Term Pregnant Women Research Articles

Predicting vaginal delivery after labor induction using machine learning: Development of a multivariable prediction model.

Induction of labor, often used for pregnancy termination, has globally rising rates, especially in high-income countries where pregnant women present with more comorbidities. Consequently, concerns on a potential rise in cesarean section (CS) rates after induction of labor (IOL) demand for improved counseling on delivery mode within this context. We aim to develop a prognostic model for predicting vaginal delivery after labor induction using computational learning. Secondary aims include elaborating a prognostic model for CS due to abnormal fetal heart rate and labor dystocia, and evaluation of these models' feature importance, using maternal clinical predictors at IOL admission. The best performing model was assessed in an independent validation data using the area under the receiver operating curve (AUROC). Internal model validation was performed using 10-fold cross-validation. Feature importance was calculated using SHAP (SHapley Additive exPlanation) values to interpret the importance of influential features. Our main outcome measures were mode of delivery after induction of labor, dichotomized as vaginal or cesarean delivery and CS indications, dichotomized as abnormal fetal heart rate and labor dystocia. Our sample comprised singleton term pregnant women (n = 2434) referred for IOL to a tertiary Obstetrics center between January 2018 and December 2021. Prediction of vaginal delivery obtained good discrimination in the independent validation data (AUROC = 0.794, 95% CI 0.783-0.805), showing high positive and negative predictive values (PPV and NPV) of 0.752 and 0.793, respectively, high specificity (0.910) and sensitivity (0.766). The CS model showed an AUROC of 0.590 (95% CI 0.565-0.615) and high specificity (0.893). Sensitivity, PPV and NVP values were 0.665, 0.617, and 0.7, respectively. Labor features associated with vaginal delivery were by order of importance: Bishop score, number of previous term deliveries, maternal height, interpregnancy time interval, and previous eutocic delivery. This prognostic model produced a 0.794 AUROC for predicting vaginal delivery. This, coupled with knowing the features influencing this outcome, may aid providers in assessing an individual's risk of CS after IOL and provide personalized counseling.

Relationship between exposure to air pollutants in the first trimester and spontaneous abortion in pregnant women in the river valley city

Purpose The relationship between exposure doses of 2.5-micrometer Particulate Matter (PM2.5), Inhalable particles (PM10), Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2) and Ozone (O3) in the first trimester and spontaneous abortion of pregnant women was evaluated by global average method and nearest monitoring station method, respectively. Method Retrospective analysis of the clinical data of pregnant women with spontaneous abortion and full-term pregnant women in the Department of Obstetrics and Gynecology of two third-class hospitals in a valley city in Northwest China. According to the age factor, the eligible pregnant women were matched at a ratio of 1 : 4. The global average method and the nearest monitoring station method were used to evaluate the exposure of pollutants. The rank-sum test and conditional logistic regression were used to analyze the correlation between air pollutants and spontaneous abortion. Results Although the global average method and the nearest monitoring station method are slightly different in the assessment of exposure dose, they do not affect the correlation evaluation with spontaneous abortion. The exposure of pregnant women to PM2.5(OR1 = 1.156, OR2 = 1.036), SO2 (OR1 = 1.432, OR2 = 1.429) and NO2 (OR1 = 1.121, OR2 = 1.159) in the first trimester is related to the occurrence of spontaneous abortion.(OR1: the global average method, OR2: the nearest monitoring station method) Conclusion The exposure of PM2.5, SO2 and NO2 in the first trimester in valley cities is associated with the occurrence of spontaneous abortion in pregnant women.

Vaginal microbiota in term pregnant women with differences in cervical ripeness revealed by 2bRAD-M

BackgroundCervical ripening is a multifactorial outcome, and the association between cervical ripening and vaginal microbiota remains unexplored in term primiparous women. A new sequencing technology, microbiome 2bRAD sequencing (2bRAD-M) that provides a higher level of species discrimination compared to amplicon sequencing. We applied 2bRAD-M to analyze the vaginal microbiota in a population with variations in cervical ripeness and to explore potential microbiota factors influencing cervical ripening.MethodsA total of 30 full-term primigravid women participated in this study, with 15 belonging to the low scoring group of cervical ripeness and 15 to the high scoring group. Clinical information was collected from the participants, and the vaginal microbiota and community structure of both groups were analyzed using 2bRAD-M sequencing. Microbiota diversity and differential analyses were conducted to explore potential factors influencing cervical ripening.ResultsA total of 605 species were detected. There was no difference in vaginal microbiota diversity between the two groups, and the vaginal microbial composition was structurally similar. In the two groups, Lactobacillus crispatus and Lactobacillus iners were identified as the two pivotal species through random forest analysis. Concurrent, extensive and close connections between species within the two groups were observed in the correlation analysis, influencing the aforementioned two species. Pairwise comparisons showed that Sphingomonas (P = 0.0017) and three others were abundant in high scoring group, while Alloprevotella (P = 0.0014), Tannerella (P = 0.0033), Bacteroides (P = 0.0132), Malassezia (P = 0.0296), Catonella (P = 0.0353) and Pseudomonas (P = 0.0353) and so on showed higher abundance in low scoring group. Linear discriminant analysis effect size identified 29 discriminative feature taxa.ConclusionFor the first time, vaginal microbiota was sequenced using 2bRAD-M. With a relatively simple structure, a more stable vaginal microbiota is associated with higher cervical ripeness, and certain microorganisms, such as Sphingomonas, may play a beneficial role in cervical ripening.

Effectiveness and Safety of Sublingual versus Vaginal Misoprostol for Induction of Labor for Full Term Pregnant Women in Cha-Am Hospital

Objective: To study the effectiveness and safety of sublingual misoprostol compared with the same dose administered vaginally every four hours for induction of labor at term pregnancy within 24 hours. Materials and Methods: One hundred seventy-six pregnant women of 37 to 42 gestational age fulfilling the study inclusion criteria were recruited and assigned by randomization into two groups. Each group was treated separately by 25-mcg misoprostol sublingually or vaginally every four hours within 24 hours. Results: Mean age of sublingual and vaginal misoprostol group was 25.9±6.9 and 25.5±7.2 years old, respectively, while the mean parity of sublingual and vaginal group was 0.9±1.0 and 1.0±1.0, respectively, which most were first pregnant. Three out of four had no underlying diseases. The initial cervical diameter before receiving misoprostol was 1.7±1.0 and 1.7±0.9 mm, respectively. The total labor time between the two groups was not significantly different. The percentage of success in the sublingual group was more than in the vaginal group, at 79.3 and 74.7, respectively. The side effects of induction were more significantly found in the vaginal group (p<0.05). The pain score was not different, but the satisfactory score was better reported in the sublingual group than in the vaginal one (p<0.05). The Apgar score at 5 minutes of neonates between the two groups were not significantly different (9.8±0.4 and 9.9±0.2). Conclusion: Twenty-five mcg misoprostol administered through sublingual for labor induction in full term pregnant women could not make the total labor time significantly shorter than in the vaginal group. The success rate in the sublingual group was not significantly better than in the vaginal group. The satisfaction was higher in the sublingual group but the pain scores and Apgar score at 5 minutes were not different between the groups.

Effect of Dural Puncture Epidural Technique on Management of Breakthrough Pain for Parous Women Receiving Labor Analgesia during Induced Labor: A Retrospective Cohort Study.

This study assessed the effectiveness of the dural puncture epidural (DPE) technique in managing breakthrough pain in parous women receiving labor analgesia during induced labor. This single-center retrospective cohort study included term pregnant women with singleton pregnancies who received treatment for breakthrough pain during labor. All participants underwent induced labor, and some parous women among them underwent DPE. The DPE technique consisted of placing an epidural catheter after dural puncture with a 27-gauge spinal needle. Eligible women were allocated into a DPE group and conventional epidural (CE) anesthesia group. Pain was assessed with a numerical rating scale (NRS), and a patient-controlled epidural analgesia (PCEA) bolus was administered when the NRS score was ≥3. Breakthrough pain was defined as an NRS score ≥3 during PCEA management. The primary outcome was the efficacy of rescue interventions in managing breakthrough pain, as determined by a reduction in pain intensity to an NRS score <3 before birth. Among the 55 parous women who received labor analgesia, 44 required additional rescue administration for breakthrough pain. Of the remaining women, 23 received DPE and 19 received CE anesthesia. The DPE group experienced significantly more effective relief of breakthrough pain before birth than did the CE group (DPE: 100%; CE: 68.4%; p=0.005). In parous women, DPE anesthesia was more effective than CE anesthesia in providing analgesia for breakthrough pain immediately before delivery during induced labor.

Comparative Study between the Effects of Dexamethasone versus Dexmedetomidine as Additives to Transversus Abdominal Block on Post-Operative Analgesia in Elective Caesarean Sections

Abstract Background The transversus abdominis plane (TAP) block is a peripheral nerve block designed to anesthetize the nerves supplying the anterior abdominal wall (T6 to L1). It was first described in 2001 by Rafi as a traditional blind landmark technique using the lumbar triangle of Petit. Dexamethasone acts locally on nociceptive C-fibers (through glucocorticoid receptors) to increase the activity of inhibitory potassium channels, thus decreasing their activity. The combined use of a local anesthetic agent and dexmedetomidine, applied in a TAP block, which targets peripheral nociceptive receptors, may be an ideal protocol for pain control after abdominal surgery. Aim and Objectives The main and primary goal of this research is to compare the efficacy and safety of dexmedetomidine and dexamethasone as a local anesthetic adjuvant to bupivacaine in TAP block for patients scheduled for elective CS. The secondary goal is to assess the effect of both additives as regard the duration of block. Subjects and Methods This was a Double blinded 2-arms parallel controlled trial, which was conducted in Ain Shams University Hospitals for 6 months, it was carried out on 50 full term pregnant women. Result Data showed no statistically significant difference according to demographic data, medical history, laboratory investigation (Mean±SD), heart rate, mean arterial blood pressure mmHg, mean random blood sugar, VAS score, time to need analgesics, and Side effects between groups. Conclusion the current study showed that both dexmedetomidine and dexamethasone were equally safe and effective as a local anesthetic adjuvant to bupivacaine in TAP block for patients scheduled for elective CS.

Influence of perinatal factors on full-term low-birth-weight infants and construction of a predictive model.

Being too light at birth can increase the risk of various diseases during infancy. To explore the effect of perinatal factors on term low-birth-weight (LBW) infants and build a predictive model. This model aims to guide the clinical management of pregnant women's healthcare during pregnancy and support the healthy growth of newborns. A retrospective analysis was conducted on data from 1794 single full-term pregnant women who gave birth. Newborns were grouped based on birth weight: Those with birth weight < 2.5 kg were classified as the low-weight group, and those with birth weight between 2.5 kg and 4 kg were included in the normal group. Multiple logistic regression analysis was used to identify the factors influencing the occurrence of full-term LBW. A risk prediction model was established based on the analysis results. The effectiveness of the model was analyzed using the Hosmer-Leme show test and receiver operating characteristic (ROC) curve to verify the accuracy of the predictions. Among the 1794 pregnant women, there were 62 cases of neonatal weight < 2.5 kg, resulting in an LBW incidence rate of 3.46%. The factors influencing full-term LBW included low maternal education level [odds ratio (OR) = 1.416], fewer prenatal examinations (OR = 2.907), insufficient weight gain during pregnancy (OR = 3.695), irregular calcium supplementation during pregnancy (OR = 1.756), and pregnancy hypertension syndrome (OR = 2.192). The prediction model equation was obtained as follows: Logit (P) = 0.348 × maternal education level + 1.067 × number of prenatal examinations + 1.307 × insufficient weight gain during pregnancy + 0.563 × irregular calcium supplementation during pregnancy + 0.785 × pregnancy hypertension syndrome - 29.164. The area under the ROC curve for this model was 0.853, with a sensitivity of 0.852 and a specificity of 0.821. The Hosmer-Leme show test yielded χ 2 = 2.185, P = 0.449, indicating a good fit. The overall accuracy of the clinical validation model was 81.67%. The occurrence of full-term LBW is related to maternal education, the number of prenatal examinations, weight gain during pregnancy, calcium supplementation during pregnancy, and pregnancy-induced hypertension. The constructed predictive model can effectively predict the risk of full-term LBW.

Abdominal Circumference and Hypotension Incidence in Caesarean Section Under Spinal Anaesthesia.

Hypotension is a common side effect during caesarean deliveries under spinal anaesthesia, influenced by factors like obesity, physiological changes and abdominal circumference (AC). This study delves into the intricate relationship between abdominal circumference and hypotension incidence, spinal anaesthesia levels, hemodynamic shifts, and vasopressor requirements in caesarean sections. Method: A prospective observational study with 232 term pregnant women undergoing caesarean sections was categorized into two groups based on their abdominal circumference, group A (AC < 95 cm) and group B (AC > 109 cm). The studycompared hypotension incidence, achieved spinal anaesthesia levels, hemodynamic changesand ephedrine necessity and dosage between the two groups. Results: Group B with a larger abdominal circumference, exhibited a significantly higher rate of hypotension, more pronounced hemodynamic changes,higher level of spinal anaesthesia andrequired more doses of ephedrine to manage hypotension compared to group A with a smaller abdominal circumference. Conclusion: This study highlights the crucial role of abdominal circumference as a predictive factor for hypotension during caesarean sections under spinal anaesthesia. Recognizing this association enables targeted preventive measures, potentially enhancing maternal and fetal outcomes during such procedures. Awareness of this correlation emphasizes the necessity for tailored interventions to mitigate the risk of hypotension, ensuring safer caesarean deliveries under spinal anaesthesia.

Comparing Sublingual and Vaginal Misoprostol for Labor Induction in Full-term Pregnant Women: A Comprehensive Review

Comparing Sublingual and Vaginal Misoprostol for Labor Induction in Full-term Pregnant Women: A Comprehensive Review

Comapring a lower dose of carbetocin to the standard dose of carbetocin in the prevention of postpartum hemorrhage during elective cesarean delivery: A randomised parallel group trial

Prophylactic use of uterotonic is a universal practice in vaginal and cesarean delivery. Heat stable carbetocin is a relatively new uterotonic. Lower doses of uterotonics are as effective as standard doses in elective cesarean deliveries. This study aimed to compare the effectiveness and safety of 50 mcg carbetocin (lower dose) to 100mcg carbetocin (standard dose) for the prevention of postpartum hemorrhage during elective cesarean delivery. A total of 212 term pregnant women were randomized to two group. Group I received 50 mcg of carbetocin and Group II received 100 mcg of carbetocin. The blood loss, tone of the uterus, use of additional uterotonics or styptics, requirement of blood transfusions and adverse effects of the drug in both the groups were compared. There were no statistically significant differences in both the groups with respect to blood loss, uterine tone, blood transfusions or additional use of uterotonics or styptics.(p&amp;#62;0.05).: A lower dose of 50 mcg is as effective as the standard dose of 100 mcg of carbetocin in elective caesarean delivery in preventing post-partum hemorrhage.

Evaluation of f(QRS-T) Angle as a Marker of Coronary Artery Disease Risk in Term Pregnant Women

Evaluation of f(QRS-T) Angle as a Marker of Coronary Artery Disease Risk in Term Pregnant Women

Comparative hemodynamic effects of carbetocin vs oxytocin in mothers with stenotic valvular heart disease undergoing cesarean delivery: a randomized controlled trial

Background &amp; objective: Postpartum hemorrhage (PPH) is quite common an obstetric emergency, and is a nightmare for the anesthesiologist as well as the obstetrician. We compared the hemodynamic profiles of oxytocin and carbetocin for prevention of postpartum hemorrhage during elective cesarean delivery in patients with mild to moderate mitral or aortic stenosis. Methodology: This randomized controlled trial included full term pregnant women with known mild to moderate mitral or aortic valve stenosis and undergoing elective cesarean delivery. After delivery of the shoulder of the baby, the participant received either oxytocin or carbetocin. Patients’ hemodynamic parameters, including blood pressure, heart rate, cardiac output, and systemic vascular resistance, were recorded. The primary outcome was the 5-min average cardiac output after the drug administration. Secondary outcomes were cardiac output, systolic blood pressure, heart rate and systemic vascular resistance, blood loss, and the need for rescue uterotonics. Results: Forty-five patients (23 patients in the carbetocin group and 22 in the oxytocin group) were analyzed. The 5-min average cardiac output after drug injection was comparable between the two groups. The number of participants needing rescue uterotonic boluses were significantly more in the oxytocin group than in the carbetocin group (P = 0.022). Conclusion: In full-term pregnant women with stenotic valvular pathologies, carbetocin showed superior uterotonic effect compared to oxytocin; however, both drugs resulted in the equivalent hemodynamic effects. Trial registration: Clinical trial registration with clinicaltrials.gov No. NCT05110482 Keywords: oxytocin; carbetocin; mitral stenosis; aortic stenosis; cesarean delivery; hemodynamics Citation: Refaat S, Amin S, Tarek H, El Regal EA, Eissa AA, Zayed M, Ibrahim M. Comparative hemodynamic effects of carbetocin vs oxytocin in mothers with stenotic valvular heart disease undergoing cesarean delivery: a randomized controlled trial. Anaesth. pain intensive care 2024;28(4):681−686; DOI: 10.35975/apic.v28i4.2369 Received: January 03, 2024; Reviewed: May 05, 2024; Accepted: June 11, 2024

The Impact of a Care Bundle on the Prevention of Post-cesarean Surgical Site Infection

Background: The most common complication in the first 10 days after a cesarean section is surgical site infection (SSI), leading to poorer health outcomes, financial consequences, and maternal mortality. However, about 40 to 60% of such complications are preventable. Objectives: The present study aimed to examine the effect of a care bundle on the prevention of post-cesarean surgical site infection. Methods: This clinical trial was conducted on pregnant women undergoing cesarean section at Ali Ibne Abitalib Hospital, Zahedan, in the summer of 2022. A total of 60 full-term pregnant women who were candidates for cesarean section were selected using convenience sampling based on the inclusion criteria and were divided into two groups (each with 30 members) using random permuted blocks. The patients in the intervention group received preoperative, intraoperative, and postoperative care using an infection prevention care bundle, while the patients in the control group received routine care in the surgical department and operating room. The participants’ demographic, pregnancy, and surgical data were collected through interviews with the patients and by reviewing their medical files and were recorded in a checklist. The surgical incision was checked using the wound assessment checklist and the Redness, Oedema, Ecchymosis, Discharge, Approximation (REEDA) Scale, 24 hours after surgery and on the 10th and 30th days after surgery to confirm or reject wound infection. A score greater than 6 confirmed a surgical site infection. The data were analyzed with SPSS-21 software using independent samples t-test and chi-square test. The level of significance in this study was set at P &lt; 0.05. Results: The data in this study showed that the patients in the two groups did not have statistically significant differences in terms of demographic, pregnancy, and surgical variables, except for the history of infection (P &gt; 0.05). The mean REEDA scores for the patients in the intervention group 24 hours after surgery and on the 10th and 30th days after surgery were 2.52 ± 4.6, 1.3 ± 2.7, and 0, respectively. The corresponding values for the patients in the control group were 3.64 ± 5.26, 1.7 ± 3.07, and 0.08 ± 0.3, respectively. The independent samples t-test showed that the mean REEDA scores in the intervention and control groups 24 hours after surgery and on the 10th and 30th days after surgery did not have a statistically significant difference (P &gt; 0.05). Moreover, 2 patients (6.67%) in the intervention group and 5 patients (16.67%) in the control group showed signs and symptoms of SSI, but the chi-square test did not show a significant intergroup difference (P &gt; 0.05). Conclusions: The findings suggested that the care bundle was not effective in the prevention of cesarean wound infection, but we cannot deny the positive effects of care bundles on the prevention of surgical site infections. Thus, the components of the care bundle should be carefully examined, and any potential issues need to be more carefully analyzed in subsequent studies, especially intraoperative interventions that should be performed with extensive collaboration between surgical and operating room nurses and technicians.

Vaginal dinoprostone vs Foley catheter for induction of labor at term with an unfavorable cervix: an open-label randomized controlled trial

BackgroundInduction of labor (IOL) with mechanical methods or pharmacological agents is used in about 20% to 30% of all pregnant women. We specialized in comparing the effectiveness and safety of dinoprostone vs transcervical Foley catheter for IOL in term pregnant women with an unfavorable cervix with adequate samples. ObjectiveTo compare the effectiveness and safety of dinoprostone vs transcervical Foley catheter for IOL in term pregnant women with an unfavorable cervix. Study DesignThis is a parallel, open-label randomized controlled trial in two maternal centers in Shanghai, China between October 2019 and July 2022. Women with a singleton pregnancy in cephalic presentation at term and an unfavorable cervix (Bishop score <6) scheduled for IOL were eligible. A total of 1860 women were randomly allocated to cervical ripening with either a dinoprostone vaginal insert (10 mg) or a 60 cc Foley catheter for up to 24 hours. The primary outcomes were vaginal delivery rate and time to vaginal delivery. Secondary outcomes included time to delivery and maternal and neonatal morbidity. Analysis was done from an intention-to-treat perspective. The trial was registered with the China trial registry (CTR2000038435). ResultsThe vaginal birth rates were 72.8% (677/930) vs 69.9% (650/930) in vaginal dinoprostone and Foley catheter, respectively (aRR 1.04, 95% confidence interval [CI] 0.98-1.10, risk difference: 0.03). Time to vaginal delivery was not significantly different between the two groups (sub-distribution hazard ratio 1.11, 95% CI 0.99-1.24). Vaginal dinoprostone was more likely complicated with hyperstimulation with fetal heart rate changes (5.8% vs 2.8%, aRR 2.09, 95% CI 1.32-3.31) and placenta abruption (0.9% vs 0.1%, aRR: 8.04, 95% CI 1.01-64.15), while Foley catheter was more likely complicated with suspected intrapartum infection (5.1% vs 8.2%, aRR: 0.62, 95% CI 0.44-0.88) and postpartum infection (1.4% vs 3.7%, aRR: 0.38, 95% CI 0.20-0.72). The composite of poor neonatal outcomes was not significantly different between the two groups (4.5% vs 3.8%, aRR 1.21, 95% CI 0.78-1.88), while more neonatal asphyxia occurred in the dinoprostone group (1.2% vs 0.2%, aRR 5.39, 95% CI 1.22-23.92). In a subgroup analysis, vaginal dinoprostone decreased vaginal birth rate slightly in multiparous women (90.6% vs 97.0%, aRR 0.93, 95% CI 0.88-0.99). ConclusionsIn term pregnant women with an unfavorable cervix, IOL with vaginal dinoprostone or Foley catheter has similar effectiveness. Foley catheter leads to better safety for neonates, while it may result in a higher risk of maternal infection. Furthermore, Foley catheter should be preferred in multiparous women.

Association of C-reactive Protein in Preeclampsia

Introduction: Preeclampsia is a multisystemic disorder that complicate about 7-10 percent of human pregnancies.Worldwide this syndrome contributes high maternal and perinatal mortality and morbidity. C-reactive protein, a marker of tissue damage and inflammation, is elevated in seurm in overt preeclampsia. It is used as an objective and sensitive index of overall inflammatory activities in the body. Aims and Objectives: To explore the association of C-reactive protein level with the preeclampsia patients. Materials and Methods: The present study was a Case–Control study, conducted in the Department of Obstetrics and Gynaecology in collaboration with the Department of clinical pathology of Sir Salimullah Medical College Hospital, Mitford, Dhaka during the period of January 2013 to December 2013.The study population was pregnant women with preeclampsia and normal term pregnant patients admitted during study period. A total of 66 patients were included in the study. Among them 33 were clinically diagnosed preeclampsia women grouped as Cases and another 33 were age, parity and BMI matched term pregnant women as Controls. Eastmation of serum C-reactive protein was done by Nyco Card Reader-II method (Appendix-11). Statisticians analysis was perform by using SPSS. Results: C-reactive protein concentration (mg/L) was found significantly higher (p&lt;0.001) in case group (17.93±10.5) than control group (7.45±1.80). Creactive protein was _ 6mg/L in 29(87.9%) in case group and 9 (27.3%) in control group and C-reactive protein values showed significant positive correlation with systolic and diastolic blood pressure (p&lt;0.001) in case group. C-reactive protein concentration was found significantly higher (p&lt;0.001) in severe preeclampsia group than mild preeclampsia group. Conclusion: Therefore, it can apparently be concluded from this study that increased maternal serum C-reactive protein level might be a strong risk factor for preeclampsia, although the precise role of C-reactive protein in this regard whether causal or consequential, is yet to be determined. Finding of this study might be helpful for formulating a guideline for management of pregnant women with preeclampsia. Medicine Today 2024, Vol.36 (2): 67-71

Comparison of the efficacy and safety of titrated oral misoprostol solution and conventional oral misoprostol tablet regimen for Induction of labor

Objective: To compare the efficacy and safety of titrated oral misoprostol solution (OMS) and conventional oral misoprostol tablet (OMT) regimen for induction of labor. Material and Methods: A cohort of two hundred pregnant women with term, singleton pregnancies with an indication for induction were included in the study. The study group(OMS) included hundred women who were allocated to receive 20 ml of oral misoprostol solution(1µg/ml) hourly maximum of 4 doses , then titrated to 40 ml (40µg) hourly maximum of 8 doses. In the control group (OMT) hundred women were induced with 50 µg of misoprostol tablet orally, 4 hourly maximum of 6 doses. The induction to delivery interval, requirement of oxytocin, dose of misoprostol used, mode of delivery, maternal and neonatal outcome were analyzed statistically. Results: The number of patients who delivered vaginally were more in study group i.e 81(81%) patients as compared to control group i.e 73(73%) patients and the difference was statistically significant(p value=0.03). The number of patients who had meconium stained liquor with non reassuring fetal heart rate were significantly higher in control group (OMT) as compared with study group(OMS)[26 {96%} versus 12{63%} p value =0.01].Whereas induction to delivery interval, proportion of patient delivered vaginally in 24 hours, need for oxytocin augmentation, maternal adverse reaction and neonatal outcome were not significantly different (p&gt;0.05). Conclusion: Titrated oral solution is as effective as conventional oral tablet of misoprostol for labor induction in term pregnant women and small doses at frequent intervals seem to be safer in terms of risk of meconium stained liquor with abnormal fetal heart rate and caesarean section. Keywords: Titrated misoprostol, Induction of labor, Cesarean section, Efficacy and safety

The Effect of Maternal Blood Glucose on Umbilical Cord Blood Fibrinogen in Women With Gestational Diabetes.

Gestational diabetes mellitus (GDM) is delineated by the presence of glucose intolerance at any level that manifests or is initially identified during pregnancy. Factor I fibrinogen is among the most essential blood coagulation proteins. The concentration of fibrinogen influences platelet aggregation and blood viscosity. This study aimed to determine the correlation between fetal cord blood fibrinogen and plasma fibrinogen in pregnant women with GDM and between fetal cord blood fibrinogen and maternal blood sugar. A cross-sectional study was executed at Al-Elwiya Maternity Teaching Hospital in the obstetrics and gynecology department. The sample included 90 term pregnant women: 45 were confirmed to have GDM, and 45 healthy pregnant women served as control. Estimation of prelabor maternal fasting and random plasma glucose and plasma fibrinogen was performed. During delivery, blood was drawn from the umbilical cord to estimate neonatal plasma glucose and fibrinogen levels. The mean maternal plasma fibrinogen level exhibited a notable increase in women with GDM compared to the control (330.11 ± 56.92 mg/dl versus 254.89 ± 41.01 mg/dl). The infants of diabetic mothers had significantly lower mean cord plasma glucose levels (65.71 ± 14.63 mg/dl versus 77.80 ± 7.81 mg/dl) and higher mean cord plasma fibrinogen levels (269.42 ± 25.91 mg/dl versus 229.69 ± 21.29 mg/dl). Umbilical cord plasma fibrinogen was correlated positively with maternal plasma sugar and fibrinogen. A positive correlation between maternal and fetal cord fibrinogen levels was determined in women with GDM. Monitoring plasma fibrinogen levels in neonates of mothers with GDM could be facilitated by longitudinal, large-scale validation studies enabled by artificial intelligence as a new, evolving technique that contributes to more valuable outcomes. This would shed additional light on the course and function of plasma fibrinogen for a more comprehensive analysis of the fetal clotting system.

Determinants of Higher Oxytocin Dose Need During Labor Induction

Background: Several guidelines have been published regarding intrapartum oxytocin infusion for labor induction or augmentation; however, many of them lack specificity. Objectives: Therefore, this study aimed to assess oxytocin dose administered during labor and evaluate its association with maternal characteristics and short-term perinatal outcomes. Methods: This retrospective cross-sectional study was conducted on 162 term pregnant women who were admitted to the labor ward for vaginal delivery in two academic hospitals during 2021 - 2022. Maternal demographic features, obstetric and medical history data, labor process details (initial Bishop score, membrane status on admission and at the time of labor induction or augmentation, latent and active phase duration, oxytocin dose, delivery mode, and neonatal outcomes) were obtained and recorded. Participants were divided into two main groups based on the intrapartum oxytocin dose, and the desired outcomes were reported and compared between the groups. Results: The median maternal age was 28 years (range: 16 - 46). The median oxytocin dose administered during labor induction was 10 mU/min (range: 2.5 - 25 mU/min). Oxytocin dose was significantly correlated with gestational age (P &lt; 0.001), cervical dilation and effacement (P &lt; 0.001), fetal head station (P &lt; 0.001), cervical consistency (P &lt; 0.001), and cervical Bishop score before labor induction (P &lt; 0.001). The cervical dilation at the time of membrane rupture was also positively correlated with the intrapartum oxytocin dose (P = 0.013). Higher gestational age was correlated with a higher required oxytocin dose (P &lt; 0.001). The cesarean rate was 22.8% in the study population, and it was positively correlated with intrapartum oxytocin dose (P &lt; 0.001). Conclusions: The cervical Bishop score and its components, except for cervical position, were correlated with the intrapartum oxytocin dose. In other words, the less favorable the cervix, the higher the likelihood of requiring higher doses of oxytocin and consequently experiencing a longer duration of labor. Additionally, the cesarean rate was higher in those who needed oxytocin doses of more than 10 mU/min; however, short - term neonatal outcomes were not different.

Effect of acidic vaginal pH on the efficacy of dinoprostone (PGE2) vaginal tablet for labor induction in full term pregnant women: a randomized controlled trial.

There is controversial evidence that acidification of vaginal pH may increase the efficacy of vaginal prostaglandins in labor induction, with research being mainly focused on misoprostol. This study aims to evaluate the impact of this intervention on the progress of labor induction with dinoprostone (PGE2) vaginal tablet. This double-blind, parallel-group, randomized study was conducted between October 2021 and December 2022 at Alexandra General Hospital, Athens, Greece. A total of 230 women with singleton, full term pregnancy that were scheduled for labor induction were randomly divided into two groups: Group A, who received acidic vaginal wash (5 % acetic acid) and Group B, who received a normal saline vaginal wash. Afterwards, participants received a vaginal tablet of 3 mg dinoprostone every 6 h (maximum two doses). There were no statistically significant differences in mode of delivery, duration of different labor stages, Bishop score changes and possible complications. Participants in the acidification group needed less often labor augmentation with oxytocin and epidural anesthesia (p=0.03). Vaginal acidification seems to have no effect on the efficacy of the dinoprostone vaginal tablet. Even though it may reduce the need for oxytocin augmentation, there is no apparent benefit on clinical outcomes, such as reduction in cesarean section rates or shorter labor duration. Future research is necessary in order to validate these findings.

A Comparative Study of the Cardiovascular Effects of a Lower Dose of Heat-Stable Carbetocin Versus the Standard Dose in the Prevention of Postpartum Hemorrhage During Elective Cesarean Delivery: A Single-Blinded, Randomized, Parallel-Group Trial.

Oxytocin is a uterotonic drug that acts on receptors in the myometrium, causing uterine contractions. However, oxytocin receptors are also present in other organs, including the myocardium.Heat-stable carbetocin, a long-acting analog of oxytocin, is also known to act on these oxytocin receptors. As carbetocin has a long half-life of 40 minutes, its duration of action on the myocardium may be relatively longer than that of oxytocin. Therefore, this study aimed to study the cardiovascular effects of using a lower dose of carbetocin (50 mcg) compared to the standard dose (100 mcg) during elective cesarean delivery. A total of 212 full-term pregnant women were randomized into two groups: group I received 50 mcg of intravenous carbetocin, and group II received 100 mcg of intravenous carbetocin. Heart rate, blood pressure (BP), oxygen saturation, electrocardiogram changes, and pre- and postoperative (12 hours after cesarean delivery) high-sensitivity cardiac troponin I levels were compared between the groups. No statistically significant differences were observed between the groups with respect to heart rate, BP, electrocardiogram changes, or difference in pre- and postoperative high-sensitivity cardiac troponin I levels (p> 0.05). Carbetocin's cardiovascular effects were similar in both groups. None of the participants had adverse cardiovascular effects from the drug, and there were no differences in cardiovascular effects between the groups.