Terms Of Neonatal Outcomes Research Articles

Neurodevelopmental outcome in children between one and five years after persistent pulmonary hypertension of term and near-term newborns

BackgroundPersistent pulmonary hypertension of the newborn (PPHN) is a serious condition that affects 1–2 per 1,000 newborns. Scientific data report the existence of neurological developmental abnormalities between 10 and 30%, but the description of these disorders linked with this situation of cerebral hypoxia and haemodynamic failure remains poorly documented.ObjectiveThe main goal of this study was to describe the prevalence of neuro-psychomotor developmental disorders in children aged between one and five years old who have been hospitalised at birth in a neonatal intensive care unit for the management of PPHN.MethodsAll of the newborns ≥34 weeks of gestational age (WGA) with PPHN, treated with inhaled nitric oxide in our neonatal intensive care unit between January 2015 and December 2019 were retrospectively enrolled. An ASQ-3 standardised questionnaire, adapted to the appropriate age (12, 24, 36, 48 and 60 months) was performed by the parents.ResultsFifty-five children (81% of answers) with a median age of 36 months (11–68), whose real age was close to the one of the questionnaire (12, 24, 36, 48 and 60 months), have been included in this study. There was 47% of pathological score [borderline: less than 1 standard deviation (SD) or suspect: less than 2SD] in at least one of the five studied domains, mainly in communication (25%) and individual and social skills (22%), despite a high overall score of 250 [220; 285] out of 300 that improved with age.ConclusionThis study showed a significant prevalence of neuro-psychomotor developmental disorders which justifies making more accessible a prolonged and adapted follow-up for early and multidisciplinary screening and management of these children with PPHN history. Larger cohorts are needed to better explore long term outcome of these vulnerable term neonates.

Determinants of Higher Oxytocin Dose Need During Labor Induction

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

Neonatal Outcomes in Labor After Intravenous Remifentanil Analgesia vs. Epidural Analgesia: A Retrospective Observational Study.

Background Some evidence indicates that maternal analgesia during labor may have adverse effects on neonates due to exposure to specific drugs or the potential effects of analgesia on the course of labor. We assessed the clinical outcome of term neonates born to mothers who received epidural analgesia (E) or systemic analgesia with remifentanil (R) during labor. Methods Data was collected retrospectively over one year. We have evaluated the medical records of 247 full-term neonates; 208 were born to mothers who received E and 39 to mothers who received R. Data on Apgar scores and neonatal complications(perinatal asphyxia, respiratory distress, infection, hyperbilirubinemia, and birth injuries), and average hospital stay were collected. Mann-Whitney U test, chi-square test, and logistic regression analysis were used where appropriate. Results The values of the mean Apgar scores between E and R at 1 and 5 minutes were similar (8.83 vs. 8.97,p= 0.252; 9.81 vs. 9.87,p= 0.762, respectively). The average length of neonatal hospitalization did not differ between groups (4.19 vs. 4;p= 0.557). The percentages of neonates with any complication were similar between groups (28.3% vs. 32.5%,p= 0.598). Neonates born by cesarean delivery (CD) had significantly worse outcomes than those born vaginally (p= 0.008, OR 2.8, 95% CI [1.30, 6.17]). Conclusion We did not find a statistically significant difference in mean Apgar scores and neonatal complications between neonates who received epidural vs. remifentanil analgesia. An increased rate of complications in neonates born via CD was found. Future studies should have a larger sample size and be powered to detect associations in these findings.

Indications affect neonatal outcomes following early rescue ICSI: a retrospective study.

To investigate the impact of heterogeneity in patient indications or insemination protocols on neonatal outcomes of singletons following early rescue ICSI (rICSI) treatments. A retrospective study was conducted. Propensity score matching and multivariable logistic regression were used to adjust for confounders and biases. A total of 9095 IVF patients, 2063 ICSI patients, and 642 early rICSI patients were included in the study. No differences were detected in neonatal outcomes except small for gestational age (SGA) which increased in early rICSI patients compared with both unmatched and matched IVF groups with the risk ratio (RR) of 1.31 (95% CI: 1.05, 1.64) and 1.49 (95% CI: 1.05, 2.12). Further analysis showed that SGA increased significantly in partial fertilization failure (PFF) cycles with RRs of 1.56 (95% CI: 1.08, 2.27) and 1.78 (95% CI: 1.22, 2.59) compared with both unmatched and matched IVF patients but not in TFF patients. A positive association between fertilization rate via IVF and birth weight z-score was revealed in the PFF patients. Early rICSI in patients with total fertilization failure (TFF) appeared to be safe in terms of neonatal outcomes. However, when expanding the indications of rICSI to PFF patients, the SGA in the offspring increased, suggesting a potential effect on long-term health. Since other treatment options, such as using only the IVF-origin embryos still exist for these patients, further studies were needed to confirm the optimal decision for these patients.

An audit of the maternal medicine clinic: Cancer and pregnancy.

To explore the incidence and complexity of women presenting for maternity care who require concurrent cancer care, and to report the birth outcomes of these women. A retrospective audit of women attending a 'high risk' maternal medicine clinic at an Australian tertiary maternity hospital between 1 October 2021 and 30 April 2023 was conducted. The inclusion criteria were a diagnosis of cancer and a concurrent pregnancy, or a diagnosis of cancer prior to the current pregnancy. Clinic lists and coding data were screened via the electronic medical record to identify potential subjects. Data were collected from the individual maternity and neonatal records. Forty of 705 (5.7%) women attending the maternal medicine clinic met the inclusion criteria, of which ten had a new diagnosis of cancer in pregnancy and 30 presented for maternity care after a previous diagnosis of cancer. Cancer therapy during pregnancy included surgery and chemotherapy. Most pregnancies (92.5%) resulted in term deliveries (≥37 weeks gestation). Four neonates were preterm, and one was small-for-gestational-age. Caesarean section delivery and post-partum haemorrhage were more common than expected, but the rate of other adverse pregnancy outcomes was consistent with the background population. Over half of neonates required neonatal intensive care unit / special care nursery admission but the indications for admission were common, self-limiting conditions, and the length of stay was short (mean <5.0 days). Approximately 6% of women attending the maternal medicine clinic had a current or previous diagnosis of cancer. Most pregnancies resulted in term deliveries and neonatal outcomes were excellent.

Delayed cord clamping vs cord milking in elective cesarean delivery at term: a randomized controlled trial

BackgroundDelayed cord clamping has significant beneficial effects for the neonate and its transition to extrauterine life and is therefore common practice at vaginal births in the Netherlands. In 2015, 16% of neonates were born by caesarean section, in 81% of these cases the umbilical cord was clamped and cut immediately. Neonatal benefits of delayed cord clamping are an increased circulating volume of 25-30ml/kg, leading to a higher preload of both right and left ventricle during transition from umbilical to pulmonary circulation, thus maintaining a stable left ventricle output, and to higher neonatal hemoglobin and hematocrit levels 24 to 48 hours postpartum. At present, little is known about whether the above-mentioned neonatal benefits of delayed cord clamping could apply to neonates delivered by caesarean section. In these cases, possible negative effects on neonatal outcomes (i.e., neonatal hypothermia, lower APGAR scores and hyperbilirubinemia) and maternal outcomes (i.e., increased maternal blood loss and higher postoperative infection rate) should also be taken into consideration. ObjectivesTo determine if clamping the umbilical cord after two minutes is superior when compared to cord milking during elective caesarean sections at term, taking both short and long term neonatal and maternal outcomes into consideration. Additionally, to determine if cord milking could be an appropriate alternative to delayed cord clamping. Study DesignA randomized controlled trial was performed in a large secondary care centre in the Netherlands (Amphia Hospital in Breda) from October 2020 to April 2022. A total of 115 patients who underwent an elective caesarean section between 37+0 and 41+6 weeks of gestation were included. Primary outcomes were neonatal hemoglobin and hematocrit levels at 48 hours postpartum, secondary outcomes were divided into neonatal and maternal outcomes. ResultsAfter randomization 58 participants were treated with cord milking and 57 with delayed cord clamping. There were no significant differences regarding demographic characteristics between both groups. There was no significant difference in primary outcomes, with a mean hemoglobin level 48 hours postpartum of 12.1 mmol/L in the delayed cord clamping group and 12.2 mmol/L in the cord milking group (p=0.80). Regarding our secondary outcomes, there were no significant differences regarding Apgar score, neonatal body temperature, maternal blood loss and post-operative infection rate between our intervention groups. ConclusionsHemoglobin and hematocrit levels at 48 hours postpartum showed no significant differences when comparing delayed cord clamping to cord milking. Delayed cord clamping does not lead to increased maternal blood loss or postoperative infections when compared to a method with a much shorter timeframe between delivery and clamping of the umbilical cord, namely cord milking. Additionally, delayed cord clamping did not lead to lower APGAR score or neonatal temperature compared to cord milking. Our research suggests that delayed cord clamping can be safely performed during elective caesarean sections at term. If per operative circumstances do not allow for delayed cord clamping, cord milking can be an appropriate alternative for the neonate at term.

The demographic profile, clinical spectrum, and outcome of term neonates requiring continuous positive airway pressure in a tertiary care teaching hospital

Background: Respiratory distress is the major cause of neonatal intensive care unit (NICU) admission of full-term neonates for which they require different levels of mode of ventilation. Aims and Objectives: The objective of this study was to determine the demographic profile, clinical spectrum, and outcome of term neonates, requiring continuous positive airway pressure (CPAP) in tertiary care teaching hospitals. Materials and Methods: The study was a prospective observational study conducted from December 2020 to November 2022 in the neonatal section of the department of pediatrics. Results: A total of 261 neonates were included in the study. The male-to-female ratio was 1.7:1, the range of birth weight was between 2.1 kg and 3 kg (60.91%), the gestation age was 38 weeks (59.2%), and 73.6% were lower-segment cesarean section born. The age of starting CPAP in most of the newborns was at admission to NICU (in 69.73% of cases). The success rate of CPAP therapy was high (60.9%) and the rest 39.08% of patients did not settle with CPAP and required higher modes of respiratory support such as nasalintermittent positive pressure ventilation (IPPV) (5.89%) and IPPV (94.11%). Conclusion: In the resource-limiting settings, due to the non-availability of higher levels of ventilatory gadgets, the early use of CPAP as a mode of ventilation in full-term babies with transient tachypnea of newborns is well-documented and it can be safely used in other common neonatal conditions which can cause respiratory distress in full-term neonates. The low-middle-income countries are facing challenges to improve comprehensive neonatal care; there is a dire need for simple and cost-effective methods of respiratory support. Bubble CPAP is one such promising ventilatory support intervention, which may reduce the need for costly mechanical ventilators.

Significant Effect of Ritodrine Hydrochloride Combined with Magnesium Sulfate for Treatment of Patients with Premature Rupture of Membranes

To investigate the effect of magnesium sulfate combined with ritodrine hydrochloride on maternal and infant outcomes in patients with premature rupture of membranes (PROM), a total of 76 PROM patients admitted to our hospital from July 2021 to July 2022 were selected as the research objects, and they were divided into observation group and experimental group according to the treatment methods of the patients. The observation group consisted of 38 patients who received magnesium sulfate monotherapy, whereas the experimental group received ritodrine hydrochloride in addition to the treatment received by the patients in the observation group. The treatment effects, levels of inflammatory factors, negative emotions, as well as maternal and child outcomes, along with any adverse reactions during the medication, were compared between the two groups. The effective rate of treatment in the observation group was 78.95%, and that in the experimental group was 97.37%. The effective rate in the experimental group was significantly higher than that in the observation group (P &lt; 0.05). The levels of α and IFN-y were significantly lower than those of the observation group (all, P &lt; 0.05); the SAS scores and SDS scores of the experimental group after treatment were significantly lower than those of the observation group (all, P &lt; 0.05). The observation group showed significantly lower uterine contraction inhibition time and postpartum hemorrhage compared to the observation group, along with significantly higher gestational age extension time (all, P &lt;0.05). In terms of neonatal outcomes, the birth weight, Apgar. The scores were significantly higher than those of the observation group, and the incidence of complications was significantly lower than that of the observation group (all, P &lt; 0.05). The incidence of adverse reactions in the observation group was 21.05%, compared to 23.68% in the experimental group. There was no significant difference in the incidence of adverse reactions between the two groups of patients (P &gt; 0.05). Magnesium sulfate combined with ritodrine hydrochloride has a significant effect in the treatment of patients with PROM. The application of the combined program can effectively reduce the inflammatory response of patients, regulate the negative emotions of patients, and improve the maternal and infant outcomes of patients. Moreover, the combined program does not increase the risk of adverse reactions in patients, demonstrating its ideal safety in clinical medication.

Maternal and neonatal consequences of cystocele and rectocele in the delivery process.

The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.

Epidemiology and factors associated with preterm births in multiple pregnancy: a retrospective cohort study

ObjectiveMultiple pregnancies carry an increased risk of maternal and perinatal complications, notably prematurity. Few studies have evaluated the risk factors for preterm births in multiple pregnancies within the Thai population. This study aims to ascertain maternal and perinatal outcomes and identify factors linked to preterm births in multiple pregnancies.MethodsThis study was carried out at Khon Kaen University, Faculty of Medicine, Department of Obstetrics and Gynecology in Thailand. We reviewed the medical records of women with multiple pregnancies who delivered at a gestational age of more than 20 weeks between January 1, 2012 and December 31, 2021. We excluded patients with incomplete data or those for whom data were missing.ResultsOut of 21,400 pregnancies, 427 were multiple pregnancies, constituting approximately 1.99%. Over the ten-year period, 269 multiple pregnancies (65.1%) resulted in preterm births. Of these, 173 (64.3%) were monochorionic twins, and 96 (35.7%) were dichorionic twins. Monochorionic twins had a notably higher rate of preterm delivery (AOR, 2.06; 95%CI 1.29—3.30). Vaginal delivery was observed in 7.9% of the cases, while cesarean sections were performed for both twins in 91.5% of cases. In 0.5% of the cases, only the second twin was delivered by cesarean section. In terms of neonatal outcomes, 160 infants (19.4%) weighed less than 1,500 g at birth, and there were 78 perinatal deaths (9.4%). Birth asphyxia was noted in 97 cases (20.2%) among monochorionic twins and in 28 cases (8.1%) for dichorionic twins.ConclusionThe prevalence of multiple pregnancies was 1.99%, with 65.1% resulting in preterm births. Neonatal complications were notably more frequent in monochorionic twins. Monochorionic placenta and antepartum complications emerged as significant risk factors for preterm birth.

Comparison of Umbilical Cord Arterial Blood Gas and Neonatal Outcomes in Women with and without Meconium-Stained Amniotic Fluid During Labor

Introduction: Meconium-stained amniotic fluid (MSAF) may increase maternal and neonatal complications. The favorable mode of delivery is controversial in women with MSAF. This study aimed to compare umbilical cord arterial blood gas (ABG) and neonatal outcomes in deliveries complicated by meconium and clear amniotic fluid during the active phase of labor. Materials and Methods: This observational study was performed on 144 term pregnant women (72 with MSAF and 72 with clear amniotic fluid) during the active phase of labor with ruptured membranes admitted to Al-Zahra and Taleghani hospitals in Tabriz, Iran, from June 2019 to June 2020. A checklist was used to record the ABG and neonatal outcomes. Results: The frequency of cesarean delivery in the MSAF group (25%) was significantly higher than in the women with clear amniotic fluid (20%) (P = 0.006). There was no statistically significant difference between the groups regarding pH, base excess, PCO2, 1- and 5- minute Apgar scores, and neonatal intensive care unit (NICU) admission of the newborn due to MSAF (P&gt; 0.05). There was no incidence of hypoxic-ischemic encephalopathy, sepsis, and seizure. Conclusion: Given the non-significant difference between two groups of women with and without MSAF during labor in terms of neonatal outcomes and umbilical cord ABG, it seems that MSAF alone is not an indication for cesarean delivery. Thus, vaginal delivery is recommended in pregnant women with MSAF.

Does cesarean section prevent adverse neonatal outcomes associated with meconium amniotic fluid?

BackgroundMaking decisions regarding the mode of delivery in the cases of meconium amniotic fluid (MAF) presents a challenge for healthcare providers. We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section (CS) versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes. MethodsIn this retrospective study, we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 2020-2022. Mothers with certain adverse pregnancy conditions were excluded from the study. These conditions included: abnormal fetal heart rate and pattern, bloody amniotic fluid, malpresentation, abnormal placentation, chorioamnionitis, intrauterine growth restriction, intrauterine fetal death, obstructed labor, and maternal comorbidities. The MAF mothers were divided into two groups based on the method of delivery: those who had CS and those who had a normal vaginal delivery (NVD). Demographic factors, obstetrical factors, and neonatal outcomes were compared between the two groups. ResultsOut of 746 MAF mothers, 213 (28.5%) underwent CS, while 533 (71.4%) had NVD. There were no significant differences between the groups in terms of demographic characteristics. Among MAF mothers who had CS, 66.2% were primiparous, and 33.8% were multiparous. For those who had NVD, 35.1% were primiparous, and 64.9% were multiparous. The first and 5-min Apgar values, rates of asphyxia, neonatal intensive care unit (NICU) admission, and neonatal death were not statistically different between the two delivery modes. The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery. Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS (11.1% vs. 2.3%), no correlation was found between the mode of delivery and the need for resuscitation using logistic regression. ConclusionsOur research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers. Further studies are needed to provide more substantial evidence to support this conclusion.

Interpretable artificial intelligence-assisted embryo selection improved single-blastocyst transfer outcomes: a prospective cohort study

Research questionWhat is the pregnancy and neonatal outcomes of an interpretable artificial intelligence (AI) model for embryo selection in a prospective clinical trial? DesignThis single-centre prospective cohort study was carried out from October 2021 to March 2022. A total of 330 eligible patients were assigned to their preferred groups, with 250 patients undergoing a fresh single-blastocyst transfer cycle after the exclusion criteria had been applied. For the AI-assisted group (AAG), embryologists selected the embryos for transfer based on the ranking recommendations provided by an interpretable AI system, while with the manual group, embryologists used the Gardner grading system to make their decisions. ResultsThe implantation rate was significantly higher in the AAG than the manual group (80.87% versus 68.15%, P = 0.022). No significant difference was found in terms of monozygotic twin rate, miscarriage rate, live birth rate and ectopic pregnancy rate between the groups. Furthermore, there was no significant difference in terms of neonatal outcomes, including gestational weeks, premature birth rate, birth height, birthweight, sex ratio at birth and newborn malformation rate. The consensus rate between the AI and retrospective analysis by the embryologists was significantly higher for good-quality embryos (i.e. grade 4BB or higher) versus poor-quality embryos (i.e. less than 4BB) (84.71% versus 25%, P < 0.001). ConclusionsThese prospective trial results suggest that the proposed AI system could effectively help embryologists to improve the implantation rate with single-blastocyst transfer compared with traditional manual evaluation methods.

The difference of Bishop score change and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks

HIGHLIGHTS Oral misoprostol is more effective than vaginal misoprostol in cervical ripening as a part of induction of labor. Oral misoprostol is as safe as vaginal misoprostol. ABSTRACT Objective: To compare Bishop score changes and labor event between oral and vaginal misoprostol in pregnancy beyond 41 weeks. Materials and Methods: A total of 52 pregnant women with more than 41 weeks of gestation, had a Bishop score less than 5, and were undergoing induction labor were randomly divided into two groups: oral and vaginal misoprostol. In the oral misoprostol group, participants were given 25 mg of misoprostol in a solution with a concentration of 1 ug/ml every 2 hours. In the vaginal misoprostol group, a 25 mg misoprostol tablet was inserted into the posterior fornix every 6 hours. The two groups were compared in terms of Bishop score during the first 6 hours, changes in Bishop score, labor at term events, neonatal outcomes, complications, and side effects after the administration of misoprostol. Results: The oral group showed significantly higher changes in Bishop score compared to the vaginal group (5.5 vs 3.6; p=0.0001). The median interval times for induction of labor at term, induction at stage II, and induction at birth were found to be shorter in the oral misoprostol group compared to the vaginal group (7.3 hours vs 10.6 hours, 14.0 hours vs 16.8 hours, and 14.6 hours vs 17.6 hours; p=0.002, 0.003, 0.002). Labor at term occurred much more frequently in the oral group (53.8% vs 15.4%). Additionally, the oral misoprostol group had a 3.5 times higher likelihood of experiencing labor at term within the first 6 hours after the initial administration compared to the vaginal group (OR 3.5, 95% CI 1.33-9.23). Conclusion: Oral administration of misoprostol for cervical ripening has been demonstrated to be more effective than vaginal administration, greater bishop score changes while maintaining an equivalent level of safety.

Effect of re-cryopreservation on pregnancy and neonatal outcomes: Analysis using propensity score matching.

To comprehensively assess the effect of re-cryopreservation procedure on pregnancy and neonatal outcomes by using propensity matching (PSM) analysis. The patients were divided into two groups according to the times of embryo cryopreservation: the cryopreservation group (n = 8034) and the re-cryopreservation group (n = 66). To optimize the precision of the present study, we used PSM to adjust the different baseline characteristics between the two groups, including maternal age, the number of good-quality embryos transferred and endometrial preparation protocols. The primary outcome was live-birth rate. The secondary outcomes were biochemical pregnancy rate, clinical pregnancy rate, and miscarriage rate. We found that the rates of biochemical pregnancy and clinical pregnancy were comparable between the two groups, whereas miscarriage rate was increased, resulting in significantly reduced live-birth rate in the re-cryopreservation group. No differences were observed in terms of neonatal outcomes, including cesarean section, birth weight, and malformation as well as pregnancy complications. Moreover, multivariable analysis demonstrated that re-cryopreservation was an independent risk factor for live-birth rate. The present study demonstrated the adverse effect of re-cryopreservation on pregnancy outcomes, providing valuable information for clinical decision making and patient counseling.

Association between Maternal Neuraxial Analgesia and Neonatal Outcomes in Very Preterm Infants.

Background Although the use of neuraxial analgesia has been shown to improve uteroplacental blood flow and maternal and fetal hemodynamics related to labor pain, possibly improving immediate outcomes in term neonates, the association between neuraxial analgesia use and outcomes in preterm neonates remains unclear. Objective The aim of this article was to evaluate the association between maternal use of neuraxial analgesia and neonatal outcomes in very preterm infants. Methods This is a retrospective cohort study of women delivering singleton neonates between 23 and 32 weeks' gestation at a large academic center between 2012 and 2016. Outcomes of neonates born to women who used neuraxial analgesia for labor and/or delivery were compared to those whose mothers did not. Multivariable logistic regression was utilized to assess the independent associations of neuraxial analgesia use with neonatal outcomes after controlling for potential confounders, including gestational age, mode of delivery, and existing interventions to improve neonatal outcomes of prematurity. Results Of 478 eligible women who delivered singleton very preterm neonates in this study period, 352 (73.6%) used neuraxial analgesia. Women who used neuraxial analgesia were more likely to have delivered at a later preterm gestational age, to have a higher birthweight, to have preeclampsia and/or hemolysis, elevated liver enzymes, low platelet count (HELLP), to have undergone labor induction, to have delivered by cesarean delivery, and to have received obstetric interventions such as magnesium prophylaxis for fetal neuroprotection, antenatal corticosteroids for fetal lung maturity, and antibiotics prior to delivery; they were less likely to have been diagnosed with a clinical abruption. Neuraxial analgesia was associated with decreased incidence of cord umbilical artery pH less than 7.0 (24.7 vs. 34.9%, p = 0.03), as well as decreased incidence of neonatal intensive care unit length of stay over 60 days (35.5 vs. 48.4%, p = 0.01), although these associations did not persist on multivariable analysis. On multivariable analyses, neuraxial analgesia remained independently associated with decreased odds of necrotizing enterocolitis (adjusted odds ratio [aOR]: 0.28, 95% confidence interval [CI]: 0.12-0.62) and grade III/IV intraventricular hemorrhage (aOR: 0.33, 95% CI: 0.13-0.87). These associations remained significant on sensitivity analyses, which were performed between 10 and 90% of the overall cohort in order to control for outliers, as well as between the subgroup of patients who received obstetric interventions. Conclusions Maternal neuraxial analgesia use may be associated with lower odds of adverse outcomes in very preterm infants, even after controlling for existing interventions for prematurity. Prior work has suggested such effects may be due to improved neonatal acid-base status from changes in placental perfusion and maternal pain management, but further work is required to prospectively investigate such associations.

P-285 Analysis, including morphokinetic data, of IVF/ICSI cycles with oocytes containing aggregates of smooth endoplasmic reticulum (SER)

Abstract Study question Is there a difference in ART outcomes and morphokinetic parameters for SER+ and SER- cycles and oocytes? Summary answer Fertilisation and blastulation rates are lower in the SER+ group but no difference was seen in pregnancy or live birth rates. What is known already The SER is an organelle found in eukaryotic cells, including oocytes. SERs synthesize lipids and steroids, and store and metabolise calcium ions, needed for fertilization and early embryonic development. SERs can aggregate in the oocyte, forming an intracytoplasmic dimorphism, thought to interfere with reproductive outcomes. It is suggested that SER aggregates in an oocyte may negatively effect embryo development and implantation. Oocytes without SERs, but which arise from the same oocyte cohort as SER+ oocytes may also affect outcomes. Evidence around the safety and use of these SER+ and SER- oocytes is conflicting, with widespread variations in clinical practice. Study design, size, duration A retrospective review was conducted of all IVF/ICSI[MW1] cycles between January 2019 and December 2020 at Merrion Fertility Clinic, Dublin. Cycles containing SER+ oocytes were identified, and their outcomes were compared with those of a matched control group of SER- cycles. Within the SER+ group, results were compared for SER+ and SER- oocytes within the same cohort. Participants/materials, setting, methods Once participants had been identified, a chart review was undertaken noting demographics, IVF protocol used, duration of stimulation, ART and neonatal outcomes and morphokinetic parameters in the embryoscope. Statistical analysis was performed using PRISM. Main results and the role of chance There were 77 SER+ cycles with a total of 135 SER+ oocytes and 645 SER- oocytes, accounting for 8% of total cycles for the study period. These were matched to 64 control cycles with 528 SER- oocytes. 12 embryo transfers occured using blastocysts derived from SER+ oocytes. SER+ cycles had a higher mean oocyte number than controls (9.3 vs 7.3) and 92% of oocytes were mature compared to 88% of the control group. Fertilisation rates were significantly lower in the study group (60% SER+cycle; 68% in SER-cycle), related to the SER+ oocytes in that cohort. Good/top quality blastocyst rates differed (SER+ cycle 28%, SER- cycle 36%) but pregnancy(SER+ cycle 53%, SER- cycle 51%) and livebirth (SER+31%, SER- 32% ) rates were similar, even when blastocysts derived from SER+ oocytes were transferred. 5 morphokinetic variables were studied – time to 2-cell (t2), 3 cell (t3) 4 cell (t4), 5 cell (t5) and time to blastulation (tB). T5 appears to be shorter in embryos derived from SER+ oocytes than in controls, with the other parameters being comparable. In terms of neonatal outcomes there were no congenital malformations reported in the SER+ groups and one case of upper limb amelia in the control group. Limitations, reasons for caution This study is limited by its retrospective nature. We only have embryoscope data on 46 out of 77 patients with SERs, limiting numbers. Embryos transferred which derived from SER+ve oocytes were limited by the clinic policy to only transfer these embryos if no other embryos available. PGT was not performed. Wider implications of the findings This preliminary study shows that, while SER+ cycles have lower fertilisation rates than SER- cycles, pregnancy rates and live birth rates are comparable. Neonatal outcomes are reassuring. Initial analysis of morphokinetic data shows little effect. Larger numbers and further analysis are needed to fully understand the importance of these aggregates. Trial registration number n/a

P-601 Comparison of adverse obstetric outcomes in women with the hyperandrogenic syndromes, polycystic ovary syndrome and Cushing’s syndrome: an evaluation of a population database

Abstract Study question How does the risk for adverse obstetric outcomes differ among women with polycystic ovary syndrome (PCOS) and women with Cushing’s syndrome (CUS)? Summary answer PCOS increased the risk of gestational diabetes and cesarean section relative to CUS, whereas CUS increased the prevalence of operative vaginal delivery and blood transfusions. What is known already PCOS and CUS are hyperandrogenic disorders that have previously been associated with unique adverse obstetric outcomes. Despite there being similarities in the hyperandrogenism and insulin resistance of these disorders, there is a lack of knowledge when comparing their specific risks of pregnancy complications. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS), was performed. A dataset of all deliveries between 2004 and 2014 inclusively, was created. 14 881 deliveries to women with PCOS and 134 deliveries to women with CUS were identified. The HCUP-NIS presents information on approximately 20% of admissions to US hospitals. Data was not continued into 2015 when ICD-10 codes were used, which are not comparable. Participants/materials, setting, methods Descriptive analyses were performed to compare the demographic features among both groups using chi-squared tests. Multivariate logistic regression analysis was performed to calculate unadjusted and adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CI). According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance At baseline, CUS was associated with a higher risk of chronic hypertension (P &amp;lt; 0.001), pregestational diabetes mellitus (P = 0.01), thyroid disease (P = 0.004), and higher rates of smoking during pregnancy (P = 0.02) whereas PCOS was associated with higher rates of obesity (P = 0.01). In terms of obstetric outcomes, PCOS increased the prevalence of gestational diabetes mellitus (P = 0.002, adjusted[a] OR 2.73; 95% CI 1.46 to 5.12), and cesarean section (P &amp;lt; 0.001, aOR 2.63; 95% CI 1.81-3.83) in comparison to CUS. CUS increased the prevalence of operative vaginal delivery (P &amp;lt; 0.001, aOR 0.10; 95% CI 0.06-0.14), and transfusion (P = 0.002, aOR 0.25; 95% CI 0.11-0.59) in comparison to deliveries to women with PCOS. No significant differences were found in terms of pregnancy-induced hypertension (P = 0.78), gestational hypertension (P = 0.86), preeclampsia (P = 0.25), preeclampsia or eclampsia superimposed on pre-existing hypertension (P = 0.13), premature rupture of membranes (P = 0.99), preterm delivery (P = 0.17), placental abruption (P = 0.82), chorioamnionitis (P = 0.16), spontaneous vaginal delivery (P = 0.35), postpartum hemorrhage (P = 0.29), and maternal infection (P = 0.11). In terms of neonatal outcomes, both deliveries to women with PCOS and women with CUS had similar outcomes for small for gestational age infants (P = 0.52), intrauterine fetal demise (P = 0.94), and congenital anomalies (P = 0.53). Limitations, reasons for caution The data within this retrospective cohort study relies on the accuracy of the individuals collecting the data. Data on medication use and compliance was unavailable. Wider implications of the findings Pregnant women with PCOS and CUS are at risk for certain specific obstetric complications, with most risks being similar. The magnitude of the insulin resistance in PCOS may be greater than in CUS due to the increased risk of gestational diabetes in PCOS when controlling for obesity and confounding effects. Trial registration number Not applicable

Why do we fear bottles and pacifiers?

Why do we fear bottles and pacifiers?

EVALUATION OF INTRATHECAL DEXMEDETOMIDINE ADDED TO BUPIVACAINE FOR LABOR ANALGESIA

Background And Aims: The aim of this study was to evaluate the effectiveness of intrathecal dexmedetomidine with bupivacaine for labor analgesia by assessment of onset, duration and quality of analgesia and neonatal outcomes. Method: In this study 40 eligible parturient who received dexmedetomidine 5 g and heavy bupivacaine 0.5% 2.5 mg diluted upto 2.5 cc with sterile NS intrathecally for labor analgesia were selected. The time of onset, duration and quality of analgesia were noted. Maternal parameters pulse rate, systolic blood pressure, motor block and side effects of pruritus, nausea, vomiting, hypotension and headache were recorded. Neonatal outcomes in terms of mode of delivery and APGAR score were noted. If VAS &gt;3, analgesia was supplemented with epidural bupivacaine 0.125% 10 ml during labor. For rescue analgesia, Inj. Tramadol 1 – 2 mg/kg iv was given as per institutional protocol if the patient VAS score was still more than 3 even after second dose of epidural. Result: Mean time for onset of analgesia was 2 minutes (VAS&lt;3). All parturient had VAS &lt; 3 throughout the labor. Mean duration of Labor was 99.4 ± 48.35 min. Total duration of labor ranges from 45 minutes to 210 minutes in our study. Most 92.5% of parturient had maximum motor blockade of grade 1 and it was lasted maximum upto 30 min. Hypotension was observed in two parturient and one parturient had nausea, which responded to conservative management. The mean APGAR score at 1 min was 8.85 ± 0.97 and at 5 min it was 10 (excluding LSCS delivery). Out of 40 total, 30 parturient have graded labor analgesia as excellent and rest have graded as good. Conclusion: Dexmedetomidine (5μg) seems to be a safe and efcacious adjuvant to intrathecal bupivacaine 0.5% (2.5 mg) in women undergoing vaginal delivery. This may be helpful for parturient coming late to the delivery room, seeking rapid onset with good quality of analgesia