Term Pregnant Women Research Articles

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.

Is borderline oligohydramnios a problem at term pregnancy? a prospective study of a tertiary hospital

Aims: The objective of this study is to conduct a comparative analysis and ascertain the perinatal and early postnatal outcomes in term pregnant women who have a borderline amniotic fluid index (AFI) in comparison to those with a normal AFI.
 Methods: This prospective study was conducted on 376 pregnant women of 37-42 weeks gestational age. Ultrasound evaluation was performed, and the AFI was calculated. Borderline and normal AFI were defined as 5.1 < AFI < 8 cm and 8.1 < AFI < 24 cm, respectively. Age, body mass index, gestational age at delivery, gravida, and parity were compared between the borderline and normal AFI groups, patient demographics, obstetric data, and information on delivery complications data were recorded. Newly born babies received a thorough physical evaluation and were followed up for two months by a neonatologist. Umbilical artery pH, birth weight, admission to neonatal intensive care unit (NICU), neonatal complications were also reported.
 Results: There were 202 patients in the borderline AFI group and 174 patients in the normal AFI group. There was no statistically significant difference between groups in terms of normal delivery, operative vaginal delivery, elective cesarean delivery, or emergency cesarean delivery (p=0.088). Apgar score at 5 minutes, umbilical artery pH value, birth weight, admission to the NICU, small for gestational age, and cesarean delivery for non-reassuring fetal heart rate testing were not statistically different between the groups (p=0.139, p=0.644, p=0.790, p=0.317, and p=0.16, respectively)
 Conclusion: Our study indicates that borderline oligohydramnios does not have an adverse effect on perinatal or early postnatal outcomes in term pregnancy.

Term gebelerde plasenta ağırlığını etkileyen antenatal faktörlerin değerlendirilmesi

ABSTRACT:
 
 Objective: The aim of this study was to evaluate whether various antenatal factors affect placental weight in term pregnant women who gave birth vaginally.
 
 Materials and Methods: This observational study was conducted between January and August 2022 in Karaman Training and Research Hospital. Six hundred and thirty parturients after thirtyseventh gestational week with vaginal delivery were enrolled to this study. The maternal age, parity, body mass index, chronic diseases, and placental weight, weight, length and gender of he newborns were documented. 
 Primary outcome of this study was to evaluate the factors such as age, body mass index, parity, anemia and chronic disesase of mothers and weight of the newborns that may affect placental mass. Assessment of the influence of gender as well as tobacco usage during pregnancy was a secondary outcome of this study. Linear regression analyses with Enter methos was applied while evaluating the factors affecting placental weight.
 Results: As we evaluated the findings of the study, we found that birth weight and parity had a statistically significant influence on placental weight (p>0,001 and p=0,024 ,respectively). In primipar pregnants , the average weight of the placenta was 580 grams, whereas it was 600 grams in multiparas (p=0,008). Only gestational diabetes was shown to have a significant effect on placental weight when 13 disease categories were investigated (p=0,024).Body mass index of mothers , maternal anemia with hemoglobin level ≤11 gr/dL and smoking habitus had no effect on placental weight.
 Conclusion: The results of this study support , parity , birthweight of the newborn and gestational diabetes mellitus are 
 critical factors affecting placental weight.

Effect of Using Midazolam and Propofol in Low Doses for Intraoperative Nausea and Vomiting Prevention in Pregnant Women Underwent Cesarean Section under Regional Anesthesia

Aim: To investigate if and how severe intraoperative nausea and vomiting occur following elective cesarean sections performed under spinal anesthesia using sub-hypnotic dosages of midazolam and propofol.
 Study Design: Clinical trial.
 Methodology: The current study was conducted at the Gynecology and Obstetrics Department of a Teaching Hospital in Baghdad, Iraq. The study included 90 full-term pregnant women with single viable fetuses who underwent elective C/S by spinal anesthesia and were randomly assigned to one of three groups: group A included 30 women who received propofol, group B included 30 women who received midazolam, and Group C included 30 women who received placebo. The Bellville scoring score was used to assess nausea and vomiting. The Richmond Agitation Sedation Score (RASS) was used to assess sedation intraoperatively.
 Results: Patients in group C had the highest prevalence of nausea and vomiting (56.7%), which was significantly different from groups A (16.7%, P=0.001) and B (13.3%, P=0.001); however, there was no statistically significant difference between groups A and B (P= 0.717). The group B patients had the highest prevalence of drowsiness (20%), which was substantially different from group C (3.3%, P=0.044), whereas there were no statistically significant differences between groups A and B (P= 0.278) or A and C (P= 0.3).
 Conclusion: Low doses of midazolam or propofol administered after cesarean section (after the umbilical cord has been clamped) can lessen intraoperative nausea and vomiting without significantly lowering blood pressure or heart rate, with midazolam being more effective than propofol in this regard.

Efficacy of intravenous ketamine as premedicant for prevention of intraoperative hypotension after spinal anesthesia in parturients posted for elective cesarean section

Background: Hypotension following spinal anesthesia (SA) in lower segment cesarean section can be deleterious to the parturient and to fetus. Ketamine acts by stimulating the cardiovascular system leading to high blood pressure and increase in heart rate (HR) and cardiac output. Aims and Objectives: This study aimed to assess the efficacy of 15 mg of prophylactic intravenous ketamine in elective cesarean section for prevention of hypotension after SA. Materials and Methods: This double-blinded randomized controlled study was conducted on 98 participating parturients who were American Society of Anesthesiologists term pregnant women. The parturients were randomly divided into two groups (n=49 in each). All the parturients received SA. Ketamine group - Group K received 15 mg of ketamine IV bolus in 3 mL saline and control group - Group C received the same volume of normal saline IV bolus. HR and systolic blood pressure (SBP) were recorded at baseline at 5, 10, 15, and 20 min after the injection and then every 15 min till the end of the operation. Incidences of hypotension were recorded. The total number dose of ephedrine used, APGAR score, and Visual Analog Scale scores were recorded. The Ramsay Sedation Score was also recorded at baseline, then 5, 10, 15, 30, and 45 min after injection, and then at the end of the operation. Results: This study showed a statistically significant increase in the incidence of hypotension and higher use of intravenous ephedrine 6 mg boluses in the control group when compared to the ketamine group. Forty-two parturients in the control group developed hypotension compared to 23 parturients in the ketamine group with P<0.001. The total ephedrine dose was significantly lower among the ketamine group. Sedation was observed for the first 15 min intraoperatively in the ketamine group with P=0.001. There was no statistically significant difference in APGAR score between the two groups. Conclusion: There was significantly higher hemodynamic stability in the ketamine group with regard to SBP, diastolic blood pressure, and HR. Hence, low-dose ketamine, when used as a premedicant, is an effective agent that can be used in preventing post-spinal intraoperative hypotension in parturients undergoing cesarean section delivery.

Changes in Salivary Oxytocin Level of Term Pregnant Women after Aromatherapy Footbath for Spontaneous Labor Onset: A Non-Randomized Experimental Study.

Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women. In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels. In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups. The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.

Comparison of the efficacy between controlled-release dinoprostone delivery system (PROPESS) and Cook's double balloon catheter plus oxytocin: A retrospective single-center study in Japan.

To compare the efficacy of the controlled-release dinoprostone delivery system (PROPESS) and Cook's double balloon catheter (DBC) plus oxytocin as induction treatment. A total of 197 term pregnant women with unfavorable cervix were admitted for scheduled induction and enrolled retrospectively (PROPESS, 113; Cook's DBC plus oxytocin, 84). The main birth outcomes were cervical ripening at the treatment-end and 24 h after the treatment-start, and rate of vaginal birth. Logistic regression and propensity score matching analyses were performed to evaluate the association between the outcomes and clinical characteristics including which treatment was selected. The choice of PROPESS was associated with the success of cervical ripening at 24 h after (adjusted odds ratio (OR) 2.17, 95% confidence interval (CI) 1.11-4.26, p = 0.024) and increased the rate of vaginal birth (adjusted OR 2.03, 95% CI 1.04-3.98, p = 0.039). Similar trends in the association between PROPESS and birth outcomes were maintained after adjusting for propensity scores (p = 0.072 and p = 0.163, respectively). However, some of the women with gestational age of early 39 weeks and low Bishop scores could achieve cervical ripening at 24 h after using Cook's DBC plus oxytocin, and none by PROPESS. Our findings suggest the possibility of slight advantages of PROPESS for scheduled induction of labor. In women with early term and extremely low Bishop scores, Cook's DBC plus oxytocin may be a superior or alternative treatment to PROPESS. Therefore, the optimal choice of induction treatment should be managed on an individual basis.

Evaluating Ultrasonography Fetal Weight in Comparison to Actual Birth Weight in Term Pregnant Women at Tertiary Care Center Hospital

Background: Prenatal mortality is very high in Pakistan. One of the most reasons is low birth weight and preterm babies. Hence, estimating the baby's weight is paramount in antennal care. Birth weight refers to the body weight of a newborn. Multiple elements, like genetics epigenetics, nutritional and environmental factors can influence fetal weight. Ultrasonography is an important non-invasive tool for fetal weight estimation in normal and high-risk pregnancies. The role of ultrasound as a safe and non-invasive measurement for fetal growth and weight in pregnancy is well established. Objective: To determine the relationship between Sonographic fetal weight estimation in the prenatal period and definite birth weight in pregnant women in a multidisciplinary hospital set up Study design: A comparative study Place and Duration: Study was conducted in Department of Radiology, Chiniot General Hospital Korangi Karachi from January 2022 to June 2022 for six months duration. Methodology: The sample size is 50. Expecting mothers were taken in this study. These women were booked and they underwent an ultrasound examination of fetal weight in a prenatal period which was then correlated to actual fetal weight after birth by a pediatrician. Fetal weight was estimated and noted. It was measured by using. Hadlock's formula: log (10) birth weight = 1.335-0.0034(abdominal circumference) (femur length) + 0.0316 (Biparietal diameter) +0.0457(abdominal circumference) +0.1623(femur length). Results: Most of our patients were between 20-30 year age brackets. There was a strong linear relationship between ultrasound fetal weight and real birth weight. The mean age of females was 26.12±5.65 years, and the mean BMI of patients was 26.17±4.19kg/m2. A strong positive correlation (r=0.575, p<0.05) was found between the fetal weight estimation on USG and actual birth weight. Conclusion: This study shows that ultrasound can be a valuable method of assessing fetal weight in pregnant women. Hence ultrasound can be used for informed decision-making for birthing decisions in expecting mothers. Keywords: Correlation, Ultrasonography, Birth Weight, Fetal

Sub-hypnotic dose of midazolam is effective in reducing intraoperative nausea and vomiting during cesarean sections under spinal anesthesia

Background & Objectives: Intra and postoperative nausea and vomiting under regional anesthesia is a common problem in cesarean sections. Globally, the incidence has been documented to be from 40−80%, and various drugs have been used to control it. We aimed to determine if a subhypnotic dose of midazolam will be effective to reduce intraoperative nausea and vomiting during an elective cesarean section under spinal anesthesia.
 Methodology: A randomized interventional study was done through a period of 6 months from March 11, 2019 to September 11, 2019 and included 100 full term pregnant women undergoing elective cesarean sections (CS) under spinal anesthesia. The participants were allocated to one of two groups: Midazolam group (received midazolam 1 mg bolus then 1.0 mg/h infusion after umbilical cord clamping), and placebo group (received normal saline). Bellville score was used to evaluate nausea and vomiting (N/V). The hemodynamic parameters were monitored at three-minute intervals.
 Results: No statistically significant differences were noted between study groups regarding mean arterial pressure, heart rate and total ephedrine used in the two groups. Intraoperative nausea and vomiting were recorded midazolam (81.6%) with a significant association between prevention of intraoperative N/V and receiving midazolam. Insignificant association was noticed between the level of sedation and receiving midazolam.
 Conclusion: Administration of low dose of midazolam during cesarean sections under spinal anesthesia can lessen intraoperative nausea/vomiting without significantly effect on blood pressure or heart rate and without any negative side effects.
 Abbreviations: BMI – Body Mass Index; CS - Cesarean Section; LA – Local Anesthesia; N/V - Nausea/Vomiting; RASS - Richmond Agitation Sedation Score SA - Spinal Anesthesia
 Key words: Nausea; Vomiting; Anesthesia, Spinal; Midazolam; Cesarean Section
 Citation: Ibrahem IG. Sub-hypnotic dose of midazolam is effective in reducing intraoperative nausea and vomiting during cesarean sections under spinal anesthesia. Anaesth. pain intensive care 2023;27(4):485−489; DOI: 10.35975/apic.v27i4.2087
 Received: October 12, 2022; Reviewed: May 16, 2023; Accepted: June 23. 2023

Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections

Background & Objective: There is an increased ratio of cesarean sections (CS) compared to normal deliveries the world over. Both general and regional anesthetic techniques are in practice for CS. Limited information is available on the determination of blood cholinesterase (ChE) activity in conjunction with oxidative stress biomarkers after the CS. The purpose of the present study was to determine and compare the plasma and erythrocyte ChE activity as well as malondialdehyde (MDA) level and total antioxidant status in pregnant women before anesthesia and after the use of general anesthesia (GA) or spinal anesthesia (SA) for elective CS.
 Methodology: A pre-post study was conducted on 102 full-term pregnant women, who underwent elective CS in four hospitals at Duhok (Iraq) from January 2022 to July 2022. GA with propofol and SA with bupivacaine 0.5% were administered to 52 and 50 women, respectively. Maternal blood samples before anesthesia and after the completion of operation were assayed for the ChE activity in the plasma and erythrocytes, and plasma oxidative stress biomarkers malondialdehyde and total antioxidant status.
 Results: Plasma ChE activity significantly decreased in the GA and SA groups after the cesarean-deliveries compared to the corresponding pre-anesthetic values. The plasma MDA level in both GA and SA groups, but not the total antioxidant status, was significantly reduced. Estimation of the odds ratio and the relative risk indicated that a risk factor is associated with the reduced plasma ChE activity in women after the CS when the general anesthetic propofol is used.
 Conclusion: Both general anesthesia with propofol and spinal anesthesia with bupivacaine inhibited plasma cholinesterase activity and reduced oxidative stress biomarker malondialdehyde after the cesarean sections.
 Abbreviations: CS - Cesarean section; ChE: Cholinesterase; EChE: Erythrocyte Cholinesterase; MDA: Malondialdehyde; OS: Oxidative Stress; PChE: Plasma ChE; TAS: Total Antioxidant Status.
 Key words: Anesthesia, Spinal; Cesarean section; General anesthesia; Malondialdehyde; Oxidative stress
 Citation: Karam RS, Mohammad FK. Changes in blood oxidative stress biomarker and cholinesterase activity after general vs spinal anesthesia for elective cesarean sections. Anaesth. pain intensive care 2023;27(3):396−404; DOI: 10.35975/apic.v27i3.2244
 Received: March 23, 2023; Reviewed: May 06, 2023; Accepted: May 09, 2023

Effects of Right Lateral Position on Changes of Fetal Hemodynamics in Late Pregnancy.

We aim to evaluate the effect of right lateral position on fetal hemodynamics (including umbilical artery [UA] and middle cerebral artery (MCA) blood flow-velocity waveform). In total, 150 low-risk singleton full-term pregnant women were included in the study from November 2021 to January 2022. Doppler flow velocity waveforms of the fetal UA and MCA tested by ultrasound were collected in gestation of 37-40 weeks. Computational analysis was performed using the one-way ANOVA test. Compared with the maternal left lateral position, there was a significant increase in Doppler indices of UA-RI (P = .033), UA-S/D (P = .019) and MCA-PSV (P = .021) and a significant decrease in MCA-RI (P = .030) in the supine position group. There was no statistical significance in all Doppler indices between the left and right lateral position (P > .05). Among the Doppler indices of three different maternal positions, there was no significance in both UA-PI and MCA-PI (P > .05). There were no significant differences on changes of the fetal hemodynamics between left and right lateral positions. Pregnant women could adopt to lie in the left or right lateral position alternately to relieve the discomfort in late pregnancy.

The analgesic effect of transmuscular quadratus lumborum block versus erector spinae plane block for women undergoing elective Caesarean section: A randomized controlled trial.

We aimed to compare the analgesic effect and quality of recovery of transmuscular quadratus lumborum block (QLB) and erector spinae plane block (ESPB) in the presence of multimodal analgesia following Caesarean section. This randomised controlled trial included full-term pregnant women who underwent elective Caesarean section under spinal anaesthesia without intrathecal morphine. The included women were randomised to receive either bilateral QLB (n = 51) or bilateral thoracic ESPB (n = 51), in addition to the control group (n = 51) who did not receive any block. All participants received regular paracetamol (1g/6h) and diclofenac (50mg/8h). Intravenous morphine was used as a rescue analgesic. The primary outcome was time to first morphine requirement. Secondary outcomes included total postoperative morphine consumption and total Obstetric Quality of Recovery-11 (ObsQoR-11) score. We analysed 51, 50 and 48 patients in the QLB, ESPB and control groups, respectively. The time to first morphine requirement in both QLB and ESPB groups was longer than that in the control group (median [quartiles] time: 6 [6,12] h, 6 [6,6] h and 4 [3,4] h, respectively; p-value <0.001), without significant differences between the two former groups. The total morphine consumption in both QLB and ESPB groups was lower than that in the control group (median [quartiles]:0 [0,5] mg, 0 [0,5] mg and 25 [25,30] mg, respectively; p-value <0.001), without significant differences between the two former groups. The QLB and ESPB groups had comparable ObsQoR-11 score, and both groups' scores were higher than the control group. In patients undergoing elective Caesarean section under spinal anaesthesia without intrathecal morphine, both QLB and ESPB provided superior analgesia and quality of recovery compared to the standard care, without significant difference between the two blocks.

Comparing delayed cord clamping and umbilical cord milking during elective cesarean section for the neonatal outcome.

to compare between immediate cord clamping, delayed cord clamping, and umbilical cord milking and their effects on hemoglobin and bilirubin level in term infants in cesarean section. A randomized clinical trial was conducted from November 2021 to June 2022, including 162 full term pregnant women undergoing elective cesarean section at EL-Shatby Maternity University Hospital. They were randomly assigned (1:1:1 ratio) either to immediate cord clamping just after delivery (Group 1) or delayed cord clamping for 30s (Group 2) or umbilical cord milking 10 times for 10-15s (Group 3). The primary outcome measures included hemoglobin and hematocrit levels of the newborn at birth and the secondary outcome was bilirubin level measurement at 72h of life. one hundred sixty- two newborns were randomized into 3 groups, fifty-four cases in each, and were investigated on hemoglobin and hematocrit levels; five were lost to follow-up and one hundred fifty-seven were tested for bilirubin. Participants among groups had no significant difference regarding demographic and clinical characteristics, regarding the hemoglobin at birth it was significant higher in the umbilical cord milking group (Group 3) through all groups (14.91±0.91g/dl vs15.38±0.74g/dl vs 16.56±1.03g/dl, p value <0.001), regarding hematocrit level at birth it was significant in the umbilical cord milking group (Group 3) through all groups (44.71±2.94 vs 46.48±2.61 vs 49.74±3.26, p value <0.001). On the other hand, bilirubin level after 72h had no significant different through the 3 groups (8.80(IQR 4.50-17.20), vs 9.70(IQR3.50-14.70), vs 8.50(IQR 3.20-19.50), respectively p value=0.348). this study showed that umbilical cord milking 10 times for 10-15s is more effective than delayed cord clamping for 30s in enhancing hemoglobin and hematocrit levels in newborn delivered by cesarean section with no significant difference on bilirubin level in the newborn.

Impact of Maternal Essential Fatty Acid Intake on the Birth Weight of Infants.

Increased uptake of essential fatty acids during pregnancy through seafood and supplementation has been shown to positively correlate with gestational age and increased infant birth weight. We aimed to evaluate the effect of maternal dietary intake of essential fatty acids, supplementation on gestational period and infant birth weight. A literature search with the help of various databases such as PubMed, Google Scholar, Web of Science and Scopus was conducted. Original research articles and intervention-based studies, which involve an association between dietary intake and supplementation of essential fatty acids during full-term pregnancy on human infant birth outcomes and published from 2011 to 2021, were included. In total, there were 21 intervention-based studies, including full-term pregnant women with or without existing comorbidities, which compared essential fatty acids in the form of dietary sources and supplementation with dietary counseling and with or without placebo. The intervention trials included in this review were conducted in developed and developing countries. Half of the pregnant women who enrolled in the study had comorbidities such as diabetes and hypertension, which might increase their risk of adverse maternal and infant birth outcomes. Most of the studies included in the review have reported a positive association between improvised dietary and supplementation intake of essential fatty acids with increased length of gestation, infant birth weight and other parameters such as head circumference, infant birth length and growth velocity. Positive correlations were found between increased consumption of essential fatty acids in food sources and supplements with improvised infant birth weight and gestational period.

8-Hydroxy-2-deoxyguanosine, a product of oxidative DNA degradation, is increased in the amniotic fluid of preterm births.

8-Hydroxy-2-deoxyguanosine (8-OH-2dG) is a measurable biomarker of oxidative DNA damage. This study was designed to determine amniotic fluid 8-OH-2dG levels in healthy full-term pregnant women and preterm pregnant women. To reveal the effect of reactive oxygen species on 8-OH-2dG levels, amniotic fluid total oxidant capacity (TOS), total antioxidant capacity (TAC) and oxidative stress index (OSI) were also measured. A total of 60 patients, 35 patients with full-term pregnancy and 25 patients with preterm pregnancy, participated in the study. Labor occurring before 37 weeks of gestation was considered as spontaneous preterm birth. Amniotic fluid samples were collected from full-term patients during cesarean section or normal vaginal delivery. 8-OH-2dG concentrations in amniotic fluid samples were measured quantitatively by Enzyme-Linked Immunosorbent Assay (ELISA). Amniotic fluid total antioxidant capacity (TAC) and total oxidant capacity (TOC) was determined in amniotic samples. The amniotic fluid 8-OH-2dG levels of the preterm group were significantly higher than the full-term group (60.8±7.02 ng/mL vs. 33.6±4.11 ng/mL, p<0.01). Similarly, TOC levels of the preterm group were significantly higher than the full-term group (89.7±4.80 µmol/L vs. 54.3±6.60 µmol, p<0.02). TAC was significantly higher in the full-term group compared to the preterm group (1.87±0.10 mmol/L vs. 0.97±0.44 mmol/L, p<0.01). The OSI values of the preterm group were significantly higher than the full-term group. A negative and significant correlation was found between gestational age and amniotic fluid 8-OH-2dG levels in the full-term pregnancy group (r=-0.78, p<0.01). A negative and significant correlation was observed between TAC and amniotic fluid 8-OH-2dG levels in the full-term group (r=-0.60, p<0.02). A positive and significant correlation was also detected between TOC, OSI and amniotic fluid 8-OH-2dG levels in the full-term group. There was a negative but insignificant correlation between fetal weight and amniotic fluid 8-OH-2dG levels. The correlation analysis results of the preterm pregnancy group were similar to the full-term group. Increased reactive oxygen derivatives in preterm birth increase amniotic fluid levels of DNA degradation product 8-OH2dG and may lead to premature rupture of fetal membranes. This is the first clinical study investigating 8-OH-2dG levels in amniotic fluid of preterm birth.

Correlation between vitamin D intake with level of 25-hydroxy vitamin D serum maternal

Vitamin D deficiency is a health problem that is of concern at this time. During pregnancy, vitamin D is associated with fetal growth and development, wherein the 25(OH)D level of the fetus is completely dependent on the mother's supply. This study aims to examine the relationship between vitamin D intake and maternal serum 25(OH)D levels. This research uses a cross-sectional design. Data collection was carried out in samples at Hermina Hospital, BMC and Army Hospital in June-December 2022. The sampling technique used consecutive sampling, totaling 40 term pregnant women. Data collection was carried out by taking maternal blood. Data on vitamin D intake were obtained from interviews using the FFQ questionnaire. Maternal serum was examined using the ELISA method at the Unand Biomedical Laboratory. The test used is Pearson correlation The results showed that the mean intake of vitamin D and levels of 25(OH)D in maternal serum were 16.54 ± 2.99 mcg, 14.74 ± 4.93 ng/ml. The relationship between vitamin D intake and maternal serum 25(OH)D levels with a value of r=0.379 was significantly ρ=0.016. The conclusion of this study was that the correlation between vitamin D intake and maternal serum 25(OH)D levels was significantly correlated

Quantitative strain elastography of the uterine cervix assessed by the GE Voluson E10 system in combination with a force-measuring device

Objective During pregnancy, the stiffness of the cervical tissue decreases long before the cervical length decreases. Therefore, several approaches have been proposed in order to ensure a more objective assessment of cervical stiffness than that achieved by digital evaluation. Strain elastography has shown promising results. This technique is based on an ultrasound assessment of the tissue deformation that occurs when the examiner applies pressure on the tissue with the ultrasound probe. However, the results are only semi-quantitative as they depend on the unmeasured force used by the examiner. We, therefore, hypothesized that a force-measuring device applied to the handle of the ultrasound probe may render the technique quantitative. With this approach, the stiffness is the force (measured by the device) divided by the compression (measured by the elastography platform). One perspective is the early identification of women at risk of preterm birth in whom cervical stiffness may decrease long before cervical shortening. Another perspective is cervical evaluation when planning labor induction. In this feasibility study, we aimed to evaluate how quantitative strain elastography performs when a commercially available strain elastography platform (by which the algorithm is unavailable) is combined with a custom-made, force-measuring device. We studied how the assessments were associated with the gestational age in women with uncomplicated pregnancies and how they were associated with cervical dilatation time from 4 to 10 cm in women undergoing labor induction. Methods In the analysis, we included quantitative strain elastography assessments from 47 women with uncomplicated singleton pregnancies, with gestational age between 12+0 and 40+0, and from 27 singleton term-pregnant women undergoing labor induction. The force-measuring device was mounted on the handle of a transvaginal probe. The strain values (i.e. the compression of the cervical tissue) were obtained by the elastography software of the ultrasound scanner (GE Voluson E10). The region of interest was placed within the central part of the anterior cervical lip. Based on the force data and strain values, we calculated the outcomes cervical elastography indexGE (CEIGE ) and the cervical strength indexGE (CEIGE x cervical length: CSIGE ). Results The average CEIGE was 0.24 N at week 12 and 0.15 N at week 30–34. For CSIGE these figures were 8.2 and 4.7 N mm, respectively (p = 0.002). Among women undergoing labor induction, the CEIGE was associated with a cervical dilatation time (4–10 cm) beyond 7 h. For nulliparous women, this area under the ROC curve was 0.94. Conclusion Quantitative strain elastography may constitute a tool for the evaluation of a uterine cervix with normal length in women at risk of preterm birth and in women undergoing labor induction. The performance of this tool deserves evaluation in larger clinical trials.

Role of Matrix Metalloproteinase–9 in the Pathogenesis of Preeclampsia

Objectives: The goal of this research was to investigate whether metalloproteinases could be used as predictors of preeclampsia (PE) during pregnancy. Materials and Methods: This case-control study included 100 pregnant women which they further grouped into PE and control group (each composed of 50 women). Both groups were further subdivided according to their gestational age (GA), using the 37th week of gestation as a divider, as preterm and term infants. Results: In both preterm (P=0.001) and term infants (P=0.001), mean metalloproteinase-9 (MMP-9) was considerably lower in PE mothers compared to controls, with the difference being greater in preterm infants. In ROC analysis, MMP-9 showed excellent ability to predict PE in preterm infants (AUC = 0.980, cut-off ≤26.2) and good ability to predict PE in term infants (AUC 0.770, cut-off ≤ 34.4). Conclusions: The matrix MMP-9 is a non-specific predictor of PE for term and preterm pregnant women, with higher accuracy for preterm pregnant women.

Histological changes in the amniotic membrane structure of gestational diabetic women’s’ in comparison with pregestational diabetic and non-diabetic women

The main objective of this study was to compare the demographic characteristics and histological changes in the amniotic membrane (AM) of gestational diabetes mellitus (GDM), pregestational diabetes mellitus (PGDM), and non-diabetic women. A total of thirty AM samples (n = 10 for each group) were obtained from full-term pregnant women without any complications. These samples were processed for paraffin blocks, sectioned, and stained with H&amp;E. The results of demographic characteristics showed the mean maternal age of the PGDM and GDM groups was significantly higher compared with the control. Neonatal weight decreased significantly in the PGDM group, but both diabetic groups showed no significant differences between them in terms of maternal age and neonatal weight. A random blood sugar (RBS) test and WBC count showed a highly significant increase in GDM and a significant increase in PGDM. The highest significant value of RBC was recorded for PGDM. The thickness of the epithelial layer plus the basement membrane (BM) was significantly increased due to the PGDM. while the compact layer plus the fibroblast layer and the total thickness of AM showed a significant increase in GDM. The nucleus diameter of AM epithelial cells was significantly decreased in diabetic groups. The histological examination revealed that both diabetic groups caused several changes and damage in AM, including: hypertrophy and hyperplasia in epithelial cells associated with the formation of the vacuole between them; degeneration of some of these cells that pinched off from the lining epithelium; breakdown of the compact and fibroblast layers and caused damage to the stromal collagen fibril; epithelial cells and their nuclei became elongated and resembled columnar epithelium; and the basement membrane appeared thicker in comparison to the control group. In conclusion, GDM and PGDM induced various alterations and damage to the AM, which in turn delayed embryonic development and the delivery.

A descriptive study to assess the difference between estimated fetal weight using Johnsons formula and the actual birth weight of newborn babies born to women availing maternity services in a tertiary care hospital, Haryana

Introduction: Knowledge about weight of the fetus in-utero is important for the health care professionals to decide upon the antepartum as well as intrapartum initiatives and thereby reducing fetal complications. Johnson’s formula is one of the important and easiest methods of clinical estimation of fetal weight. The aim of the study was to assess the difference between estimated fetal weight calculated by Johnson’s formula and actual birth weight of newborns, to associate and correlate selected maternal and fetal variables with the estimated fetal weight and actual birth weight. Methods: The study sample was 110 term pregnant women in labour and their just born babies. Research approach - quantitative non-experimental descriptive. Tool - data sheet. Data analyzed using descriptive and inferential statistics.Result: The difference between estimated fetal weight and Actual birth weight had a mean of 774.9 and SD ± 403.21. Study revealed that the estimated fetal weight using Johnson’s formula had a difference in comparison with the actual birth weight of babies (371.69 to 1178.1).Discussion: Obstetric Score (OS) Mean 1.59 SD ± 0.76, Period of Gestation (POG) Mean 39 SD ± 1.2. Pre-delivery Weight Mean 64.5 SD ± 9.839. Post-delivery Weight Mean 61.4 SD ± 9.28. Estimated fetal weights (EFW) range 2945 to 4340gms. (Mean 3800.7 SD ± 295.9), Actual birth weight (ABW) range 2120gms to 4145gms (Mean 3025.8 SD± 388.5). Placental Weight Mean 516 SD ± 112.7. Chi square test revealed that there was no association between obstetric score, period of gestation and estimated fetal weight. Similarly Fisher’s exact test revealed that there was no association between obstetric score, period of gestation and actual birth weight.