219: Neonatal morbidity in preterm growth-restricted fetuses: does mode of delivery matter?

INTRODUCTION- Cervical insufciency, earlier known as cervical incompetence, is the inability of the cervix to maintain pregnancy till term due to structural or functional defects. Approximately 16.25% of second-trimester pregnancy losses and 2% of premature deliveries are due to cervical incompetence. OBJECTIVE- The purpose of this study was to compare the outcome of pregnancy in patients who underwent early (12-16 weeks) cervical cerclage along with oral progesterone supplementation versus those having remedied with high dose intravaginal progesterone supplementation. MATERIAL AND METHODst This retrospective study was conducted in a maternity hospital in Gwalior from 1 January 2018 to th 30 June 2021. Comprehensive history, thorough clinical examination, laboratory investigations, ultrasonography measurement of cervical length, mode of delivery, gestational age at the time of delivery, neonatal outcome, NICU admission, and other parameters were collected from the medical les. patients were divided into two groups. Ÿ Group 1(N-49) – Those who were remedied with high-dose vaginal progesterone supplementation continued uptil 34 wks of gestation. Group 2 (N-49) – Those who underwent Mc Donald type of cervical encerclage at 12-16 weeks along with oral progesterone (10 mg Duphaston twice daily dose) supplementation continued up till 34 weeks of gestation. RESULT- In our study, in the cervical cerclage group, only (4.1%) patients were delivered before 34 weeks while in the vaginal progesterone group (18.4%) patients were delivered before 34 weeks. In the cervical cerclage group (53.1%) patients were delivered between 34-37 weeks while in the vaginal progesterone group, (44.9%) of the patient delivered between 34-37 weeks. In the cervical cerclage group, the cesarean section rate was lower than only the vaginal progesterone group and admission to NICU of babies was also less (22.4%) in this group in comparison to the vaginal progesterone only group (36.7%). CONCLUSION- Our study showed that cervical cerclage plus oral progesterone supplementation in women with extremely shortened cervix signicantly decreased overall spontaneous preterm birth rates, prolonged pregnancy latency, and decreased the overall neonatal morbidity and mortality and is more effective than the vaginal progesterone group.

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Prelabour Rupture of Membranes: Mode of Delivery and Outcome

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2015.037 ◽

2015 ◽

Vol 3 (2) ◽

pp. 237-240 ◽

Cited By ~ 3

Author(s):

Vlora Ademi Ibishi ◽

Rozalinda Dusan Isjanovska

Keyword(s):

Cesarean Section ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Fetal Distress ◽

Maternal Complications ◽

Cephalopelvic Disproportion ◽

Cesarean Section Delivery ◽

Clinical Center ◽

Failed Induction ◽

The University

BACKGROUND: Pre-labour Rupture of Membranes (PROM) is an important cause of maternal and fetal morbidity and increased rate of cesarean section delivery. AIM: The aim of this study is to investigate the clinical characteristics, PROM-delivery interval, mode of delivery, and early maternal neonatal outcome among pregnant patients presenting with pre-labour rupture of membranes.MATERIAL AND METHODS: This prospective case control study is implemented at the Obstetric and Gynecology Clinic of the University Clinical Center of Kosovo. The study included 100 pregnant patients presenting with prelabour rupture of membranes of which 63 were primigravida and 37 patients were multigravida.RESULTS: The incidence of cesarean section in this study is 28 % and the most common indications for cesarean delivery were fetal distress, malpresentation, cephalopelvic disproportion, and failed induction. The most common maternal complications in this study are chorioamnionitis, retained placenta and postpartum hemorrhage. Neonatal infectious morbidity was present in 16 % of cases.CONCLUSION: PROM is a significant issue for obstetricians and an important cause of maternal and neonatal morbidity and increased rate of cesarean section delivery.

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Neonatal morbidity in second twin according to gestational age at birth and mode of delivery

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2004.04.009 ◽

2004 ◽

Vol 191 (3) ◽

pp. 773-777 ◽

Cited By ~ 39

Author(s):

Shi Wu Wen ◽

Fung Karen Fung Kee ◽

Oppenheimer Lawrence ◽

Demissie Kitaw ◽

Yang Qiuying ◽

...

Keyword(s):

Gestational Age ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Gestational Age At Birth ◽

Age At Birth ◽

Second Twin

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Electrolyte abnormalities in asphyxiated newborns

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20181537 ◽

2018 ◽

Vol 5 (3) ◽

pp. 1036

Author(s):

Satheesh Kumar D. ◽

Thenmozhi M. ◽

Kumar .

Keyword(s):

Serum Sodium ◽

Perinatal Asphyxia ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

Postnatal Period ◽

P Value ◽

Sodium Potassium ◽

Neonatal Deaths ◽

Electrolyte Abnormalities

Background: Perinatal asphyxia is the most common cause of neonatal morbidity and mortality in worldwide. It accounts for 23% of all neonatal deaths. Electrolyte abnormalities are more common in the immediate post asphyxiated period and influence neonatal the outcome effectively. Aim of this study was to measure the serum sodium, potassium and calcium levels in immediate postnatal period of asphyxiated newborns and assess the correlation with different degree of birth asphyxia.Methods: The serum sodium, potassium and calcium levels were measured in asphyxiated newborns in the early post-natal period. Both intramural and extramural newborns were included irrespective of their mode of delivery but according to the Apgar score. The measured electrolyte values were compared with the different severity of asphyxia. Results: Out of 100 newborns 53 had hyponatremia, 10 had hyperkalemia and 3 had hypocalcemia. The serum sodium and potassium levels showed significant P value (<0.00) with the different degree of both asphyxia but calcium levels were not significant (p valve = 0.06). There was a negative linear correlation with sodium and calcium levels and positive correlation with the serum potassium levels.Conclusions: Hyponatremia was significant in all stages of birth asphyxia, hyperkalemia was significant with increased severity of birth asphyxia and hypocalcemia was only weakly significant even in severe birth asphyxia.

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Impact of Implementation of a Breech Clinic in a Tertiary Hospital.

10.21203/rs.3.rs-19314/v3 ◽

2020 ◽

Author(s):

Sara Derisbourg ◽

Elena Costa ◽

Laura De Luca ◽

Soraya Amirgholami ◽

Valery Bogne Kamdem ◽

...

Keyword(s):

Care Pathway ◽

Mode Of Delivery ◽

Breech Presentation ◽

Neonatal Morbidity ◽

Primary Objective ◽

Neonatal Outcomes ◽

Tertiary Referral Centre ◽

Breech Delivery ◽

Vaginal Deliveries ◽

Before And After

Abstract BACKGROUND The incidence of breech presentation in single pregnancies at term is between three to five percent. In order to support eligible women in their choice of mode of delivery, a dedicated breech clinic with a care pathway was developed in December 2015 in a tertiary referral centre in Brussels. The primary objective of this study was to evaluate the vaginal birth rate before and after the introduction of a dedicated breech clinic. The secondary objective was to compare the early neonatal outcomes before and after the breech clinic was introduced. METHODS This was a single centre retrospective and prospective study. The inclusion criteria were term (from 37 weeks), singleton fetus and breech presentation at delivery. The exclusion criteria were suspected intrauterine growth restriction, severe fetal malformations and intrauterine fetal demise. We used a composite outcome as an indicator of neonatal morbidity and mortality. RESULTS After the introduction of the breech clinic, we observed a significant increase in planned vaginal delivery from 7.4% (12/162) to 53.0% (61/115) (OR: 13.5; 95%CI: 6.7-27.0). The effective vaginal breech delivery rate (planned and unexpected) significantly increased from 4.3% (7/162) pre-implementation of breech clinic to 43.5% (50/115) post-implementation (OR: 17.0; 95%CI: 7.3-39.6). Neonatal outcomes were not statistically different between the before and after periods. CONCLUSION The introduction of a dedicated breech clinic has led to an increase in vaginal deliveries for breech babies without adversely affecting neonatal outcomes .

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Outcomes of induction in trial of labor after cesarean delivery

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190882 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1076

Author(s):

Anubha Varshney ◽

Zehra Mohsin

Keyword(s):

Cesarean Section ◽

Cesarean Delivery ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Induction Of Labor ◽

Control Group ◽

Study Group ◽

Previous Cesarean Section ◽

Trial Of Labor ◽

Previous Cesarean

Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.

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Prevalence of Late Preterm and Early Term Birth in Portugal

Acta Médica Portuguesa ◽

10.20344/amp.6523 ◽

2016 ◽

Vol 29 (4) ◽

pp. 249 ◽

Cited By ~ 2

Author(s):

Joana Goulão Barros ◽

Nuno Clode ◽

Luís M. Graça

Keyword(s):

Mode Of Delivery ◽

Neonatal Morbidity ◽

Public Hospitals ◽

Late Preterm ◽

Preterm Neonates ◽

Recent Discussion ◽

Term Neonates ◽

Term Birth ◽

Early Term ◽

Obstetric Department

Introduction: Late preterm birth (defined as birth between 34 and 36 complete weeks’ gestation) and early term birth (defined as birth between 37 and 38 complete weeks’ gestation) have become a topic of recent discussion as the morbidity associated with delivery at these gestational ages has become increasingly evident. Our objective was to evaluate the characteristics of late preterm and early term birth in Portugal. Material and Methods: We developed a survey questionnaire that was sent to the Obstetric Department of all public hospitals in Portugal. The questionnaire consisted on questions on prevalence and mode of delivery of late preterm and early term period and associated neonatal morbidity and mortality. The questions referred solely to single births occurred during 2013. Results: We received completed questionnaires from 14 hospitals, corresponding to nearly one third (33.5%) of total deliveries in Portugal. We report 5.4% of late preterm and 27% of early term deliveries. Approximately two thirds of late preterm and three quarters of early term deliveries were spontaneous. The cesarean section rate was higher in late preterm (39.1%) than in early term (26.4%) births. Neonatal complications were more frequent in late preterm neonates (34.2%) when compared to early term neonates (14.2%). Discussion: The prevalence of late preterm and early term birth in our cohort is comparable, although slightly reduced, to other published series. Conclusion: The obstetric community should raise efforts to limit deliveries below 39 weeks’ gestation to the ones with a valid medical indication.

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Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170579 ◽

2017 ◽

Vol 6 (3) ◽

pp. 1030 ◽

Cited By ~ 2

Author(s):

Dharna Desai ◽

Nandita Maitra ◽

Purvi Patel

Keyword(s):

Heart Rate ◽

Amniotic Fluid ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Caesarean Section Rate ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Neonatal Morbidity ◽

P Value ◽

Meconium Staining

Background: This study assesses the role of abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid and its association with perinatal outcomes.Methods: Prospective unmatched case-control study on 2 groups of 136 subjects each- cases had thick MSAF and controls had clear liquor with abnormal fetal heart rate tracings on cardiotocography.Results: Gestational age (GA) >40 weeks, was found to have a significant association with MSAF (p value 0.01556 CI 95%). Premature Rupture of membranes at term (PROM) showed a significant association with MSAF with an OR of 2.25 (95% CI 1.37, 3.7); Post datism had significantly higher odds for being a risk factor for MSAF with an OR (3.194) (CI 95% 1.003-10.165). MSAF was not found to be significantly associated with abnormal trace on CTG. Neonatal morbidity (MAS, birth asphyxia, sepsis, HIE) had statistically higher odds in cases 1.669 (0.884-3.150) as compared to controls.Conclusions: No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labor. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.

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A comparative study of feto-maternal outcome in expectant management versus active management in pre-labor rupture of membranes at term

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20175836 ◽

2017 ◽

Vol 7 (1) ◽

pp. 146

Author(s):

Savitha T. S. ◽

Pruthvi S. ◽

Sudha C. P. ◽

Vikram S. Nadig

Keyword(s):

Caesarean Section ◽

Maternal Morbidity ◽

Caesarean Section Rate ◽

Mode Of Delivery ◽

Expectant Management ◽

Neonatal Morbidity ◽

Neonatal Infection ◽

Induction Of Labour ◽

Active Management ◽

Induction Group

Background: Premature rupture of the membranes at term is spontaneous rupture of the membranes after 37 weeks of gestation and before the onset of the regular painful uterine contractions, complicates 5-10% of pregnancies, 80% of cases of PROM occur at term. It complicates the pregnancy leading to maternal and fetal complications, immediate risks such as cord prolapse, cord compression and placental abruptions, and later risks such as maternal or neonatal infection and the interventions such as caesarean section and instrumental vaginal delivery. These cases are either managed conservatively or by immediate induction of labour. Objective of present study is to compare the efficacy and safety of induction of labor versus expectant management at term PROM, in terms of maternal and fetal outcome.Methods: A randomized control trial of 100 women coming to KIMSH from 01 /04 /2015 to 01 /05 /2016 with PROM at term with duration of leak ≤6 hours and a Bishop score ≤5 were assigned to group A immediate induction group and group B expectant management group with 50 cases in each group.Results: The mean interval from PROM to delivery was significantly shorter in the induction Group 15.62±4.97 as compared with expectant group 17.58±4.78. Incidence of maternal morbidity and neonatal morbidity was comparable in both the groups. Intrapartum complications and mode of delivery were similar in both groups.Conclusions: Immediate induction of labour in cases of PROM at term using oral misoprostol resulted in shorter induction delivery interval and hospital stay. Maternal morbidity and neonatal morbidity was comparable in both groups. It is concluded that immediate induction is better than expectant management. With active management many patients delivered vaginally within 24 hours without increase in the Caesarean section rate and decreased the need for oxytocin augmentation.

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Twin pregnancy, the study of maternal and perinatal outcome: what being a twin is like?

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20194875 ◽

2019 ◽

Vol 8 (11) ◽

pp. 4457

Author(s):

Smitha K. ◽

Jasiya Afreen M. H.

Keyword(s):

Perinatal Outcome ◽

Twin Pregnancy ◽

Mode Of Delivery ◽

Neonatal Morbidity ◽

Hyaline Membrane Disease ◽

Perinatal Complications ◽

Maternal Complications ◽

Singleton Pregnancy ◽

Risk Pregnancy ◽

Twin Pregnancies

Background: Twin pregnancy is considered as a high-risk pregnancy due to associated high maternal and perinatal morbidity mortality in comparison with singleton pregnancy. The objectives of this study were to study the maternal and perinatal complications in twin pregnancies. To find out various factors that contribute to adverse perinatal outcome.Methods: This retrospective study was conducted at Kempegowda Institute of Medical Sciences Hospital, Bengaluru. 92 women with twin pregnancies admitted in KIMS Hospital from September 2014 to September 2018, both booked and referred patients were studied. Individual patient parameters like age, parity, gestational age, mode of delivery, maternal complications were tabulated. Neonatal morbidity and mortality were noted, data thus obtained was analysed and results studied.Results: In the study the incidence of twin pregnancies was more in second gravida (53%). 72% of the patients were admitted between 28-36 weeks of gestation with preterm labour (23%) as the main cause for admission. Anaemia (8.69%), hypertensive disorders of pregnancies (17.39%), PPROM (21%), single foetal demise (5%) and IUGR (5.4%) were the antenatal complications observed. Out of the 92 patients, 29 (35.4%) patients delivered by vaginal route whereas 53 (64.6%) had to undergo C-section. DCDA twin constituted 66% of twins in the study and mal presentation was the commonest indication for caesarean section (50%). Among the 164 babies out of 92 twin pregnancies 8 babies were still born and 12 babies died by the end of one week due to complications related to prematurity like hyaline membrane disease, IVH.Conclusions: Early detection of twin pregnancies and proper antenatal care reduces both maternal and perinatal complication thereby improving maternal and perinatal outcome.

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