Term Pregnant Women Research Articles

Assessment of accuracy of two dimensions ultrasonography of fetal thigh soft tissue versus Hadlock's formula in estimation of fetal weight

Abstract Objective The current study aims to compare between mid-thigh soft tissue formula and modified mid-thigh soft tissue formula with Hadlock formula in estimation of fetal weight. Materials and methods Two hundred full term pregnant women attending Ain Shams Maternity Hospital in the period from April 2018 and April 2019 were included in this comparative study. Whole study group (200 women) had 2D ultrasonography using Hadlock's formula, thigh soft tissue formula and Modified thigh soft tissue formula. Results In our current study Hadlock's formula was better than thigh soft tissue and modified thigh soft tissue formula in estimation of fetal weight. Conclusions Fetal mid-thigh SST is a simple, useful, and easily applicable parameter for fetal weight estimation.

Premature rupture of membranes

Prenatal (premature) rupture of membranes (PROM) is defined as rupture of fetal membranes before the onset of labor or regular uterine contractions. PROM can lead to serious complications such as uterine cavity infection, umbilical cord compression, oligohydramnios, fetal malpresentation, umbilical cord prolapse, preterm delivery, fetal asphyxia and death. Initial evaluation of all term pregnancies with suspected PROM should include confirmation of membrane rupture and assessment of maternal and fetal well-being. Immediate initiation of labor is recommended in term pregnant women with PROM. Compared with expectant management, induction of labor is associated with a reduction in maternal and possibly neonatal infection and lower treatment costs without an increase in cesarean delivery. Induction with oxytocin is recommended. Oxytocin is as effective as prostaglandins, easier to titrate and may be less expensive depending on the preparation. Balloon catheter use is not recommended for cervical ripening in PROM.

Comparison of ultrasonographic estimated fetal weight and actual birth weight.

Objective: To determine the accuracy of estimated fetal weight by ultrasound compared with actual birth weight. Study Design: Cross Sectional study. Setting: Department of Radiology, Fatima Memorial Hospital, Lahore. Period: September 2017 to January 2018. Material & Methods: A sample of 139 pregnant women who fulfilled the inclusion and exclusion criteria were included in this study Ultrasonography of full term pregnant women was performed to determine the comparison and accuracy with the actual weight of baby at birth. Results: In a sample of 139 pregnant women, the mean age was 27.8±4.2 years (with minimum age of 20 years and maximum age of 40 years). Ultrasonographic estimated fetal weight and actual birth weight was compared by using paired t-test. No significant difference was found between estimated fetal weight and actual birth weight with P-value 0.237. Conclusion: Ultrasound is highly sensitive, good, reliable, safe and accurate modality for estimation of fetal weight. There is no significant difference between fetal weight and actual birth weight.

Matrix metalloproteinse-9 expression in fetal membranes and maternal serum in cases of premature rupture of membranes: Impact of subclinical chorioamnionitis

Background: Matrix metalloproteinase-9 (MMP-9) is the most active MMPs in the fetomaternal membranes. It plays an important role in the breakdown and remodeling of these membranes. Thus, increased knowledge of its expression in cases of premature rupture of membranes (PROM) with and without chorioamnionitis (CA) is essential for developing effective treatment strategies. Patients and Methods: expression of MMP-9 in fetomaternal membranes and maternal serum were performed in 70 full-term pregnant women; 20 cases were with intact membranes (group I), 35 with PROM (group IIA) and 15 with PROM and CA (group IIB). Results: A significant difference in MMMP-9 expression was detected between the studied groups. The highest MMP-9 expression was reached in women with PROM accompanied by histological (subclinical) CA followed by women with PROM without CA, compared to the control group (with intact membranes) at the time of delivery. Immunohistochemical expression was associated with a concomitant increase in serum MMP-9. Conclusion: MMP-9 could predict women liable for premature rupture of membranes, and the determination of its serum level may be an effective tool for PROM detection.

Conducción del trabajo de parto en gestantes con cesárea previa en el Hospital Central Universitario Dr. Jesús María Casal Ramos. Acarigua-Estado Portuguesa.

Objective: To estimate the safety of vaginal delivery in pregnant women at term in spontaneous labor with previous cesarean section who attended the Obstetric Emergency Service of the Dr. Jesús María Casal Ramos University Hospital, in the period January-June 2018. Methods: A prospective, descriptive, cross-sectional and non-causal correlational study was conducted in pregnant women at term with a previous caesarean section in labour. The medical records of full-term pregnant women who entered into spontaneous labor and who underwent conduction of labor were reviewed if the indication for cesarean section did not persist, recording maternal, fetal and neonatal complications. Results: We attended 245 pregnant women, with previous cesarean section, 108 patients were included of which 99 (92 %) did not present complications and of the remaining nine, 4 (44 %) presented grade I tear, 4 (44 %) grade II tear and only 1 (12 %) grade III tear. The most frequent anatomical location was vaginal in 6 (67 %), cervical in 3 (33 %); the size of the same was not described; the grade III vaginal tear was sutured, did not require blood transfusion and the product weighed 4000 kg. There were no maternal deaths or fetal complications or fetal deaths. Conclusions: Spontaneously initiated vaginal delivery in pregnant women with previous caesarean section is 92% safe. Keywords: Vaginal Birth, Prior caesarean, Interpartum interval, Labor conduction.

The Efficacy of In-Phase and Quadrature Demodulation in Electronic Fetal Heart Rate Monitoring During Labor

Abstract Objective: To investigate the efficacy of in-phase and quadrature (IQ) demodulation in electronic fetal heart rate monitoring (EFM) to reduce false reports of fetal heart rate (FHR) doubling or halving. Methods: This is a prospective cohort study. A total of 263 full-term pregnant women who delivered at Peking University Shenzhen Hospital between August 2019 and July 2020 were prospectively enrolled in the study. FHR monitoring began when the cervix was dilated to 2–3 cm and continued until delivery. Raw fetal Doppler audio signals and internal and external cardiotocography curves from internal electrode monitoring, EFM with conventional demodulation (external), and EFM with IQ demodulation (external) were acquired to compare FHR doubling and halving time. In cohort 1, FHR was compared between IQ demodulation and conventional demodulation. In cohort 2, FHR was compared between IQ demodulation, conventional demodulation, and internal FHR monitoring. Count data were statistically analyzed using the Chi-squared test, and measurement data were statistically analyzed using t-test for correlation coefficients, and Bland-Altman analysis for concordance ranges. Results: To compare IQ demodulation and conventional demodulation, 225 pregnant women were monitored for a total of 835,870 seconds. The beat-to-beat interval of FHRs in raw fetal Doppler audio signals was used as the reference. The results showed a doubling time of 3401 seconds (0.407%, 3401/835,870) and a halving time of 2918 seconds (0.349%, 2918/835,870) with conventional demodulation, compared to 241 seconds (0.029%, 241/835,870) and 589 seconds (0.070%, 589/835,870), respectively, with IQ demodulation. IQ demodulation reduced FHR doubling by approximately 93% (3160/3401) and FHR halving by approximately 80% (2329/2918) compared to conventional demodulation (P < 0.01). To compare IQ demodulation, conventional demodulation, and internal FHR monitoring, 38 pregnant women were monitored for a total of 98,561 seconds. FHR from internal electrode monitoring was used as the reference. The results showed a doubling time of 238 seconds (0.241%, 238/98,561) and a halving time of 235 seconds 0.238%, 235/98,561) with conventional demodulation, compared with 30 seconds (0.030%, 30/98,561) and 81 seconds (0.082%, 81/98,561), respectively, with IQ demodulation (P < 0.05). No significant difference was observed in doubling or halving time between IQ demodulation and internal FHR monitoring (P > 0.05). IQ demodulation was more closely correlated with internal FHR monitoring than conventional demodulation (0.986 vs. 0.947). The Bland-Altman analysis showed that the concordance range of IQ demodulation vs. internal FHR monitoring was significantly narrower than that of conventional demodulation vs. internal FHR monitoring ((−5.32,6.01) vs. (−10.87,11.46)). Conclusion: EFM with IQ demodulation significantly reduces false FHR doubling and halving, with an efficacy similar to that of internal FHR monitoring.

Impact of epidural labor analgesia using sufentanil combined with low-concentration ropivacaine on maternal and neonatal outcomes: a retrospective cohort study

BackgroundWhether epidural administered sufentanil combined with low-concentration ropivacaine affected labor progress as well as maternal and neonatal outcomes still remained unknown. The aim of this study was to assess the impact of epidural sufentanil plus ropivacaine on maternal and neonatal outcomes.Methods This is a retrospective cohort study. Data of singleton full-term pregnancy women who received epidural labor analgesia for vaginal delivery from May 2018 to June 2020 were collected. Parturients were divided into two groups (the R group and the SR group) according to different medication regimens for epidural labor analgesia. The implementation of epidural analgesia during labor was performed with 0.167 % ropivacaine in the R group and 0.1 % ropivacaine in combination with 0.5 µg/ml sufentanil in the SR group. The primary outcome of our study included the duration of labor progress and the incidence of maternal fever, postpartum hemorrhage, fetal distress and neonatal Apgar scores less than 7 at 1 and 5 min. The secondary outcome included the incidence of episiotomy, instrumental delivery, caesarean section and grade III meconium-stained amniotic fluid.ResultsThere were a total 3778 deliveries during the study period, 1994 and 1784 parturients were included in the R group and in the SR group, respectively. The length of the first stage of labor was remarkably shorter in the R group in comparison to the SR group (548.0 ± 273.0 vs. 570.9 ± 273.0, P = 0.013). No significant difference was found in the incidence of maternal fever, postpartum hemorrhage, fetal distress and in the neonatal Apgar scores less than 7 at 1 and 5 min between two groups. Other Maternal outcomes were comparable in the R group and the SR group.Conclusions0.5 µg/ml sufentanil plus 0.1 % ropivacaine for epidural labor analgesia prolonged the duration of the first stage of labor, but did not have additional impact on maternal and neonatal outcomes compared with the sole 0.167 % ropivacaine.Trial registrationClinical Research Information Service with registration number ChiCTR2100045162. Registered 7 April 2021.

Norepinephrine versus phenylephrine for maintenance of blood pressure during spinal anaesthesia for caesarean delivery - A randomized double blind controlled study

: Currently phenylephrine is a preferred 1 line vasopressor for maintenance of blood pressure during spinal anaesthesia, may be associated with reflex bradycardia and decreased cardiac output, posing risk to mother or foetus. Norepinephrine may be an useful alternative as being potent alpha with weak beta adrenergic agonist activity. : This study compared the effectiveness of prophylactic and treatment boluses of norepinephrine and phenylephrine to maintain systolic blood pressure at or above 80% of baseline value during spinal anesthesia for cesarean delivery with the primary aim to compare cardiac output. Secondary aims were total doses of study drug required, neonatal outcome and perioperative complications.: Total 100, term pregnant women with ASA status II undergoing caesarean delivery under spinal anaesthesia were enrolled in this prospective, double blind controlled study. Patients were randomized to receive prophylactic bolus dose of norepinephrine (6 µg) or phenylephrine (100 µg) immediately after spinal anaesthesia. Systolic blood pressure, cardiac output and heart rate were monitored. Intermittent bolus doses were repeated whenever required. Student ‘t’ test and chi square test were used for analysing the data. : Both the drugs were able to maintain the systolic blood pressure ≥ 80% of baseline (p=0.356). Significant difference observed in cardiac output while comparing both the groups from 3 to 15 minutes after spinal anesthesia (p=0.014). The incidence of bradycardia was lower in norepinephrine group as compared to phenylephrine group (P=0.018). : Norepinephrine is as effective as phenylephrine for maintenance of blood pressure after spinal anaesthesia for caesarean delivery with stable heart rate and cardiac output.

Baseline parameters for non-activated rotational thromboelastometry tests with and without heparinase in healthy pregnant women at term gestation

ObjectiveTo determine the normal values for non-activated thromboelastometry parameters among pregnant women. DesignProspective, observational study. SettingTertiary care hospital. PatientsNon-laboring women at term gestation without history of bleeding or clotting disorder or anticoagulation use. InterventionsVenous blood samples were collected and ROTEM® was performed using NATEM and NaHEPTEM assays. MeasurementsReference ranges were derived by calculating 2.5 and 97.5 percentiles for the following parameters: clotting time (CT), clot formation time (CFT), amplitude at 10 (A10) and 20 min (A20), alpha angle, maximum clot firmness (MCF), and lysis index at 30 (LI30) and 60 min (LI60). The NATEM/NaHEPTEM CT ratio was calculated to determine the baseline ratio in term pregnant women. Main results146 women were screened and 120 were enrolled. The median age was 34 years [31–36], median gestational age was 39.1 weeks [38.3–39.3], and median parity was 1 [0–2]. Median pre-delivery platelet and hematocrit levels were within the normal ranges. The reference ranges for NATEM parameters were: CT (232–759 (s)), CFT (69–243 (s)), alpha angle (50–77 (°)), A10 (44–69 (mm)), A20 (54–75 (mm)), MCF (57–77 (mm)), LI30 (100–100 (%)), LI60 (90–100 (%)). The reference ranges for NaHEPTEM parameters were: CT (224–717 (s)), CFT (66–210 (s)), alpha angle (53–77 (°)), A10 (44–67 (mm)), A20 (55–73 (mm)), MCF (58–74 (mm)), LI30 (99–100 (%)), LI60 (90–100 (%)). The NATEM to NaHEPTEM CT ratio reference range was 0.73–1.3. ConclusionsThis study is the first to our knowledge to report reference ranges for non-activated ROTEM® tests with and without heparinase in non-laboring term pregnant women. These reference ranges may serve as a baseline comparison and may be useful for future research on anticoagulation management in pregnancy.

Inferior vena cava assessment in term pregnant women using ultrasound: A comparison of the subcostal and right upper quadrant views.

Point-of-care ultrasound can be used at the bedside to assess the haemodynamic status and fluid responsiveness of a pregnant woman. Previous studies demonstrated that views from the apical and parasternal windows are readily obtainable in labouring women. However, using the subcostal window to assess the inferior vena cava can be challenging because of the gravid uterus. A potential alternative is the right upper quadrant transhepatic window. We sought to compare visualisation of the inferior vena cava via the subcostal and right upper quadrant windows, in full-term pregnant women. This was a prospective pilot study carried out in a tertiary academic obstetric centre. Thirty pregnant non-labouring women at full term were recruited. In each patient, the inferior vena cava was visualised through both the subcostal and the right upper quadrant windows. Time to acquire each image, acquisition success rates and ease of obtaining images were compared for both approaches. Image quality was then reviewed and rated by two independent expert reviewers. There was a significant difference in the time required to obtain each view; subcostal median (interquartile range): 52 (35-59) seconds, right upper quadrant median (interquartile range): 23 (11-55) seconds (P=0.0045). Operator-defined successful image acquisition was 100% for the right upper quadrant window compared to 80% for the subcostal window. Ease of obtaining the view, as rated by the operator, was significantly easier in the right upper quadrant window compared to the subcostal window (P <0.0001). Both reviewers independently rated image adequacy to be significantly greater in the right upper quadrant window (73% and 57%) compared to the subcostal window (40% and 10%) (P=0.0213 and P=0.0005, respectively). Inter-rater agreement ranged between good (Cohen's kappa coefficient 0.64) for right upper quadrant windows to fair (Cohen's kappa coefficient 0.29) for subcostal windows. Inferior vena cava visualisation in term pregnant patients may take less time, be easier and provide better quality images when the right upper quadrant window is used compared to the subcostal window.

Intramuscular meperidine analgesia at the beginning of active phase shortens labor duration without adverse effects on obstetric lacerations

The primary objectives of this study were to evaluate the impact of intramuscular meperidine on shortening of the active phase of labor, the neonatal outcome and the rate and severity of perineal lacerations in term pregnant women in the first stage of labor. A total of 571 primiparous term pregnant women delivered vaginally were included into this retrospective study. In 437 of them, meperidine (100 mg IM) at the beginning of the active phase was administered and 134 women did not receive any meperidine dose. The length of labor phases, obstetric lacerations, and neonatal outcomes were recorded. The results of this study showed that meperidine could be used safely as an obstetric analgesic with its additional benefit of shortening the active phase of the first stage and second stage of labor without increased risk of obstetric lacerations and perinatal adverse outcomes. In case of limited use of neuraxial analgesia in a busy state maternity hospital, intramuscular meperidine administration as obstetric analgesia seems beneficial in reducing the length of the active phase of the first stage of labor and the second stage of labor without adversely affecting obstetric lacerations and neonatal outcomes.

Perinatal Outcome in Newborns of Women with Gestational Diabetes Mellitus

Objective: This study was planned to determine the perinatal outcomes of the newborns of term pregnant women who were diagnosed with GDM and decided to have cesarean delivery. Materials and Methods: Thirty-five pregnant patients diagnosed with GDM were included in the study. The control group consisted of 35 patients who did not have any pregnancy-related disease and were decided to deliver with elective cesarean section. All participants were screened with a 50-g GCT at 24-28 weeks of gestation. Pregnant women with meeting the following laboratory criteria were accepted as GDM. If the serum glucose level was greater than 140 mg/dL on the 50-g GCT, a 100-g OGTT was applied. Diagnosis of GDM was confirmed if 2 of the blood glucose test results were above the following levels: fasting serum glucose ≥ 92 mg/dL and/or 1-hour glycemia ≥ 180 mg/dL, and/or 2-hour glycemia ≥ 153 mg/dL. Perinatal outcome between GDM subjects and control group was compared. All participants in GDM and control groups underwent cesarean deivery. Primary outcome measures included gestational birthweight, gestational age at delivery, stillbirth and neonatal death, minor and major birth defects. Results: While neonatal hypoglycemia was detected in 4 cases in the GDM group, it was found in one case in the control group. No stilbirth was detected in either the GDM group or the control group. While neonatal death was detected in one case in the GDM group, no neonatal death was observed in the control group. While mild preeclampsia was detected in one case in the GDM group, it was not found in the control group. Birth weeks and birth weights of the cases in both groups were recorded similarly. While 8 babies of 2500 grams or less were born in GDM cases, all of the cases in the control group were over 2500 grams. While prematurity was detected in two babies in the GDM group, no prematurity was reported in the control group. Neonatal intensive care needs were seen in three babies in the GDM group, and there were no infants in need of intensive care in the control group. Conclusions: There is a slight increase in low birth weight, prematurity and intensive care unit needs of babies born to mothers with GDM.

The effects of body mass index, smoking and anemia on fetal birth weight

Objective Fetal growth is an important indicator of fetal health. Low birth weight (LBW) is also associated with increased perinatal morbidity and mortality. Numerous factors that affect fetal weight have been identified. In this study, we aimed to investigate the effect of body mass index, smoking, and anemia on fetal birth weight on term pregnant women who had vaginal delivery in our clinic. Methods This study is a retrospective cross-sectional study. This study included patients who had a spontaneous vaginal delivery at our hospital between January 1st, 2018, and June 15th, 2020. Measurements of hemoglobin (Hb) and hematocrit (Hct) levels during birth supported the diagnosis of anemia. Hb levels were compared in three categories in this study: (1) Hb&lt;10 g/dL; (2) ≥10&lt;11 g/dL; and (3) Hb ≥11 g/dL. Anemia was defined as having a Hb level &lt;11 mg/dL. Birth weight was categorized as LBW &lt;2500 g; normal birth weight (NBW) as ≥2500–3999 g, and macrosomia as ≥4000 g. Results Analysis was performed on 1428 pregnant women. There was a statistically significant difference for the Hct and Hb subgroups between the groups (p&lt;0.05). Fetal birth weight was found higher in the non-smoking group than in the smoking group (3302.1± 381.5 g vs. 2839.7±491.5 g; p&lt;0.001). Body mass index (BMI) and Hb levels positively predicted fetal birth weight (β=0.134; p&lt;0.001 and β=0.051; p=0.046), smoking was negatively predicted fetal birth weight (β=-0.245; p&lt;0.001). Conclusion BMI, Hb levels, and smoking status during mothers’ delivery are effective on fetal weight. Smoking was the strongest predictor of fetal birth weight compared with the other variables.

Evaluating the Effect of Dexmedetomidine Intravenous Infusion on Labour Pain Management in Primipara Pregnant Women: A Nonrandomised Clinical Trial Study.

The pain of labour is very severe. Most women prefer painless labour to routine labour if they are aware of the methods of analgesia. The aim of this study was to evaluate the effect of dexmedetomidine intravenous infusion on labour pain management in primipara term pregnant women. In this nonrandomised clinical trial with control group, all primipara term pregnant women from August 2019 to March 2020 were included. In the intervention group, after the active phase of labour, dexmedetomidine was given according to the protocol and continued until phase 2 of labour. The control group received no intervention to reduce pain. Patients in both groups were evaluated for fetal heart rate, Apgar scores, vital signs, pain intensity, and sedation score. There were no significant differences in primary fetal heart rate, primary maternal hemodynamics, and mean Apgar scores at 1 and 5 minutes between the two groups (p > .05). There was no significant difference in the mean fetal heart rate in different stages between the two groups. Intragroup analysis in the intervention group showed that mean systolic and diastolic blood pressures were significantly decreased after drug administration but were in the normal range. The active phase of labour in the intervention group was significantly shorter than in the control group (p = 0.002). The mean Visual Analogue Scale (VAS) score after dexmedetomidine administration decreased significantly from 9.25 at baseline to 4.61 after drug administration, 3.88 during labour, and 1.88 after placental expulsion. The mean Ramsay Sedation Scale score after dexmedetomidine administration increased significantly from 1.00 at baseline to 2.05 after drug administration, 2.22 during labour, and 2.05 after placental expulsion. Based on the study's results, the administration of dexmedetomidine to manage labour pain with careful monitoring of mother and fetus is recommended.

Does wearing double surgical masks during the COVID-19 pandemic reduce maternal oxygen saturation in term pregnant women?: A prospective study.

PurposeThis study aimed to compare the effects of using single and double surgical masks (SM) on maternal oxygen saturation in pregnant women.MethodsIn this prospective study, single or double SM were worn by term pregnant women who applied for routine controls. The vital signs of the participants such as oxygen saturation, pulse, respiratory rate, fever, systolic and diastolic blood pressure were measured at admission and 30 min later.ResultsThere were 223 participants in the single SM group and 231 participants in the double SM group. Thirty minutes after putting on the mask, there was no significant difference in the proportion of patients whose oxygen saturation fell below 95 (3.6 vs 5.6%, p = 0.301). No significant difference was observed between the admission and 30 min oxygen saturation levels of the pregnant women in the single SM group. However, maternal oxygen saturation after 30 min of the pregnant women in the double SM group was significantly lower (97.4 ± 1.1 vs 96.6 ± 1.3, p < 0.001). No significant changes were observed in the vital signs of either groups.ConclusionWhen using double SM, oxygen saturation is significantly reduced compared to pre-mask values. Nevertheless, it seems difficult to say that these decreases have clinical significance.

Exploring maternal nutrition counseling provided by health professionals during antenatal care follow-up: a qualitative study in Addis Ababa, Ethiopia-2019

BackgroundNutritional awareness and practice of women during pregnancy could be determining their nutritional status, which significantly affects the outcome of pregnancy. Therefore this study aims to explore the maternal nutrition counseling provided by health professionals for pregnant women, Barriers to maternal nutrition, and major interventions.MethodsA descriptive study design with a qualitative method by using ground theory tradition, based on constructivist research approach and Charmaz’s (2000) study design has been conducted from September-01/2019 _November-16/2019 among pregnant women who got ANC service in Addis Ababa, Ethiopia. A purposive sampling technique was used. Practical observations and in-depth interviews were conducted. The sample size adjustment has been carried out according to the information saturation obtained, and finally, 81 practical observations, In-depth interview with two center managers, nine health professionals and eleven term pregnant women has been conducted. An observational checklist and Semi-structured, open-ended questionnaires were used. Data, the environment, and methodological triangulation were carried out. A conceptual framework has been established based on the data collected about the whole process of maternal nutrition counseling during pregnancy. ATLAS TI software was utilized for information analysis.The resultsMost participants responded that maternal nutrition counseling provided to pregnant mothers is not adequate and neglected by most stakeholders. From 81 practical observations, health professionals counseled to mothers were 10 what to feed, 4 what to limit to consume, and 5 were counseled about what to eat during pregnancy. Close to all the respondents agreed on the importance of providing nutrition counseled by the nutritionists. Most of the study participants emphasized a shortage of time as primary barriers. Institutional Barriers, Professional Barriers, Maternal Barriers, and Community Barriers were major barriers to nutrition counseling.ConclusionsGenerally, maternal nutrition counseling provided to pregnant mothers was not adequate and neglected by most stakeholders. Shortage of time due to client flow, Institutional Barriers, Professional Barriers, Maternal Barriers, and Community Barriers were major categories of maternal nutritional counseling barriers. Information update and timely preparation were recommended to health professionals.

Effect of vaginal pH on efficacy of dinoprostone gel for labour induction: a cross-sectional study

The purpose of this study was to assess the effect of vaginal pH on efficacy of intracervical dinoprostone gel (PGE2) for labour induction, progression and induction delivery interval. A cross-sectional study was done among 150 term pregnant women planned for induction with unfavourable Bishop’s score ≤5. Women were categorised into two groups based on vaginal pH >4.5 and ≤4.5. Induction was done with maximum of three doses of PGE2 based on Bishop’s score, followed by oxytocin administration. Failed induction rate was 14.5%. There was no significant association between vaginal pH and Bishop’s score change after first gel application. There was no significant difference in failed induction rates, time from induction to active labour as well as induction delivery interval between two groups. Similarly, there was no significant association between oxytocin requirement and mode of delivery with vaginal pH. Intracervical PGE2 is an ideal route, unaffected by vaginal pH. Impact Statement What is already known on this subject? Prostaglandins are organic acids that have diminished solubility in aqueous solution with a low pH. The release of the drug could be altered by the acidity of vagina and this could result in variable clinical response. Vaginal pH may alter the efficacy of intravaginally administered prostaglandins through several potential mechanisms. What the results of this study add? There was no significant effect of change in vaginal pH on effectiveness of intracervical administered PGE2. There was no significant association between vaginal pH and time from induction to time women is entering into active labour as well as time from induction to delivery. Similarly, there was no significant association between mode of delivery and oxytocin usage with vaginal pH in labour. Intracervical PGE2 is an ideal route, unaffected by vaginal pH. What the implications are of these findings for clinical practice and/or further research? Further randomised studies are required comparing both vaginally administered PG inserts and intracervical PGE2 gels with vaginal and cervical pH, to directly compare their effectiveness in labour induction.

Effect of applying cold gel pack on reduction of postoperative pain in cesarean section, low midline skin incision: A randomized controlled trial.

The present study aims to investigate the efficacy of cryotherapy in pain reduction following low midline cesarean section. This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Thammasat University Hospital, Thailand from December 2019 to February 2020. Participants were term pregnant women who were indicated for low midline cesarean section. The control group received standard postoperative care while cold pack was applied to the intervention group for 6h after the operation. The primary outcome was the postoperative visual analog scale (VAS) score in both the control and intervention groups. The secondary outcomes consisted of the amount of intravenous pain reliever each participant required and the length of hospital stay. All 100 pregnant women were recruited into the study. They were equally allocated into intervention or control groups. Both groups underwent cesarean section under spinal anesthesia. The demographic characteristics of both groups were comparable. VAS of intervention and control group were 3.2 ± 2.4 versus 5.3 ± 2.2, 3.0 ± 2.4 versus 5.6 ± 2.0, 2.0 ± 2.3 versus 5.3 ± 2.2, and 1.1 ± 1.7 versus 4.8 ± 2.4 at 6, 8, 12, and 24 h postoperatively (p-value <0.05), respectively. Moreover, the intervention group showed a statistically significantly lower number of participants who needed intravenous meperidine or tramadol (14% vs. 24%, p-value <0.05) and lower intravenous meperidine or tramadol usage than in control group (13.2 ± 0.9 vs. 19.9 ± 4.0mg, p-value <0.05). Cryotherapy could reduce postoperative pain from 6h to within 24 h of the postoperative period, as well as lower overall opioid requirement.

The effect of the birth method on changes of the prepartum and postpartum dimensions of perineal body

ObjectiveThe perineal body is critical for maintaining the integrity of the pelvic floor, especially in females as it can be injured during vaginal delivery. This study aimed to evaluate the effect of childbirth on perineal body dimensions by using a transperineal 2D ultrasound. Study designThis prospective cohort study was performed in a tertiary obstetric care center. A total of 172 term pregnant women who delivered either by cesarean section or vaginal delivery were enrolled in the study. All demographic data and information were collected prospectively. The perineal body was measured in length, height, perimeter, and area. Mode of delivery was classified into four categories, including prelabor cesarean section, cesarean section during the first stage of labor, the first vaginal delivery, and more than one previously vaginal delivery. A postpartum evaluation was performed after 6 weeks. ResultsAmong the 172 women, 40 (23.3 %) had a history of cesarean section (CS) and they delivered with scheduled CS, 40 (23.3 %) women delivered by primary CS during active labor, 48 (27.9 %) women had the first vaginal delivery, 44 (25.6 %) women who delivered vaginally had a history of at least one vaginal delivery. The postpartum perineal body measurements were significantly lower in terms of length, perimeter, and area in all pregnancy groups. ConclusionPregnancy and delivery change perineal body dimensions, significantly. Cesarean section does not completely protect against changes in perineal body morphology.

Sonographic Lower Uterine Segment Thickness to Predict Cesarean Scar Defect in Pregnant Women

Objective: To study the validity of sonographic lower uterine segment (LUS) thickness in predicting intraoperative cesarean scar defect (CSD) and thin incision sites in term pregnancy. Methods: This was a cross-sectional study involving 111 full-term pregnant women who were scheduled for repeat cesarean delivery from April, 2019 to January, 2020. The sonographic myometrial LUS thickness was measured prior to surgery. The cesarean scar was assessed using the morphologic classification system as either grade 1 (a normally formed LUS), grade 2 (a thin LUS, but without visible content), or grade 3 (a thin LUS with visible content). Then, the ophthalmic caliper was used to measure the incision site’s uterine-wall thickness. The correlations between the sonographic measurements and intraoperative findings were reported. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.Results: There were two cases (1.8%) of grade 3 CSD. The overall correlation between the sonographic and intraoperative incision-site thickness showed r=0.559 with p-value &lt; 0.001. The sonographic cut-off value of 1.5 mm could predict CSD and a thin incision-site uterine wall with sensitivity, specificity, PPV, NPV of 50.0%, 90.8%, 9.1%, 99.0%, and 37.5%, 94.6%, 54.5%, 90.0%, respectively. A receiver operating characteristic curve was generated to determine the optimum cut-off value at 2.5 mm with a sensitivity of 76.5% and a specificity of 73.3%. The area under the curve was 0.8 (a 95% confidence interval, 0.718-0.885).Conclusion: Abdominal sonography is a valuable tool for the preoperative prediction of CSD. A myometrial LUS thickness of more than 1.5 mm is associated with a lower likelihood of cesarean scar dehiscence.