Term Pregnant Women Research Articles

Depolarization imaging for fast and non-invasive monitoring of cervical microstructure remodeling in vivo during pregnancy

The cervix plays a crucial role in conception, maintenance of pregnancy, and childbirth. The mechanical properties of a pregnant woman's cervix change dramatically during gestation due to a remodeling of its microstructure, necessary for delivery. However, external factors can accelerate this process and lead to prematurity, the primary cause of perinatal mortality worldwide, due to the inefficiency of existing diagnostic methods. This study shows that polarized light is a powerful tool to probe the cervical microstructure during pregnancy. A wide-field multispectral polarimetric imaging system was fabricated to explore in vivo the cervix of full-term pregnant women. The polarimetric properties of the cervix change significantly with pregnancy progression. In particular, a set of several depolarization parameters (intrinsic and extrinsic) showed a strong linear correlation with gestational age in the red part of the visible spectral range. This trend can be attributed, among other things, to a decrease in collagen density and an increase in hydration of cervical connective tissue. Wide field depolarization imaging is a very promising tool for rapid and non-invasive analysis of cervical tissue in vivo to monitor the steady progression of pregnancy, providing the practitioner with useful information to improve the detection of preterm birth.

Association Between Zinc Level and Prelabour Rupture of Membranes

Background: Assessment of micronutrients in pregnant women particularly ZINC and whether its concentration is different between term and preterm birth is important to optimize the normal pregnancy and to reduce the incidence of pregnancy complications, especialy preterm labour and pre labour rupture of membrane. Objectives: Assessment of correlation between maternal serum ZINC level and the prelabour rupture of membrane in both preterm and term pregnant women. Study Design: Case control study. Materials and Methods: A case control study performed in Al-Imamain Al- Kadhumain Medical City/Obstetrics and Gynecology department from 1st of February to 1st of November 2019, Including 400 pregnant women their gestational age ranged between (24 to 42) divided in to 4 group: group A, group B, group C, group D which all undergo serum Zinc level measurement. Result: The mean ± SD of serum ZINC in group A which include the preterm prom, which is less than the control group (B) preterm intact membranes which, and the mean ± SD of serum zinc of group (C) which include the term prelabour rupture of membranes which is less than group (D) which is the control group of group (C) term intact membranes. This study shows significant relationship between ZINC deficiency and prelabour rupture of membrane in both term and preterm pregnant women at a P value< 0.001 and <0.001 respectively, also this study show inverse relationship between serum zinc and increasing parity, maternal age, vaginal infection, and BMI. Conclusion: Pregnant women with prelabour rupture of membranes wether term or preterm tend to have lower Zinc level. Increasing maternal age, increasing parity, high BMI, vaginal infection are associated with low Zinc.

Differences in cognition, short-chain fatty acids and related metabolites in pregnant versus non-pregnant women: a cross-sectional study

BackgroundPregnancy induces cognitive reorganization which can lead to mental disorders. The aim of this study is to determine differences in cognitive scores, short-chain fatty acids (SCFAs) and related metabolites between pregnant and non-pregnant participants.MethodsThis cross-sectional study included 67 full-term pregnant women and 31 non-pregnant women. We compared scores of mental state and cognitive assessment tests, as well as serum concentrations of SCFAs, hormones, inflammatory factors, and neurotransmitters between these groups.ResultsScores for information processing speed, immediate visual memory, motor response speed and accuracy, execution ability and verbal use ability in the pregnant group were lower than those in the non-pregnant group (p < 0.05 for all tests). Total serum SCFAs in the pregnant group were significantly lower than those in the non-pregnant group (P = 0.031). Among them, acetate and propionate were significantly decreased (P = 0.013 and 0.037, respectively) whereas butyrate was significantly increased (P = 0.035). Serum peptide YY, glucagon-like peptide-1, γ-aminobutyric acid, and dopamine showed no differences between the two groups. However, cortisol, adrenocorticotropic hormone, and acetylcholine were significantly increased in the pregnant group as compared with the non-pregnant group (P = 0.039, 0.016, and 0.012, respectively). Tumor necrosis factor-α was increased and interleukin-10 significantly decreased in the pregnant group (P = 0.045 and 0.019, respectively).ConclusionAccording to our study findings, cognitive reorganization in the third trimester of pregnancy showed that both the passive storage capacity of working memory and the executive function of online information processing were decreased to varying degrees. At the same time, the changes in total SCFAs, the proportions of SCFAs and related metabolites were also detected. These changes in the internal environment may be increasing the risk of perinatal mental illness.

Comparison of Hemodynamic Changes after Use of Intrathecal 0.75% Hyperbaric Bupivacaine Versus 0.5% Hyperbaric Bupivacaine with Dexmeditomidine in Patients Undergoing Cesarean Section

Objective: To compare analysis of hemodynamic changes after use of intrathecal 0.75% and 0.5% hyperbaric bupivacaine with dexmedetomidine in cesarean section patients. Study Design: Comparative analytical study Place and Duration of Study: Divisional Headquarters Teaching Hospital Mirpur from 1st April 2020 to 30th April 2021. Methodology: Seventy women were enrolled as study participants. Full term pregnant women between the age of 20-35 years were enrolled. These women were further grouped into two major groups with both groups having equal number of participant (35 in each group). Group A consisted of those women who were given 12mg of 0.5% hyperbaric bupivacaine with 1µg dexmedetomidine while Group B women were intervened with 12mg 0.75% hyperbaric bupivacaine. The localized anesthesia with 2-3ml xylocaine (2%) was administered within intended space in all patients. A 25-gauge needle was used post confirmation of the free cerebrospinal fluid flow. Patient’s vital signs were continuously monitored. Results: The mean age was 31±4 years in group A while it was 27±4 year in group B. The post-operative parameters presented a decrease in blood pressure among both group women. The pulse rate showed that group A had slight higher reduction in pulse than group B however the difference was not significant (p=0.46).Both groups required ephedrine injections for substantial decrease in blood pressure. Conclusion: Patients administered with 0.75% hyperbaric bupivacaine for lower segment caesarean section showed significant and relevantly more hemodynamic alterations than 0.5% hyperbaric bupivacaine with Dexmedetomidine. Keywords: C-section, Spinal anesthesia, Adjuvants, Hemodynamic changes

Sezaryen doğumlarda spinal anesteziye bağlı hipotansiyonu önlemede bolus doz norepinefrin efedrin kadar etkili midir?

Objective: Spinal anesthesia is the preferred technique in cesarean delivery. Hypotension (&gt;80%) is the most common and concerning adverse effect (&gt;80%) if no prophylaxis is given, which is major cause of maternal and fetal morbidity. Current literature suggests that vasopressor therapy is mainstay in prevention and management of spinal anesthesia-induced hypotension. Here, we aimed to compared effects of prophylactic intravenous ephedrine and norepinephrine boluses on hypotension incidence in elective cesarean delivery under spinal anesthesia. &#x0D; Method: The study included 62 term pregnant women (ASA II) with baseline systolic blood pressure (SBP) of 90-140 mmHg who were scheduled for elective cesarean section under spinal anesthesia. Ephedrine (10 mg, IV bolus) and norepinephrine (6 µg, IV bolus) were given simultaneously with spinal induction in group E and N, respectively. Hypotension was defined as SBP below 90% of baseline value (10% decrease from baseline) and respective agents in each group were given at same doses for treatment.&#x0D; Findings: Hypotension incidence was comparable in group E and N (64.5% vs. 74.2%, respectively). Severe hypotension (defined as SBP

Term Pregnancy Women with Human Immunodeficiency Virus Infection Receiving Antiretroviral Threapy as A Risk Factor for Low Expression of Mitochondiral Deoxyribose-Nucleic Acid in Placenta

Antiretroviral therapy (ART) given to pregnant women with Human Immunodeficiency Virus (HIV) has the effect of mitochondrial DNA (mtDNA) depletion through several steps, either directly or indirectly. This decrease may trigger the occurrence of reactive oxygen species (ROS) and mitochondrial toxicity which are characterized by energy insufficiency, cell dysfunction, and maternal and placental apoptosis. This study aimed to determine whether term pregnant women with HIV infection receiving antiretroviral therapy are risk factors for low mtDNA expression in the placenta. This cross-sectional analytic study was conducted at Sanglah Hospital Denpasar and affiliation hospitals. Inclusion samples were termed pregnant women with HIV (+) who received ART ≥ 6 months as a risk group and pregnant women with HIV (-) as a non-risk group. Expression of mtDNA was assessed by real-time Polymerase Chain Reaction (rtPCR) examination of placental samples. The estimated relative amount of mtDNA was calculated by dividing the number of mtDNA to the number of nDNA, as a reference. The cut-off value of mtDNA expression was determined by plotting a Receiver Operating Characteristics (ROC) curve. The results of the analysis found that pregnant women with HIV who received ART≥6 months had a prevalence of low mtDNA expression by 2.83 times higher than pregnant women without HIV (95% confidence interval = 1.42 – 5.67; p-value = 0.000). The conclusion of this study is that term pregnant women with HIV infection who receive ART is a risk factor for low mtRNA expression in the placental.

A snapshot of women's and clinicians' perceptions of the double balloon catheter for induction of labor.

INTRODUCTIONInduction of labor (IOL) is rising globally and is growing steadily in the state of New South Wales, Australia. There are numerous methods of induction of labor, including the double balloon catheter (DBC). There is minimal evidence on women’s attitudes and experiences and clinician’s opinions on the use of the DBC. This study aims to explore the views regarding DBC insertion and effectiveness from women induced with a DBC and clinicians involved in the catheter insertion and care.METHODSThis study is a descriptive survey of two prospective, de-identified, self-reported questionnaires which were completed in 2016. One questionnaire was administered to term pregnant women that were admitted to the antenatal ward post IOL, and the other was completed by midwives and obstetric doctors working in the ward at the time.RESULTSThe DBC appeared to be a well-accepted method of cervical ripening among women (61%) and clinicians (>82%). Success of DBC to achieve an artificial rupture of membrane post removal, directly correlates to women’s acceptance (61%). While most clinicians (59–67%) perceived insertion of DBC in an outpatient setting and then women discharged home was appropriate, only 13% of women were in favor. On the logistics of the procedure in respect to insertion and removal of the DBC, there were differences of opinion, with only 43% of women, 77% of midwives and 33% of doctors stating that the timing of insertion and removal needed to be improved.CONCLUSIONSThis study highlights the need to undertake qualitative research to further explore women’s views and perceptions on IOL in order to ensure that clinical practice is woman-centered and evidenced-based, and to guide policy and protocol.

Aterm Pregnant Women with Human Immunodeficiency Virus Infection Which Receive Antiretroviral Therapy Combination of Nucleoside Analogue Reverse Transcriptase Inhibitor as A Risk Factor of High Expression of Apoptosis Including Factors

Aim: To determine whether term pregnant women with human immunodeficiency virus infection who received antiretroviral therapy had high apoptosis inducing factor expression in the placenta. Methods: This cross-sectional analytical study was conducted at Sanglah General Hospital, Denpasar, and educational network hospitals. Subjects collected were termed pregnant women with HIV (+) who received antiretroviral therapy (ART) 6 months as a risk group and pregnant women with HIV (-) as a non-risk group. AIF expression was assessed by immunohistochemical examination of placental tissue. The AIF expression cut-off value was determined by constructing a receiver operating characteristics (ROC) curve. The chi-square test assessed the difference in proportion by displaying the prevalence ratio (RP) results. The significance of this study was p&lt;0.05. Results: 40 pregnant women were included in the risk and no-risk groups. There was no difference in age, gestational age, parity and BMI in the two groups. The mean AIF expression was significantly higher in the group with HIV (+) (162±52.5) ​​than HIV (-) (126.75±61.4), p-value = 0.003. The cut-off value of AIF expression was 112.50, with a sensitivity of 80% and a specificity of 45%. After classification, a significantly higher proportion of AIF expression was found in the HIV (+) group (42.5%) than in the HIV (-) group (27.5%) with p=0.038. Pregnant women with HIV (+) and receiving antiretroviral therapy for six months had a 4.6 times higher chance of having a high AIF prevalence than pregnant women who were not infected with HIV (RP=4.63; 95% CI=1.023 – 21.004). Conclusion: Term pregnant women with HIV infection who received antiretroviral therapy had high AIF expression in the placenta.

Aterm Pregnancy Woman with Human Immunodeficiency Virus Infection and Antiretroviral Therapy as Risk Factor of High Caspase-3 Expression in Placenta

Aim: To determine whether term pregnant women with human immunodeficiency virus infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta. Methods: This cross-sectional analytical study was conducted at Sanglah General Hospital, Denpasar, and affiliated hospitals. Subjects were termed pregnant women with HIV (+) who received a minimum of six months of antiretroviral therapy as a risk group and pregnant women with HIV (-) as a non-risk group. Caspase-3 expression was assessed by immunohistochemical examination of placental tissue. The cut-off value for caspase-3 levels was determined by constructing a receiver operating characteristics (ROC) curve. The difference in proportion was assessed by the chi-square test, and the prevalence ratio (PR) was reported. The significance of this study was p&lt;0.05. Results: Each 20 pregnant women were included in the risk and no-risk groups. There was no difference in age, gestational age, parity, and body mass index (BMI) between the two groups. The mean expression of caspase-3 was significantly higher HIV (+) group than in the HIV (-) group (162.62 vs. 105.83; p = 0.000). The selected cut-off value of Caspase-3 was 127.05, with a sensitivity of 75% and a specificity of 75%. After classification, a significantly higher proportion of Caspase-3 expression was found in the HIV (+) group than in the HIV (-) group (75% vs. 25%; p=0.002). Pregnant women with HIV (+) and receiving antiretroviral therapy for a minimum of six months had a three times higher chance of having a high Caspase-3 prevalence than pregnant women who were not (RP=3.0; 95% CI = 1.348 – 6.678). Conclusion: Pregnant women with HIV infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta.

Role of intrapartum amnioinfusion in meconium-stained amniotic fluid

Background: Intrapartum amnioinfusion in meconium-stained amniotic fluid has been known to dilute the meconium and prevent meconium aspiration syndrome (MAS). However, the literature available on intrapartum amnioinfusion is varying. Objective: To assess the neonatal outcomes following intrapartum transcervical amnioinfusion in full-term pregnant women. Methods: This case-control study included pregnant women in active labor, divided into case group (n=63) receiving amnioinfusion and control group (n=63) without amnioinfusion. In the case group, 500 mL of warm, normal saline was infused into the uterine cavity. Both groups were compared for liquor quality, mode of delivery, and neonatal outcomes like APGAR score, resuscitation, meconium presence, MAS, neonatal intensive care unit (NICU) admission, and length of NICU stay. Chi-square test was used to analyze the difference between cases and controls. Results: Mode of delivery was spontaneous vaginal delivery in most cases (71%), with only 19% undergoing cesarean section. APGAR score at 1 min was &gt;7 in cases compared to controls, which was significant (12.69% vs 0%, P=0.005). Resuscitation was required less in cases than controls (9.52% vs 50.79%, P&lt;0.001). Presence of meconium below the vocal cord was more in controls (34.92% vs 4.76%, P=0.003). MAS was observed more in controls (26.98% vs 4.76%, P&lt;0.001)

P.9 An observational study into the normal TEG6s values in term pregnant women undergoing elective caesarean section

P.9 An observational study into the normal TEG6s values in term pregnant women undergoing elective caesarean section

Sweeping of Membranes for Induction of Labour in Low Risk Term Pregnancy

Objective: To determine the frequency of spontaneous labour in the swept and non-swept groups.&#x0D; Study Design: Quasi-experimental study.&#x0D; Study and Duration of Study: Department of Gynaecology and Obstetrics, Sheikh Khalifa bin Zayed Hospital, SKBZ Hosp/AK CMH Muzaffarabad, from Nov 2019 to Apr 2020.&#x0D; Methodology: Patients were randomly divided into two groups (with lottery method). Group-A underwent a sweeping membrane while group-B was the control group. Spontaneous labour and other outcomes were observed in both groups.&#x0D; Results: A total of 250 women were included in the study. There were 125 women in each group. The mean age of women was 23.4 ± 1.3 years in swept-group and 24.5 ± 1.7years in the non-swept group. The swept-group showed a high frequency of spontaneous labour compared to the non-swept group (24.8% vs 15.2%, p=0.01). Swept-group showed less postpartum haemorrhage (p=0.001), pain (p=0.001), pre-labour membrane rupture (p=0.03) and admission to neonatal intensive care unit (p=0.01).&#x0D; Conclusion: Sweeping of the membrane is a safe and beneficial procedure for labour induction among low-risk term pregnant women. It is an effective procedure preventing women from reducing the incidence of post-term pregnancy with minimum complications.

Association of intravenous antispasmodics (hyoscine-N butyl bromide) injection with obstetric lacerations at vaginal delivery

Aim: To study whether hyoscine-N butyl bromide injection affects the incidence of obstetric lacerations at vaginal birth.&#x0D; Materials and methods: This retrospective cohort study consists of 15806 term pregnant women who undergone vaginal delivery, in Tepecik Training and Research Hospital, İzmir between January 2018 and December 2020. Patients who received intravenous injection of Hyoscine-N-butylbromide during the active period of labor were compared with those who did not in terms of the incidence of obstetric laceration.&#x0D; Results: The data of a total of 9216 deliveries meeting the study criteria were analyzed. Hyoscine-N-butylbromide was used in 4014 of these deliveries(HBD), and it was not used in 5202 of these deliveries. In both primigravid and multigravid patients in the HBD group, the first stage of delivery was found to be shorter than in patients who did not receive spasmolytics(p &lt;0.001).There was no difference between the groups in terms of the second stage of labor. Intravenous injection of Hyoscine-N-butylbromide in the active phase of labor significantly reduced 1st and 2nd degree obstetric lacerations in primigravid patients, but had no effect on 3rd and 4th degree obstetric lacerations.&#x0D; Conclusion: Hyoscine-N-Butylbromide shortens the active phase of labor and reduces minor obstetric lacerations in primigravid women.

Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese)

BackgroundWe aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties. MethodsAfter ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24 h (±6 h) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese. ResultsOne hundred thirteen enrolled women completed the surveys at 24 h and 29 women at 25 h (100% response rate). Validity: (i) convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r = −0.587) and GHVAS score (r = 0.568) at 24 h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p < 0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r = 0.191; p = 0.043). (iv) Cross-cultural validity: differential item functioning analysis suggested bias in 2 items. Reliability: (i) internal consistency was good (Cronbach’s alpha = 0.82 and inter-item correlation = 0.31). (ii) Split-half reliability was very good (Spearman–Brown Prophesy Reliability Estimate = 0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient = 0.87). (iv) Floor and ceiling effects: < 5% women scored either 0 or 100 (lowest and highest scores, respectively). ConclusionObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.

A Comparative Study of Maternal-Fetal Outcomes in Pregnant Women With Induction of Labor and Spontaneous Onset of Labor in a Rural Tertiary Care Center

OBJECTIVEThe present prospective observational study was conducted to study the incidence, indications, and outcomes of induction of labor in a tertiary care center.MATERIAL AND METHODThe study group of this prospective cross-sectional study was constituted by all term pregnant women underwent trial of labor. The whole study group was further subdivided in two groups, group 1: Was having all pregnant women with spontaneous onset of labor pains and group 2 was containing all pregnant women underwent induction of labor. For induction only prostaglandins (PGE1 25 microgram tablet and PGE2 gel) were used. The measure of outcome included assessment of the incidence of induction in term pregnant women, major indications of induction of labor, duration of labor, mode of delivery, intrapartum and postpartum maternal-fetal complications and duration of hospital stay. The study group included 3264 pregnant women and was differentiated into group 1 with 2,588 pregnant women and group 2 with 676 pregnant women.RESULTSThe incidence of induction was 20.71%. Major indications of induction were a fetus who was postdates, premature rupture of membranes, and preeclampsia. The average duration of the induction to delivery interval was 19.13 ± 15.14 hours (hrs.) and admission to delivery interval in the spontaneous labor group was 8.79 ± 07.18 hrs. The incidence of cesarean delivery was 19.52% in the induction group (gp2). Failed induction was the most common indication of lower segment cesarean section (CS). The incidence of CS was 15.99% in spontaneous group (gp1) and fetal distress was most common indication in this group. With this study, we found the importance of rest after the induction process was completed. During this watchful rest period, 51 pregnant women delivered vaginally. The neonatal intensive care unit (NICU) admission and neonatal death rate was more in group 1.CONCLUSIONThis study revealed that the incidence and indications of induction of labor among term pregnant women were similar to developed countries in spite of active physical life. The complication rate, operative intervention and hospital stay was more with induction group.

Faktor - Faktor Yang Mempengaruhi Keteraturan Pemeriksaan Antenatal Care Pada Ibu Hamil Aterm

The coverage of ANC visits in Indonesia in general is still low at 83.9% from the targeted 85% - 95%. Some of the factors that cause it include lack of knowledge, attitude, husband's support, distance and support from health workers. This study aims to determine the factors that affect the regularity of antenatal care in pregnant women at term. The research uses a cross-sectional correlation analytic design. The research population of all term pregnant women in Balongmojo Village, Puri District, Mojokerto Regency in March 2020 was 35 people. The number of samples is 31 respondents with purposive sampling technique. The research instrument used a husband's support questionnaire, a cadre role questionnaire, and a distance affordability questionnaire, and the regularity of ANC was measured using the MCH Handbook. Data analysis using Chi Square. The results of the study, most respondents received positive support from their husbands, namely 16 people (51.6%), most considered that the role of positive cadres was 17 people (54.8%), most of the distance from their homes were close to health care facilities, namely 17 people. (54.8%), and most of them perform ANC regularly, namely 18 people (58.1%). There is a relationship between Husband's Support (pvalue = 0.000), Role of Cadres (pvalue = 0.022, and Affordability (pvalue = 0.000) with ANC Regularity in Balongmojo Village, Puri District, Mojokerto Regency. Pregnant women are advised to perform ANC regularly from the beginning of pregnancy until before delivery so that maternal and fetal health is monitored.

An Observational Study to Correlate Maternal Serum and Cord Blood Zinc with Fetal Growth Restriction

Objectives: To study maternal serum and cord blood zinc as causal factor in fetal growth restriction and to find out correlation, if any, between birth weight and maternal serum and cord blood zinc levels. Material and methods: This prospective observational study was carried out on 120 term pregnant women who attended the Department of Obstetrics and Gynaecology, Pt. B. D. Sharma PGIMS, Rohtak, of which, 60 had FGR babies and 60 had normal growth babies. Serum zinc levels were studied in these women and cord blood zinc levels in their neonates. Results: After adjusting for other variables in the multivariable model we found that the mean serum zinc level in study group women was 115.65±6.36µg/dL at term and 116.91±6.39µg/dL in late preterm neonates. Also, we found that the mean cord blood zinc levels were 136.03±9.25µg/dL in study group and 135.24±4.72µg/dL in control group in term neonates while in late preterm neonates, it was 135.06±9.52µg/dL in study group and 133.18±6.58µg/dL in control group. A statistically significant positive correlation was found between birth weight of FGR babies with the maternal serum zinc levels at term and between cord blood zinc levels and birth weight in both preterm and term neonates. Conclusion: Zinc is an essential micronutrient during pregnancy and is needed for fetal development and placental functions. Its role in fetal growth and development, need of supplementation in pregnant women needs to be studied further to demonstrate better clinical outcomes in women with growth retarded fetus. Keywords: Cord blood zinc, Fetal growth restriction, late preterm neonates, maternal zinc, micronutrients, term neonates.

Intrapartum care algorithms for liquor abnormalities: oligohydramnios, meconium, blood and purulent discharge.

To construct evidence-based algorithms for the assessment and management of common amniotic fluid abnormalities detected during labour. Low-risk singleton, term pregnant women in labour. Birth facilities in low- and middle-income countries. We searched international guidelines published by the American College of Obstetricians and Gynecologists (ACOG), the National Institute for Health and Care Excellence (NICE), the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetrics and Gynaecology (SOGC) and the World Health Organization (WHO). We also searched The Cochrane Library and MEDLINE up to 20 January 2020 using keywords for relevant systematic reviews and randomised trials. We developed evidence-based intrapartum care algorithms for four case scenarios: oligohydramnios; meconium-stained amniotic fluid; bloody amniotic fluid or vaginal bleeding; and purulent amniotic fluid or discharge. These conditions may be associated with fetal and /or maternal morbidity. Differential diagnosis includes uteroplacental insufficiency, fetal growth restriction, fetal distress, abruption, placenta or vasa praevia, uterine rupture and intra-amniotic infection, respectively. Algorithms include how to assess for, diagnose and manage these conditions. Four algorithms are presented, to provide a systematic approach and guidance on the clinical management for the following amniotic fluid abnormalities: oligohydramnios; meconium-stained liquor; bloody amniotic fluid or vaginal bleeding; and purulent amniotic fluid or discharge. These algorithms may be beneficial in supporting clinical decision making, particularly in low-resource settings. Evidence based algorithms for management of common amniotic fluid abnormalities seen during labour.

Estimating blood loss during cesarean delivery: A comparison of methods

ObjectivesObstetrical hemorrhage contributes significantly to maternal morbidity and mortality. Assessment of blood loss while undergoing cesarean sections (CS) is essential in lowering the morbidity and mortality, however this amount is commonly underestimated by the surgeon and probably the anesthetist too. MethodsThis study addresses this issue by comparing three separate ways of assessing blood loss during cesarean sections. For each of 97 full-term pregnant women undergoing elective CS, blood loss was measured by the following: visual estimation by both the obstetrician and the anesthetist, weighing surgical pads pre operatively and post operatively and by calculations (multiplying the difference of pre-operative and postoperative hemoglobin values by the patient's estimated blood volume). ResultsThe results of this study indicated that the lowest estimated value for blood loss came from visual estimation, while the highest value came from the mathematical formula. Anesthetists were more accurate in their visual estimation of blood loss than were obstetricians. ConclusionThis study found the amount of blood loss during CS to be overestimated by the mathematical calculation and underestimated by obstetricians. However, the estimate given by anesthetists was close to that obtained by weighing pads. This underscores the need for more accurate methods of blood loss estimation in cesarean sections to be adopted.

Comparison of Prophylactic Phenylephrine Infusion Versus Intravenous Ondansetron on Hypotension During Spinal Anesthesia for Cesarean Section

Multiple methods have been proposed to prevent the incidence of hypotension in women undergoing cesarean section under spinal anesthesia. This study was conducted to compare the efficacy of phenylephrine (50 μg.min-1) versus ondansetron (8 mg) in the prevention of such complications. We included a total of 184 full-term pregnant women who were randomly divided into two groups: Group P included 92 cases who were commenced on phenylephrine infusion (50 μg.min-1 given after puncture) and Group O included the other 92 cases who were administered ondansetron (8 mg given 5 min before puncture). Demographic data were not significantly different between the two groups. Maternal hypotension was significantly more encountered in the ondansetron group (51.6% vs. 22%) and ephedrine was used more significantly in that group (19.8% vs. 8.8%). In addition, nausea and skin flushing were more commonly encountered in the same group. The incidence of vomiting and patient discomfort was not significantly different between the two study groups. Phenylephrine is markedly superior to ondansetron in the prevention of maternal hypotension and vasopressor need during cesarean section under spinal anesthesia.