower risk of uterine hyperstimulation compared with PGE2.. · Cervical osmotic dilators may be superior to PGE2 in view of their similar efficacy and better safety..

Influence of bronchopulmonary dysplasia on cerebral blood flow in preterm infants: a prospective study based on arterial spin labeling

To investigate local cerebral blood perfusion in preterm infants with bronchopulmonary dysplasia (BPD) based on cerebral blood flow (CBF) values of arterial spin labeling (ASL). A prospective study was conducted on 90 preterm infants with a gestational age of <32 weeks and a birth weight of <1 500 g who were born in the Department of Obstetrics and admitted to the Department of Neonatology in the Third Affiliated Hospital of Zhengzhou University from August 2021 to June 2022. All of the infants underwent cranial MRI and ASL at the corrected gestational age of 35-40 weeks. According to the presence or absence of BPD, they were divided into a BPD group with 45 infants and a non-BPD group with 45 infants. The two groups were compared in terms of the CBF values of the same regions of interest (frontal lobe, temporal lobe, parietal lobe, occipital lobe, thalamus, and basal ganglia) on ASL image. Compared with the non-BPD group, the BPD group had a significantly lower 1-minute Apgar score, a significantly longer duration of assisted ventilation, and a significantly higher incidence rate of fetal distress (P<0.05). After control for the confounding factors such as corrected age and age at the time of cranial MRI by multiple linear regression analysis, compared with the non-BPD group, the BPD group still had higher CBF values of the frontal lobe, temporal lobe, parietal lobe, occipital lobe, basal ganglia, and thalamus at both sides (P<0.05). BPD can increase cerebral blood perfusion in preterm infants, which might be associated with hypoxia and a long duration of assisted ventilation in the early stage.

Doppler Ultrasound Imaging Combined with Fetal Heart Detection in Predicting Fetal Distress in Pregnancy-Induced Hypertension under the Guidance of Artificial Intelligence Algorithm.

This study was to improve the feasibility and economic benefits of intelligent medical system Doppler ultrasound (DUS) imaging technology combined with fetal heart detection to predict the fetal distress in pregnancy-induced hypertension (PIH), so as to reduce the risk of deterioration of the patient's condition. The characteristics of DUS images were analyzed, and a diffusion filter reducing the specificity was adopted to improve the smooth speckle noise of DUS images. 120 pregnant women in hospital were the subjects of the study, all of whom received ultrasound cord blood flow testing and fetal heart monitoring. 88 PIH patients with fetal distress were diagnosed and included in the observation group, and 32 healthy pregnant women tested during the same period were identified as the control group. Clinical data were reviewed and analyzed. The diagnostic rates of fetal distress by simple fetal heart monitoring and DUS detection combined with fetal heart monitoring were compared. The results showed that 26.7% of fetal distress were diagnosed by fetal heart monitoring alone, and 73.3% of fetal distress were diagnosed by combined testing, so the diagnostic accuracy of the combined detection method was greatly higher than the single fetal heart detection (P < 0.05). The Pulsatility index (PI), resistance index (RI), and S/D values detected by the umbilical artery in the observation group were 1.48, 0.85, and 4.31, respectively. The PI, RI, and S/D values detected by the umbilical artery in the control group were 0.96, 0.64, and 3.59, respectively. The results of arterial detection were significantly higher than those of the control group, and the difference was of significant scientific significance (P < 0.05). In summary, the PI and RI values of the middle cerebral artery (MCA) detected by DUS diagnosis can effectively reflect the current status of the fetus in the uterus and reduce the mortality of the fetus. The images guided by DUS imaging technology can clearly show the current status of the fetus in the uterus, effectively improve the medical diagnostic efficiency, and have important reference value for the development of intelligent medical equipment.

MATERNALAND PERINATAL OUTCOMES WITH COVID-19: A TERTIARY CARE CENTRE STUDY

Background: With the exponential increase in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2/COVID-19) worldwide, an increasing proportion of pregnant women are now infected during their pregnancy. The knowledge gained from previous human coronavirus outbreaks suggests that pregnant women and their fetuses are particularly susceptible to poor outcomes. The aim of this study was to summarize the maternal and perinatal outcomes of pregnant women infected with COVID-19 during their pregnancy. Methods:Eligibility criteria included pregnant women positive for COVID-19 as detected by real-time polymerase chain reaction (PCR). Results: Atotal of 40 pregnant women positive for COVID-19 as conrmed by RT-PCR, were included in the study. 5% cases had preterm deliveries and LSCS was the preferred mode of delivery in 28 of 40 i.e., 70% cases. There was a tendency for low Apgar score at birth, higher rates of fetal distress, meconium, NICU admissions. There was one IUD only in this study. The treatment patterns of COVID-19 infection among pregnant women during their pregnancy or following delivery was mostly supportive in the form of oxygen and antibiotic therapy. Conclusions: Although the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID-19 were reported. Vertical transmission of the COVID-19 could not be ruled out. Pregnant infected women had different symptoms, and they were given mostly supportive treatments than the general infected population. Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection are warranted.

Serum Bile Acids in Intrahepatic Cholestasis of Pregnancy (ICP), Versus Pregnant and Nonpregnant Controls in Asian Indian Women and a Proposed Scoring to Optimize Management in ICP.

This prospective clinical trial was conducted to assess serum bile acids (BA) levels in women with intrahepatic cholestasis of pregnancy (ICP) compared to both pregnant and non-pregnant controls; and evaluate perinatal outcome in relation to bile acid levels. A scoring is proposed based on biochemical markers to optimize management in ICP cases. Serum bile-acids(BA) were assessed in 71 intrahepatic-cholestasis of pregnancy(ICP) cases (group-I), versus 50 pregnant (group-II) and 35 non-pregnant (group-III) controls. Ursodeoxycholic acid (UDCA) was administered in ICP group. Baseline bilirubin (SB), aminotransferases (AT), alkaline-phosphatase were sent in groups I & II. Investigations were repeated in group-I after 4weeks. Perinatal complications were noted. Mean BA in group-I was 75.92 ± 39.9µmol/L which reduced to 41.3 ± 15.4µmol/L(45.6%, p < 0.001) with UDCA. Mean BA was 29.2 ± 5.7 and 5.9 ± 1.8µmol/L in group-II and group-III. UDCA significantly reduced itching-score. Rate of fetal distress linearly increased with the increasing baseline levels of serum BA, AT and SB: from 2.5 to 100% at BA < 40 and ≥ 200µmol/L, (p = 0.008); from 16.1 to 100% at AT < 100 and ≥ 500IU/mL(p = 0.016); and from 6.8 to 100% at SB < 0.8 and > 5mg/dL (p = 0.001); respectively. Their baseline levels were divided into 5 groups in correlation to fetal distress. Serum BA < 40, 40-80, 80-120, 120-200, ≥ 200µmol/L; AT < 100,100-200,200-500, ≥ 500IU/mL; and SB < 0.8, 0.8-1.0, 1.1-2, 2.1-5 and > 5mg/dL. Nutan ICP scoring was proposed with a score 0 to 4 given to each parameter and score-based management protocol was suggested for fetal surveillance and delivery. SBA are higher in Asian Indian pregnant women. Levels > 30µmol/L can be taken as a cut off for diagnosing ICP in Asian-Indian women. Adopting higher cut-offs for this geographic part will avoid over-diagnosing ICP and iatrogenic early termination of pregnancy. Suggested scoring will help clinicians in optimizing the time of delivery on an individualized basis.

Vertical transmission of chikungunya virus: A systematic review.

ObjectivesTo describe and estimate the frequency of pregnancy outcomes, clinical and laboratory characteristics of vertical transmission of CHIKV in the neonate.Study designWe performed a systematic review evaluating the clinical presentation of perinatally-acquired CHIKV infection in neonates. The search was performed using Medline (via PubMed), LILACS, Web of Science, Scielo, Google Scholar and Open grey to identify studies assessing vertical transmission of CHIKV up to November 3, 2020. There were no search restrictions regarding the study type, the publication date or language. Studies with no documented evidence of CHIKV infection in neonates (negative RT-PCR or absence of IgM) were excluded.ResultsFrom the 227 studies initially identified, 42 were selected as follows: 28 case reports, 7 case series, 2 cross-sectional studies and 5 cohort studies, for a total of 266 CHIKV infected neonates confirmed by serological and/or molecular tests. The vertical transmission rate was 50% in the Reunion Island outbreak, which was the subject of the majority of the studies; the premature delivery were reported in 19 (45.2%) studies; the rate of fetal distress was 19.6% of infected babies and fetal loss occurred in 2% of the cases. Approximately 68.7% of newborns were diagnosed with encephalopathy or encephalitis after perinatally acquired CHIKV. Most of the infected neonates were born healthy, developing CHIKV sepsis clinical syndrome within the first week of life.ConclusionsWe alert neonatologists to the late manifestations of neonatal CHIKV infection, relevant to the management and reduction of morbidity. A limitation of our review was that it was not possible to carry out meta-analysis due to differences in study design and the small number of participants.

Clinical analysis of risk factors and pregancy outcomes of fetal growth restriction in the third trimester

Objective The aim of this study is to analyze risk factors and perinatal outcomes of fetal growth restriction (FGR) in the third trimester to improve pregnancy outcomes. Methods The retrospective study collected 676 fetus, included 338 FGR and 338 appropriate for gestational infants. All samples were collected between January 1st 2014 and January 1st 2016 from Fujian Provincial Maternity and Children's Hospital. Multivariate logistic regression analysis was used to analyze the risk factors and pregnancy outcomes of fetal growth restriction between FGR and control group. Results ⑴ Multivariate logistic regression analysis showed that the independent risk factor of FGR was severe preeclampsia for 28-33+ 6 weeks FGR. The independent risk factors of 37-40+ 6 weeks FGR were severe preeclampsia, oligohydramnios, velum attachment of cord and cord around neck. ⑵ Compared with the control group of the same gestational week, the fetal distress rate, 1 minute asphyxia rate of newborn and cesarean section rate of FGR in the 28-33+ 6 gestational week group were all higher than those in the same gestational week group (P<0.05). ⑶ The fetal distress in FGR group was more than in cesarean delivery that in vaginal delivery at 28-33+ 6 weeks of gestation, and that in FGR group was more than that in vaginal delivery at 34-36+ 6 weeks of gestation (P<0.05). Conclusions Severe preeclampsia, oligohydramnios, velum attachment of umbilical cord and cord around the neck are the independent risk factors of FGR in the third trimester. During pregnancy, early intervention such as screening in high risk pregnant women and fetal intrauterine monitoring should be carried out to improve the perinatal outcome. Key words: Pregnancy trimester, third; Fetal growth restriction; Risk factors; Pregnancy outcome

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents.

BackgroundAdolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents.Material/MethodsA total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded.ResultsPrimary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%).ConclusionsIn conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Effect of painless delivery technique in vaginal delivery of elderly primipara

Objective To investigate the effect of painless delivery technique in vaginal delivery of elderly primipara. Methods A total of 110 elderly primipara in the Women and Children Hospital of Ningbo from June 2016 to August 2017 were selected as study objects, and they were divided into two groups by double blind random grouping method, with 55 women in each group. The control group received routine delivery technique, the observation group received painless delivery technique. The mood, degree of pain, duration of labor, delivery mode and complications of the two groups were compared and analyzed. Results In the observation group, there were more women with anxiety and depression, and less women with mild symptoms, and less women with moderate and severe symptoms than those in the control group (χ2=6.26, 6.88, 5.43, 11.76, 7.12, 8.59, 8.30, 10.75, all P<0.05). In terms of pain grading, the patients with pain of classⅠ, Ⅱ in the observation group were more, and the patients with pain of category Ⅲ were less than those in the control group(χ2=30.62, 4.27, 49.09, all P<0.05). The duration of the first delivery[(210.25±34.34)min], the duration of the second delivery[(49.63±21.15)min] and the duration of the third delivery[(8.49±3.14)min] in the observation group were shorter than those in the control group(t=8.03, 7.55, 2.51, all P<0.05). In the observation group, the cesarean section rate(5.45%) was lower and the spontaneous delivery rate(87.27%) was higher than those in the control group(χ2=8.42, 7.25, all P<0.05). The maternal bleeding rate(1.82%) and fetal distress rate(0.00%) in the observation group were lower than those in the control group(χ2=3.81, 5.24, all P<0.05). Conclusion The technique of painless delivery is safe and reliable, and the effect is satisfactory in aged primipara. Key words: Natural childbirth; Analgesia, obstetrical; Pain; Anxiety; Depression; Labor stage, first; Labor stage, second; Labor stage, third; Old age; Primipara

Maternal-Fetal Outcomes of Pregnancies with Thrombocytopenia-One Center Experience

Objective: To investigate the etiology, obstetric risk factors, complications, and outcomes of pregnancies affected by thrombocytopenia. Material and Methods: A retrospective surveillance study was conducted based on the hospital records of 1286 women that gave birth during the period between 1st January 2017 and 31st December 2018 at the Department of Gynecology and Obstetrics of the Trakya University's School of Medicine. Clinical data including basic history, physical examination, and investigations of women with thrombocytopenia were evaluated. We randomly selected 154 patients without thrombocytopenia that delivered in our clinic during the same period, as the control group, and compared the maternal and fetal outcomes with the thrombocytopenic patient group. Results: A total of 154 out of 1286 women (11.9%) had thrombocytopenia of varying severity. Gestational thrombocytopenia (GT) was the most common cause, being identified in 76.2% of the cases with thrombocytopenia. This was followed by preeclampsia (15.5%). About 4.5% of pregnant women with thrombocytopenia were accounted for by idiopathic thrombocytopenic purpura (ITP), 2.5% of the patients by eclampsia, while HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome was observed in 1.3% of the pregnant women with thrombocytopenia. An increased rate of IUGR (Intrauterine growth restriction), fetal distress, and adverse neonatal outcomes were recorded among patients that had thrombocytopenia with preeclampsia, eclampsia, and HELLP syndrome. Furthermore, we observed higher rates of fetal distress and adverse neonatal outcomes in patients with thrombocytopenia compared to the control group. Conclusion: GT was the most common cause of thrombocytopenia in pregnancy, followed by preeclampsia. Eclampsia, HELLP syndrome, and ITP were rare causes of this disorder during pregnancy. Early detection and treatment of expected complications are critical for the effective management of such cases.

Peripartum fetal distress in diabetic women: a retrospective case-cohort study

BackgroundMajor concerns of pregnancies complicated by diabetes mellitus are an increased risk of adverse perinatal outcome. The objective of this study was to analyse the rate of fetal distress during labor in women with type 1, type 2 and gestational diabetes compared to control women.MethodsA retrospective case-cohort study was conducted at the VU University Medical Center, Amsterdam; a tertiary care hospital. 117 women with type 1 diabetes, 59 women with type 2 diabetes, 303 women with gestational diabetes and 15,260 control women were included, who delivered between March 2004 and February 2014. Linear and logistic regression analyses were used to compare maternal and pregnancy characteristics. Risk of fetal distress and perinatal asphyxia was assessed by multiple regression analyses, adjusted for confounding factors as age, smoking, parity, previous cesarean section, hypertensive disorder, pre-eclampsia, prematurity, induction of labor and macrosomia. Main outcome measure was fetal distress, defined either as clinical indication for instrumental or cesarean delivery; or low umbilical artery pH (UA pH), or admission to neonatal unit (NU).ResultsThe indication for instrumental or cesarean delivery in women with type 1 and type 2 diabetes mellitus was more frequently based on fetal distress as compared to controls (adjusted OR 2.76 CI 1.74–4.40 and adjusted OR 2.31 CI 1.19–4.51, respectively). In comparison with the control group, infants of women with type 1 diabetes had an increased risk of UA pH < 7.20 (adjusted OR 1.88 CI 1.23–2.87) or UA pH < 7.10 (adjusted OR 3.35 CI 1.79–6.27). Also, infants of women with type 1 diabetes were at increased risk for admission to NU as compared to infants of control women (OR 8.07 CI 4.75–13.70).ConclusionsWomen with type 1 and type 2 diabetes are at increased risk of fetal distress during labor as compared to controls.

Detection rate of fetal distress using contraction-dependent fetal heart rate variability analysis

Objective: Monitoring of the fetal condition during labor is currently performed by cardiotocograpy (CTG). Despite the use of CTG in clinical practice, CTG interpretation suffers from a high inter- and intra-observer variability and a low specificity. In addition to CTG, analysis of fetal heart rate variability (HRV) has been shown to provide information on fetal distress. However, fetal HRV can be strongly influenced by uterine contractions, particularly during the second stage of labor. Therefore, the aim of this study is to examine if distinguishing contractions from rest periods can improve the detection rate of HRV features for fetal distress during the second stage of labor. Approach: We used a dataset of 100 recordings, containing 20 cases of fetuses with adverse outcome. The most informative HRV features were selected by a genetic algorithm and classification performance was evaluated using support vector machines. Main results: Classification performance of fetal heart rate segments closest to birth improved from a geometric mean of 70% to 79%. If the classifier was used to indicate fetal distress over time, the geometric mean at 15 minutes before birth improved from 60% to 72%. Significance: Our results show that combining contraction-dependent HRV features with HRV features calculated over the entire fetal heart rate signal improves the detection rate of fetal distress.

Therapeutic effect of one-day outpatient on gestational diabetes mellitus patients

To study the effect of one-day outpatient intervention on gestational diabetes mellitus (GDM) patients, and to explore the pregnancy outcome relevant to GDM patients and their fetus. Methods: The GDM patients were divided into two groups according to their own intention to the one-day outpatient. According to systematic sampling method, we chose 200 GDM patients from the above 2 groups, respectively. The 200 GDM patients in the control group were matched the observation group with the age and gestational age, then the pregnancy outcome was tracked. Results: The control level and success rate for the two hours blood sugar after breakfast and hemoglobin A1c (HbA1c) in the observation group were better than those in the control group (P<0.001). The maternal complication rate (46.50%) and neonatal complication rate (21.50%) in the observation group were lower than those in the control group (71.50%, 41.50%; P<0.001). The maternal complications rate of fetal distress, premature and the neonatal complications rate of fetal macrosomia, neonatal respiratory distress syndrome (NRDS), low weight, congenital heart disease, neonatal pneumonia, and rate in neonatal NICU were significantly lower than those in the control group (P<0.05). Conclusion: One-day outpatient intervention could control blood sugar effectively, reduce the maternal and neonatal complications. It is worth promoting.

The Comparison of Perinatal Outcomes in Early Delivery Versus Postdate Labor

Background: Prenatal mortality and morbidity increase after 40 weeks of gestation. The current study aimed at comparing maternal and neonatal outcomes between term and postterm pregnancies. Methods: The current prospective cohort study was performed on 1180 singleton, cephalic fetus, and uncomplicated pregnancy cases admitted for labor. Pregnant mothers were divided into 3 groups. Group 1 included 750 cases in 38 to 40 weeks, group 2 included 250 cases in 40 to 41 weeks, and group 3 included 180 cases in over 41 weeks of gestation. Prenatal outcomes were recorded as: fetal distress, meconium passage, meconium aspiration, fetal weight ≥ 4 kg, Apgar score in 1 and 5 minutes, neonatal intensive care unit (NICU) admission, maternal infection, postpartum hemorrhage, and the rate of cesarean section. Results: There were significant differences in the rate of fetal distress (P < 0.001), meconium passage (P = 0.001), meconium aspiration syndrome (P < 0.001), Apgar score ≤ 3 at 1 (P = 0.025) and 5 minutes (P < 0.001), admission to NICU (P < 0.001), rate of cesarean section (P < 0.001), and maternal infection (P = 0.001) among the groups. The frequency of fetal distress was lower in group1 compared with group 2 (1.6% versus 4.4%; P = 0.011). Also fetal distress was significantly lower in group 1 than group 3 (1.6% versus 10.9%; P < 0.001). The meconium passage and meconium aspiration syndrome were statistically lower in group 1 compared with group 2 (1.6% versus 8%; P < 0.001 for meconium passage, and 0.9% versus 5.6%; P < 0.001 for meconium aspiration syndrome). Also meconium passage and meconium aspiration syndrome were significantly lower in group 1 compared with group 3 (1.6% versus 13.9%; P < 0.001 for meconium passage, and 0.9% versus 10%; P < 0.001 for meconium aspiration syndrome). The cesarean section was more frequent in group 2 compared with group 1 (24.8% versus 13.6%; P < 0.001) and in group 3 compared with group 1 (33.3% versus 13.6%, P < 0.001). There was no significant difference in the mean fetal weight, fetal weight ≥ 4 kg, and postpartum hemorrhage in females between the 3 groups. Conclusions: Late-term and postterm births are associated with higher rates of fetal and neonatal morbidity and maternal risks compared to pregnancy termination before 40 weeks of gestation, and earlier birth induction is recommended in such cases.

Clinical significance of group B streptococcus testing in late pregnancy

Purpose: This study aimed to detect the maternal group B streptococcus (GBS) by real-time PCR method, aiming to understand its germ-carrying situations and clinical significance. Materials and Methods: The secretions of one-third inferior segment of maternal vagina of 1,540 pregnant and postnatal women were collected for GBS detection by real-time PCR method, and the impacts of positive results on the fetus were observed. Results: The detection rate of GBS was 5.6% (86/1540); the premature birth rate of GBS-positive pregnant women was 29.1% (25/86), the miscarriage rate was 19.8% (17/86), the premature rupture rate was 26.7% (23/86), and the fetal distress rate was 24.4% (21/86). Conclusions: The GBS germ-carriers showed increased rates of premature birth, miscarriage, premature rupture, and fetal distress, thus forming adverse effects towards the maternal and infant outcomes.

Comparison between continuing midwifery care and standard maternity care in vaginal birth after cesarean.

Objective:To determine whether continuing midwifery care has more benefits than standard maternity care in vaginal birth after cesarean (VBAC).Methods:This study was conducted on women in labour who had history of previous cesarean section and received vaginal birth in obstetrical department of our hospital from May 2013 to November 2014. The included patients were divided randomly into observation group and control group. The women in labour allocated to the observation group received continuing midwifery care, and those to control group received standard maternity care in all the stages of labour. The duration of labor stage together with the rate of fetal distress, neonatal asphyxia, vaginal birth and postpartum bleeding were compared between the two groups.Results:Ninety-six participants were included in the current study, forty-eight in each group. The length of labor was significantly longer (p<0.05), the vaginal birth rate was significantly lower (p<0.05) and the postpartum hemorrhage rate was significantly higher (p<0.05) in the control group than the observation group. In addition, the rate of fetal distress and neonatal asphyxia were higher in the control group, but there was no significant difference between the two groups (p>0.05).Conclusion:The continuing midwifery care has more benefits than the standard maternity care in vaginal birth after cesarean (VBAC).

A preliminary study on the pregnancy outcomes of pregnant women with positive thyroid peroxidase antibody

Objective To explore the correlation between simple thyroid peroxidase antibody(TPOAb)positive(higher than the normal reference value )and the adverse pregnancy outcomes; and to discuss the necessity of clinical intervention on TPOAb positive and the characteristic of gestational thyroid peroxidase antibody changes. To study wether clinical intervention affects its direction. Methods Subjects were selected from TPOAb positive pregnant women during June 2012 to February 2015. They were registered regularly for thyroid function during pregnancy and 6 weeks postpartum, and timely treated for abnormal thyroid function. They were grouped according to the thyroid function: Group 1(n=122), simple TPOAb positive group; Group 2(n=67), patients with elevated TSH and positive TPOAb who accept the levothyroxine(L-T4)intervention; Group 3(n=120), TPOAb negative healthy pregnant women. They were regularly tested for thyroid function during pregnancy, and with follow-up until 6 weeks postpartum. Results When Group 1 compared with Group 3: the risk of premature rupture of membranes, abnormal amniotic fluid, and fetal distress rate increased, the relative risk(RR)were 3.066, 4.782, 2.605, all P 0.05). When Group 2 compared with Group 3, the risk of premature rupture of membranes, abnormal amniotic fluid, and fetal distress increased(RR were 3.830, 5.537, 3.600 respectively, all P 0.05). Compared with Group 2, Group 1 had no statistical difference between the above observational parameters. The levels of TPOAb from stage T1(the first trimester)to T3(the third trimester)showed a overall downward trend in Group 1 and Group 2, rise again six weeks after child birth. Comparison of the two groups(Group 1 and Group 2), the median value during this period did not reveal any significantly statistical differences(P>0.05). Conclusion In simple TPOAb positive pregnant women, premature rupture of membranes, abnormality in amniotic fluid, and fetal distress were significantly higher than those in healthy pregnant women; even with thyroid function correction the TPOAb positive pregnant women still cannot reduce the adverse pregnancy outcomes. Levels of TPOAb from T1 to T3 presented the overall downward trend and to rise again six weeks after pregnancy. L-T4 intervention for TPOAb positive pregnancy did not show any significant effect.(Chin J Endocrinol Metab, 2015, 31: 1041-1045) Key words: Pregnancy; Thyroid peroxidase antibody; Pregnancy outcomes