Spontaneous Vaginal Delivery Research Articles

A Medical Student Obstetric Curriculum Consisting of Online Modules and a Normal Spontaneous Vaginal Delivery Simulation Exercise.

In many medical schools, students are exposed to obstetrics for 2 weeks during the third-year obstetrics and gynecology clerkship. Hence, the purpose of this study was to evaluate the effectiveness of a curriculum combining online obstetric modules and a normal spontaneous vaginal delivery (NSVD) simulation on medical student knowledge and comfort pertaining to obstetrics at the start of the clerkship. Students completed the curriculum at the start of the clerkship. They completed questionnaires before and after each module and the simulation. The questionnaires assessed knowledge, management comfort level, and satisfaction with module/simulation. Comfort level and satisfaction scores were based on a 1-5 Likert scale (1 = very uncomfortable/unfavorable, 5 = very comfortable/favorable). Satisfaction scores for online modules were compared with those for a historical cohort of traditional lectures on the same topics. Students also rated satisfaction with the curriculum. Sixty students participated. Mean knowledge and comfort scores significantly increased from 7.2 to 9.2 (P < .001) and from 2.7 to 3.9 (P < .001) before and after the modules, respectively. Although satisfaction scores for traditional lectures were significantly higher than for online modules (4.7 vs. 4.4, P < .001), online modules were still favorably received. Mean satisfaction score for the NSVD simulation was 4.8. Overall, satisfaction score for the curriculum was 4.5. An obstetric curriculum consisting of online modules and simulation significantly increases medical student learner knowledge and comfort and is associated with a high level of satisfaction.

Successful antenatal treatment of MAGED2-related Bartter syndrome and review of treatment options and efficacy.

A new form of transient antenatal Bartter syndrome (aBS) was recently identified that is associated with the X-linked MAGED2 variant. Case reports demonstrate that this variant leads to severe polyhydramnios that may result in preterm birth or pregnancy loss. There is limited but promising evidence that amnioreductions may improve fetal outcomes in this rare condition. We report a woman with two affected pregnancies. In the first pregnancy, the patient was diagnosed with mild-to-moderate polyhydramnios in the second trimester that ultimately resulted in preterm labor and delivery at 25weeks with fetal demise. Whole exome sequencing of the amniotic fluid sample resulted after the pregnancy loss and revealed a c.1337G>A MAGED2 variant that was considered diagnostically. The subsequent pregnancy was confirmed by chorionic villi sampling to also be affected by this variant. The pregnancy was managed with frequent ultrasounds and three amnioreductions that resulted in spontaneous vaginal delivery at 37weeks and 6days of a viable newborn with no evidence of overt electrolyte abnormalities suggesting complete resolution. A detailed review of the published cases of MAGED2-related transient aBS is provided. Our review focuses on individuals who received antenatal treatment. A total of 31 unique cases of MAGED2-related transient aBS were compiled. Amnioreduction was performed in 23 cases and in 18 cases no amnioreduction was performed. The average gestational age at delivery was significantly lower in cases without serial amnioreduction (28.7 vs. 30.71weeks, p=0.03). Neonatal mortality was seen in 5/18 cases without serial amnioreduction, and no mortality was observed in the cases with serial amnioreduction. In cases of second trimester severe polyhydramnios without identifiable cause, whole exome sequencing should be considered. Intensive ultrasound surveillance and serial amnioreduction is recommended for the management of MAGED2-related transient aBS.

Effect of psychological care on the prenatal mental state and vaginal delivery in pregnant women during the early stages of the COVID-19 epidemic

The COVID-19 pandemic has had a profound impact on the lives of people globally, including pregnant women. We aimed to explore the influence of a psychological care intervention based on behavioral change theory on the prenatal mental state and mode of delivery in pregnant women from June 2020 to June 2022 during the early stage of the COVID-19 epidemic in China. A retrospective analysis was conducted of the records of pregnant women who delivered in our hospital from June 2020 to June 2022. They were assigned to an observation and a control group according to the care that they received. The Symptom Checklist-90 (SCL-90) was used to evaluate their negative emotions. The duration of each labor stage and the mode of delivery (cesarean section, spontaneous vaginal delivery, or assisted vaginal delivery) were recorded. A total of 216 women were included in the analysis. Before care, there were no significant differences in the SCL-90 scores between the 2 groups. After delivery, the SCL-90 scores in the observation group were significantly lower than those in the control group. The vaginal delivery rate in the observation group was 92.59%, which was significantly higher than that in the control group (70.39%). The duration of the first stage of labor and the total duration of labor in the observation group were 447.95 ± 53.45 minutes and 498.15 ± 35.14 minutes, respectively, which were significantly lower than those in the control group. The implementation of psychological care based on behavioral change theory in pregnant women during the early stage of the COVID-19 epidemic significantly improved their prenatal psychological state, promoted vaginal delivery, and help shorten the labor process, and reduce the risk of adverse pregnancy outcomes. This intervention is thus worth promoting.

Predicting Urinary Incontinence among Postpartum Women

Urinary incontinence (UI) is common during a pregnancy-puerperium period, with a prevalence of 18.6-75% during pregnancy and 6-31% during postpartum. This study aims to review several published studies on which risk factors impact the incidence of UI.The search was conducted on Pubmed®, Cochrane Library®, and Ovid®, resulted in 57, 30, and 11 studies, respectively. We included cross-sectional, cohort, or case-control studies related to this aim. The risk of bias within the study was assessed using the Cochrane and Forrest plot was analysed using Review Manager 5.3. On maternal characteristics, age less than 35 years (OR 0.49; 95% CI 0.35-0.67), primiparity (OR 0.29; 95% CI 0.22-0.38), and BMI &lt;25 kg/m2 (OR 0.67; 95% CI 0.55-0.83) were considered as protective factors. A low level of education (OR 2.16; 95% CI 1.69-2.77) increased the risk of UI, Meanwhile, they showed heterogeneity among studies (I2&gt;50%). On delivery methods, the most prone to UI was emergency caesarean section followed by instrumental vaginal deliveries, spontaneous vaginal deliveries, and caesarean section. Episiotomy, epidural analgesia, and obstetric anal sphincter injury (OASIS) were not associated with UI (p&gt;0.05). On neonatal parameters, head circumference &lt;35 cm has a protective effect on UI (OR 0.82; 95% CI 0.73-0.93; I2=0%). Methods of delivery and head circumference will affect postpartum UI according to p-value (p&lt;0.05) and homogeneity among studies (I2&lt;50%).

Maternal and Perinatal Outcome After Induction of Labor Versus Expectant Management in Low-risk Pregnancies Beyond Term.

Due to still controversial discussion regarding appropriate termination of low-risk singleton pregnancies beyond term, this retrospective study aimed to evaluate maternal and perinatal outcomes depending on gestational age and obstetric management. This is a retrospective cohort analysis including 3.242 low-risk singleton deliveries at the Department of Obstetrics of the University Hospital of Cologne between 2017 and 2022. According to current national guidelines, the cohort was subdivided into three gestational groups, group 1: 40+0-40+6 weeks, group 2: 40+7-40+10 weeks and group 3>40+10 weeks. In our cohort, advanced gestational age was associated with higher rates of secondary caesarean sections, lower rates of spontaneous vaginal deliveries, higher rates of meconium-stained amniotic fluid and depressed neonates with APGAR < 7 after 5 min. Analyzing obstetric management, induction of labor significantly increased the rate of secondary sections and reduced the rate of spontaneous deliveries, while the percentage of assistant vaginal deliveries was independent from obstetric management and gestational age. Induction of labor also significantly enhanced the need for tocolytic subpartu and epidural anesthesia and caused higher rates of abnormalities in cardiotocography (CTG), which also resulted in more frequent fetal scalp blood testing; however, the rate of fetal acidosis was independent of both obstetric management and gestational age. Our study supports expectant management of low-risk pregnancies beyond term, as induction of labor increased the rate of secondary sections and did not improve perinatal outcome.

A meta-analysis of metformin and insulin on maternal outcome and neonatal outcome in patients with gestational diabetes mellitus

Introduction The use of metformin for treating gestational diabetes mellitus (GDM) remains controversial because it can pass through the placenta. This meta-analysis aimed to compare the effects of metformin and insulin on maternal and neonatal outcomes in patients with GDM. Methods We conducted a comprehensive search of the PubMed, Embase, and Cochrane Library databases, focusing on randomized controlled trials (RCTs) that evaluated the impacts of metformin and insulin on both maternal and neonatal outcomes in patients with GDM. Results Twenty-four RCTs involving 4934 patients with GDM were included in this meta-analysis. Compared with insulin, metformin demonstrated a significant reduction in the risks of preeclampsia (RR 0.61, 95% CI 0.48 to 0.78, p < .0001), induction of labor (RR 0.90, 95% CI 0.82 to 0.98, p = .02), cesarean delivery (RR 0.91, 95% CI 0.85 to 0.98, p = .01), macrosomia (RR 0.67, 95% CI 0.53 to 0.83, p = .0004), neonatal intensive care unit (NICU) admission (RR 0.75, 95% CI 0.66 to 0.86, p < .0001), neonatal hypoglycemia (RR 0.55, 95% CI 0.48 to 0.63, p < .00001), and large for gestational age (LGA) (RR 0.80, 95% CI 0.68 to 0.94, p = .007). Conversely, metformin showed no significant impact on gestational hypertension (RR 0.84, 95% CI 0.67 to 1.06, p = .15), spontaneous vaginal delivery (RR 1.13, 95% CI 1.00 to 1.08, p = .05), emergency cesarean section (RR 0.94, 95% CI 0.77 to 1.16, p = .58), shoulder dystocia (RR 0.65, 95% CI 0.31 to 1.39, p = .27), premature birth (RR 0. 92, 95% CI 0.61 to 1.39, p = .69), polyhydramnios (RR 1.11, 95% CI 0.54 to 2.30, p = .77), birth trauma (RR 0.87, 95% CI 0.54 to 1.39, p = .56), 5-min Apgar score < 7 (RR 1.13, 95% CI 0.76 to 1.68, p = .55), small for gestational age (SGA) (RR 0.93, 95% CI 0.71 to 1.22, p = .62), respiratory distress syndrome (RDS) (RR 0.74, 95% CI 0.50 to 1.08, p = .11), jaundice (RR 1.09, 95% CI 0.95 to 1.25, p = .24) or birth defects (RR 0.80, 95% CI 0.37 to 1.74, p = .57). Conclusions The findings suggest that metformin can reduce the risk of certain maternal and neonatal outcomes compared with insulin therapy for GDM. However, long-term follow-up studies of patients with GDM taking metformin and their offspring are warranted to provide further evidence.

Кровоизлияния в сетчатку у новорожденных. Клинические особенности и факторы риска

Material and methods. The study included newborns born at the Perinatal Center of St. Petersburg State Pediatric Medical University in the period from July 2021 to October 2022. Anamnestic and other risk factors for the development of retinal hemorrhages were assessed in newborns with and without retinal hemorrhages (RH). Depending on the severity of RH (according to the results of the examination on the RetCam retinal camera), the newborns were divided into groups in which the bilaterality of the RH was assessed, localization in the layers and area of the retina, with an emphasis on the macular region and the optic disk. Results. Of the 75 newborns, 16 had birth-related RH (23.1%). Normal spontaneous vaginal delivery showed the highest association with RH (odds ratio, 5.515; 95% confidence interval, 1.15–26.46, p&lt;0.001). Hemorrhages were more often bilateral (68.8%), intraretinal (87.5%) and localized in the central zone of the retina (81.3%). At the same time, severe RH were more often located in zones I and II, in each newborn they affected the optic nerve or macula, in 6.3% of cases they spread to the vitreous body, and in 25% they were accompanied by Roth’s spots. Conclusion. RH occur in 21.3% of full-term newborns and are largely associated with normal delivery. The main characteristics of hemorrhages in newborns differ notably depending on their severity. Severe retinal hemorrhages in newborns may have negative consequences for the development of visual functions at an older age, which requires further long-term studies. This study confirmed that the digital wide-angle retinal camera is an effective method for examining a large number of newborns with RH. Key words: newborn, retinal hemorrhages, vitreous hemorrhages, Roth’s spots

Prevalence and Factors Associated with Puerperal Sepsis among Women Attending the Postnatal Ward at Fort Portal Regional Referral Hospital

Puerperal sepsis is a widespread issue globally, causing maternal health complications across hospital maternity wards. Typically, around 4-6% of hospital-admitted patients within maternity wards contract clinical infections, including sepsis. The overarching aim of this study was to identify the contributing factors to puerperal sepsis among postnatal mothers in the maternity ward at Fort Portal Regional Referral Hospital. Conducted as a cross-sectional investigation, questionnaires were distributed to mothers in the maternity ward for selfcompletion. All postnatal mothers who delivered at Fort Portal Regional Referral Hospital and developed puerperal sepsis were included in the study. Quantitative data was manually analyzed using Microsoft Excel, summarized through averages and percentages, and presented via tables, graphs, and pie charts. The study uncovered that the prevalence of puerperal sepsis at Fort Portal Regional Referral Hospital stands at 22.4%. Key findings include that the majority of respondents were multiparous (80.6%), with 49.4% delivering at the hospital, 41.7% at home, and 8.8% with the assistance of a traditional birth attendant. Furthermore, 64.7% had spontaneous vaginal deliveries, while 35.3% underwent cesarean sections. Additionally, 58.8% were assisted by doctors, and 41.2% were assisted by midwives/nurses. Of note, 57.6% experienced normal labor duration, while 42.4% endured prolonged labor, and 12.9% encountered antepartum hemorrhage. The prevalence of puerperal sepsis was strongly associated with factors such as parity, mode of delivery, place of delivery, duration of labor, and concurrent medical conditions like diabetes, hypertension, and HIV infection. Recommendations stemming from these findings emphasize collaborative efforts between the government (particularly the Ministry of Health) and hospitals to alleviate costs for mothers during critical health situations. Moreover, aseptic techniques during delivery assistance should be rigorously practiced to mitigate the incidence of puerperal sepsis. Keywords: Puerperal sepsis, Clinical infection, Patients, Postnatal mothers, Caesarean section, Vaginal delivery.

The effect of general anesthesia applied during cesarean section on newborn bilirubin

Aims: Today, delivery is often performed as normal spontaneous vaginal delivery (NSVD) and cesarean section operations. Deliveries with NSVD mostly take place in the delivery room without the need for additional anesthetic agents. General anesthesia and regional anesthesia techniques are applied in cesarean section operations. In this study; The aim of this study was to examine the effect of general anesthesia on newborn bilirubin and to compare it with the bilirubin level of babies born without general anesthesia with NSVD method. Methods: Between March 2022 and September 2022, 152 patients over the age of 18 with term pregnancy NSVD and elective cesarean section without complications were randomly included in the study. Cases diagnosed with liver and biliary tract disease, systemic liver and biliary tract effective drug use, DCOOMBS( +) and Covid (+) clinics were excluded. Results: Of the patients included in our study, 75 (49.3%) were given general anesthesia and 77 (50.7%) delivered with NSVD without general anesthesia. It was determined that the first hour bilirubin and the fourth hour bilirubin values were significantly higher (p &lt;0.05) in the general anesthesia group compared to the group that did not receive general anesthesia. In the group that did not receive general anesthesia, the APGAR 5th min score was found to be significantly (p &lt;0.05) higher than the general anesthesia group. APGAR 1 min value did not differ significantly (p &gt; 0.05) between the anesthesia-free and general anesthesia groups. Neonatal weight, head circumference, and infant height did not differ significantly between the groups that did not receive general anesthesia and those who did not receive general anesthesia (p&gt; 0.05). Conclusion: Among the groups that did not receive general anesthesia and anesthesia; Bilirubin value was found to be higher among babies born by cesarean section under general anesthesia. It seems that it is more beneficial to avoid systemic effects as much as possible and to disseminate NSVD.

To study the incidence of rheumatic heart disease and congenital heart disease with pregnancy

The aim of the study is to study the incidence of rheumatic heart disease and congenital heart disease with pregnancy. Patients with heart Diseases either booked or unbooked cases who were admitted in OBGY during study period, were recruited. The booked cases were seen by obstetrician in outpatient department and by cardiologist in the respective O.P.D.to check their cardiac status. Maximum no. of cases were in age group 21-25 yrs. Followed by equal no. of cases in age group &amp;#60;20 yrs. and 26-30 yrs. 30 cases, 30(90%) cases were suffering from rheumatic heart disease while only 03 (10%) cases had congenital heart disease. The distribution of cases according to period of gestation in weeks. The maximum no. 14 (46.6%) of cases had come with the pregnancy of 33-40 weeks. Only 01 cases were postmature. 23.3% of cases delivered spontaneously. L.S.C.S. done in 16.6%. ventouse applied in 03 cases &amp; forceps in 1 case. Premature deliveries in 20% cases. We conclude an incidence of 0.2%. Mostly cases were rheumatic heart disease (90%). Out of which 32% had mitral stenosis as commonest lesion. 8.9% cases were of congenital heart disease. Maximum cases 4.3% were between age group 21-25 but mostly belong to low risk category. 23.3% cases had spontaneous vaginal delivery. LSCS was done only in 16.6% cases, with mostly because of obstetrics and foetal causes.Pre-conception counseling should be offered to all women with heart disease with the aim of avoiding risks and helping them to plan their future.

Maternal and fetal outcomes among women with GDMA1 before and post-date

ObjectiveTo investigate adverse pregnancy outcomes in patients complicated with GDMA1 who delivered at term before or after 40 weeks of gestation. Study DesignA population-based cohort study including all women with GDMA1 during pregnancy was conducted. Deliveries occurred between 1988 and 2016 at a large university tertiary medical center. ResultsDuring the study period, 11,765 women with GDMA1 met the inclusion criteria.Of these, 1303 (11 %) delivered after 40 weeks (post-date, study group), while 10,462 (89 %) delivered at term before 40 weeks of gestation (before date, control group).Those who delivered after 40 weeks of gestation (the study group) had a significantly lower percent of cesarean deliveries (CD), higher rates of spontaneous vaginal deliveries and induction of labor in comparison to those who delivered before 40 weeks of gestation (the control group). The control group had significantly higher rates of preeclampsia and intrauterine growth restriction than the study group.Using a multivariable logistic regression model, delivery after 40 weeks was noted as an independent protective factor for CD (adjusted OR = 0.78, 95 %CI 0.66–0.92, p value = 0.001). Delivery after 41 + 0 weeks had a significantly higher rate of CD and LGA. ConclusionNo significant increase in adverse pregnancy outcomes at term post-date pregnancies complicated with GDMA1 was demonstrated. Furthermore, there was no increase in the rate of CD with the increase in gestational age until 41 weeks of gestation.

Maternal Risk Factors &amp; Perinatal Outcomes in Women with Placenta Previa: A Cross Sectional Study

Background and objectives: Placenta previa is one of the main factors in adverse maternal and neonatal outcomes. This study was conducted to determine risk factors for placenta previa and subsequent maternal and perinatal outcomes. Methods: This cross sectional study was conducted at Maternity Teaching Hospital, Erbil City, Kurdistan region, Iraq, from August 2020 to August 2021. Sixty Patients with placenta previa who presented with antepartum hemorrhage after 24 weeks of gestational age were included in the study. Participants underwent complete obstetrical and clinical assessment including history of risk factors, general physical, abdominal and pelvic examinations. Imaging methods used included transabdominal and transvaginal ultrasound. Patients were managed according to maternal and fetal conditions, and any maternal and fetal complications were recorded. Results: previous history of placenta previa was observed in 16.7% and previous cesarean section in 60% of women. Maternal outcome was good in majority (91.7%) of cases. Hysterectomy was performed on two women (3.3%). Emergency caesarean section was performed on 58.3% of women, and elective caesarean section was performed on 36.7% of women and neonatal death rate was 66.7% among those delivered by spontaneous vaginal delivery. Greater gestational age, lesser neonatal death rate. Women with grade IV placenta previa had worse neonatal and maternal outcomes than women with lower grades of placenta previa. Conclusion: A higher incidence of placenta previa is seen in patients with previous cesarean section, advanced maternal age, and high parity. No significant association was detected between neonatal outcomes and maternal risk factors.

Internal manual rotation in intrapartal arrest of fetal head engagement

ObjectiveThe success of internal manual or digital rotation of the head in mechanical dystocia due to malpresentation, malposition or malrotation is presented in this paper on our own clinical material with reference of today's research and clinical recommendations. Study designThrough a retrospective bicentric clinical study, we investigated the success of internal head rotation in two University Clinics for gynecology and obstetrics from year 2017 to 2023. In 152 singleton term (37–42 weeks) in cases of persistens intrapartum arrest of the fetal head. After palpatory and ultrasonographically verified arrest of fetal head engagement, a therapeutic manual (Liepmann) or digital rotation was performed. ResultsIn 152 cases, manual rotation was performed in 108 (71.05 %) and digital rotation in 44 (28.94 %) cases in 73 (48.02 %) primiparous and 79 (51.97 %) multiparous. Intrapartum identification by digital palpation was done in all cases, and the following are: persistent occipital posterior position in 68 (44.73%), persistent deep transverse head presentation in 12 (7.89%), persistent high (longitudinal) occipital presentation in 64 (42.10 %) and persistent anterior asynclitism in 8 (5.26 %) cases. Episiotomy was used in 36 (23.68%) cases. Vacuum extraction was completed in 14 (9.21 %) deliveries, and cesarean section due to unsuccessful internal rotation in 15 (9.8 %) cases (%) without other indication. We did not record any intrapartum complications or cardiotocographic abnormalities. Cervical lacerations were treated with sutures in 4 cases (2.63 %). Successful correction of internal rotation procedure with spontaneous vaginal delivery was found in 80.92 % of cases. If we exclude delivery assisted by vacuum extraction whose indications were fetal hypoxia or dystocia after successful internal head rotation procedure, then the success rate of this method was 90.13 %. ConclusionInternal head rotation is a simple, safe and successful obstetric manual intervention that directly increases the rate of vaginal deliveries after correction of the birth mechanism anomaly and directly reduces the percentage of cesarean section. Manual or digital head rotation is an established midwifery/obstetric skill in several centers which, based on numerous clinical researches and experience, should become protocolized and included in the guidelines of professional associations.

Pregnancy with Peripheral Arteriovenous Malformation

22 years old primigravida with 37 weeks singleton gestation was admitted with profuse bleeding from swelling over left anterior superior iliac spine region. Ultrasound findings suggested a high flow vascular malformation with feeder from left common femoral artery. Bleeding was managed conservatively with pressure bandage. Delivery was uneventful. Live female baby of 2.045 kg was delivered by spontaneous vaginal delivery at 38 weeks. After 4 weeks of delivery vascular malformation was confirmed with angiography and treated successfully with endovascular embolization of the major arterial feeder. In periodic follow up until 6 months, no further complication was reported by the patient.

Congenital hyperextension of the knee without dislocation in a child: A case report

Congenital hyperextension of the knee, also known as congenital genu recurvatum, is a rare medical condition with an incidence of 1:100,000 deliveries. It is typically diagnosed clinically at birth, aided by radiological findings. Treatment with serial casting and close follow-up has been demonstrated to provide most favourable results. A Tanzanian 15-years-old primigravid girl with a normal gynaecological history was enrolled into a clinical trial evaluating the immunogenicity of different doses of two human papillomavirus vaccines (clinicaltrials.gov identifier NCT02834637). Fifty-five weeks after she received the second dose of the bivalent vaccine, Cervarix®, she delivered a female infant by spontaneous vaginal delivery following normal labour, at an estimated gestational age of 41 weeks. The infant had a notable right knee deformity but was otherwise well. Five days later, the baby was examined at the research clinic and noted to have a right knee hyperextension with limited flexion. X- rays reviewed by a consultant orthopaedic surgeon revealed congenital hyperextension of the right knee without dislocation. The baby girl recovered fully after three months of serial casting.

Sepsis Risk Factors in Neonatal Intensive Care Units of Public Hospitals in Southeast Ethiopia, 2020: A Retrospective Unmatched Case-Control Study.

Neonatal sepsis is a significant contributor to neonatal morbidity and mortality worldwide. It is more prevalent in developing countries. Thus, understanding the risk factors for neonatal sepsis is critical to minimizing the incidence of infection, particularly in Ethiopia. The purpose of this study was to identify the risk factors for neonatal sepsis in neonates admitted to neonatal intensive care units of public hospitals in Southeast Ethiopia in 2020. An institution-based, retrospective unmatched case-control study was conducted on 97 cases and 194 controls in neonatal intensive care units of public hospitals in Southeast Ethiopia. A pretested, structured questionnaire was used to collect the data. Data was entered using EpiData 3.1 and analyzed using SPSS version 23. Bivariable and multivariable logistic regression analyses were performed to identify associated factors. An adjusted odds ratio with a 95% confidence interval was used to determine the degree of association, and statistical significance was declared at a p value of < 0.05. In this study, 97 cases and 194 controls were included. About two-thirds (63.9%) of cases were with early onset neonatal sepsis (<7 days). Mode of delivery with spontaneous vaginal delivery (AOR:5.032; 95% CI (1.887-13.418)), type of birth attendant (traditional birth attendant) (AOR: 4.407 95% CI (1.213,16.004)), history of STI/UTI (AOR:2.543; 95% CI (1.313,4.925)), intrapartum fever (AOR:4.379; 95% CI (2.170,8.835)), APGAR score at the 5thminute < 7 (AOR:4.832; 95% CI (1.862,12.537)), neonate received resuscitation (AOR:3.830; 95% CI (1.753,8.369)), low birth weight (AOR:6.101; 95% CI (2.124,17.525)) were the identified risk factors for neonatal sepsis. Both maternal and neonatal factors contribute to the risk of neonatal sepsis. Spontaneous vaginal delivery, birth attended by the traditional birth attendant, history of STI/UTI, presence of intrapartum fever, low APGAR score at the 5th minute, neonate receiving resuscitation, and low birth weight were identified as independent risk factors for neonatal sepsis. Prompt identification of the aforementioned factors and management should be sought for all newborns.

A case of sacrococcygeal teratoma associated with antenatally acquired urethrovaginal fistula and hydrocolpos

BackgroundSacrococcygeal teratomas (SCTs) are known to cause urological complications, but urethrovaginal (UV) fistula as a complication of SCT is rare. We herein report a case of SCT with UV fistula and hydrocolpos.Case presentationA 1-day-old female neonate presented to our department with prominent swelling in the sacrococcygeal region. She was born at 37 gestational weeks via spontaneous vaginal delivery from a 39-year-old woman. The weight of the baby was 2965 g, and her Apgar scores were 4/10 (at 1 and 5 min). An MRI examination confirmed an 11 × 11 cm Altman classification typeII SCT associated with hydrocolpos, a dilated urinary bladder, and bilateral hydronephrosis. When she was 5 days, the SCT was excised totally and a coccygectomy was performed. After the operation, as her urinary output appeared unstable, a cystoscopic examination was performed on the third postoperative day. This revealed that the UV fistula was located approximately 1 cm from the urethral opening. In addition, the proximal urethra was unobstructed and connected to the bladder. The cystoscope allowed for the passage of a urinary catheter through the urethra. After 1 month of catheter placement, she was discharged from the hospital at 57 days of age. Follow-up was uneventful, with neither urinary infection nor retention.ConclusionsSCTs are associated with not only trouble with rectal function and lower extremity movement but also urinary complications. The pathogenesis of this UV fistula is thought to be the rapid growth of the SCT that developed in the fetal period, resulting in obstruction of the urethra by the tumor and the pubic bone, which in turn caused urinary retention and the formation of a fistula as an escape route for the pressure. Because SCTs can cause a variety of complications depending on the course of the disease, careful examination and follow-up are necessary.

Efficacy of Manual Vacuum Aspiration versus Dilatation and Curettage in First Trimester Miscarriages

Objective: To compare the efficacy of Manual Vacuum Aspiration (MVA) with Dilatation and Curettage (DNC) in miscarriages of the first trimester. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology CMH, Peshawar Pakistan, from Feb to Aug 2018. Methodology: A total number of 182 Adult female (20-35 years of age) patients having miscarriage during the first trimester who were either primigravida or with previous history of spontaneous vaginal delivery were included in this study. Patients were assigned randomly into Manual vacuum aspiration (MVA) and Dilatation and Curettage (DNC) groups using the draw randomization technique. Data regarding the efficacy of both procedures and procedural success rate was measured in all patients. Results: A total of 182 Adult female patients, with a mean age of 30.53+5.23 years, having miscarriage in the first trimester, were evaluated. The mean gestational age at the time of abortion was 8.64+1.30 weeks, and the mean parity of study females was 1.96±0.82. The procedure was successfully done in 87(95.6%) patients in the MVA Group versus 84(92.3%) in the D&amp;C Group (p-value 0.35). Conclusion: Manual vacuum aspiration (MVA) is an effective and safe method of abortion with a success rate comparable to that of Dilatation and Curettage (D&amp;C).

Comparison of efficacy and safety of the Dinoprostone Vaginal tape and Dinoprostone vaginal tablet for the induction of labor in para three and more women: A retrospective cohort Study

Background: Prostaglandins have a central role in the cervical ripening and parturition, and have been widely used for induction of labor (IOL). This study aimed to compare the effectiveness and safety of Dinoprostone vaginal tape (Propess) over Dinoprostone vaginal tablets (Prostin) for IOL and find which has better outcome to be applied in clinical practice. Participants and Methods: A retrospective cohort study was conducted via reviewing of medical records of multipara women admitted to King Fahad Medical City, Riyadh between January-2021 and December-2022 for IOL by Propess or Prostin. Results: A total of 87 multipara women were included in the study; 39 (44.8%) were treated by Propess and 48 (55.2%) were treated by Prostin for IOL. Full dilatation of the cervix after induction of labour was reported among majority of women (94.2%): being 92.1% among women treated with Propess and 95.8% among those treated with Prostin, however, this difference was not statistically significant, p&gt;0.05. Regarding mode of delivery, normal spontaneous vaginal delivery was reported among 84.9% of women; 86.8% among women treated with Propess and 83.3% among those treated with Prostin while emergency cesarean section delivery was reported among 10.5% of women; 7.9% among women treated with Propess and 12.5% among those treated with Prostin. However, these differences were not statistically significant, p&gt;0.05. Conclusion: The success rate of IOL among multipara women was high; however, no difference was reported between Propess and Prostin as regards the effectiveness (maximum cervical dilatation) and safety (rate of emergency cesarean section).

SAT612 Granulomatous Mastitis: An Unusual Presentation Of Prolactinoma

Abstract Disclosure: H.R. Alkaissi: None. E. Kim: None. S. McFarlane: None. Background: Granulomatous mastitis (GM) is a rare, benign inflammatory breast disease of unclear etiology with clinical presentation that is similar to inflammatory breast cancer and periductal lobular mastitis. It occurs mainly in younger females and during the postpartum period. Prolactin (PRL) is an essential hormone of pituitary and extrapituitary origin that promotes lactation and the development of mammary glands within breast tissues. In addition to its lactogenic effect, it has over 300 other effects, several of which are immunomodulatory, including the expression and secretion of proinflammatory cytokines from macrophages. Clinical Case: A 37-year-old African American woman presented with right breast pain and swelling for a few weeks. Her medical history includes amenorrhea for five years. She is gravida 1, para 1 with normal spontaneous vaginal delivery at the age of 20. Physical exam showed non-bloody, non-purulent nipple discharge bilaterally, otherwise unremarkable. A breast ultrasound showed a 1 cm complex cystic mass. Biopsy showed benign breast tissue, with noncaseating granulomas formed by macrophages (CD68 positive on immunohistochemistry). Ziehl-Neelsen staining for acid-fast bacilli was negative. Staining for fungi was also negative. Prolactin level was 237 ng/mL. TSH, IGF-1, and ACTH were within normal. Pituitary MRI showed a focus of abnormal signal and diminished enhancement measuring 2.8x3.2x4.2 mm within the left side of the pituitary gland is compatible with a microadenoma. The patient was started on bromocriptine 2.5mg daily. Discussion: Our patient represents a rare case of granulomatous mastitis in the setting of microprolactinoma, likely long-standing, given the five years history of amenorrhea. The immunomodulatory effect of PRL on several immune system cells, including B-cells, T-cells, and macrophages, might be an underlying mechanism. In a recent study of 25 samples of GM, metagenomics studies identified unusual organisms in 68% of the samples. Of these, Corynebacterium kroppenstedtii was the most common (60%), followed by Pseudomonas oleovorans (16%), Epstein-Barr virus (4%), Acinetobacter baumannii (4%), and Tepidiphilus thermophilus (4%). In addition, 50% of the patients had elevated PRL, and elevated immunological markers, such as C3 and IgA [1]. This suggests that GM results from an interaction between the presence of certain pathogens in a host with elevated PRL that mediates proinflammatory response.