Special Care Baby Unit Admission Research Articles

Admission Cardiotocography and Neonatal Outcomes at a Tertiary Health Facility in Southwestern Nigeria

Background: Admission cardiotocography (CTG), a noninvasive procedure, is used to indicate the state of oxygenation of the fetus on admission into the labor ward. Objective: This study assessed the association of admission CTG findings with neonatal outcome at a tertiary health facility. Materials and Methods: A prospective, observational study of 206 pregnant women who were admitted into the labor ward with singleton live pregnancies. Information on the demographic characteristics, obstetrics and medical history, admission CTG tracing, and neonatal outcome was obtained using a structured data collection form. Data were analyzed using the SPSS software version 20.0 with the level of significance set at P < 0.05. Results: The admission CTG findings were normal in 73.3%, suspicious in 13.6%, and pathological in 13.1% of the women. The occurrence of low birth weight, special care baby unit (SCBU) admission, asphyxiated neonates, neonatal death, and prolonged hospital admission was significantly more frequent among those with pathological admission CTG results compared with normal and suspicious results (P < 0.05). The incidence of vaginal delivery was more common when the CTG findings were normal, whereas all women with pathological CTG result had a cesarean delivery. Conclusion: Admission CTG was effective in identifying fetuses with a higher incidence of perinatal asphyxia. Neonatal outcome such as low birth weight, APGAR score, SCBU admission, and prolonged hospital admission was significantly associated with pathological CTG findings. In the absence of facilities for further investigations, prompt intervention for delivery should be ensured if admission CTG is pathological.

Prediction of labour outcomes using prelabour computerised cardiotocogram and maternal and fetal Doppler indices: Aprospective cohort study.

To investigate the association and the potential value of prelabour fetal heart rate short-term variability (STV) determined by computerised cardiotocography (cCTG) and maternal and fetal Doppler in predicting labour outcomes. Prospective cohort study. The Prince of Wales Hospital, a tertiary maternity unit, in Hong Kong SAR. Women with a term singleton pregnancy in latent phase of labour or before labour induction were recruited during May 2019-November 2021. Prelabour ultrasonographic assessment of fetal growth, Doppler velocimetry and prelabour cCTG monitoring including Dawes-Redman CTG analysis were registered shortly before induction of labour or during the latent phase of spontaneous labour. Umbilical cord arterial pH, emergency delivery due to pathological CTG during labour and neonatal intensive care unit (NICU)/special care baby unit (SCBU) admission. Of the 470 pregnant women invited to participate in the study, 440 women provided informed consent and a total of 400 participants were included for further analysis. Thirty-four (8.5%) participants underwent emergency delivery for pathological CTG during labour. A total of 6 (1.50%) and 148 (37.00%) newborns required NICU and SCBU admission, respectively. Middle cerebral artery pulsatility index (MCA-PI) and MCA-PI z-score were significantly lower in pregnancies that required emergency delivery for pathological CTG during labour compared with those that did not (1.23 [1.07-1.40] versus 1.40 [1.22-1.64], p = 0.002; and 0.55 ± 1.07 vs. 0.12 ± 1.06), p = 0.049]. This study demonstrated a weakly positive correlation between umbilical cord arterial pH and prelabour log10 STV (r = 0.107, p = 0.035) and the regression analyses revealed that the contributing factors for umbilical cord arterial pH were smoking (p = 0.006) and prelabour log10 STV (p = 0.025). In pregnant women admitted in latent phase of labour or for induction of labour at term, prelabour cCTG STV had a weakly positive association with umbilical cord arterial pH but was not predictive of emergency delivery due to pathological CTG during labour.

Vaginal prostaglandin E2 versus oxytocin for induction of labor in women with prelabor rupture of membranes at term

Aims: Majority of women with prelabor rupture of membranes (PROM) at term will go in to labor within 24 hours. However early delivery will reduce the maternal and fetal infection and reduce the need for antibiotics for newborn. It will also increase maternal satisfaction. Oxytocin is being used for several decades for induction of labor in PROM. Prostaglandin E2 (PGE2) has shown promising results for the same purpose. A randomized controlled trial carried out to determine the effectiveness and acceptability of vaginal prostaglandin E2 for induction of labor in women with PROM at term. Methods: A total of 162 women with singleton pregnancies at >37 weeks, cephalic presentations, Bishop scores of and#60;6 were randomly allocated to receive either oxytocin or vaginal PGE2. The primary outcome measure was induction to delivery interval. Secondary outcomes were caesarean section rate, postpartum maternal fever, neonatal fever, and special care baby unit (SCBU) admissions. Results: The induction to delivery interval was not significantly different (p -0.558) in oxytocin group (630.9 + 31.1 min) as compared to PGE2 group (635.2 + 27.1 min). Incidence of postpartum maternal fever, neonatal fever, and SCBU admission were almost similar in both groups. Uncomplicated vaginal delivery rates 2022were almost same in both groups (65.3% in PG group and 62.5% in oxytocin group). Conclusion: Vaginal PGE2 appears to be as efficient as oxytocin for labor induction in term pregnancies with PROM and unfavorable cervices. However PGE2 doesn’t have additional advantages over oxytocin. As vaginal PGE2 is more expensive, it is rational to opt for oxytocin infusion to induce labor in term prelabor rupture of membranes accompanied with low Bishop’s scores.

A retrospective cohort study on effects of antenatal steroids on respiratory morbidity for term elective caesarean sections in South Asian women

Background Respiratory distress (RD) is higher among newborns born by caesarean section (CS) compared to vaginal delivery. Royal College of Obstetricians and Gynaecologists recommend steroid administration for CS prior to 39 weeks. Effectiveness of steroids for neonatal RD at term is inconclusive. The racial differences are yet to be studied. Methods A single center retrospective cohort study was conducted in Colombo, Sri Lanka from December 2016 to February 2019. All mothers delivered by CS between 37+0 and 38+6 weeks were included. Mothers with severe maternal hypertension, fetal rhesus sensitization, intrauterine infection, multiple pregnancies and who received steroids at a prior gestation were excluded. Cohort was subdivided according to administration of intramuscular dexamethasone prior to CS. Primary outcomes measured were RD, admissions to neonatal intensive care unit (NICU) and special care baby unit (SCBU). Neonatal infections and maternal duration of hospital stay were recorded as secondary outcome measures. Results 560 patients were included. 23.2% of patients received antenatal corticosteroids. Incidence of RD, NICU admissions and SCBU admissions in the study cohort was 10%, 0.9%, and 2.7% respectively. Relative risk for developing RD in the steroid group compared to non-steroid group was 2.67 (95CI 1.64-4.35). 4.6% of the steroid group and 3.3% of the non-steroid group needed to be admitted to the NICU/SCBU (p=0.464). A significantly higher number of babies in the steroid group needed IV antibiotics. The average number of days the mothers were admitted to the hospital was 2.45 days (SD+/- 1.424) for steroid group and 1.4 days (SD+/- 0.856) for the non-steroid group (p < 0.001). Conclusions There is a significant increase in the respiratory morbidity in the dexamethasone administered south Asian mothers at term prior to CS. However, this effect has no clinical significance since the admissions to NICU and SCBU were not significantly different.

Evaluation of Low-dose and High-dose Intravaginal Misoprostol for Induction of Labour: A Randomised, Double-blinded, Single Centre Study

Introduction: Misoprostol is a synthetic prostaglandin E1 analogue widely used for cervical ripening and labour induction. However, misoprostol optimal dose required to induce labour is still controversial. Aim: To determine the efficacy and safety of 25 µg and 50 µg of intravaginal misoprostol for induction of labour at term and to evaluate maternal and neonatal complications. Materials and Methods: The present study was a prospective, randomised, double blind, single centre study carried out during March 2019 to December 2020. All the selected participants were randomised (1:1) to group 1 which received 25 µg of intravaginal misoprostol (n=70) and group 2 received 50 µg of intravaginal misoprostol (n=70). Based on the Bishop’s score, misoprostol was chosen as labour inducing agent. Number of misoprostol doses, mode of delivery, vaginal delivery duration, maternal and neonatal complications was recorded. Statistical significance among study groups were analyzed by using Chi-square test. Results: Postdatism was most frequently reported indication in both the study groups (57.1% and 52.9%). A total of 14 and 4 participants in group 2 and group 1 received only single dose of misoprostol (p<0.01). Participants who received misoprostol 50 µg (n=60, 85.7%) has slightly showed higher vaginal deliveries compared to misoprostol 25 µg (n=57, 81.4%). The mean duration of induction time in group 2 was 10.12 hours and group 1 women showed 13.56 hours (p<0.0001). Maternal and neonatal complications were slightly higher in 50 µg misoprostol group. Maternal complications such as uterine tachysystole (n=4), Postpartum Haemorrhage (PPH) (n=3) and uterine hyperstimulation syndrome (n=2). Neonatal complications with 50 µg misoprostol were Apgar <7 at 1 min (n=4), Apgar <7 at 5 min (n=3), Special Care Baby Unit (SCBU) admissions (n=2) and severe birth asphyxia (n=1). Misoprostol with 25 µg has showed Apgar <7 at 1 min (n=2), Apgar <7 at 5 min (n=2), SCBU admissions (n=1). Conclusion: The efficacy and safety results of 25 µg intravaginal misoprostol were comparable with 50 µg of intravaginal misoprostol for labour induction. The advantages of 50 µg misoprostol were it favours the vaginal deliveries, lesser active induction time and decrease number of misoprostol doses required to induce labour. However, higher dose of misoprostol showed higher frequencies of both maternal and neonatal complications.

Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

BackgroundOn the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available.This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented.MethodsThis was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital.ResultsBetween January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32.ConclusionsOverall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

Identifying Targets to Improve Antenatal Care for Substance Misuse in Pregnancy: An Observational Study

Background: Substance misuse in pregnancy contributes to increased maternal and fetal morbidity and mortality. Women who misuse drugs are, however, less likely to attend antenatal care. An observational study of the women who attended our substance misuse antenatal clinic was undertaken to identify targets for improving antenatal care for substance misuse in pregnancy derived from trends in maternal profiles, pregnancy outcomes and childhood consequences. Methods: Data were retrospectively analysed from computer records and patient notes of the women who attended substance misuse antenatal clinic (n=100) and children born from these pregnancies (n=99). Results: The women presented with complex heterogeneous substance misuse patterns. Attendance to the clinic was “good” in 73% with poor attendance in a sub-population with high alcohol use. Special care baby unit admissions (14% vs 6%, p=0.14) and length of hospital stay were greater than the non-substance misusing group (5.3 ± 7.4 vs 1.2 ± 1.3 days, p<005). More premature infants in the substance-misuse group had birth-weights less than the tenth centile (86% vs 0%, p<0.05). At five years, a higher percentage of children in substance-misuse group had an ocular diagnosis compared with the control (22% vs 4%, p=0.0029), and increased social service involvement and out-of-home care. Conclusions: We suggest better sexual health education for women in high-risk groups. This could be achieved by better integration between services. Antenatal care should target high-risk groups with earlier intervention and longer-term follow-up of children born to substance-misusing mothers.

Determinants of preterm survival in a tertiary hospital in Ghana: A ten-year review.

Prematurity (gestational age <37 completed weeks) accounts for the majority of neonatal deaths worldwide and most of these occur in the low-resource countries. Understanding factors that determine the best chances of preterm survival is imperative in order to enhance the care of neonates and reduce adverse outcomes in such complicated births. This was to find out the proportions of preterm babies who survived at the Special Care Baby Unit (SCBU) in the Cape Coast Teaching Hospital (CCTH) and the factors which influenced their survival. This was a retrospective review of data on all the live preterm babies seen at the SCBU of CCTH from 2010 to 2019. Data on 2,254 babies that met the inclusion criteria were extracted. Descriptive statistics were generated and tests of association done with chi-square and multivariable logistic regression. The main outcome measure was the proportion of live preterm neonates who were discharged after SCBU admissions. The CCTH had a total of 27,320 deliveries from 2010 to 2019. Of these, 1,282 were live preterm births, giving a prevalence of live preterm babies over the ten-year period of 4.7% (1,282/27,320). An increasing trend in prevalence was observed with 2019 recording the highest at 9% (271/3027). Most (48.8%) of the deliveries were vaginal, 39.2% were by caesarean section (CS); the mode of birth for 12% of the women were not documented. The mean gestational age was 31.8 (±2.77) weeks. Of the birth weights documented, <1000g babies accounted for 11.9%, 1000-1499g babies made up 34.8%, while 1500g to 2499g babies accounted for 42.6%. The babies with weights >2500g made up only 3.7%. The average length of hospital stay was 8.3 (±9.88) days. Regarding the main outcome variable, 67.6% were discharged alive, 27.6% died and 4.9% were unaccounted for due to incomplete documentation. Factors which influenced survival were: birth weight (p <0.001); gestational age (p <0.001); mode and place of delivery (p <0.001 for both); APGAR scores at 1st and 5th minutes (p <0.001); and length of stay at the SCBU (p <0.001). No association was found for sex of the baby, maternal age and parity. This study shows the possibility of achieving good preterm survival rates through the provision of specialised neonatal care, even in resource-constrained countries. This provides an updated benchmark for clinical decision-making and antenatal counselling. It also highlights the problem of inadequate data capture in our part of the world, which needs considerable improvement.

EFFECT OF ANTENATAL CARE ON MATERNAL AND NEONATAL OUTCOMES IN WOMEN'S HEALTH HOSPITAL

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primipara women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

EFFECT OF ANTENATAL CARE ON MATERNAL AND NEONATAL OUTCOMES IN WOMEN'S HEALTH HOSPITAL

Introduction: Good antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. World Health Organization recommendation of initiation of antenatal care within the first four months of pregnancy and at least four antenatal care visits during the course of an uncomplicated pregnancy. Inadequate care during this time breaks a critical link in the continuum of care and affects both women and her neonate. Objectives: The aim of the study was to identify effects of antenatal care on maternal and neonatal outcomes in Women Health Hospital Subjects & Method: Three hundred parous women and their neonates conducted a comparative study. They were divided into two groups' according to parity the first group (primipara =150), and the second group (high parity=150) and divided every group into two groups the first was poor antenatal care and other was adequate antenatal care during the period from February 2017 to August 2017 using a stratified sampling. Results: Most of the primiparous women had poor antenatal care (88%) but high parity (67.3%). There was the highly significant relationship between two groups. More than half were had poor antenatal care (60.3%) but less than half were adequate antenatal care. The most common complication in primipara group was eclampsia (36.4%) while in high parity group was anemia (14.3%) in poor antenatal care. The most common complication in labor was premature rupture of membrane (19.0% & 14.3%) respectively, in poor antenatal care of two groups. In primipara group, the proportion of low birth weight was 16.0% in poor antenatal care, while stillbirth was (11.0%) inadequate antenatal care also neonatal weight in Kg related to poor antenatal care and adequate antenatal care were (2.636 ± 0.659 & 3.050 ± 0.503) respectively. In high parity group, the proportion of Special Care Baby Units admission was 12.2% in poor antenatal care, while Special Care Baby Unit admission was 11.9% inadequate antenatal care also neonatal weight related to poor antenatal care and adequate antenatal care were (2.973 ± .709 & 3.081 ± 0.643) respectively. Conclusion: Good quality antenatal care promote the health of the mother and decreases the percentage of iron deficiency anemia, gestational hypertension and before term labor and promote maternal outcomes, including a reduced risk of under birth weight, preterm neonates and Special Care Baby Unit admission. Recommendations: the women should have access to good quality antenatal care. Both the woman and the neonatal are at a greater risk during pregnancy and labor. This risk can be reduced with good antenatal care and delivery by trained personnel. And awareness of the adverse impact of high parity on obstetric

A Review of Twinning in Niger Delta Region, Nigeria

Background: Twin pregnancy is as fascinating as it is high risk and its epidemiology is globally more dynamic in the recent times. It is associated with increase maternal morbidities, fetal wastage and neonatal morbidities and mortality. Objectives: To determine the current incidence, assess the trend and investigate maternal and perinatal outcomes and influencing factors of twinning. Methods: For this case control study, data was collected on twin pregnancies; the study group and singleton pregnancies; the control group between January 2009 and December 2016 at a missionary Hospital in south-south Nigeria. EPI INFO and INSTAT statistical software were used for analyses and Fisher’s exact test for tests of statistical associations setting the statistical significance at <.05. Results: Among 8769 deliveries were 207 pairs of twins, a twinning incidence of 2.4% or 1 in 42 with an upward trend in incidence. Twin mothers were relatively older with those aged 30-34 years (41.2%) as the modal age group, less literate and less likely to have prenatal care. They were more prone to anemia, caesarean birth, Postpartum hemorrhage, gestational hypertension and blood transfusion (P<0.05). Mean gestational age and birth weight of twins were 35.5±3.8 weeks and 2352.9±746.4gm respectively. The twins were associated with increased preterm births (OR 28.1, P<0.001), Low birth weight (OR 15.6-24.1, P<0.001), perinatal death (OR 3.6, P<0.001), birth asphyxia (OR 2.9-5.9, P<0.01) and Special Care Baby Unit admission (OR 9.8-12.5, P<0.001). About 7 (66.2%) and 3 (31.4%) of every 10 first twins were in cephalic and breech presentation respectively with cephalic/cephalic (44.0%) the leading paired presentations. Conclusion: There was high and increasing incidence of twinning in this population. Twin pregnancy is associated with increased maternal morbidity and perinatal morbidity and mortality. To improve twinning outcome will require quality obstetric and perinatal care.

Decision-to-Delivery Time Intervals in Emergency Caesarean Section Cases: Repeated cross-sectional study from Oman.

In cases of fetal intolerance to labour, meeting the standard decision-to-delivery time interval (DDI) of ≤30 minutes is challenging. This study aimed to assess DDIs in emergency Caesarean section (CS) cases to identify factors causing DDI delays and the impact of a delayed DDI on perinatal outcomes. This repeated cross-sectional study included all emergency CS procedures performed due to acute fetal distress, antepartum haemorrhage or umbilical cord prolapse at the Nizwa Hospital, Nizwa, Oman. Three audit cycles of three months each were conducted between April 2011 and June 2013, including an initial retrospective cycle and two prospective cycles following the implementation of improvement strategies to address factors causing DDI delays. Poor perinatal outcomes were defined as Apgar scores of <7 at five minutes, admission to the Special Care Baby Unit (SCBU) or a stillbirth. In the initial cycle, a DDI of ≤30 minutes was achieved in 23.8% of 84 cases in comparison to 44.6% of 83 cases in the second cycle. In the third cycle, 60.8% of 79 women had a DDI of ≤30 minutes (P <0.001). No significant differences in perinatal outcomes for cases with a DDI of ≤30 minutes versus 31-60 minutes were observed; however, a DDI of >60 minutes was significantly associated with poor neonatal outcomes in terms of increased SCBU admissions and low Apgar scores (P <0.001 each). Factors causing DDI delays included obtaining consent for the CS procedure, a lack of operating theatre availability and moving patients to the operating theatre. The identification of factors causing DDI delays may provide opportunities to improve perinatal outcomes.

Full-term newborns with normal birthweight requiring special care in a resource-constrained setting

IntroductionThe level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. However, the nature of the required care is not evident in current literature. This study therefore set out to determine maternal and perinatal profile of surviving full-term newborns with normal birth weight in a poorly-resourced setting.MethodsA retrospective cohort study of newborns with gestational age ≥37 weeks and birth weight ≥2500g recruited in an inner-city maternity hospital in Lagos, Nigeria. Primary factors/outcomes were determined by multivariate logistic regression analyses and population attributable risk (PAR).ResultsOf the 2687 full-term newborns with normal birth weight studied, 242 (9.0%) were admitted into special care baby unit (SCBU) representing 53.6% of all SCBU admissions. Fetal distress, low 5-minute Apgar scores, neonatal sepsis and hyperbilirubinemia as well as maternal factors such as primiparity, type of employment, lack of antenatal care and emergency cesarean delivery were predictive of SCBU admission. The leading contributors to SCBU admission were neonatal sepsis (PAR=96.8%), and hyperbilirubinemia (PAR=58.7%).ConclusionA significant proportion of newborns requiring special care are full-term with normal birth weight and are associated with modifiable risk factors that can be effectively addressed at appropriately equipped secondary-level hospitals. Prenatal maternal education on avoidable risk factors is warranted.

Neurodevelopmental outcome at 5 years after operative delivery in the second stage of labor: a cohort study

The purpose of this study was to compare the neurodevelopmental outcome of children at 5 years of age after instrument vaginal delivery and cesarean delivery in the second stage of labor. This prospective cohort study was comprised of women with term, singleton, cephalic pregnancies who needed operative delivery in the operating room during the second stage of labor from February 1999 to February 2000. Data were collected with postal questionnaires and review of medical records. The primary outcome measure was the neurodevelopment of children at 5 years of age. A total of 393 women required operative delivery, of whom 264 women (67%) completed questionnaires at 5 years. A total of 66 children (17%) had been born in poor condition (Apgar score <7 at 5 minutes, umbilical artery pH <7.10, significant trauma, sepsis, or special care baby unit admission). Medical records were available for all 66 children. Rates of neurodevelopmental morbidity were low, with no significant differences between delivery groups. Two children had significant neurodevelopmental morbidity, but this was unlikely to relate to the mode of delivery. In this cohort, the rates of neurodevelopmental morbidity were low overall and comparable, irrespective of the mode of delivery.

A randomised controlled trial of morphine versus phenobarbitone for neonatal abstinence syndrome

Background: The incidence of neonatal abstinence syndrome (NAS) has increased 10-fold over the last decade in Glasgow. In the Princess Royal Maternity Hospital, it now accounts for 17% of special...

Treatments for gestational diabetes and impaired glucose tolerance in pregnancy.

Gestational diabetes and impaired glucose tolerance (IGT) in pregnancy affects between 3 and 6% of all pregnancies and both have been associated with pregnancy complications. A lack of conclusive evidence has led clinicians to equate the risk of adverse perinatal outcome with pre-existing diabetes. Consequently, women are often intensively managed with increased obstetric monitoring, dietary regulation, and in some cases insulin therapy. However, there has been no sound evidence base to support intensive treatment. The key issue for clinicians and consumers is whether treatment of gestational diabetes and IGT will improve perinatal outcome. The objective of this review was to compare alternative policies of care for women with gestational diabetes and IGT in pregnancy. We searched the Cochrane Pregnancy and Childbirth Group trials register (12 September 2002) and the bibliographies of relevant papers. The Cochrane Central Register of Controlled Trials was also searched (The Cochrane Library, Issue 3, 2002). Randomised controlled trials comparing alternative management strategies for women with gestational diabetes and IGT in pregnancy. Quality was assessed according to the criteria defined by the Cochrane Reviewers' Handbook. Data were extracted and checked independently by two reviewers. Any disagreements were resolved through discussion with the third reviewer. Three studies with a total of 223 women were included. All three included studies involved women with IGT. No trials reporting treatments for gestational diabetes met the criteria. There are insufficient data for any reliable conclusions about the effect of treatments for IGT on perinatal outcome. The difference in abdominal operative delivery rates is not statistically significant (relative risk (RR) 0.86, 95% confidence interval 0.51 to 1.45) and the effect on special care baby unit admission is also not significant (RR 0.49, 95% confidence interval (CI) 0.19 to 1.24). Reduction in birthweight greater than 90th centile (RR 0.55, 95% CI 0.19 to 1.61) was not found to be significant. This review suggests that an interventionist policy of treatment may be associated with a reduced risk of neonatal hypoglycaemia (RR 0.25, 95% CI 0.07 to 0.86). No other statistically significant differences were detected. A number of outcomes are only reported by one study resulting in a small sample and wide confidence intervals. There are insufficient data for any reliable conclusions about the effects of treatments for impaired glucose tolerance on perinatal outcome.

Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland

To describe the incidence and risk factors for neonatal hypoglycaemia among the offspring of women with gestational diabetes mellitus (GDM) in South Auckland, New Zealand A retrospective audit was undertaken of singleton pregnancies delivered between 1991 and 1994. Data were obtained for 373 women and their deliveries (57 European, 76 Maori, 198 Pacific Islands, 42 other). Pacific Islands women were most likely to have large babies with neonatal hypoglycaemia in spite of a high use of insulin. Postnatally Maori and Pacific Islands women had a high incidence of Type 2 diabetes mellitus (21.4, 21.7 vs. 4.3% Europeans, 12.0% others, P =0.035). Babies experiencing hypoglycaemia were more likely to have a mother with past GDM (51.2 vs. 27.2%, P = 0.01) and greater hyperglycaemia (at diagnosis fasting 6.8 +/- 1.7 vs. 5.7 +/- 1.1 mmol/l, P < 0.001; finger-prick glucose 5.7 +/- 1.0 vs. 5.2 +/- 0.8 mmol/l, P < 0.001). Macrosomia, Caesarian section and special care baby unit admission were more common in pregnancies complicated by neonatal hypoglycaemia. Maternal hyperglycaemia was a major contributing factor to neonatal hypoglycaemia in this population. Undiagnosed Type 2 diabetes was common among Maori and Pacific Islands women, confirming the need for earlier detection and treatment.

Obstetric Outcome in Women Who Present With a Reduction in Fetal Movements in the Third Trimester of Pregnancy

A complaint of decreased fetal movements is a common indication for the assessment of fetal well being. The aim of this study was to review the outcome of a group of women whose primary indication for referral was decreased fetal movements. Over a 20 month period, 435 patients were seen in the fetal assessment unit of an inner London teaching hospital, following a primary complaint of reduced fetal movements. Investigations included: the fetal abdominal circumference (AC), amniotic fluid volume (AFV), the umbilical artery pulsatility index (UAPI) derived from Doppler ultrasound waveforms and a computerised analysis of fetal heart rate (FHR) recordings or cardiotocograph (CTG). Outcome measures were: gestational age at delivery, Apgar score < 7 at 5 minutes, admission to the Special Care Baby Unit (SCBU), the need for delivery by an emergency cesarean section for fetal compromise (CSFC), and any perinatal deaths. A comparison of actual versus expected outcome for women with decreased fetal movement revealed the following relative risks, with the 95% confidence intervals (CI) in brackets; low 5 minute Apgar score 0.03 vs. 0.05 expected (CI = 0.01, 0.05), SCBU admission, 0.06 vs. 0.07 (0.04, 0.08), and preterm delivery, 0.08 vs. 0.11 (0.05, 0.10). Cesarean sections for fetal compromise, 0.07 vs. 0.053 (0.050-0.096). The addition of FHR monitoring to standard ultrasound assessment of well being did not appear to confer any added benefit. There were no fetal deaths. The outcome for pregnancies where the mother presents with decreased fetal movements in the third trimester is comparable with the outcome for the general population.

Obstetric outcome in women who present with a reduction in fetal movements in the third trimester of pregnancy.

A complaint of decreased fetal movements is a common indication for the assessment of fetal well being. The aim of this study was to review the outcome of a group of women whose primary indication for referral was decreased fetal movements. Over a 20 month period, 435 patients were seen in the fetal assessment unit of an inner London teaching hospital, following a primary complaint of reduced fetal movements. Investigations included: the fetal abdominal circumference (AC), amniotic fluid volume (AFV), the umbilical artery pulsatility index (UAPI) derived from Doppler ultrasound waveforms and a computerised analysis of fetal heart rate (FHR) recordings or cardiotocograph (CTG). Outcome measures were: gestational age at delivery, Apgar score < 7 at 5 minutes, admission to the Special Care Baby Unit (SCBU), the need for delivery by an emergency cesarean section for fetal compromise (CSFC), and any perinatal deaths. A comparison of actual versus expected outcome for women with decreased fetal movement revealed the following relative risks, with the 95% confidence intervals (CI) in brackets; low 5 minute Apgar score 0.03 vs. 0.05 expected (CI = 0.01, 0.05), SCBU admission, 0.06 vs. 0.07 (0.04, 0.08), and preterm delivery, 0.08 vs. 0.11 (0.05, 0.10). Cesarean sections for fetal compromise, 0.07 vs. 0.053 (0.050-0.096). The addition of FHR monitoring to standard ultrasound assessment of well being did not appear to confer any added benefit. There were no fetal deaths. The outcome for pregnancies where the mother presents with decreased fetal movements in the third trimester is comparable with the outcome for the general population.

Antenatal Prediction of ‘Small-for-Dates' Babies. What Proportion are Growth Retarded?

SummarySummaryThe number of low birth weight neonates (< 10th centile) that had objective neonatal evidence of intra-uterine malnutrition was studied prospectively. A fetal ‘weight for gestational age' centile chart nomogram was constructed retrospectively for the local population in an area of East Anglia. When the Norfolk and Norwich birth weight centiles (10th, 50th, 90th) for each week of pregnancy (29–40 weeks) were compared with national reference centile charts the local neonates were smaller by 0–250g (P< 0·01). Of 418 singleton deliveries at the Norfolk and Norwich Hospital in June 1989, 42 had birth weights below the 10th centile for that population. On paediatric assessment only 17 (40 per cent) of these had morphological features of intra-uterine growth retardation. These babies were associated with more operative deliveries and special care baby unit admissions (P < 0·001) than the rest of the 'small for dates' babies. The overall incidence of intra-uterine growth retardation for this populat...