Gestation Term Research Articles

Effect of maternal hyperoxygenation on neonatal outcomes among women in labour with pathological cardiotocography: an open-label randomized controlled trial

Hyperoxygenation has shown promise in improving suspicious fetal heart patterns in women in labor. However, the effect of hyperoxygenation on neonatal outcomes in women in labor with pathologic fetal heart rate tracing has not been studied. This study aimed to evaluate the effect of fractional inspiration of oxygen of 80% compared with fractional inspiration of oxygen of 40% on neonatal outcomes in women with pathologic fetal heart rate tracing. This randomized, open-label, parallel arm, outcome assessor-blinded clinical trial was conducted in a large tertiary care university hospital. Singleton parturients aged ≥18 years at term gestation in active labor (cervical dilatation of ≥6 cm) with pathologic fetal heart rate tracing were recruited in the study. Pathologic fetal heart rate tracing was defined according to the International Federation of Gynecology and Obstetrics 2015 guidelines. The International Federation of Gynecology and Obstetrics classifies fetal heart rate tracings into 3 categories (normal, suspicious, and pathologic) based on rate, variability, and deceleration. Women in the intervention arm received oxygen at 10 L/min via a nonrebreathing mask, and those in the usual care arm received oxygen at 6 L/min with a simple face mask. Oxygen supplementation was continued until cord clamping. The primary outcome measure was a 5-minute Apgar score. The secondary outcome measures were the proportion of neonatal intensive care unit admission, umbilical cord blood gas variables, level of methyl malondialdehyde in the cord blood, and mode of delivery. Overall, 148 women (74 women in the high fractional inspiration of oxygen arm and 74 in the low fractional inspiration of oxygen arm) with pathologic fetal heart rate tracing were analyzed. The demographic data, obstetrical profiles, and comorbidities were comparable. The median 5-minute Apgar scores were 9 (interquartile range, 8-10) in the hyperoxygenation arm and 9 (interquartile range, 8-10) in the usual care arm (P=.12). Furthermore, the rate of neonatal intensive care unit admission (9.5% vs 12.2%; P=.6) and the requirement of positive pressure ventilation (6.8% vs 8.1%; P=.75) were comparable. Concerning cord blood gas parameters, the hyperoxygenation arm had a significantly higher base deficit in the umbilical vein and lactate level in the umbilical artery. The cesarean delivery rate was significantly lower in women who received hyperoxygenation (4.1% [3/74]) than in women who received normal oxygen supplementation (25.7% [19/74]) (P=.00). In addition, umbilical vein malondialdehyde level in the umbilical vein was lower in the hyperoxygenation group (8.28±4.65 μmol/L) than in the normal oxygen supplementation group (13.44±8.34 μmol/L) (P=.00). Hyperoxygenation did not improve the neonatal Apgar score in women with pathologic fetal heart rate tracing. In addition, neonatal intensive care unit admission rate and blood gas parameters remained comparable. Therefore, the results of this trial suggest that a high fractional inspiration of oxygen supplementation confers no benefit on neonatal outcomes in women with pathologic fetal heart rate tracings and normal oxygen saturation.

Experience of VBAC in A Private Hospital

Background: Vaginal birth after cesarean section (VBAC) for a non-recurring indication has been described by several authors as safe & having a success rate of 60-80%. VBAC increases the possibilities of subsequent vaginal deliveries & reduces the rate of repeat cesarean section with associated postoperative morbidity. Objective: To estimate the success rate & risks of an attempted vaginal birth after one cesarean delivery (VBAC). Materials & Methods: The study was conducted as a private hospital based cross sectional descriptive study from July2021 to December 2021. Total 176 patients were admitted with history of prior CS in this study. Among these cases common indications of primary CS were caesarean delivery on maternal request (CDMR), fetal distress, less fetal movement etc. All cases with previous one cesarean section who delivered vaginally within the study period comprised the study population. Women with 1 previous cesarean section, singleton pregnancy, cephalic presentation & term gestation were included in this study. However, women with history of 2 or more C/S, previous uterine surgery like myomectomy & classical C/S were excluded. Result: Out of 37 cases enrolled in the study, 24 (64.86%) successfully delivered vaginally without any complication. 11(29.73%) cases needed repeat cesarean section and 2 (5.41%) cases had to undergo emergency cesarean section for scar tenderness, those were found to be uterine scar rupture. Conclusion: This study suggested that trial of labour after caesarean section (TOLAC) was effective in decreasing CS in this study population. TOLAC and VBAC can be offered to pregnant women without contraindication. To establish the finding definitively, large multicenter prospective studies are required. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(1): 28-31

Educational achievement to age 11 years in children born at late preterm and early term gestations

ObjectiveTo investigate the effects of being born late preterm (LPT, 34–36 weeks’ gestation) or early term (37–38 weeks) on children’s educational achievement between ages 5 and 11 years.DesignA series of...

The association between umbilical cord coiling index and adverse perinatal outcomes at term pregnancies

Objectives: The umbilical coiling index, calculated by dividing the total coil number to the cord length, is a representative parameter for umbilical cord coiling status. Recent studies have shown that abnormal umbilical coiling index is associated with adverse perinatal outcomes. Here, we aimed to determine this association at term gestation in our population. Methods: A total of 98 singleton, term pregnant women were included in this prospective study. Demographic, obstetric features and perinatal outcomes of the patients were recorded. Patients were grouped according to the umbilical coiling index as hypocoiled, normocoiled and hypercoiled. Recorded parameters were firstly compared between normocoiled (n = 60) and abnormal coiled (n = 38) groups. Then, they were compared between normocoiled, hypocoiled (n = 20) and hypercoiled (n = 18) groups. Significantly different adverse perinatal outcomes were compared between normocoiled and other groups. Results: Abnormal coiled group had an higher incidence of low fifth minutes Apgar scores, meconium-stained amniotic fluid, intrauterine growth restriction and acute fetal distress as compared to normocoiled group. No significant adverse perinatal outcome was detected between hypocoiled and normocoiled groups. Intrauterine growth restriction (p = 0.004), low Apgar scores (p = 0.046) and fetal distress (p = 0.038) and meconium-stained amniotic fluid were found to be more common in hypercoiled group than normocoiled ones. Conclusions: Abnormal umbilical coiling is associated with adverse perinatal outcomes. Hence antenatal measurement of umbilical coiling index could be a useful parameter to determine high-risk pregnancies and can provide close monitoring for fetal well-being.

Paternal and maternal birthweight and offspring risk of macrosomia at term gestations: A nationwide population study.

There is a paucity of data on whether parents' macrosomia (birthweight ≥4500 g) status influences the risk of macrosomia in the offspring. The role of maternal overweight in the generational effect of macrosomia is not known. To estimate the risk of macrosomia by parental birthweight at term and evaluate if this risk varied with maternal body mass index (BMI, kg/m2) early in pregnancy. We used data from the Medical Birth Registry of Norway on all singleton term births (37-42 gestational weeks) during 1967-2017. The primary exposure was parental macrosomia, and the outcome was macrosomia in the second generation. The secondary exposure was maternal BMI. We used binomial regression to calculate relative risk (RR) with a 95% confidence interval. We assessed potential unmeasured confounding and selection bias using a probabilistic bias analysis and performed analyses with and without imputation for variables with missing values. The data included 647,957 singleton parent-offspring trios born at term. The prevalence of macrosomia was 3.2% (n = 41,396) in the parental generation and 4.0% (n = 25,673) in the offspring generation. Macrosomia in parents was associated with an increased risk of macrosomia in offspring, with the RR for both parents were born macrosomic being 6.53 (95% confidence interval [CI] 5.31, 8.05), only mother macrosomic 3.37 (95% CI 3.17, 3.57) and only father macrosomic RR 2.22 (95% CI 2.12, 2.33). These risks increased by maternal BMI in early pregnancy: if both parents were born macrosomic, 17% of infants were macrosomic among mothers with normal BMI. If both parents were macrosomic and the mothers were obese, 31% of offspring were macrosomic. Macrosomia-related adverse outcomes did not differ with parental macrosomia status. Parents' weight at birth and maternal BMI appear to be strongly associated with macrosomia in the offspring delivered at term gestations.

The Relationship Between Premature Rupture Of Membranes And Leukocyte Levels In Laboring Mothers At Pku Muhammadiyah Mamajang Hospital

Premature rupture of membranes is one of the important complications in Obstetrics related to birth complications and other complications in the mother and fetus. Objective: to determine the relationship between the incidence of premature rupture of membranes with leukocyte levels in laboring women at PKU Muhammadiyah Mamajang Hospital, Makassar City. Methods: This study was a quantitative study with an observational analytic research design through a cross sectional approach. The population was all laboring mothers and recorded in the register book and medical record records at PKU Muhammadiyah Mamajang Hospital, Makassar City in 2020 and 2021, the sample obtained was 101 respondents. This study used purposive sampling technique data processed using SPSS with chi-square test. Results: the relationship between age, parity, leukocyte levels and the incidence of premature rupture of membranes successively obtained a p-value, namely: p-value 0.003<0.05, p-value 0.041<0.05, p-value 0.004<0.05. And for the relationship between leukocyte levels of pregnant women with the incidence of premature rupture of membranes at term and preterm gestation, the p-value is 0.040 <0.05. Conclusion; There is a relationship between leukocyte levels and the incidence of premature rupture of membranes.

The Effect of Rebozo Technique on the Length of Time for Active Phase I Labor in the Noemuti Health Center Area in 2023

There are still numerous problems in Indonesia, including prolonged labor that can murder mothers and infants. The rebozo technique is a physiological endeavor to prevent prolonged labor that can accelerate or shorten the active phase of labor. In 2023, the objective is to ascertain the impact of the rebozo technique on the duration of active phase I labor in the Noemuti Health Center Region.Research technique The research design is a Quasi-Experiment employing a One-Group Pretest-Posttest Design with a control. 30 respondents in the population, 15 in the experimental group and 15 in the control group as the cohort. The investigation lasted one month, from April 2022 to May 2023. The rebozo technique intervention group had a rank value of 3.8 and a standard deviation of 2.0, and the p value was greater than 0.005, so it can be concluded that there was a significant difference between the intervention group and the control group. With a p value of 0.003 0.005, mothers who were intervened by the rebozo technique were able to reduce labor time to 6 hours and reduce pain. The conclusion The rebozo technique should be communicated to mothers and families at term gestation regarding the intervention of the rebozo technique if done regularly, it is hoped that when the mother enters the inpartu period, it can accelerate the opening of the cervix and the decrease in the fetal head in laboring mothers during the active phase I, thereby shortening the duration of labor.

Comparison of Clinical and Radiological Findings for the Prediction of Scar Integrity in Women With Previous Lower Segment Cesarean Sections.

We aimed to compare the clinical and radiological findings to predict scar integrity in term antenatal mothers with a previous lower segment cesarean section (LSCS). This prospective study was conducted in the obstetrics and gynecology department of LN Medical College, Bhopal, India, from August 2020 to August 2021. We included all pregnant women with term gestation (37+0 to 42+0 weeks) who were admitted either for elective repeat LSCS or for emergency LSCS and had a history of a previous LSCS. A detailed history and clinical examinations were performed. We noted the presence of scar tenderness and conducted transabdominal ultrasound (USG) to assess the integrity of the uterine scar in all women. During surgery, the surgeon identified the lower uterine segment scar and graded it as normal, thinned-out, dehiscent, or ruptured. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for both clinical findings (scar tenderness) and ultrasound findings as predictors of scar integrity. A total of 60 pregnant women were included in the study. During a repeat cesarean section, we found a thinned-out scar in 26 women out of 60 (43.3%). Out of 60 women, 13 had scar tenderness, and among these 13 women, 12 had thinned-out scars intraoperatively. Forty-seven women had no scar tenderness; 14 had thinned-out scars intraoperatively. The sensitivity of scar tenderness as a predictor of a thinned-out scar was 46.2%, specificity was 97.1%, PPV was 92.3%, and NPV was 70.2%. Whereas the sensitivity of ultrasound scar thickness as a predictor of a thinned-out scar was only 19.2%, with a specificity of 94.1%, a PPV of 71.4%, and an NPVof 60.4%. Thus, we documented a significant correlation between intraoperative and clinical findings (κ = 0.46; p<0.05), but no agreement could be found between ultrasound and intraoperative findings (p>0.05). Clinically evident scar tenderness continues to be a useful parameter to predict intraoperative scar status.

Equine Placentitis in Mares Induces the Secretion of Pro-Inflammatory Cytokine eIL-1β and the Active Extracellular Matrix Metalloproteinase (MMP)-9.

Equine placentitis is characterized by infection and inflammation of the placenta. Different biomarkers associated with this inflammatory response have been evaluated in experimentally induced equine placentitis, but not in pregnant mares with spontaneous placentitis. The aim of the current study was to determine the concentration of eIL-1β and the activity of proMMP-2 and proMMP-9 in the serum of healthy mares and mares with placentitis on days 240 and 320 of gestation to explore whether these biomarkers are associated with equine maternal placentitis and/or with the birth of an infected or inviable foals. Serum samples were collected from sixteen pregnant English Thoroughbred mares, retrospectively classified as follows: (1) healthy mares with full-term gestation; and (2) mares with ultrasonographic signs of placentitis. The health of each foal was examined at birth, and it was decided to classify the cases into four groups: (1) healthy mares delivering a healthy foals (HM-HF, n = 6); (2) mares with USP delivering a healthy foal (USP-HF, n = 3); (3) mares with USP delivering a live septic foal (USP-LSeF, n = 4); and (4) mares with USP delivering a dead foal (USP-DF, n = 3). eIL-1β was quantified by ELISA, and proMMP-2 and proMMP-9 activity by gelatin zymography electrophoresis. In healthy mares, the serum concentrations of eIL-1β underwent a significant 16.5-fold increase from day 240 to day 320 of gestation. Although similar results were found in the mares with ultrasonographic signs of placentitis that delivered a healthy foal, those delivering a live septic or nonviable foal exhibited much higher concentrations of eIL-1β. proMMP-2 and proMMP-9 activity was not associated with maternal placentitis, foal infection, or death. Hence, the presence of placentitis severe enough to affect the health of the foal can be confirmed or discarded by determining the eIL-1β concentration in mares that have shown ultrasonographic signs of placentitis.

Neonatal outcomes from in vitro fertilization-conceived pregnancies

Background In vitro fertilization (IVF) shows potential to improve pregnancy success, especially for infertile couples. This technique has some risks for neonates in the perinatal period and may affect their future health.&#x0D; Objective To investigate the characteristics and clinical outcomes of neonates from IVF-conceived pregnancies.&#x0D; Methods This retrospective study was conducted in neonates from IVF-conceived pregnancies from January to December 2021 at Bunda Women’s and Children’s Hospital, Jakarta. We gathered data from medical records about maternal age and morbidity, gravidity, gestational age, method of delivery, multiple gestation, also neonates’ significant profiles like prematurity, birth weight, Apgar score, and morbidities in perinatal period. We would like to investigate the characteristics and clinical outcomes of neonates born from IVF-conceived pregnancies program.&#x0D; Results There were 361 neonates whose mothers underwent IVF included in this study. Most mothers were ?35 years (70.9%) and on their first pregnancy (69.2%). Maternal complicating factors were premature contractions (16.6%), premature rupture of membranes (8.3%), and twin pregnancy (31.5%). About 98.6% of deliveries were performed by caesarean section and from IVF-conceived pregnancies program most 61.2% neonates were born at full term gestation (61.2%). Preterm deliveries occurred at a mean gestational age of 34.4 (SD 2.4) weeks. Subjects’ mean birth weight was 2,800.2 (SD 640.3) grams, with 26.3% in the low-birth-weight category. Most neonates (93.0%) were appropriate weight for gestational age and had good Apgar scores in the first minute (92.2%) and fifth minute (99.7%). However, 24.3% of neonates needed intensive care (NICU) with morbidities. The longest length of NICU stay was 100 days, with mortality of 7.9% of NICU-treated infants.&#x0D; Conclusion In our setting, most neonates from the IVF program were born with good outcomes, although preterm birth rate, low birth weight, need for NICU care, and mortality rate were quite high. Further study is needed to evaluate long-term outcomes of IVF neonates.

Brain Region Size Differences Associated With Dystonia in People With Cerebral Palsy Born Premature

BackgroundDystonia in cerebral palsy (CP) is classically associated with deep gray matter injury at term gestation, but the patterns of injury associated with dystonia following premature birth are unclear. We examined whether there were brain regional size differences associated with dystonia in people with CP born premature. MethodsIn this retrospective cohort study, we identified subjects with CP born premature (<37 weeks gestational age) seen at a tertiary care CP center between February 1, 2017, to February 1, 2021, who had T1-weighted brain magnetic resonance imaging (MRI) done between ages one and five years available in the clinical record. We measured the following on these brain MRI images per the 2013 Kidokoro criteria: interhemispheric distance, biparietal width, lateral ventricle diameter, transcerebellar diameter, deep gray matter area, and corpus callosum thickness. We then compared the sizes of these structures between those with and without dystonia correcting for gestational age at birth and gross motor functional ability (univariate general linear models). ResultsFifty-five subjects met the inclusion and exclusion criteria. Interhemispheric distance was significantly greater in those with dystonia, suggesting decreased cortical volume (P = 0.005). There was no significant difference in the other measured structures between those with and without dystonia, including deep gray matter area. ConclusionsIncreased interhemispheric distance, not measures of deep gray matter size, correlate with the presence of dystonia in people with CP born premature.

Correlation of Placental Weight with Neonatal Weight and HbA1c in Normal Sudanese Pregnant Ladies in Alban-Jaded Teaching Hospital

Background: The placenta is a life-supporting organ for the growing fetus. Several studies have highlighted the relationship between placental weight and neonatal birth weight; however, the role of glycosylated hemoglobin (HbA1c) has not been addressed. Aim: The study aimed to determine the relationship between the placental weight, neonatal birth weight, and HbA1c at term pregnancy in a Sudanese hospital. Methods: This was a cross-sectional hospital-based study conducted at Al Ban-Jaded Hospital between November and December 2022. Data, including the gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, and presence or absence of maternal medical diseases, was obtained from 60 singleton term deliveries who met the inclusion criteria for the study. The tested data was analyzed using SPSS version 25, and t-test was used to compare the statistical significance (P value ≤ 0.05 was considered statistically significant). Results: The mean age was 27.02 ± 6.8 years. The mean HbA1C was 5.98% ± 0.39% (5.2%–6.9%). Glycated hemoglobin was elevated (≥5.7%) in the majority (46, 76.7%) of pregnancies. The mean placental weight was 290 ± 106 g (100 g–700 g), while the mean birth weight was 3.00 kg ± 0.36 kg (2.3 kg–3.8 kg), and the placental/birth weight ratio was 9.6%. There was a significant positive correlation between neonatal weight and placental weight (r=0.514, P value=0.000). Also, neonatal weight and placental weight had a significant positive correlation with HbA1C (r=0.657, P value=0.000). Placental weight and neonatal birth weight significantly increased with the gestational age of neonates (P value &lt;0.05), with a slight drop noted in term gestation. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate in pregnancies with high maternal HbA1C, and placental weight and birth weight were higher than in pregnancies with normal maternal HbA1C.

Correlation of Placental Weight with Neonatal Weight and HbA1c in Normal Sudanese Pregnant Ladies in Alban-Jaded Teaching Hospital

Background: The placenta is a life-supporting organ for the growing fetus. Several studies have highlighted the relationship between placental weight and neonatal birth weight; however, the role of glycosylated hemoglobin (HbA1c) has not been addressed. Aim: The study aimed to determine the relationship between the placental weight, neonatal birth weight, and HbA1c at term pregnancy in a Sudanese hospital. Methods: This was a cross-sectional hospital-based study conducted at Al Ban-Jaded Hospital between November and December 2022. Data, including the gestational age at delivery (in weeks), parity, mode of delivery, fetal birth weight, placental weight, fetal gender, and presence or absence of maternal medical diseases, was obtained from 60 singleton term deliveries who met the inclusion criteria for the study. The tested data was analyzed using SPSS version 25, and t-test was used to compare the statistical significance (P value ≤ 0.05 was considered statistically significant). Results: The mean age was 27.02 ± 6.8 years. The mean HbA1C was 5.98% ± 0.39% (5.2%–6.9%). Glycated hemoglobin was elevated (≥5.7%) in the majority (46, 76.7%) of pregnancies. The mean placental weight was 290 ± 106 g (100 g–700 g), while the mean birth weight was 3.00 kg ± 0.36 kg (2.3 kg–3.8 kg), and the placental/birth weight ratio was 9.6%. There was a significant positive correlation between neonatal weight and placental weight (r=0.514, P value=0.000). Also, neonatal weight and placental weight had a significant positive correlation with HbA1C (r=0.657, P value=0.000). Placental weight and neonatal birth weight significantly increased with the gestational age of neonates (P value &lt;0.05), with a slight drop noted in term gestation. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate in pregnancies with high maternal HbA1C, and placental weight and birth weight were higher than in pregnancies with normal maternal HbA1C.

Growth and neurodevelopmental outcome in newborns with congenital non-cardiac surgical anomalies: A single-centre retrospective study

BackgroundSurvival of infants with congenital anomalies has increased dramatically, shifting the focus of clinical care and research toward optimising growth and neurodevelopment. ObjectiveTo evaluate growth and determine the impact of growth on neurodevelopmental outcomes of neonates born at term gestation with congenital non-cardiac surgical anomalies (NCSA), who required a laparotomy. MethodsThis was a single-centre retrospective cohort study. Demographic details, measurements of growth, and mean scores of Bayley Scales of Infant and Toddler Assessment, third edition, were collected. Means z-scores of growth measurements at birth, discharge and one-year-assessment were compared. Regression analysis was performed to explore predictive ability of growth measurements on mean scores of developmental assessment. ResultsA total of 105 infants were included. Mean z-scores for weight (-0.85) and head circumference (-0.34) at birth, though below population mean, were age-appropriate. Statistically significant decrease in z-score for weight was noted at discharge. Mean scores across the domains developmental assessment were normal. Z-scores for weight and height at one-year assessment predicted scores of gross motor (p-value 0.005) and cognitive development (p value 0.03) respectively. ConclusionsNeonates born at term gestation with NCSA had normal growth at birth. Postnatal growth restriction was noted at discharge. This loss in growth was not fully recouped at one-year assessment. As growth failure at one-year assessment could predict scores of developmental assessment, this group of infants needs careful nutritional and developmental monitoring.

Umbilical Cord Blood Hemoglobin as a Predictor of Significant Neonatal Hyperbilirubinemia in Term Newborns in a Tertiary Care Centre in North Kerala

Aims: Neonatal hyperbilirubinemia is one of the most common problems during first week of life and is the most common cause of readmission in early neonatal period. The present study aimed to predict the development of significant hyperbilirubinemia in term neonates using cord blood hemoglobin.&#x0D; Study Design: Prospective study.&#x0D; Place and Duration of Study: Department of Paediatrics, MMCH &amp; RC, Kozhikode, Kerala from March 2021 to July 2022.&#x0D; Methodology: The prospective study enrolled 162 appropriate for gestational age term newborns, delivered at MMCH &amp; RC. Cord blood hemoglobin was measured and bilirubin estimation was done at 48-72 hours of life. Hyperbilirubinemia was considered significant if serum bilirubin value was above standard as per American Academy of Pediatrics guidelines. Data was entered in Microsoft Excel and analysed using SPSS 20.0 version. The relationship between cord hemoglobin in predicting significant neonatal hyperbilirubinemia was studied using appropriate statistical tests. Sensitivity and specificity of the variables were defined using ROC curve and Pearson correlation coefficient to determine the correlation between the variables.&#x0D; Results: Out of the total 162 neonates enrolled, 86 were boys (53.1%) and 76 were girls (46.9%). The mean cord hemoglobin value was 15.3g/dl. 20 neonates (12.3%) had developed significant hyperbilirubinemia and required phototherapy while none of them needed exchange transfusion. Correlation between cord hemoglobin with serum bilirubin showed weak correlation (r=0.194) but the correlation was statistically significant (p&lt;0.05). On ROC curve analysis, cord hemoglobin cut off value ≥14.9g/dl showed 75% sensitivity and 39.4% specificity to predict significant neonatal hyperbilirubinemia.&#x0D; Conclusion: There is significant correlation between umbilical cord blood hemoglobin level and neonatal hyperbilirubinemia. Cord hemoglobin ≥14.9g/dl can predict future development of significant neonatal hyperbilirubinemia. This will be useful in very low resource centres to plan early discharge of newborns without fear of hyperbilirubinemia.

Comparison of adverse maternal and perinatal outcomes between induction and expectant management among women with gestational diabetes mellitus at term pregnancy: a systematic review and meta-analysis

BackgroundInduction at 38–40 weeks of gestation has been broadly suggested for women with gestational diabetes mellitus (GDM), yet its benefits and risks remain unclear. This study aimed to systematically review and meta-analyze existing evidence on the effect of induction at term gestation among women with GDM.MethodsWe searched MEDLINE, EMBASE, Cochrane Libraries, and Web of Science from inception to June 2021. We included randomized controlled trials (RCTs) and observational studies comparing induction with expectant management among GDM term pregnancies. Primary outcomes included caesarean section (CS) and macrosomia. All screening and extraction were conducted independently and in duplicates. Meta-analyses with random-effects models were conducted to generate the pooled odds ratios (ORs) and 95% confidence intervals (CIs) using the Mantel-Haenszel method. Methodological quality was assessed independently by two reviewers using the Cochrane Risk of Bias Tool for RCTs and the Newcastle-Ottawa Scale for observational studies.ResultsOf the 4,791 citations, 11 studies were included (3 RCTs and 8 observational studies). Compared to expectant management, GDM women with induction had a significantly lower odds for macrosomia (RCTs 0.49 [0.30–0.81]); observational studies 0.64 [0.54–0.77]), but not for CS (RCTs 0.95 [0.64–1.43]); observational studies 1.03 [0.79–1.34]). Induction was associated with a lower odds of severe perineal lacerations in observational studies (0.59 [0.39–0.88]). No significant difference was observed for other maternal or neonatal morbidities, or perinatal mortality between groups.ConclusionsFor GDM women, induction may reduce the risk of macrosomia and severe perineal lacerations compared to expectant management. Further rigorous studies with large sample sizes are warranted to better inform clinical implications.

Pregnancy-induced differential expression of SARS-CoV-2 and influenza a viral entry factors in the lower respiratory tract.

Despite differences in the clinical presentation of coronavirus disease-19 and pandemic influenza in pregnancy, fundamental mechanistic insights are currently lacking because of the difficulty in recruiting critically ill pregnant subjects for research studies. Therefore, to better understand host-pathogen interaction during pregnancy, we performed a series of foundational experiments in pregnant rats at term gestation to assess the expression of host entry factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus (IAV) and genes associated with innate immune response in the lower respiratory tract. We report that pregnancy is characterized by a decrease in host factors mediating SARS-CoV-2 entry and an increase in host factors mediating IAV entry. Furthermore, using flow cytometric assessment of immune cell populations and immune provocation studies, we show an increased prevalence of plasmacytoid dendritic cells and a Type I interferon-biased environment in the lower respiratory tract of pregnancy, contrary to the expected immunological indolence. Our findings, therefore, suggest that the dissimilar clinical presentation of COVID-19 and pandemic influenza A in pregnancy could partly be due to differences in the extent of innate immune activation from altered viral tropism and indicate the need for comparative mechanistic investigations with live virus studies.

Survey of Postpartum People in the United States During the First Wave of the COVID-19 Pandemic to Explore Their Perspective on Support After Discharge.

The purpose of this study was to capture the experiences of postpartum people during the first wave of COVID-19, specifically their access to contraception and lactation support. This cross-sectional study surveyed individuals in the United States who used the Ovia Pregnancy and Parenting app. The survey was administered via an email Web link sent to postpartum people who gave birth between March 1, 2020, and June 11, 2020. Quantitative and qualitative analyses were conducted. A total of 388 postpartum people completed the survey. Most participants had just given birth to their first baby (68.5%; n = 261) at term gestation (37-41 weeks) (92.9%; n = 355). From the qualitative data, using content analysis, we derived 6 themes and 2 subthemes: quarantine, changes in postpartum care, loneliness and isolation, stress, resource changes, and positive impact. The theme loneliness and isolation had 2 subthemes: depression/sadness/hopelessness and anxiety. The experience of being postpartum during the COVID-19 pandemic brought unforeseen challenges. Providing care and support to postpartum people during a pandemic, specifically during a time of quarantine, should be reimagined. Increased use of virtual postpartum care services and expanded mental health support could serve to fill the gaps identified by participants.

The clinical performance and population health impact of birthweight-for-gestational age indices at term gestation.

The assessment of birthweight for gestational age and the identification of small- and large-for-gestational age (SGA and LGA) infants remain contentious, despite the recent creation of the Intergrowth 21st Project and World Health Organisation (WHO) birthweight-for-gestational age standards. We carried out a study to identify birthweight-for-gestational age cut-offs, and corresponding population-based, Intergrowth 21st and WHO centiles associated with higher risks of adverse neonatal outcomes, and to evaluate their ability to predict serious neonatal morbidity and neonatal mortality (SNMM) at term gestation. The study population was based on non-anomalous, singleton live births between 37 and 41 weeks' gestation in the United States from 2003 to 2017. SNMM included 5-min Apgar score <4, neonatal seizures, need for assisted ventilation, and neonatal death. Birthweight-specific SNMM was modelled by gestational week using penalised B-splines. The birthweights at which SNMM odds were minimised (and higher by 10%, 50% and 100%) were estimated,and the corresponding population, Intergrowth 21st, and WHO centiles were identified. The clinical performance and population impact of these cut-offs for predicting SNMM were evaluated. The study included 40,179,663 live births and 991,486 SNMM cases. Among female singletons at 39 weeks' gestation, SNMM odds was lowest at 3203 g birthweight, and 10% higher at 2835 g and 3685 g (population centiles 11th and 82nd, Intergrowth centiles 17th and 88th and WHO centiles 15th and 85th). Birthweight cut-offs were poor predictors of SNMM, for example, the cut-offs associated with 10% and 50% higher odds of SNMM among female singletons at 39 weeks' gestation resulted in a sensitivity, specificity, and population attributable fraction of 12.5%, 89.4%, and 2.1%, and 2.9%, 98.4% and 1.3%, respectively. Reference- and standard-based birthweight-for-gestational age indices and centiles perform poorly for predicting adverse neonatal outcomes in individual infants, and their associated population impact is also small.

Pregnancy and delivery after lumbosacral junction fixation: A clinical observation

The clinical signs of spondylolysis and spondylolisthesis most commonly appear at a young age in professional athletes and ballet dancers. The development and improvement of diagnostic methods and surgical treatment techniques for these pathologies lead to an increase in the number of patients of reproductive age with implants in the lumbosacral junction. A multidisciplinary approach in the management of pregnancy and determination of the delivery method in women with this pathology allows for safe reduction in the incidence of unwarranted operative delivery without worsening maternal and perinatal outcomes. This study presents the clinical case of a patient who had surgery for spondylolysis and spondylolisthesis and delivered successfully through natural childbirth at full-term gestation.