scholarly journals Our experience of nifedipine as a tocolytic agent in preterm labor (24 weeks to 36 weeks 6 days)

2017 ◽  
Vol 6 (2) ◽  
pp. 636
Author(s):  
Parag M. Hangekar ◽  
Anand Karale ◽  
Neelesh Risbud
Keyword(s):  
Side Effects ◽  
Preterm Labor ◽  
Mode Of Delivery ◽  
Previous History ◽  
Fetal Lung ◽  
Delivery Mode ◽  
Birth Complications ◽  
Gestational Age At Delivery ◽  
Nicu Admission ◽  
One Year

Background: Preterm birth is defined as birth between the age of viability and 37 completed weeks of gestation. The aim of this study is to evaluate the safety and efficacy of nifedipine, a calcium channel blocker, as a tocolytic in prolonging duration of pregnancy in case of preterm labor.Methods: This is a retrospective analytical study conducted in Department of Obstetrics and Gynaecology, SKNMC and GH, Pune, India conducted over a period of one year from June 2014 to May 2015. All uncomplicated, singleton preterm labor cases were given Cap. Nifedipine as tocolytic and Inj. Betamethasone for enhancing fetal lung maturity. Maternal parameters studied were Gravida and Parity, previous history of preterm labor, gestational age at delivery, mode of delivery, side effects. Neonatal parameters studied were weight at birth, APGAR score at birth, complications at birth, NICU admissions, mortality.Results: Out of total 4478 deliveries from June 2014 to May 2015, 252 women with preterm labor were treated with nifedipine. 214 out of 252 delivered at term with overall success rate of 84.92%. Out of remaining 38 cases, 36 cases delivered as preterm normal deliveries and 2 required Caesarean section. No major side effects observed in mothers receiving nifedipine. As regards neonatal outcome, 12 babies required NICU admission and mortality was of 2.Conclusions: Nifedipine is safe and effective in prolonging preterm labor and has minimal maternal and neonatal side effects. It eliminates the need for intensive maternal monitoring as required in case of betamimetics.

scholarly journals HIV transmission in twin pregnancy: Maternal and perinatal outcomes

2017 ◽  
Vol 32 (2) ◽  
pp. 54-56
Author(s):  
L. L. Makunyane ◽  
J. Moodley ◽  
M. J. Titus
Keyword(s):  
Highly Active Antiretroviral Therapy ◽  
Twin Pregnancy ◽  
Hiv Transmission ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Dual Therapy ◽  
Highly Active ◽  
Gestational Age At Delivery ◽  
One Year ◽  
Twin Pregnancies

Background: Despite over two decades of studies of mother-to-child transmission (MTCT) of HIV, very little data is available on HIV transmission in twin pregnancies in Africa.Objective: To determine transmission rates of the HIV virus between twins and the maternal and perinatal outcomes in HIV positive twin pregnancies.Methods: An audit involving 186 sets of twin pregnancies delivered at two hospitals in KwaZulu-Natal, South Africa was conducted over a one year period. Relevant data included maternal age, parity, obstetric history, foetal presentation, gestational age at delivery, Apgar scores, birth weight and pregnancy complications.Results: Of 9521 deliveries, 186 (1.95%) women were identified with a twin pregnancy; 80 (43%) of these mothers were HIV infected. One twin was HIV infected giving an incidence of 0.9%. The infected twin was the first-born twin (or twin 1) and was delivered by Caesarean delivery. Based on mode of delivery, there was no transmission for twin 1 or twin 2 via vaginal delivery, but a 1.4% transmission for twin 1 and 0% for twin 2 following Caesarean delivery.Conclusion: Twin pregnancies are at low risk of MTCT of HIV provided the mother is on highly active antiretroviral therapy (HAART) or has taken effective antiretroviral (ARV) treatment (dual therapy) in the antenatal period.

scholarly journals PRETERM PRE LABOUR RUPTURE OF MEMBRANES;

2013 ◽  
Vol 20 (05) ◽  
pp. 765-771
Author(s):  
SAADIA YASIR, ◽  
BUSHRA KANT, ◽  
TAHIRA JABBAR
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Post Partum ◽  
Previous History ◽  
Latency Period ◽  
Study Objective ◽  
Gestational Age At Delivery ◽  
History Of ◽  
One Year ◽  
Foetal Lung

Study Objective: The objective of this study is to describe the maternal and perinatal outcome of conservative managementin PPROM. Design: Descriptive prospective study. Period: One year from August 2006 to August 2007. Setting: Maternal and child health(MCH) Centre PIMS Islamabad. Material and Methods: 50 patients between 28-36 weeks of gestation presenting with PPROM. Results:The mean age was 27+5.1 years, 14(28%) were having gestational age between 28to 32 weeks and 36 (72%) were between 33 to 36weeks of gestation. 34 (68.0%) of the mothers had no history of abortions while 10 (20.0%) had 1-2 abortions and 6 (12.0%) had 3 ormore abortions. Sixteen (32.0%) women had previous PRROM while 10 (20.0%) had previous history of preterm labor. Inversecorrelation was observed between latency period and gestational age. Among 14(28%) women with gestational ages between 28 to 32weeks 10 delivered within 48 hours and 4 after 48 hours. Among 36(72%) women with gestational ages between 33-36 weeks 31(62%)delivered in less than 48 hours and 5 (10 %) women delivered after 48 hours.14(28%) of the 50 babies were admitted in NICU withsepticemia, 7(14.0%) with RDS, hypoglycemia in 2(4.0%) and necrotizing enterocolitis in 3(6.0%). 3 neonates died from septicemia and2 from RDS. On first follow-up 34.0% mothers had infections and 8.0% had post-partum hemorrhage. Conclusions: Expectantmanagement till 36 weeks is a suitable option as gestational age at delivery and birth weight both affect neonatal survival and offer time toadminister corticosteroids to allow foetal lung maturity. Foetal deaths occurred due to septicaemia and RDS with direction co-relationshipwith low birth weight.

scholarly journals Foetal and Neonatal Outcome in Pregnant Women with COVID-19

2020 ◽  
Vol 40 (3) ◽  
pp. 143-156
Author(s):  
Rupesh Shrestha ◽  
Srijana Basnet ◽  
Laxman Shrestha
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Neonatal Outcome ◽  
Mode Of Delivery ◽  
Conclusive Evidence ◽  
Adverse Outcomes ◽  
Delivery Mode ◽  
Still Births ◽  
Gestational Age At Delivery ◽  
Foetal Outcome

Introduction: The pandemic caused by coronavirus disease 2019 has adversely affected the health of all individuals including pregnant women. The susceptibility of pregnant women and their foetuses to severe acute respiratory syndrome coronavirus 2 infection is not clearly known. The objective of this review is to summarise the available evidence on foetal and neonatal outcomes of pregnant women with confirmed coronavirus disease 2019. Methods: The review was conduced by searching the PubMed and MedRxiv databases for studies reporting outcome of pregnancy with confirmed coronavirus disease from December 2019 to April 2020 using combination of terms "pregnancy", "coronavirus disease 2019", "foetal outcome" and "neonatal outcome". Only peer reviewed articles reporting outcome of pregnancy with confirmed coronavirus disease 2019 were included in the review irrespective of language. Ongoing pregnancies, induced abortion, and pregnancies without outcome were excluded from analysis. Variables extracted and analysed included gestational age at delivery, mode of delivery, foetal and neonatal outcome. Results: In total, 21 studies consisting 230 pregnant women including three twin pregnancies were enrolled in the study. Fever and cough were the most common symptoms reported in pregnant women. One hundred and sixty-two (70.4%) pregnant women underwent cesarean section and there were 68 (29.6%) preterm deliveries. Eight babies tested positive out of 161 newborns that were tested for coronavirus infection. Among adverse outcomes reported, there were two miscarriages, two still births and only one neonatal death. Conclusions: Outcome of pregnancy with coronavirus disease 2019 in late trimester appears to be favourable. Occurrence of preterm delivery and cesarean section appear higher among infected pregnant women in comparison to general population. There was no conclusive evidence of vertical transmission.

scholarly journals Comparison of oral nifedipine and oral labetalol as a single drug therapy for control of blood pressure in preeclampsia

2020 ◽  
Vol 9 (6) ◽  
pp. 2328
Author(s):  
Alpesh R. Patel ◽  
Sneha R. Arora ◽  
Jalpa K. Bhatt
Keyword(s):  
Blood Pressure ◽  
Drug Therapy ◽  
Side Effects ◽  
Mode Of Delivery ◽  
Effective Control ◽  
Delivery Mode ◽  
Single Drug ◽  
Single Drug Therapy ◽  
First Choice ◽  
Term Delivery

Background: Worldwide hypertension during pregnancy is a common cause of maternal and fetal morbidity and mortality. Effective control of blood pressure is one of the important steps in management of preeclampsia. Few drugs like nifedipine, labetalol, methyldopa, and hydralazine have acceptable high safety profile during pregnancy.Methods: In this study 120 antenatal women with non-severe preeclampsia were compared by giving either nifedipine or labetalol as a single drug therapy for control of blood pressure. Various parameters like control of blood pressure, side effects of drugs, gestational age at the time of delivery, mode of delivery, any complication and perinatal outcome were assessed.Results: In this study authors found that in both group, adequate control of blood pressure was achieved. This study shows slightly higher rate of pre term delivery and LSCS with labetalol and minimal side effects with nifedipine but difference in each group is insignificant.Conclusions: Labetalol and nifedipine both the drugs are equally effective in reducing blood pressure and any of it can safely be used as a first choice of drug for management of hypertension in preeclampsia and it can be decided as per clinician’s experience and familiarity with drug.

scholarly journals Pregnancy with thalassemia: challenges and outcomes

2018 ◽  
Vol 7 (4) ◽  
pp. 1613
Author(s):  
Vidhika Berwal ◽  
Amit Kyal ◽  
Dorothy Dessa ◽  
Joyita Bhowmik ◽  
Payel Mondal ◽  
...  
Keyword(s):  
Maternal Complications ◽  
Prospective Longitudinal Study ◽  
Autosomal Recessive Disorders ◽  
Medical College ◽  
Gestational Age At Delivery ◽  
The Mean ◽  
Nicu Admission ◽  
One Year ◽  
Recessive Disorders ◽  
Prospective Longitudinal

Background: Thalassemia syndromes are autosomal recessive disorders and the most commonly inherited haemoglobinopathies in the world. HbE β is the most common type of thalassemia in eastern India. The objectives of the study include maternal outcome and complications like anemia, hypertensive disorders, gestational diabetes mellitus and also to study the neonatal outcome in terms of low birth weight, prematurity and other complications.Methods: A prospective longitudinal study carried out over a period of one year from July 2016 to June 2017 in Medical College, Kolkata. Fifty antenatal thalassemic mothers over 20 weeks of gestation during study period were enrolled in after institutional ethical clearance and consent from study subjects. All necessary investigations (complete haemogram, reticulocyte counts, Ultrasounds etc.) were done followed by statistical analysis.Results: Out of total 50 diagnosed thalassemic patients, maximum were HbE Beta Thal i.e. 54.0%. The mean level of iron in these women varied from 95.70±17.16µg/dl to 99.46±18.19µg/dl at the time of delivery and ferritin varied from 185.40±49.26µg/L vs 194.13±48.80µg/L. The mean blood transfusion done was 6.84 Units. Incidence of maternal complications were variable, PIH was found to be 26% whereas it was just 8% for GDM. The mean gestational age at delivery (Mean±SD) was 36.30±2.08 weeks. NICU admission was high (50%).Conclusions: Pregnancy with thalassemia is considered high risk, continuous pre-conceptional, antenatal and postpartum assessment should be done for favorable outcomes.

scholarly journals Fetal Outcome in Pregnancies Complicated with Polyhydraminos: Study Done in Pokhara, Nepal

2019 ◽  
Vol 12 (1) ◽  
pp. 34-38
Author(s):  
SD Gurung ◽  
J Shrestha ◽  
A Shrestha ◽  
A Subedi ◽  
M Gyawali ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Amniotic Fluid ◽  
Glucose Intolerance ◽  
Congenital Anomalies ◽  
Preterm Labor ◽  
Mode Of Delivery ◽  
Fetal Outcome ◽  
Fetal Malformation ◽  
Vaginal Deliveries ◽  
Nicu Admission

Introduction: Amniotic fluid plays an important role in the development of fetus. Any abnormality in the production amniotic fluid may have adverse effect on the fetus and the mother. Polyhydraminos is one of the common complications occurring during pregnancy and complicates around 0.2 - 2% of pregnancies. Methods: It is a prospective study conducted in Manipal Teaching Hospital, Pokhara, Nepal from January 2013 to December 2015. All the pregnant ladies irrespective of gestational age with amniotic fluid index (AFI) 25 cm or more were enrolled for the study. According to the AFI, polyhydraminos was classified as mild (25 – 30 cm), moderate (30.1 - 35 cm) and severe (>35 cm). Fetal outcome, mode of delivery, presence of congenital anomalies, NICU admission and maternal glucose intolerance were recorded. Results: Out of 8232 deliveries, 24 were diagnosed and admitted with the diagnosis of polyhydraminos. Mild polyhydraminos, 50% (n=12) occurred after 37 weeks of gestation and 12.5% (n=3) had severe polyhydraminos. All pregnant ladies 50% (n=12), beyond 37 weeks gestation had cesarean section, whereas 25% (n=6) had vaginal deliveries. 33.3% (n=8) had preterm labor, 12.5% (n=3) had premature rupture of membrane, 25% (n=6) had congenital anomalies, one IUFD, one case of Rh isoimmunisation and one case of twin pregnancy. NICU admission needed in 20.5% (n=5). Pregnant ladies with impaired glucose intolerance were 8.3% (n=2). Conclusions: Polyhydraminos is associated with increased incidence of cesarean section, preterm labor, fetal malformation and NICU admission.

scholarly journals Do Maternal Demographics and Prenatal History Impact the Efficacy of Betamethasone Therapy for Threatened Preterm Labor?

2020 ◽  
Vol 3 ◽  
Author(s):  
Mary Kinney ◽  
David Haas ◽  
Hayley Trussell ◽  
Larissa Silva ◽  
Sara Quinney
Keyword(s):  
Race And Ethnicity ◽  
Preterm Labor ◽  
Secondary Analysis ◽  
Fetal Lung ◽  
Time Frame ◽  
Lung Maturation ◽  
Maternal Characteristics ◽  
Gestational Age At Delivery ◽  
Threatened Preterm Labor ◽  
Individualization Of Therapy

Background/Objective: Betamethasone is used to accelerate fetal lung maturation in women with threatened preterm labor, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone.     Methods: This study prospectively enrolled women, gestational ages 23-34 weeks, who received betamethasone for threatened preterm labor (n=208). Maternal demographics, prenatal history, and neonatal outcomes were abstracted from Epic and Cerner records. RDS was the primary outcome. Associations between RDS diagnosis and factors such as maternal demographics, prenatal history, and betamethasone dosing were evaluated in a multivariable regression adjusted for gestational age at delivery. A secondary analysis limited the cohort to women who delivered within 2 weeks of betamethasone dosing (n=95).    Results: Of 208 deliveries, 44.1% resulted in neonatal RDS. Within the overall cohort, the only significant association with RDS was the type of delivery, with 61.3% of cesarean births resulting in RDS versus 28.7% of vaginal births (adjusted OR 1.17 [1.06-1.28]). Among deliveries within 14 days of betamethasone dosing, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS outcome rates than those without PPROM (52.6% vs. 78.9%, adjusted OR 0.80 [0.65-0.98]). Maternal age, BMI, race, and ethnicity were not associated with RDS.    Conclusion: Maternal characteristics alone may not be useful biomarkers in predicting neonatal RDS. The association between PPROM and RDS may suggest the importance of the time frame between betamethasone dosing and delivery. The finding of higher risk for RDS among neonates born by cesarean is consistent with other studies and bears further exploration as betamethasone therapy may mediate the association. 

scholarly journals Oral dydrogesterone as an adjunctive therapy in the management of preterm labor: a randomized, double blinded, placebo‐controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Suparudeewan Thongchan ◽  
Vorapong Phupong
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Pregnant Women ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Preterm Labor ◽  
Controlled Trial ◽  
Latency Period ◽  
Gestational Age At Delivery ◽  
Double Blinded

Abstract Background Preterm birth is a major challenge in obstetric and perinatal care. It is the leading cause of neonatal death. The primary aim of this study was to evaluate the efficacy of oral dydrogesterone on latency period in managing preterm labor. The secondary aims were to evaluate the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, time to recurrent uterine contraction, pregnancy outcomes, neonatal outcomes, compliance and side effects. Methods This was a randomized, double blinded, placebo-controlled trial. Forty-eight pregnant women with preterm labor, singleton pregnancy, and gestational age of 24–34 weeks were enrolled into the study. The study group received 10 mg of oral dydrogesterone three times per day and the control group received placebo. All pregnant women received standard treatment with tocolytic and antenatal corticosteroids. Results The median latency periods were not significantly different between the dydrogesterone group (27.5 days) and placebo group (34 days, p = 0.45). Additionally, there were no differences in the gestational age at delivery, percentage of preterm delivery before 34 weeks and 37 weeks, pregnancy outcomes, neonatal outcomes, compliance and side effects. However, the time to the recurrence of uterine contractions in participants that had recurrent preterm labor was longer in the dydrogesterone group than in the placebo group (30.6 ± 12.3 vs 13.7 ± 5.0 days, p = 0.01). Conclusions Adjunctive treatment with 30 mg of oral dydrogesterone could not prolong latency period in preterm labor when compared to placebo. Trial registration ClinicalTrials.gov (Clinical trials registration: NCT 03935152, registered on May 2,2019).

Association between Number of Prior Cesareans and Early Preterm Delivery in Women with Abnormal Placentation

2020 ◽  
Author(s):  
Ayamo Oben ◽  
Elizabeth B. Ausbeck ◽  
Melissa N. Gazi ◽  
Akila Subramaniam ◽  
Lorie M. Harper ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Preterm Labor ◽  
Placenta Previa ◽  
Secondary Analysis ◽  
Blood Products ◽  
Primary Analysis ◽  
Logistic Regression Models ◽  
Placenta Accreta Spectrum ◽  
Nicu Admission ◽  
Early Preterm Birth

Objective Delivery timing at 34 to 36 weeks is nationally recommended for pregnancies complicated by placenta accreta spectrum (PAS). However, it has recently been suggested that those with ≥2 prior cesarean deliveries (CD) and PAS should be delivered earlier than 34 weeks because of a higher risk of unscheduled delivery and complications. We sought to evaluate whether the number of prior CD in women with PAS is associated with early preterm delivery (PTD) (<34 weeks). We also evaluated the same relationship in women with placenta previa alone (without PAS). Study Design This is a secondary analysis of a multicenter and observational study that included women with prior CD (maternal–fetal medicine unit cesarean registry). Women with a diagnosis of PAS (regardless of placenta previa) were included for our primary analysis, and women with known placenta previa (without a component of PAS) were independently analyzed in a second analysis. Two groups of patients from the registry were studied: patients with PAS (regardless of placenta previa) and patients with placenta previa without PAS. The exposure of interest was the number of prior CD: ≥2 CD compared with <2 CD. The primary outcome was PTD <34 weeks. Secondary outcomes included preterm labor requiring hospitalization or tocolysis, transfusion of blood products, composites of maternal and neonatal morbidities, and NICU admission. Outcomes by prior CD number groups were compared in both cohorts. Backward selection was used to identify parsimonious logistic regression models. Results There were 194 women with PAS, 97 (50%) of whom had <2 prior CD and 97 (50%) of whom had ≥2 prior CD. The rate of PTD <34 weeks in women with ≥2 prior CD compared with <2 in the setting of PAS was 23.7 versus 29.9%, p = 0.27; preterm labor requiring hospitalization was 24.7 versus 13.5%; p = 0.05. The rates of plasma transfusion were increased with ≥2 prior CD (29.9 vs. 17.5%, p = 0.04), but there were no differences in transfusion of other products or in composite maternal or neonatal morbidities. After multivariable adjustments, having ≥2 CDs was not associated with PTD <34 weeks in women with PAS (adjusted odds ratio (aOR): 0.73, 95% confidence interval [CI]: 0.39–13.8) despite an association with preterm labor requiring hospitalization (aOR: 2.69; 95% CI: 1.15–6.32). In our second analysis, there were 687 women with placenta previa, 633 (92%) with <2 prior CD, and 54 (8%) with ≥2 prior CD. The rate of PTD <34 weeks with ≥2 CD in the setting of placenta previa was not significantly increased (27.8 vs. 22.1%, aOR: 1.49; 95% CI: 0.77–2.90, p = 0.08); the maternal composite outcome (aOR: 4.85; 95% CI: 2.43–9.67) and transfusion of blood products (aOR: 6.41; 95% CI: 2.30–17.82) were noted to be higher in the group with ≥2 prior CD. Conclusion Women with PAS who have had ≥2 prior CD as compared with women with <2 prior CD did not appear to have a higher risk of complications leading to delivery prior to 34 weeks. As such, considering the associated morbidity with early preterm birth, we would not recommend scheduled delivery prior to 34 weeks in this population. Key Points

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