Signs Of Fetal Distress Research Articles

Factors influencing meconium-stained amniotic fluid in West Guji, Oromia, Ethiopia: A cross-sectional study

BackgroundMeconium-stained amniotic fluid is an obstetric problem that occurs when a baby passes their first stool into the amniotic fluid before childbirth. It can indicate that the infant is under stress while the mother is giving birth. In addition to increasing the mother's risk of morbidity, meconium-stained amniotic fluid is linked to poor neonatal outcomes such as stillbirth, neonatal death, and meconium aspiration syndrome. However, there is currently little data on this issue. Therefore, the research aimed to determine the percentage of meconium-stained amniotic fluid and the contributing factors among women who gave birth at West Guji hospitals in Oromia, Ethiopia. MethodWe surveyed 314 systematically selected women who gave birth between June 1st and July 30th, 2022. We collected information from their medical records and interviewed them. To code and enter the collected data, Epi Data version 4.6 was utilized. For both descriptive statistics and multivariable logistic regression analysis, SPSS version 25 was used. Statistical significance was declared at a p-value less than 0.05, a 95 % confidence interval, and an adjusted odd ratio. ResultsIn the current study, out of 314, 99 (29.4 %, 95 % CI = 24.6–34.6) women have meconium-stained amniotic fluid. Obstetric factors like premature rupture of membranes (AOR = 3.24, 95 % CI = 1.79–5.88), pregnancy-induced hypertension (AOR = 5.08, 95 % CI = 2.76–9.35), and non-reassuring fetal heart rate (AOR = 2.96, 95 % CI = 1.27–6.91) influenced meconium-stained amniotic fluid. ConclusionThe results of the current study emphasize the significance of close observation to identify possible signs of fetal distress during pregnancy and delivery. To protect the baby's health, pregnant women who have an early rupture of the membranes, high blood pressure, or a non-reassuring fetal heart rate should be closely observed. Early identification of these factors can help health care providers take steps to prevent or minimize complications related to meconium-stained amniotic fluid.

A pregnant lady (G3P2A0) with fetal distress and brain tumor

Intracranial tumors or brain tumors are one of the most feared diseases because the brain is an important central organ. Brain tumors share several pathophysiologic features and may present with a variety of signs and symptom.
 A 39-year-old female patient, G3P2A0 of 28 weeks gestation complained of frequent throbbing headaches for the last 2 y. On physical examination, she had decreased consciousness, fever and anisocor pupil. Laboratory tests found leukocytosis. Cerebral multi-slice computed tomography (MSCT) found heterodense lesion at intraaxial supratentorial region with irregular border, necrotic components and bleeding in the right basal ganglia to the right temporal lobe. There were signs of fetal distress on cardiotocography (CTG).
 Management during pregnancy depends on the nature of the tumor. There may be some conflict between maternal and fetal interests in the patient with increased ICP. The patient was diagnosed with brain tumor in the right basal ganglia and undergoing treatment in the ICU. As a 28-week pregnant patient with fetal distress diagnosed with brain tumor, she needed to be observed and periodically evaluated. However, the patient's prognosis was dubia ad malam.
 Key words: Brain Tumor; Fetal Distress; Pregnancy
 Citation: Arianto AT, Heryadi MI. A pregnant lady (G3P2A0) with fetal distress and brain tumor. Anaesth. pain intensive care 2023;27(6):772−775; DOI: 10.35975/apic.v27i6.2233
 Received: May 22, 2923; Revised: August 08, 2023; Accepted: October 22, 2023

Long-term neurodevelopmental effects of exclusively high cord lactate levels in term newborn

Introduction Cord arterial blood gas analysis (ABGA) results are used as diagnostic criteria for hypoxic-ischemic encephalopathy in newborns with suspected perinatal asphyxia. This study evaluated the effect of cord ABGA lactate level on the long-term neurodevelopment of newborns without any clinical signs of perinatal asphyxia. Methods This clinical observation study was designed among term babies born between 2018 and 2019 in our unit. Cases with a 5-min Apgar score <7 and signs of fetal distress in their antenatal follow-up were excluded. The cases (n = 1438) were divided into two groups those with high cord lactate levels (above 5 mmol/L, n = 92) and those with low lactate levels (below 2 mmol/L, n = 255). An Ages and Stages Questionnaire, Third Edition (ASQ-3) developmental screening questionnaire was sent to all parents. Patients with a chronological age between 24 and 42 months and for whom the parents fulfilled the questionnaire (low lactate group, n = 29, and high lactate group, n = 45) were evaluated. Results No difference was observed between the two groups in terms of demographic characteristics such as age (p = .1669), male gender (p = .906), mother’s working situation (p = .948), mother’s education level (p = .828), father’s education level (p = .507), and family’s total income (p = .642). Mean ACQ-3 developmental screening test scores were significantly lower in the high lactate group compared to the low lactate group concerning; fine motor (40 vs. 60, p = .001), problem-solving (50 vs. 60, p = .002), and personal social development (45 vs. 60, p = .003). No difference was observed in terms of communication and gross motor total scores. Discussion In general practice, routine cord ABGA is not generally recommended for patients with normal Apgar scores and no suspected hypoxia. However, in this study, we observed that cases with a normal 5-min Apgar score, no suspected perinatal asphyxia, and a cord lactate value of ≥5 fell behind their peers when evaluated with the ACQ-3 developmental screening questionnaire.

FRI629 A Mysterious Case Of Mother's Battle With Diabetic Ketoacidosis During Pregnancy

Abstract Disclosure: P.D. Sittirat: None. S.J. Choi: None. A. Gutierrez: None. M. Bashyam: None. Introduction: Changes in hormone regulatory mechanisms during pregnancy can increase the likelihood of diabetic ketoacidosis (DKA) in pregnant individuals. Despite the increased risk, the likelihood of DKA in pregnant individuals with diabetes mellitus is still low at around 0.5-3%. Management involves aggressive treatment following standard DKA protocols. We delve into a mysterious case of DKA in the second trimester of pregnancy. Case Presentation: A 31-year-old G1P0 woman at 24 weeks gestation with no past medical history presented with nausea, constipation associated with back and abdominal pain. Admission labs were significant for blood glucose 369 mg/dL, CO2 11 meq/L, anion gap 19 mEq/L, white blood cell 17.2 K/uL, HbA1c 9.5%, and serum ketones 3.9 mmol/L. Within 12 hours of admission into the intensive care unit for DKA, the patient was at 5-6 cm cervical dilation without signs of fetal distress. The newborn was delivered prematurely with complications of retinopathy and patent ductus arteriosus. Mother's lab studies showed negative for anti-GAD antibody, insulinoma associated 2 autoantibodies, islet cell antibody, and zinc transporter 8 antibody. C-peptide was low at 0.9 ng/mL (normal range 1.1 to 5.5 ng/mL). The patient was maintained on subcutaneous insulin which eventually tapered off at 2 months post-partum due to hypoglycemia. At 4 and 11-month follow-ups, her HbA1C was 5.8% and 5.5%, respectively. Her blood glucose was well controlled with a regular diet. She did get post-prandial spikes with a high carbohydrate diet. Discussion: Physiological changes in pregnancy make pregnant individuals more susceptible to DKA. Even so, the likelihood of DKA in pregnancy is rare. It is even rarer to have a new diagnosis of diabetes leading to DKA in pregnancy just before evaluation at the standard 28 weeks like the events precipitated in this case. DKA in pregnancy puts both the mother and fetus at risk for long-term complications. The maternal mortality rate in pregnancy with DKA is 5% to 15%, while the fetal mortality rate is 30% to 90%. The patient’s demographic background of being a young Caucasian, thin woman who presented with a new onset DKA and had a low C-peptide was more consistent with type 1 diabetes; however, all her antibodies were normal. It’s questionable if this patient has autoantibody negative new onset type 1 diabetes and is currently in remission. It's worth to mention that she had a history of mild Covid-19 infection at 8 weeks gestation but this new onset DKA developed at 24 weeks gestation. The chance of gestational diabetes was low due to low c-peptide on presentation. Annual follow-up of the patient is necessary to monitor her HbA1C while she is off diabetes medications. Presentation: Friday, June 16, 2023

Rare malignant tumors of the ovary during pregnancy: a clinical case report

This article describes a clinical case of a malignant ovarian neoplasm, which was first detected during an urgent visit of a pregnant woman with signs of fetal distress in the third trimester of pregnancy. The relevance of this problem lies in the possibility of early diagnosis of adnexal tumors during routine ultrasound screenings, the lack of definitive recommendations for the management of such patients and the limited range of treatment methods during pregnancy. The aim of the study is to demonstrate a clinical case of pregnancy with late-detected ovarian malignancy. A 39-year-old pregnant woman at 35 weeks and 4 days' gestation consulted the antenatal clinic of a city maternity hospital with complaints of a decrease in the number and change in the nature of fetal movements over the past 24 hours. After assessment of the fetal condition (cardiotocography, ultrasound), the woman was hospitalized with a diagnosis: Pregnancy III, 35 weeks and 4 days. Fetal distress in the antenatal period. Fetal growth restriction, stage I. Gestational hypertension without significant proteinuria. Multicompartmental cyst of the right ovary. An urgent cesarean section was performed. Clinical diagnosis: рremature delivery by cesarean section. Medical care for the mother with fetal growth restriction of the first degree, fetal distress in the antenatal period. Cyst of the right ovary. Right-sided adnexectomy. Omental resection. Gestational hypertension. On the 5th day, the patient was discharged in a satisfactory condition with a recommendation for further examination in an oncology hospital. Pathological examination of the right ovary: morphological picture, taking into account the results of immunohistochemical examination, in favor of undifferentiated carcinoma; on repeated viewing - granular cell tumor of the ovary of adult type. The patient was routinely hospitalized at the city oncology center for surgical treatment and further examination. Clinical diagnosis: Bl ovarii gr I, adult-type granulosa cell tumor, T1Nx Mx. Condition after surgical treatment: lower midline laparotomy. Pangisterectomy, omentectomy. Sampling of the retroperitoneal lymph nodes on the right. Sanitation and drainage of the abdominal cavity. Clinical group II. The results of this article are of great practical importance for obstetricians-gynecologists, general surgeons and ultrasound diagnosticians in the differential diagnosis of indirect signs of malignant tumors during pregnancy, in the need to examine all pelvic organs during routine ultrasound screening of pregnant women and in establishing cause and effect relationships in the diagnosis of obstetric complications.

Maternal COVID-19 causing intrauterine foetal demise with microthrombotic placental insufficiency: a case report

BackgroundPregnant women have an increased risk of getting infected with SARS-CoV-2 and are more prone to severe illness. Data on foetal demise in affected pregnancies and its underlying aetiology is scarce and pathomechanisms remain largely unclear.CaseHerein we present the case of a pregnant woman with COVID-19 and intrauterine foetal demise. She had no previous obstetric or gynaecological history, and presented with mild symptoms at 34 + 3 weeks and no signs of foetal distress. At 35 + 6 weeks intrauterine foetal death was diagnosed. In the placental histopathology evaluation, we found inter- and perivillous fibrin depositions including viral particles in areas of degraded placental anatomy without presence of viral entry receptors and SARS-CoV-2 infection of the placenta.ConclusionThis case demonstrates that maternal SARS-CoV-2 infection in the third trimester may lead to an unfavourable outcome for the foetus due to placental fibrin deposition in maternal COVID-19 disease possibly via a thrombogenic microenvironment, even when the foetus itself is not infected.

Impact of medication correction of labor weakness on obstetrical complications and newborn status

Objectives: To analyze the impact of medical correction of labor weakness with oxytocin on obstetric and newborn complications.Materials and methods. 100 cases of childbirth with weakness of labor activity and medical correction with oxytocin (main group) and 50 cases of childbirth without weakness of labor activity (control group) were analyzed. The analysis included pregnancy and childbirth histories of mothers aged 20–32 years with a gestation period of 37– 41 weeks with uncomplicated pregnancies, without significant somatic and obstetric-gynecological pathology, who gave birth in the Perinatal Center of Kyiv during the last 3 years.Depending on the method of delivery, the women of the main group were divided into 3 subgroups: Iа – natural vaginal, spontaneous delivery (n = 60), Ib – operative vaginal delivery using a vacuum extractor (n = 22), Іc – delivery by cesarean section (n = 18).The following factors were studied in each group: assessment of newborns status according to the Apgar scale at the 1st and 5th minutes, pH level of the umbilical cord blood, frequency of fetal distress based on cardiotocography (Fischer score &lt; 6 points), duration of labor induction, color of the amniotic fluid.Results. The average duration of labor was the largest in the subgroup of spontaneous vaginal deliveries, the smallest in the subgroup of cesarean section. In subgroup Ib in 14 (63.6%) cases indications for the vacuum extractor were signs of fetal distress and only in 8 (36.4%) cases – weakness of labor activity.In subgroup Ia compared to subgroup Ic, there was a longer average duration of labor and higher percentage of deliveries with meconium-stained waters (28.3%), higher frequency of neonatal acidemia (16.7%) and the birth of children with an Apgar score at the 5th minute ≤ 6 points (8.4%). In subgroup Ic compared to subgroup Ia, there was a higher value of cases of Fischer score &lt; 6 points (50%), the duration of labor reinforcement for more than 4 hours (44.5%), more cases of asphyxia (44.5%), and the birth of children with an Apgar score at the 1st minute ≤ 6 points (38.9%). Indications for caesarean section in subgroup Ic in 50% of cases were signs of fetal distress, in 38.9% – weakness of labor activity which was not associated with medication, in 11.1% – a clinically narrow pelvis.In all groups there was a relationship between the duration of labor induction and the condition of the newborn (the frequency of asphyxia of newborns was higher when the infusion of oxytocin lasted more than 4 hours).In subgroup Ib fetal distress was the indication for urgent delivery in 63.6% of cases, and in subgroup Iс it was 50%. This indicates signs of a mediated negative effect of exogenous oxytocin on the fetus during childbirth. The newborns condition, according to the studied criteria, was worse in the groups with labor reinforcement compared to the control group, regardless of the method of delivery.Conclusions. The use of oxytocin during childbirth can have a negative effect on the fetus, which increases the frequency of operative vaginal deliveries and cesarean sections and, as a result, is a risk factor for complications in the postpartum period. There is a correlation between duration of oxytocin injection and condition of the newborn.

Severe delta variant COVID-19 in a 28-week infant with response to corticosteroids and remdesivir: a case report

Background: In the context of a global COVID-19 pandemic, there have been a variety of reports about the impact of infection to the fetus and in the immediate newborn period. Many babies appear to have a mild clinical course, but there is limited data about preterm infants. Case Presentation: A 28 week male infant was delivered with signs of fetal distress, four days after maternal infection with COVID-19. At this time, the delta variant of the virus predominated. After an initial period of stability, the baby significantly deteriorated in the second week and intensive care was escalated approaching maximal therapy. Given the life-threatening severity of the clinical condition, an off-licence trial of remdesivir was started alongside dexamethasone. With this treatment, the patient made a significant improvement and recovered. Conclusion: This case shows the feasibility of using remdesivir in the very premature neonatal population and seems to have been well tolerated.

FEATURES OF PREGNANCY WITH VIRAL HEPATITIS B

To date, insufficient data have been accumulated on the impact of maternal hepatitis B virus (HBV) infection on the course and outcomes of pregnancy, and data from published studies on this issue are contradictory.&#x0D; The aim of the study. Determination of the features of the course of pregnancy, the state of the fetus and the newborn in viral hepatitis B.&#x0D; Research materials and methods. 86 pregnant women with HBV were comprehensively examined (main group). 50 healthy pregnant women are included in the control group. Descriptive statistics methods used in biology and medicine were used.&#x0D; Research results. The majority (67.4%) of patients with HBV are diagnosed with the inactive carrier phase, 27.9% with the replicative phase. Among obstetric and perinatal complications in women with HBV, early preeclampsia (30.2%) and the threat of abortion (29.1%), placental insufficiency (31.4%), gestational diabetes (17.4%), anemia I are most often noted and II half of pregnancy (26.7 and 29.1%), signs of fetal distress in the form of distress (26.7%) and growth retardation (14.1%). Polyhydramnios was observed in 17.4%. 2 (2.3%) cases of early pregnancy loss (miscarriage) were recorded. 20.9% of patients with hepatitis B were delivered surgically, premature birth occurred in 14.0% of patients. High frequency of fetal distress during childbirth (18.6%) and pathological blood loss (15.1%). 26.7% of women with HBV gave birth to asphyxiated children (2.3% had severe asphyxia). In 19.7% of cases, children were born with reduced body weight, in 11.6% - with signs of hypotrophy, in 8.1% of children signs of intrauterine infection were noted. Violations of the period of neonatal adaptation in the form of gastrointestinal syndrome, muscle hypotonia, increased neuroreflex excitability, thermoregulation disorders were observed in 18.6% of children. In 2 (2.3%) children born to women with HBV in the replication phase at a high level of viral load, intrauterine HBV infection was diagnosed, which was confirmed by positive PCR at 3 and 6 months.&#x0D; Conclusions. Various obstetric and perinatal complications were observed in 38 (44.2%) pregnant women with HBV; further in-depth studies are needed to clarify the pathogenetic mechanisms of such disorders and identify risk factors.

The Correlation of Cord Arterial Blood Gas Analysis Results and Apgar Scores in Term Infants Without Fetal Distress.

Objective:This study aimed to evaluate the necessity of cord arterial blood gas analysis in cases without fetal distress and normal Apgar score.Materials and Methods:The cord arterial blood gas analysis and the 1- and 5-minute Apgar scores data of 1438 cases were evaluated. Newborns with fetal distress, neonates requiring cardiopulmonary resuscitation in the delivery room, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at cord arterial blood gas analysis), and pre- and post-term newborns are excluded. Following cord arterial blood gas analysis, threshold values were accepted as abnormal pH <7.2, base excess ≥ −6 mmol/L, lactate ≥ 5 mmol/L, bicarbonate < 18 mmol/L, and partial pressure of carbon dioxide ≥ 50 mmHg. We evaluated the correlation between cord arterial blood gas analysis and 1- and 5-minute Apgar scores.Results:There was a significant correlation between both 1- and 5-minute Apgar scores and cord arterial blood gas analysis values such as pH, lactate, and partial pressure of carbon dioxide (P < .001). In addition, a significant correlation was found between the 5-minute Apgar score of <7 and some cord arterial blood gas analysis abnormal threshold values (pH, bicarbonate, base excess) (P < .001). We found that some patients with mild acidemia had 1- and 5-minute Apgar scores of ≥7 in 1.9% and 2% of cases, respectively.Conclusion:The 5-minute Apgar score of 7 or higher may not be sufficient to verify the well-being of a newborn. Relying only on the Apgar scores may create the risk of missing some newborns with mild metabolic acidosis. The necessity of routine cord arterial blood gas analysis should be considered in prospective studies even if there are no signs of fetal distress and Apgar score ≥7.

A Newborn with an Incidental Finding on Cranial Ultrasonography.

A Newborn with an Incidental Finding on Cranial Ultrasonography.

Meconium Stained Amniotic Fluid and its Relation to Maternal Risk Factors

Background: Meconium stained amniotic fluid has been considered a sign of fetal distress in presentations other than breech and associated with poor fetal outcome but others considered meconium passage by fetus as physiological phenomenon and produces environmental hazards to fetus before birth. Such magnitude of different opinion was the object behind taking up of this study. Aims and objectives: To study maternal risk factors responsible for meconium stained amniotic fluid and its correlation with the fetal outcome in terms of morbidity and mortality. Meterial and methods: 100 women in labour with meconium stained amniotic fluid studied considering the inclusion criteria in the Department of Obstetrics and Gynecology, Pravara Rural Hospital, Loni. Cases divided into two -‘thin’ and ‘thick’ meconium stained group. Maternal and Fetal monitoring, uterine contraction assessed and Apgar score, birth weight, resuscitation of baby noted. All babies of both group followed up to first week neonatal life. Results: In our study, among 100 cases, 45% of the cases had thin meconium and 55% had thick meconium. Increased incidence of meconium staining was seen in crossed dates. The other risk factors were hypertension, anemia, oligohydramnios, IUGR. 56% went in for cesarean section due to intrapartum fetal distress. 33% of the cases went into NICU in view of low APGAR score due to birth asphyxia and meconium aspiration syndrome. Perinatal death was seen in 4 cases, one due to birth asphyxia and the other three due to MAS. Conclusion: Based on this study we conclude that meconium stained amniotic fluid is associated with increased incidence of caesarean section, low APGAR score, meconium aspiration syndrome and increased NICU admission.

Admission Cardiotocography as a Predictor of Low Apgar Score: An Observational, Cross-Sectional Study.

Background and objectiveCardiotocography (CTG) has been used more frequently in recent decades to reduce intrapartum fetal mortality rates. The purpose of this study was to determine whether pathological or non-reactive CTG could predict a low Apgar (Appearance, Pulse, Grimace, Activity, and Respiration) score. An abnormal trace would indicate a distressed fetus, whereas a normal trace would indicate a well-oxygenated fetus.MethodsThis study included a total of 470 women with a gestational period of more than 37 weeks. Based on the results of their CTGs, they were divided into three groups. An emergency cesarean section (CS) was performed if there was any sign of fetal distress on CTG. The Apgar scoring for newborns was recorded in the proforma following delivery.ResultsThe study was carried out at two major tertiary-care hospitals in Pakistan. A reactive CTG was found in more than one-third (39.36%) of the 470 patients. An Apgar score above 8 was obtained by 34.26% of the newborns, while an Apgar score below 8 was obtained by more than half (63.40%). Only 2.34% of newborns had an Apgar score below 6. A third (30.64%) of the patients had grade-1 meconium-stained liquor (MSL), 24.89% had grade-2 MSL, 19.79% had grade-3 MSL, and 24.68% had no MSL. One-third (32.34%) of the neonates were admitted to the neonatal intensive care unit (NICU) shortly after birth. When CTG was pathological or non-reactive, the odds of securing a higher Apgar score decreased by 70.45% (OR: 0.30; 95% CI: 0.20-0.44; p<0.001).ConclusionThe main conclusion drawn from this study's findings is that a pathological CTG is an indicator of a low Apgar score.

IMPROVED PREGNANCY OUTCOME IN WOMEN WITH GESTATIONAL HYPERTENSION AS A RESULT OF OBSTETRICIAN AND CARDIOLOGIST TEAMWORK

Objective: Gestational hypertension remains the leading cause of maternal, fetal and neonatal morbidity and mortality worldwide. In spite of ESH and ESC guidelines (2011–2013) regarding the use of low-dose aspirin for preventing poor obstetric outcome due to preeclampsia and in spite of the many studies involving aspirin published by FMF our national obstetrical guidelines didn’t mentioned aspirin prophylaxis until 2018. So for many years the first to recommend aspirin to a pregnant women was the cardiologist and not the obstetrician. To asses the outcome of the second pregnancy in women of high risk for early onset/sever preeclampsia after introducing low dose aspirin in early gestation. Design and method: A case series of secundiparous women (2017–2019), with history of poor maternal and fetal outcome because of sever preeclampsia (2014–2015), was assessed after starting 150 mg of aspirin daily from the onset of the second gestation until week 36. In this retrospective study no women with diabetes, chronic hypertension, obesity, any type of autoimmune disease, kidney disease or multiple gestation were included. The followed-up of these patients was done both by the obstetrician and cardiologist. The evaluation criteria for assessing the obstetrical outcome were: gestational age at onset of hypertension, Doppler velocity indices and non-stress test results, time and mode of delivery, birth weight, Apgar score, length of hospitalization; all compared to the outcomes of the first pregnancy. Results: None of the patients developed severe preeclampsia or early onset hypertension, but all of them de late onset gestational hypertension or mild preeclampsia needing antihypertensive therapy. There were no preterm babies, all women delivered at term, week 38–39, by elective C-section or after induced labor. There were no cases of intrauterine growth restriction, no signs of fetal distress according to Doppler ultrasound examination or on CTG monitoring. The Apgar score was no lower than 8 and there was no NICU admission. Antihypertensive therapy was no longer required after birth and all mothers began brestfeeding. Conclusions: This improved obstetrical outcome was the result of team approach in the management of pregnant women with high risk of hypertensive disorders.

STUDY OF THE INCIDENCE AND EFFECT OF MECONIUM STAINED AMNIOTIC FLUID ON FETAL MORBIDITY AND MORTALITY OF NEONATES BORN

Aims and objectives: Meconium stained amniotic fluid was considered a sign of fetal distress and associated with poor fetal outcome, but others considered physiological phenomena to be meconium passage through the fetus and create environmental threats to the fetus before birth. Such magnitude of different opinions was the object behind taking up this study and the aim was to find out the incidence and effect of meconium in terms of morbidity and mortality. Material and Methods: The present study was undertaken to evaluate the significance of MSAF and its fetal outcome in parturients admitted to a tertiary care hospital between June 2012 to June 2014. Detection of MSAF during delivery and follow-up of mother and baby during hospital stay was done. A total number of 100 cases were studied in each group as a prospective study. Results: The total numbers of deliveries during the study period were 850 of which 100 cases had meconium staining of AF (11.6%). Thin meconium staining was seen in 37 cases (4.35%) and Thick meconium was seen in 63 cases (7.41%). The major neonatal complication was birth asphyxia in MSG (19%) which was more in thick MSG (14%). Neonatal morbidity was more in the newborn with the thick meconium group (36.5%) compared to the thin meconium-stained group (29.7%). Early neonatal mortality was 100% associated with thick MSG. Early neonatal death was 2 in thick MSG and it was due to MAS. Stillbirth was 100% associated with thick MSG and it was 4. Whereas stillbirth in the control group was 1. Perinatal mortality was 6% in MSG that was associated with thick MSG. In the control group, it was 1%. Consistency of meconium has a direct bearing on the fetal outcome. In the thick meconium-stained group, Neonatal morbidity was (in our study group) 23 out of 63 cases. Stillbirth was 4; early neonatal death was 2 out of 63 cases. Whereas in thin MSG neonatal morbidity was 11 out of 37 cases. No stillbirth or neonatal death occurred in thin MSG. Conclusion: Immediate airway management, need for suction, and intubation should be guided by the state of the newborn rather than the presence of meconium. Timely diagnosis and management of amniotic fluid stained with meconium can enhance the fetal outcome. The authors of the current study conclude that MSAF adversely affects the fetal outcome mainly by thick meconium.

A Study on Correlation of Umbilical Cord Arterial Blood pH with Perinatal Asphyxia &amp; Early Neonatal Outcome

Background: Perinatal asphyxia is one of the major causes of neonatal morbidity &amp; mortality. Asphyxia can damage almost every organ of neonate. Our purpose was to determine the correlation of cord blood pH with birth asphyxia &amp; early neonatal outcome. Subjects and Methods: A prospective study was conducted over a period of one year at STH Haldwani. We enrolled 108 term neonates with signs of fetal distress, thick MSL, non-reassuring NST &amp; there were subjected for estimation of umbilical cord blood pH, APGAR score, outcome looked were resuscitation needed, NICU admission, delay in feed &amp; encephalopathy (sarnat &amp; sarnat stage). Results: In our study, cord blood pH had significant correlation with perinatal asphyxia(R=-0.926). Area under ROC curved showed that mean pH &lt;7.1 (ROC=0.998) is very significant in predicting the adverse outcome. Conclusion: Cord blood pH is very sensitive and specific &amp; has good correlation in predicting the birth asphyxia &amp; adverse neonatal outcome. Measurement of cord blood pH is recommended in all the neonates with signs of fetal distress.

Rupture of an unscarred uterus - a case report

Introduction. Rupture of an unscarred uterus is extremely rare and associated with severe maternal and fetal morbidity. Risk factors are second-stage dystocia, grand multiparity, high parity, labor induction or augmentation with oxytocin or prostaglandins, delivery after the 42nd week of gestation, neglected labor, fetal malpresentation, breech extraction, and instrumental delivery. Case Report. A 44-year-old multipara (gravid3 para3) underwent induction of labour at 40 + 3 weeks of gestation. The patient?s medical history showed no uterine surgeries, but her first delivery was instrumental, with vacuum extractor. The induction of labour was initiated by oxytocin infusion of 6 mIU/min. Continuous fetal heart rate monitoring was performed and there were no signs of fetal distress. Fetal descent in the second stage of labor lasted an hour, which is slightly over than average duration for multiparas. A live female infant weighing 3380 g was born and the pediatrician started resuscitation of the baby. Apgar score was 1/3/3. Ten days following the delivery, the patient was admitted to Emergency Gynaecology Department of the Clinic of Gynecology and Obstetrics due to abdominal pain, left sided retrouterine hematoma, and foulsmelling vaginal discharge. Laparotomy was indicated due to suspected uterine rupture. The intraoperative findings showed subinvolution of the uterus with signs of panmetritis and on the left side below the round ligament there was a 2 cm long rupture, passing through and invading the lateral and posterior walls of the uterus. A total abdominal hysterectomy with bilateral salpingo-oophorectomy on the left side was performed. Conclusion. Although a reliable prediction and prevention do not exist, the obstetricians? awareness of this rare event in unscarred uterus may decrease maternal and neonatal morbidity. This case report is an example of a serious and difficult outcome after a seemingly low-risk situation.

Justification of Cesarean section in fetal distress: Experience in a tertiary care military hospital in Bangladesh

Background: The trend of Caesarean section (CS) carried out is rising worldwide. One of the most common indications of CS is fetal distress which is based on the cardiotocograph (CTG) recording, abnormal fetal heart rate pattern and meconium stained liquor. The aim of this study was to carry out an audit of CS performed due to fetal distress in a tertiary care military hospital with a view to justify the methods for diagnosis of fetal distress to fetal outcome.&#x0D; Methods: This cross-sectional observational study was carried out over a period of 1 year and 6 months (July 2013 to January 2015) in the Combined Military Hospital (CMH), Dhaka. All pregnant women at or beyond 37 weeks of gestation who underwent CS for fetal distress were included. Neonatal outcome were assessed based on APGAR score and neonatal intensive care admission.&#x0D; Results: Among the 260 (100%) women who underwent CS due to fetal distress, mean age was 27.8 ± 5.3 years. More than half (54.6%) of the women were primigravida. Majority (48%) of the patients presented with spontaneous onset of labor and in 43% cases labor was induced by medical methods. In the majority (40%) of the patients, fetal distress was diagnosed by seeing abnormal patterns in CTG. During CS, signs of fetal distress was found in the majority (64.6%) of the patients (meconium stained liquor 42.3%, cord abnormality 13.5% and placental abnormality 8.8%). APGAR score of the newborn babies was abnormal (&lt;7) in the majority (60%) cases. More than half of the newborn babies required admission in neonatal intensive care unit for different diagnosis. There was only 4 (1.5%) cases of neonatal death.&#x0D; Conclusion: The rate of CS for fetal distress in this study was comparable to other study findings and within recommendation of WHO. The high rate of identifiable causes of fetal distress as well as neonatal outcome justifies doing CS in these cases.&#x0D; Birdem Med J 2020; 10(1): 60-63

Maternal serum thiol/disulfide homeostasis in pregnancies complicated by fetal hypoxia

We aimed to evaluate maternal serum thiol/disulphide homeostasis in pregnancies complicated by fetal distress (FD). A total of 100 patients beyond the 34th week of pregnancy were included in this study, and they were divided into two groups. The study group included 50 patients who had been diagnosed with FD; the control group was composed of 50 patients who had shown no signs of FD and who had undergone an elective (previous) caesarean section (CS). The native thiol, total thiol and native thiol/total thiol (%) concentrations were lower in Group 1 patients than Group 2 patients (p < .001). The disulphide, disulphide/native thiol (%) and disulphide/total thiol (%) concentrations were higher in Group 1 patients than Group 2 patients (p < .001). This study suggests that maternal thiol/disulphide homeostasis is impaired in pregnancies complicated by FD. IMPACT STATEMENT What is already known about this subject? Oxidative stress (OS) has previously been investigated in FD. This study reports for the first time a new novel and automatic measurement method. What do the results of this study add? This study shows that the thiol balance shifts in the direction of disulphide in the cases of FD. What are the implications of these findings for clinical practice and further research? Thiol balance can be used for the timely diagnosis of FD.

FEATURES OF HEMODYNAMICS OF FETOPLACENTAL COMPLEX IN PREGNANT WITH PERINATAL INFECTIONS

Introduction: Perinatal infections are an important issue in modern obstetrics, perinatal and pediatric care and one of the main causes of perinatal morbidity and mortality. The persistence of infection in the mother's body can lead to an adverse outcome of pregnancy and childbirth, but it does not always mean the infection of the fetus and the development of an infectious disease. The presence of foci of infection in the body of a pregnant woman is only one of the reasons for the development of intrauterine infection. Dopplerometric study in IUI promotes identification of patients at risk of developmental retardation and helps to determine the initial signs of fetal distress. The aim: To study the features of hemodynamics of fetoplacental complex in pregnant with perinatal infections, depending on their implementation in newborns. Materials and methods: The study involved examination of 230 couples of pregnant-newborns, who were divided into clinical groups: Group I - 60 couples with viral infection; Group ІІ - 60 couples with bacterial infection; Group III - 60 couples with combined infection. Each clinical group was divided into 2 subgroups: with implementation of infection in newborns (1) and without it (0). Control group included 50 pregnant-newborns couples with physiological course of pregnancy and early neonatal period. Ultrasound (echographic and dopplerometric) study was performed according to the generally accepted technique on MINDRAY M7. The condition of the bloodstream was determined in the following vessels: umbilical artery, thoracic aorta, medial cerebral artery, uterine arteries. The resulting data was subject to statistical processing using the STATISTICA software. Results: Pregnant of the control and main groups underwent ultrasound somatogenic study with a syndromological analysis. Assessment of indices of RI and PI in the I-III clinical groups showed a tendency to increase. These values in the main group were significantly higher than the normative ones. More severe violations of the blood flow were observed in Group I and III. More pronounced changes in utero-placental-fetal blood flow were recorded in pregnant women with the implementation of infection. Peak systolic velocity in the medial cerebral artery was 1.3 times higher in Group II, 1.8 times higher in Group I and 1.6 times higher in Group III than in women with physiological pregnancy. Conclusions: Pregnant women of the main clinical group, in comparison with the normative indices of healthy pregnant, were found to have an increase in the indices of vascular resistance in the major vessels of the uterus-placental-fetal basin, which is likely due to the toxic effects of metabolic products of pathogens of infections that persist in the body on the endothelium of the blood vessels.