Fundal Height Research Articles

EFFECTS OF UDUMBARA JAL, MASANUMASIKA KALP, GARBHAPALA RASA, VASANT KALPA IN THE MANAGEMENT OF OLIGOHYDRAMNIOS - A CASE REPORT

Oligohydramnios frequently demands intensive foetal surveillance and proper antepartum and intrapartum care. Its incidence is 1:750. Oligohydramnios is associated with increased perinatal morbidity and mortality. Features include IUGR, PIH, Abortion, Prematurity, IUFD, Malpresentations, Foetal distress, and Low APGAR, which are very emerging and life-threatening conditions for both mother and foetus in which the production of amniotic fluid is reduced and require immediate treatment and care. In the modern medicine they have not any particular treatment instead of giving adequate rest which decreases dehydration, hydration – Oral/IV Hypotonic fluids (2 Lit/d) or directly infusion of fluids in amniotic cavity, serial USG – Monitor growth and AFI. All these complica-tions result in higher rates of obstetrician intervention like induction of labour and caesarean delivery, which in-crease maternal risks as well. In Ayurveda, oligohydramnios can be considered under Upavishtaka, Nagodara, which comes under Garbha vyapad. Here, Garbhakshaya, as stated by Acharya Sushruta, where Garbhaaspan-dana, i.e. Ksheena Spandana (low foetal moments) and anunatkukshitta (Less fundal height) mentioned which is mainly due to the reduced amniotic fluid. A case study of a 20-year-old patient, primigravida with 20 weeks ges-tation, presented in OPD with fundal height less than gestational age on abdominal examination and AFI 6 cm on ultrasonography is presented. She managed efficiently by administering her with Udumbara Jal, Masanu-masika Kalp, Garbhapala Ras, and Vasant Kalpa orally and eating a diet according to Ayurveda. AFI increased to 9.5 cm on the 24th week, 12.9 cm at 29 weeks & 15.5 cm at 36 weeks and fundal height was increased and corresponded to the gestational ages. Foetal weight also increased from 300 gms to 657 gms, 1339 gms, & 2821 gms, respectively. This very effective treatment modality increases the amniotic fluid and provides good nour-ishment for the foetus.

The Effect of Postpartum Exercise Practices on Uterine Fundal Height, Lochia, Diastasis Recti, Baby Blues in Accelerating Recovery in Postpartum

The Effect of Postpartum Exercise Practices on Uterine Fundal Height, Lochia, Diastasis Recti, Baby Blues in Accelerating Recovery in Postpartum

CustOmized versus standard fundal-height measuREments for the detection of small-for-gestational age fetuses in low-risk women (CORE study): A randomized controlled trial.

To compare the proportion of small-for-gestational age (SGA) infants detected by routine care versus a growth assessment protocol using customized fundal-height charts in low-risk pregnancies of a developing country. An open label randomized controlled trial was conducted at the Fatima Memorial Hospital (NUR International University, Pakistan). Low-risk pregnant women were randomly allocated to routine care (Mcdonald's rule for fundal height measurements followed by referral for scan with discrepancy of 3 cm from gestational age and a contingency third trimester scan) or the growth assessment protocol (GAP) developed by the Perinatal Institute (UK), which consists of the use of gestation-related optimal weight (GROW) customized charts, alongside management protocols for suspected SGA fetuses, audit tools and training. The primary prespecified outcome was the detection of SGA (defined as a birthweight <10th centile). Of the 2535 eligible women, 1884 (74%) were randomized (942 to standard care and 942 to GAP). After loss-to-follow-up, 1755 women were analyzed (874 in the standard measurement group and 881 in the GAP group). The detection rate of SGA infants was higher in the GAP group (83.2% [95% CI: 74.4%-89.9%] vs. 29% [95% CI: 20.4%-38.9%], P < 0.001), at the cost of an increased false positive rate (10.4% [95% CI: 8.3%-12.7%] vs. 1.4% [95% CI: 0.7%-2.5%], P < 0.001). The diagnostic odds ratio (positive likelihood ratio/negative likelihood ratio) was 42.6 (95% CI: 24.1-75.4) in the GAP group and 28.3 (95% CI:13.6-59.1) in the standard care group. In low-risk pregnant women of a developing country, a growth assessment protocol based on customized fundal-height charts is superior to standard measurements for the antenatal detection of SGA in newborns.

Methods for Gestational Age Estimation during Pregnancy in Africa: A Scoping Review

Monitoring foetal growth and managing pregnancy complications require the precise determination of gestational age. Estimation of gestational age during pregnancy is of utmost importance as it assists with the identification of high-risk pregnancies like polyhydramnios, multiple pregnancy and intrauterine growth restriction. The purpose of the SR was to map the evidence of estimation of gestational age during pregnancy in Africa using the Joanna Briggs Institute (JBI) Scoping Review Methodology. Electronic search engines were used to search articles published from 1 January 2013 to 31 December 2023. A total of 79 eligible articles were retrieved and uploaded to Rayyan – a web and mobile app for systematic reviews. The selection process included title and abstract screening as well as full text article screening, which resulted in 19 articles. A Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) flow chart was developed to report the 19 studies identified for final SR. There was a minimal publication of studies between 2013 and 2014 with a marked increase in 2019 (n = 4) and 2020 (n = 4). Countries where studies were done included Northern Africa (n = 3), Eastern Africa (n = 3), Western Africa (n = 3), Central Africa (n = 2), Southern Africa (n = 3), and multiple countries (n = 5). Among the 19 articles included in the SR, 16 adopted a quantitative design. This scoping review (SR) identified several methods for gestational age estimation, namely, ultrasound; last menstrual period (LMP); symphysis fundal height (SFH); and clinical data. More systematic reviews should be conducted on the estimation of gestational age to add to the information obtained from the SR.

COMPARISON OF PLGF LEVELS, AMONG SMALL FOR GESTATIONAL AGE AND APPROPRIATE FOR GESTATIONAL AGE MOTHERS

Objective. Early detection of small for gestational age fetuses can prevent infant morbidity and mortality. The objective of this study was to compare the levels of Placental Growth Factor among small for gestational age with appropriate for gestational age mothers and to identify the predictive value of PlGF in detecting pregnancies with Intra uterine growth retardation in local population. Design. Quasi experimental (comparative cross-sectional) study. Place &amp; duration of study. Gynecological department of Ayub Medical complex, Abbottabad from August 2021 to January 2022. Methodology. The studied population included total 68 mothers in last trimester with 34 in each group, i.e. appropriate for gestational age and small for gestational age. Fetal size was estimated either by clinical examination (symphysis fundal height) or estimated fetal weight by ultrasound examination. Sociodemographic along with reproductive history were recorded and blood samples analyzed for PlGF difference in both groups. Results. The median age of mothers was 32.5 years. The PlGF in small for gestational age was observed in the below normal concentration (mean value = 126.7 pg/mL) while it was observed in normal ranges in appropriate for gestational age mothers (mean value = 24.2 pg/ml) with P-value (&lt;0.001). Conclusion. Mothers with small for gestational age were having significantly lower placental growth factor levels compared to mothers with appropriate for gestational age.

Ambulation Support for Reduction of Pain and Uterine Fundal Height in Post-Cesarean (Case Study)

Cesarean sections continues to increase globally and now accounts for more than 1 in 5 (21%) of all births. A common problem after a cesarean section is discomfort. One of the discomforts felt after surgery is pain. The pain experienced by post-cesarean mothers is related to two main factors: surgical wounds and uterine contractions. This study aims to describe the effect of implementing ambulation support on pain and the reduction of uterine fundal height post-cesarean. The writing method is a case study. Ambulation support intervention was carried out gradually over 48 hours. After the implementation, the NRS pain scale results decreased from 5 to 3. The WBPRS pain scale decreased from 6 to 3. The uterine fundal height decreased from 12.5 cm to 8 cm, decreasing more rapidly by 4.5 cm on the second day. The results show that ambulation support can help reduce pain and uterine fundal height more quickly. It is hoped that through patient education, accompaniment, and support during ambulation, and supervision during implementation, it can significantly facilitate the recovery of cesarean patients.

Peripartum Prediction of Fetal Weight in Gravidas With Obesity.

Estimated fetal weight (EFW) is an important metric at delivery as neonates with abnormal birthweight and their mothers are at higher risk of birth complications. Data regarding optimal EFW assessment in gravidas with obesity is inconsistent, and with the increasing incidence of obesity, clarification of this question is crucial. We aimed to compare accuracy of ultrasound (US)-derived EFW and clinical assessments of EFW in predicting neonatal birthweight among gravidas with obesity. This prospective cohort study enrolled gravidas with obesity and a singleton pregnancy admitted for delivery at term. EFW was determined using either US biometry or clinical assessment (Leopold's maneuvers, Johnson's formula, and Insler's formula) at time of admission. Our primary outcome was accurate EFW, defined as EFW within 500 g of birthweight. Secondary outcomes included ability to predict small-for-gestational age (SGA) and large-for-gestational age (LGA) birthweights. These outcomes were compared between all EFW methods. A total of 250 gravidas with a median body mass index of 36.4 kg/m2 were enrolled. Admission US outperformed Leopold's maneuvers in obtaining accurate EFW (81.6% versus 74.5%, P = .03). When comparing all methods, Johnson's and Insler's formulae performed the worst, accurately predicting EFW in only 27.4% and 14.3% of cases, respectively. Likewise, US-derived EFW outperformed Leopold's maneuvers and fundal height in the prediction of SGA and LGA neonates. US is more accurate than clinical assessment of EFW in gravidas with obesity both for estimation of actual birthweight and prediction of abnormal birthweight. Universal late third-trimester or peripartum US for EFW should be considered in gravidas with obesity.

The effect of maternal fundal height and abdominal circumference on maternal blood pressure during cesarean delivery

The effect of maternal fundal height and abdominal circumference on maternal blood pressure during cesarean delivery

EFFECTIVENESS OF POSTPARTUM EXERCISE FOR POSPARTUM WOMEN ON UTERINE INVOLUTION

Postpartum exercise plays an important role in the process of uterine involution. The involution process will proceed well if uterine contractions are strong, so action must be taken to improve uterine contractions. Efforts to control bleeding from the placenta by improving strong contractions and retraction of myometrial fibers with postpartum exercises. The aim of this research is to determine the effectiveness of postpartum exercises for postpartum mothers. on Uterine Involution at the Pujud Community Health Center, Rokan Hilir Regency. This type of research is a quasi-experimental design. The population in this study were postpartum mothers, who were taken using a purposive sampling technique. Of the 17 postpartum mothers in the Pujud Community Health Center Working Area, Rokan Hilir Regency, before postpartum exercise there was a decrease in Rapid TFU of 0 (0%), a decrease in Normal TFU of 8 (47.1), a decrease in Slow TFU of 9 (52.9) and after After postpartum exercise was carried out, there was a rapid decrease in TFU in 11 people (64.7%), there was a decrease in normal TFU in 6 (35.3), there was a slow decrease in TFU in 0 (0). There was a significant influence between postpartum exercise and uterine involution as seen from the height measurement. Uterine fundus with the One-Sample Test results above show that the P value is 0.000 &lt; 0.05. So, in accordance with the basis for decision making in statistical tests, it can be concluded that postpartum exercise carried out before and after is effective in reducing the fundal height of the uterus (TFU) of postpartum mothers at the Pujud Community Health Center, Rokan Hilir Regency. It is hoped that all postpartum mothers can understand the benefits of postpartum exercise for uterine involution process. .

Extravasated Pudendal Artery Pseudoaneurysm Presenting as a Large Vaginal Hematoma Following Uncomplicated Delivery

Body of Abstract: (1) To report a case of an extravasated pudendal pseudoaneurysm presenting as vaginal hematoma following an uncomplicated delivery. (2) To discuss alternatives of management of vulvar hematomas. Introduction: Postpartum hemorrhage is a leading cause of maternal mortality and can infrequently (1/300-1/1500 deliveries) be caused by vulvar hematomas. Vulvar hematomas are typically small and resolve with conservative treatment. Rarely, they can develop rapidly, posing a significant risk to the patient. Risks for vulvar hematomas include a prolonged second stage of labor, multiple gestation, operative vaginal delivery, episiotomy, and vaginal laceration. Extravasation from a pseudoaneurysm in the pelvic arteries is a rare cause of vulvar hematomas (&lt; 5% of cases) with &gt;75% involving the uterine artery. Pseudoaneurysms typically result from damage to vasculature during a traumatic delivery. Spread into the retroperitoneal space can lead to shock and eventual demise if improperly managed. This case illustrates the exceptionally rare occurrence of a pudendal artery pseudoaneurysm with rapidly expanding potentially catastrophic hematoma formation. Case Summary: Presented is a 21-year-old G2P1011 patient at 39w5d with a large vaginal hematoma diagnosed shortly following spontaneous vaginal delivery. The case initially presented to the hospital one hour after spontaneous rupture of membranes with an unremarkable pregnancy. Normal labor ensued and stage II of labor lasted one hour with an uncomplicated nonoperative vaginal delivery. Postpartum a significant increase in fundal height was noted. Cytotec was given and bladder catheterization removed 800 ml urine. Abdominal pain increased. Vital signs were normal. Exam revealed a large posterior vaginal wall swelling extending upward, but without active bleeding. A computerized tomography (CT) scan of the abdomen/pelvis revealed a 9.7 X 10.5 X 13.2 cm pelvic hematoma arising from the posterior vaginal wall with extension cephalad into the perirectal space and right adnexa. Evidence of active bleeding and bilateral hydronephrosis were reported. Hemoglobin was 10.1, down from admission 12.5. Symptoms included worsening abdominal pain and dizziness. Based on the active bleeding noted on CT scan and the progressive symptoms, the patient was transferred to a tertiary care center. Upon tertiary center admission the patient was tachycardic and hypotensive (P 153 and BP 101/61). Hemoglobin was 9.3. Physical exam was unchanged. Interventional radiology recommended and patient underwent embolization of bilateral uterine arteries for treatment of a diagnosed pseudoaneurysm with extravasation of the right pudendal artery. Postpartum day 1, mild right lower quadrant pain was felt to be consistent with the embolization. Hemoglobin decreased to 6.5, and the patient received one unit of packed red blood cells (PRBCs). Clinically, ambulation was tolerated, but tachycardia and hypotension remained and there was decreased swelling. Hemoglobin remained low at 6.8, and another unit of PRBCs was given. Hospital course thereafter was uneventful and discharge was on day 3. Discussion: This case describes a vaginal hematoma and pudendal artery pseudoaneurysm as a very rare but potentially life-threatening postpartum hemorrhage following vaginal delivery. Association with an uncomplicated pregnancy and delivery, involvement of the pudendal artery with an expanding large hematoma dissecting the retroperitoneal space creating a hemodynamically unstable situation are only rarely seen concurrently. Hematoma treatment starts conservatively, utilizing ice, rest, and pain control if patient is hemodynamically stable and the hematoma is small. When large, rapidly expanding, or the patient is hemodynamically unstable, surgical intervention or artery embolization should be considered when imaging identifies the source of bleeding. Imaging may include ultrasound, CT, CT angiography, and magnetic resonance imaging as options for localization of hematoma. No superior mode of evaluation is identified. Pseudoaneurysms following delivery have most commonly been described in the uterine arteries with only a handful of case reports documenting other sources including the obturator, labial, vaginal, and internal pudendal arteries. Our case demonstrates that extravasated pelvic artery pseudoaneurysms can present in benign appearing nonoperative deliveries and should be considered in the differential diagnosis as a source of post-partum hemorrhage. Recently, pseudo-aneurysms have more commonly been treated with IR artery embolization as it is a less invasive and better tolerated procedure by patients. Tsumagari et al suggested an algorithm proposing vulvovaginal hematomas should be observed versus surgically evacuated, whereas upper vaginal hematomas should undergo CT angiography for assessment for selective arterial embolization. Conclusion: Pseudoaneurysms of the pudendal artery with hematoma formation occurring in an uncomplicated delivery are an extremely rare cause of potentially life-threatening hemorrhage as reported in only a handful of cases. Because of their potential for catastrophic sequelae, they should be considered in the differential diagnosis of expanding upper vaginal hematomas. This case depicts the importance and success of rapid identification and embolization of pudendal artery pseudoaneurysm to prevent mortality.

The Effect of Post-Placental Intrauterine Contraceptive Devices on Decreasing in Uterine Fundus Height in Postpartum SC Mothers

Introduction: Contraception and family planning services are an essential part of reproductive health. Postpartum IUDs in SC postpartum have a much lower expulsion rate than vaginal delivery. Objective: to determine the effect of post-placental intrauterine devices on the decrease in fundus uteri. Methods: Using a correlational analytical research design, the research design used is a prospective cohort with a sample size of 30 for the treatment group and 30 for the control group. Result: It can be concluded that the effect 2 hours after the installation of post-placental IUD is known (p-value = 0.279), which indicates that there is no influence between the variable of post-placental IUD installation of SC delivery mothers and the decrease in fundus uteri height. The effect of post-placental IUD insertion on the decrease in fundus uteri height in SC postpartum mothers at Karanganyar Regional Hospital on day 3 shows a p-value of 0.262, and it shows that there is no influence between the variable post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. On day 7, the p-value = 0.008 means that the p-value is smaller than the value of α = 0.05 (p-value &lt; 0.05) and that there is an influence between the variable of post-placental IUD insertion of SC mothers and the decrease in fundus uteri height. Post-placental IUD is a reference for making birth control choices during the postpartum period without interfering with breast milk. Conclusion: The conclusion does not prove the hypothesis in part because the rapid effect on the decrease in TFU in SC postpartum mothers is only after 7 days from the insertion of the IUD, while at 2 hours of IUD insertion and day 3 of IUD insertion, it does not have a rapid effect on reducing TFU in SC postpartum mothers. implications for the management of maternity women who plan to postpone the next pregnancy and this research can be used as empirical evidence that a post-placental intrauterine device acceptor has the potential to increase uterine contractions and accelerate the decrease in fundus uteri height on day 7.

Associations between maternal dietary intake and nutritional status with fetal growth at 14 to 26 weeks gestation: a cross- sectional study

BackgroundMaternal undernutrition during pregnancy is currently estimated at 23.5% in Africa, which is worrying given the negative impacts of malnutrition on maternal and fetal birth outcomes. The current study aimed at characterizing the associations of maternal dietary intake and nutritional status with fetal growth at 14–26 weeks gestation. It was hypothesized that maternal dietary intake was positively associated with maternal nutritional status and fetal growth both in early and late pregnancy.MethodsThis was a cross-sectional survey of 870 pregnant women in mid-western Uganda conducted in August 2013. Data were collected on women’s dietary intake (indicated by women’s dietary diversity and the diet quality score) and nutritional status (indicated by hemoglobin level and mid-upper arm circumference) at 14–26 weeks gestation. Fetal growth was determined by symphysis-fundal height Z-scores processed using the INTERGROWTH-21st calculator. Associations between maternal dietary intake and nutritional status with fetal growth were determined using correlations and chi-square tests.ResultsOverall, only 25% had adequate dietary diversity and the most utilized food groups were White tubers, roots and starchy vegetables; Pulses, nuts and seeds; Cereals and grains, Dark green leafy vegetables, and Fats and oils. A larger proportion of younger women (15–29 y) were classified as anemic (20.4% versus 4.4%) and underweight (23.7% versus 5.0%) compared to older women (30–43 y). Additionally, women aged 15 to 24 years had significantly lower mean SFH-for-gestation age Z-scores than women 36–43 years (F4, 783 = 3.129; p = 0.014). Consumption of legumes nuts and seeds was associated with reduced risk of anemia while consumption of dairy products (mostly milk) was positively associated with better fetal growth. Surprisingly, low Hb level was positively associated with normal fetal growth (rP = -0.133; p = 0.016) after 20 weeks gestation, possibly indicating normal fetal growth paralleled with physiologically necessary hemodilution.ConclusionsSub-optimal dietary patterns, characterized by limited dietary diversity and low protein intake, are likely to compromise maternal nutrition and fetal growth in limited resource settings. Improving pregnant women’s access to cheaper but nutrient-dense protein sources such as pulses, nuts and dairy products (mostly milk) has potential to improve women’s nutritional status and enhance fetal growth.

Meta-Analysis the Effect of Postpartum Exercise on Uterine Fundal Height

Background: Postpartum is a period that is at risk of causing complications and often contributes to maternal mortality rates in Indonesia. One of the causes of maternal death is an irregularity in the involution process, resulting in the risk of postpartum hemorrhage. This study aims to analyze and estimate the influence of postpartum exercise on reducing TFU in postpartum mothers. Subjects and Method: This study is a systematic review and meta-analysis. Search for articles through journal databases including: Google Scholar, PubMed, and Springer Link by selecting articles published from 2013 to February 2023. The population in the study was postpartum mothers with intervention in the form of postpartum exercise, comparison in the form of no intervention or no postpartum exercise, and the outcome is a decrease in TFU. The keywords used were (effect OR Influence) AND (“Parturition Gymnastics” OR “Postpartum Gymnastics” AND “fundal height” OR “decline of fundal height” OR “high uterine fundus” OR “Symphysial fundal height” OR “SFH” OR TFU”) AND (postpartum). The inclusion criteria were full paper articles using the Randomized Controlled Trial (RCT) research method, the analysis results used the Mean SD value, the intervention provided was postpartum exercise, the research subjects were postpartum mothers, with an outcome of decreasing TFU. Articles were collected using PRISMA flow diagrams and analyzed using the Review Manager 5.3 application. Results: Meta-analysis of 6 articles showed that postpartum exercise has an effect on reducing TFU in postpartum mothers by 0.46 units, which was higher than other interventions or no intervention, but this was not statistically significant. (SMD -0.46; 95% CI= -1.99 to 1.07; p=0.550). Conclusion: Postpartum exercise has an effect on reducing TFU in postpartum mothers.

Antenatal Care: A Comparative Review of Guidelines.

Antenatal care plays a crucial role in safely monitoring and ensuring the well-being of both the mother and the fetus during pregnancy, ultimately leading to the best possible perinatal outcomes. The aim of this study was to review and compare the most recently published guidelines on antenatal care. A descriptive review of guidelines from the National Institute for Health and Care Excellence, the Public Health Agency of Canada, the World Health Organization, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists regarding antenatal care was conducted. There is a consensus among the reviewed guidelines regarding the necessary appointments during the antenatal period, the proper timing for induction of labor, the number and frequency of laboratory examinations for the assessment of mother's well-being, and management strategies for common physiological problems during pregnancy, such as nausea and vomiting, heartburn, pelvic pain, leg cramps, and symptomatic vaginal discharge. In addition, special consideration should be given for mental health issues and timely referral to a specialist, reassurance of complete maternal vaccination, counseling for safe use of medical agents, and advice for cessation of substance, alcohol, and tobacco use during pregnancy. Controversy surrounds clinical evaluation during the antenatal period, particularly when it comes to the routine use of an oral glucose tolerance test and symphysis-fundal height measurement for assessing fetal growth, whereas routine cardiotocography and fetal movement counting are suggested practices only by Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Of note, recommendations on nutritional interventions and supplementation are offered only by Public Health Agency of Canada and World Health Organization, with some minor discrepancies in the optimal dosage. Antenatal care remains a critical factor in achieving positive outcomes, but there are variations depending on the socioeconomic status of each country. Therefore, the establishment of consistent international protocols for optimal antenatal care is of utmost importance. This can help provide safe guidance for healthcare providers and, consequently, improve both maternal and fetal outcomes.

Effect of low-intensity focused ultrasound therapy on postpartum uterine involution in puerperal women: A randomized controlled trial.

Short-term poor uterine involution manifests as uterine contraction weakness. This is one of the important causes of postpartum hemorrhage, posing a serious threat to the mother's life and safety. The study aims to investigate whether low-intensity focused ultrasound (LIFUS) can effectively shorten lochia duration, alleviate postpartum complications, and accelerate uterine involution compared with the sham treatment. A multicenter, concealed, randomized, blinded, and sham-controlled clinical trial was conducted across three medical centers involving 176 subjects, utilizing a parallel group design. Enrollment occurred between October 2019 and September 2020, with a 42-day follow-up period. Participants meeting the inclusion and exclusion criteria based on normal prenatal examinations were randomly divided into the LIFUS group or the sham operation group via computer-generated randomization. Patients in the LIFUS group received usual care with the LIFUS protocol, wherein a LIFUS signal was transmitted to the uterine site through coupling gel, or sham treatment, where no low-intensity ultrasound signal output was emitted. The primary outcome, lochia duration, was assessed via weekly telephonic follow-ups post-discharge. The involution of the uterus, measured by uterine fundus height, served as the secondary outcome. Among the 256 subjects screened for eligibility, 176 subjects were enrolled and randomly assigned to either the LIFUS group (n = 88) or the Sham group (n = 88). Data on the height of the uterine fundus were obtained from all the patients, with 696 out of 704 measurements (99%) successfully recorded. Overall, a statistically significant difference was noted in time to lochia termination (hazard ratio: 2.65; 95% confidence interval [CI]: 1.82-3.85; P < 0.001). The decline in fundal height exhibited notable discrepancies between the two groups following the second treatment session (mean difference: -1.74; 95% CI: -1.23 to -2.25; P < 0.001) and the third treatment session (mean difference: -3.26; 95% CI: -2.74 to -3.78; P < 0.001) after delivery. None of the subjects had any adverse reactions, such as skin damage or allergies during the treatment. This study found that LIFUS treatment can promote uterine involution and abbreviate the duration of postpartum lochia. Ultrasound emerges as a safe and effective intervention, poised to address further clinical inquiries in the domain of postpartum rehabilitation.

Indicated vs universal third-trimester ultrasound examination in low-risk pregnancies: a pre-post-intervention study

In low-risk pregnancies, a third-trimester ultrasound examination is indicated if fundal height measurement and gestational age discrepancy are observed. Despite potential improvement in the detection of ultrasound abnormality, prior trials to date on universal third-trimester ultrasound examination in low-risk pregnancies, compared with indicated ultrasound examination, have not demonstrated improvement in neonatal or maternal adverse outcomes. The primary objective was to determine if universal third-trimester ultrasound examination in low-risk pregnancies could attenuate composite neonatal adverse outcomes. The secondary objectives were to compare changes in composite maternal adverse outcomes and detection of abnormalities of fetal growth (fetal growth restriction or large for gestational age) or amniotic fluid (oligohydramnios or polyhydramnios). Our pre-post intervention study at 9 locations included low-risk pregnancies, those without indication for ultrasound examination in the third trimester. Compared with indicated ultrasound in the preimplementation period, in the postimplementation period, all patients were scheduled for ultrasound examination at 36.0-37.6 weeks. In both periods, clinicians intervened on the basis of abnormalities identified. Composite neonatal adverse outcomes included any of: Apgar score ≤5 at 5 minutes, cord pH <7.00, birth trauma (bone fracture or brachial plexus palsy), intubation for >24 hours, hypoxic-ischemic encephalopathy, seizure, sepsis (bacteremia proven with blood culture), meconium aspiration syndrome, intraventricular hemorrhage grade III or IV, periventricular leukomalacia, necrotizing enterocolitis, stillbirth after 36 weeks, or neonatal death within 28 days of birth. Composite maternal adverse outcomes included any of the following: chorioamnionitis, wound infection, estimated blood loss >1000 mL, blood transfusion, deep venous thrombus or pulmonary embolism, admission to intensive care unit, or death. Using Bayesian statistics, we calculated a sample size of 600 individuals in each arm to detect >75% probability of any reduction in primary outcome (80% power; 50% hypothesized risk reduction). During the preintervention phase, 747 individuals were identified during the initial ultrasound examination, and among them, 568 (76.0%) met the inclusion criteria at 36.0-37.6 weeks; during the postintervention period, the corresponding numbers were 770 and 661 (85.8%). The rate of identified abnormalities of fetal growth or amniotic fluid increased from between the pre-post intervention period (7.1% vs 22.2%; P<.0001; number needed to diagnose, 7; 95% confidence interval, 5-9). The primary outcome occurred in 15 of 568 (2.6%) individuals in the preintervention and 12 of 661 (1.8%) in the postintervention group (83% probability of risk reduction; posterior relative risk, 0.69 [95% credible interval, 0.34-1.42]). The composite maternal adverse outcomes occurred in 8.6% in the preintervention and 6.5% in the postintervention group (90% probability of risk; posterior relative risk, 0.74 [95% credible interval, 0.49-1.15]). The number needed to treat to reduce composite neonatal adverse outcomes was 121 (95% confidence interval, 40-200). In addition, the number to reduce composite maternal adverse outcomes was 46 (95% confidence interval, 19-74), whereas the number to prevent cesarean delivery was 18 (95% confidence interval, 9-31). Among low-risk pregnancies, compared with routine care with indicated ultrasound examination, implementation of a universal third-trimester ultrasound examination at 36.0-37.6 weeks attenuated composite neonatal and maternal adverse outcomes.

Predicting risk of preterm birth in singleton pregnancies using machine learning algorithms.

We aimed to develop, train, and validate machine learning models for predicting preterm birth (<37 weeks' gestation) in singleton pregnancies at different gestational intervals. Models were developed based on complete data from 22,603 singleton pregnancies from a prospective population-based cohort study that was conducted in 51 midwifery clinics and hospitals in Wenzhou City of China between 2014 and 2016. We applied Catboost, Random Forest, Stacked Model, Deep Neural Networks (DNN), and Support Vector Machine (SVM) algorithms, as well as logistic regression, to conduct feature selection and predictive modeling. Feature selection was implemented based on permutation-based feature importance lists derived from the machine learning models including all features, using a balanced training data set. To develop prediction models, the top 10%, 25%, and 50% most important predictive features were selected. Prediction models were developed with the training data set with 5-fold cross-validation for internal validation. Model performance was assessed using area under the receiver operating curve (AUC) values. The CatBoost-based prediction model after 26 weeks' gestation performed best with an AUC value of 0.70 (0.67, 0.73), accuracy of 0.81, sensitivity of 0.47, and specificity of 0.83. Number of antenatal care visits before 24 weeks' gestation, aspartate aminotransferase level at registration, symphysis fundal height, maternal weight, abdominal circumference, and blood pressure emerged as strong predictors after 26 completed weeks. The application of machine learning on pregnancy surveillance data is a promising approach to predict preterm birth and we identified several modifiable antenatal predictors.

Nonimmune hydrops fetalis in a primigravida in the third trimester: A case report

Background: Hydrops fetalis is abnormal fluid accumulation within at least two fetal compartments, which may include pericardial effusion, pleural effusions, ascites, and skin edema. In the absence of red cell alloimmunization, hydrops fetalis is nonimmune (NHIF) and affects approximately 1 in 2000 pregnancies. Case presentation: A 33-year-old primigravida presented to the high-risk clinic for further management following an abnormal obstetric scan. Her antenatal follow-up was uneventful. She was blood group O, and rhesus positive. Physical examination was unremarkable. Abdominal examination revealed a fundal height of 32 weeks, which corresponded to her date. The first obstetric scan performed in the third trimester revealed a live baby with features of hydrops fetalis. Management included couple counseling, multidisciplinary discussion with a fetomaternal specialist, dexamethasone injection for fetal lung maturation, and expectant management. Discussion: The parents agreed to keep the pregnancy to term and plan for vaginal and cesarian deliveries reserved for obstetric indications. Nonimmune hydrops fetalis is associated with severe perinatal morbidity and significant maternal risk. The main causes of NIHF are chromosomal, fetal infection, and fetal cardiovascular problems. Conclusion: NIHF is rare, and a high index of suspicion is required for antenatal diagnosis. This affords parents tailored information and choices and supports multidisciplinary care with the additional aim of recognizing cases where fetal therapy may be appropriate, including timing for delivery.

The Effect of Yoga Exercises on the Uterine Involution Process in Postpartum Mothers in the Working Area of Wanayasa Health Center, Purwakarta Regency, Indonesia

Uterine involution is the process of the uterus returning to its pre-pregnancy size and weight. This process is influenced by several factors, one of which is physical activity. Yoga exercise is one of the physical activities that postpartum mothers can do. This study aims to determine the effect of yoga exercises on the uterine involution process in postpartum mothers in the work area of the Wanayasa Health Center, Purwakarta Regency, Indonesia. This research uses quantitative methods with a quasi-experimental research design. The research sample was 60 postpartum mothers who were divided into two groups, namely the intervention group (30 people) and the control group (30 people). The intervention group was given yoga exercises for 1 week, while the control group was given no intervention. The results showed that there were significant differences between the intervention group and the control group in the uterine involution process. The average decrease in uterine fundal height (TFU) in the intervention group was 0.27 cm/day, while in the control group, it was 0.67 cm/day. This shows that yoga exercise can speed up the process of uterine involution in postpartum mothers.

Penyuluhan tentang Massase Uterus dan Pijat Oksitosin pada Ibu Nifas

The postpartum period is a phase from 2 hours after delivery to 6 weeks where the uterus shrinks (involutions) back to its pre-pregnancy size. The uterine involution process can be assisted with uterine massage. The results of Elisa's (2018) research on uterine fundus massage with health education using videos of uterine fundus massage on reducing uterine fundus height showed that there was an influence where the p value was 0.000 (&lt;0.05). Massage the spine or what is known as oxytocin massage can stimulate the hormone oxytocin which functions for uterine contractions so that the uterus shrinks. Apart from stimulating contractions, the hormone oxytocin also plays a role in producing breast milk so that it can help the breastfeeding process. The aim of this activity is to provide information as well as teach postpartum mothers to perform uterine massage at home. This activity is carried out using demonstration methods via video and direct simulation by postpartum mothers. The results of the service were found from 15 counseling participants, 13 of whom could perform uterine massage well, 2 people did not understand. Community service activities that have educational value are very beneficial for postpartum mothers. For this reason, it needs to be improved and maximized by all parties involved.