Study of amniotic fluid and its co-relation with pregnancy outcome in high risk pregnancies

Background: Amniotic fluid is an important part of pregnancy sac and helps in fetal development. There is a consistent association between low AFI and conditions like pregnancy induced hypertension, postdated pregnancy and IUGR resulting in poor fetal outcome. In fact, high risk patients with low amniotic fluid index need to deliver quickly. So, an assessment of amniotic fluid volume has become an important component of antenatal testing for the high risk pregnancy. The objective was to study the correlation between Amniotic fluid index less than 5 cm (AFI˂5) and adverse perinatal outcome in high risk pregnancies.Methods: It was a hospital based prospective, comparative study. 150 high risk patients were selected from inpatient department of obstetrics and Gynecology Government Medical College Srinagar, Jammu and Kashmir, India over a period of one and half year. High risk pregnancies belonging to study group with AFI˂5 were demographically matched with high risk pregnancies with AFI >5 serving as comparison group. Perinatal outcome, rate of caesarean section and early intervention need were compared between the two groups.Results: 77.3% women in study group underwent caesarean section as compared to 28% in control group to prevent adverse perinatal outcome. 60% babies in study group had APGAR score less than 6 at 1 minute compared to only 8% in control group. 61.4% babies in study group needed NICU admission compared to 10.7% in study group.Conclusions: AFI is predictor of adverse outcome for high risk pregnancies. The early recognition alerts an obstetrician to prevent perinatal catastrophe if timely intervention is done along with antepartum and intrapartum fetal monitoring.

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Study of effects of oligohydramnios on perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20202342 ◽

2020 ◽

Vol 9 (6) ◽

pp. 2525

Author(s):

Aashka M. Mashkaria ◽

Babulal S. Patel ◽

Akshay C. Shah ◽

Shashwat K. Jani ◽

Vismay B. Patel ◽

...

Keyword(s):

Caesarean Section ◽

Amniotic Fluid ◽

Perinatal Outcome ◽

Stress Test ◽

Fetal Distress ◽

Control Group ◽

Study Group ◽

Amniotic Fluid Index ◽

Lower Segment Caesarean Section ◽

And Control

Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.

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Perinatal outcome in meconium-stained amniotic fluid at term: a single center prospective study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20205443 ◽

2020 ◽

Vol 10 (1) ◽

pp. 107

Author(s):

Vandana Mohapatra ◽

Sujata Misra ◽

Tapas Ranjan Behera

Keyword(s):

Caesarean Section ◽

Amniotic Fluid ◽

Pregnant Women ◽

Perinatal Outcome ◽

Mode Of Delivery ◽

Birth Asphyxia ◽

Control Group ◽

Study Group ◽

The Mean ◽

Meconium Stained Amniotic Fluid

Background: The presence of meconium-stained amniotic fluid is a sign of fetal compromise and is associated with increased perinatal morbidity. The objective of this study was to determine the perinatal outcome in pregnant women at term with meconium-stained amniotic fluid (MSAF) and compare it with the outcome associated with clear liquor. Methods: A prospective observational, study was conducted in the department of obstetrics and gynecology, VIMSAR, Burla from January, 2013 to June, 2013. Pregnant women with singleton pregnancy, cephalic presentation at term were included in the study. Total 135 cases of MSAF (study group) were compared with 165 randomly selected controls with clear liquor. Outcome measures were fetal heart rate (FHR) abnormality, mode of delivery, Apgar score, neonatal intensive care unit (NICU) admission, diagnosis of meconium aspiration syndrome (MAS), birth asphyxia and neonatal death. Statistical analysis was done by using the mean and Chi-square test with or without Yates’ correction. Results: The mean gestational age for meconium staining in the present study was 40.31±0.48 weeks. Caesarean section was the most common mode of delivery in MSAF group whereas vaginal delivery was most common in control group. Significantly higher number of babies in the study group required NICU admissions. The incidence of MAS and birth asphyxia too was statistically higher among babies born to study group as compared to control group.Conclusions: MSAF has significant adverse effect on the perinatal outcome, as it increases the caesarean section rates, NICU admissions, MAS and birth asphyxia.

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Elastography and Metalloproteinases in Patients at High Risk of Preterm Labor

Journal of Clinical Medicine ◽

10.3390/jcm10173886 ◽

2021 ◽

Vol 10 (17) ◽

pp. 3886

Author(s):

Izabela Dymanowska-Dyjak ◽

Aleksandra Stupak ◽

Adrianna Kondracka ◽

Tomasz Gęca ◽

Arkadiusz Krzyżanowski ◽

...

Keyword(s):

High Risk ◽

Preterm Delivery ◽

Plasma Concentrations ◽

Cervical Length ◽

Control Group ◽

Study Group ◽

Median Length ◽

High Risk Patients ◽

Ultrasound Evaluation ◽

Risk Patients

Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality. Its etiopathology is multifactorial; therefore, many of the tests contain the assessment of the biochemical factors and ultrasound evaluation of the cervix in patients at risk of preterm delivery. The study aimed at evaluating the socioeconomic data, ultrasound examinations with elastography, plasma concentrations of MMP-8 and MMP-9 metalloproteinases, and vaginal secretions in the control group as well as patients with threatened preterm delivery (high-risk patients). The study included 88 patients hospitalized in the Department of Obstetrics and Pregnancy Pathology, SPSK 1, in Lublin. Patients were qualified to the study group (50) with a transvaginal ultrasonography of cervical length (CL) ≤ 25 mm. The control group (38) were patients with a physiological course of pregnancy with CL > 25 mm. In the study group, the median length of the cervix was 17.49 mm. Elastographic parameters: strain and ratio were 0.20 and 0.83. In the control group, the median length of the cervix was 34.73 mm, while the strain and ratio were 0.20 and 1.23. In the study group, the concentration of MMP-8 in the serum and secretions of the cervix was on average 74.17 and 155.46 ng/mL, but in the control group, it was significantly lower, on average 58.49 and 94.19 ng/mL. The concentration of MMP-9 in both groups was on the same level. Evaluation of the cervical length and measurement of MMP-8 concentration are the methods of predicting preterm delivery in high-risk patients. The use of static elastography did not meet the criteria of a PTB marker.

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The use of autologous platelet gel (APG) for high-risk patients in cardiac surgery — is it beneficial?

Perfusion ◽

10.1177/0267659109358283 ◽

2009 ◽

Vol 24 (6) ◽

pp. 381-387 ◽

Cited By ~ 5

Author(s):

Jens Litmathe ◽

Christian Philipp ◽

Muhammed Kurt ◽

Udo Boeken ◽

Emmeran Gams ◽

...

Keyword(s):

Wound Healing ◽

Cardiac Surgery ◽

High Risk ◽

Wound Complications ◽

Control Group ◽

Study Group ◽

Platelet Gel ◽

High Risk Patients ◽

Risk Patients ◽

Autologous Platelet

Background: Wound healing in cardiac surgery has become a major problem due to the impaired risk profile of many patients. The aim of this study was to prove the influence of autologous platelet gel (APG) on wound healing in a special group of high-risk patients undergoing coronary surgery. Patients and Methods: We performed a prospective, double-blind study in 44 patients with a special risk constellation relating to wound complications (obesity, diabetes, smoker, New York Heart Association (NYHA) III-IV and peripheral vascular disease). The study group was treated with APG, prepared using the Magellan© platelet separator, the control group underwent conventional wound treatment. Results: The incidence of major and minor wound complications at the thoracotomy, as well as in the area of saphenous vein harvesting, was not pronounced in either of the groups. Blood loss and pain sensations did not differ significantly either. Stay in the intensive care unit (ICU) and the in-hospital mortality were also comparable. The duration of the entire operation and the time until removing the chest-tubes were prolonged in the study group. Conclusion: Despite promising results in other fields of surgery, APG shows no beneficial effect in high-risk patients undergoing cardiac surgery. Probably, it depends on different types of microcirculation in atherosclerotic patients, which are quite different from those of other surgical areas. This factor may offset the existing beneficial platelet effects which could be observed, for example, in maxillo-facial surgery.

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Audio-guided self-hypnosis for reduction of claustrophobia during MR imaging: results of an observational 2-group study

European Radiology ◽

10.1007/s00330-021-07887-w ◽

2021 ◽

Author(s):

Adriane E. Napp ◽

Torsten Diekhoff ◽

Olf Stoiber ◽

Judith Enders ◽

Gerd Diederichs ◽

...

Keyword(s):

High Risk ◽

Mr Imaging ◽

Odds Ratio ◽

Control Group ◽

Waiting Room ◽

High Risk Patients ◽

Imaging Results ◽

Before And After ◽

Risk Patients ◽

And Coping

Abstract Objectives To evaluate the influence of audio-guided self-hypnosis on claustrophobia in a high-risk cohort undergoing magnetic resonance (MR) imaging. Methods In this prospective observational 2-group study, 55 patients (69% female, mean age 53.6 ± 13.9) used self-hypnosis directly before imaging. Claustrophobia included premature termination, sedation, and coping actions. The claustrophobia questionnaire (CLQ) was completed before self-hypnosis and after MR imaging. Results were compared to a control cohort of 89 patients examined on the same open MR scanner using logistic regression for multivariate analysis. Furthermore, patients were asked about their preferences for future imaging. Results There was significantly fewer claustrophobia in the self-hypnosis group (16%; 9/55), compared with the control group (43%; 38/89; odds ratio .14; p = .001). Self-hypnosis patients also needed less sedation (2% vs 16%; 1/55 vs 14/89; odds ratio .1; p = .008) and non-sedation coping actions (13% vs 28%; 7/55 vs 25/89; odds ratio .3; p = .02). Self-hypnosis did not influence the CLQ results measured before and after MR imaging (p = .79). Self-hypnosis reduced the frequency of claustrophobia in the subgroup of patients above an established CLQ cut-off of .33 from 47% (37/78) to 18% (9/49; p = .002). In the subgroup below the CLQ cut-off of 0.33, there were no significant differences (0% vs 9%, 0/6 vs 1/11; p = 1.0). Most patients (67%; 35/52) preferred self-hypnosis for future MR examinations. Conclusions Self-hypnosis reduced claustrophobia in high-risk patients undergoing imaging in an open MR scanner and might reduce the need for sedation and non-sedation coping actions. Key Points • Forty percent of the patients at high risk for claustrophobia may also experience a claustrophobic event in an open MR scanner. • Self-hypnosis while listening to an audio in the waiting room before the examination may reduce claustrophobic events in over 50% of patients with high risk for claustrophobia. • Self-hypnosis may also reduce the need for sedation and other time-consuming non-sedation coping actions and is preferred by high-risk patients for future examinations.

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Prevention of Hypotension following Spinal Anaesthesia in Caesarean Section - then and now

Kathmandu University Medical Journal ◽

10.3126/kumj.v8i4.6242 ◽

2012 ◽

Vol 8 (4) ◽

pp. 415-419

Author(s):

J K Mitra

Keyword(s):

Risk Factors ◽

Clinical Practice ◽

High Risk ◽

Caesarean Section ◽

Spinal Anaesthesia ◽

Limited Data ◽

First Line ◽

High Risk Patients ◽

Risk Patients ◽

Poor Efficacy

Hypotension during spinal anaesthesia for caesarean section remains a common scenario in our clinical practice. Certain risk factors play a role in altering the incidence of hypotension. Aortocaval compression counteraction does not help to prevent hypotension. Intravenous crystalloid prehydration has poor efficacy; thus, the focus has changed toward co-hydration and use of colloids. Phenylephrine is established as a first- line vasopressor, although there are limited data from high-risk patients. Ephedrine crosses the placenta more than phenylephrine and cause possible alterations in the foetal physiology.http://dx.doi.org/10.3126/kumj.v8i4.6242 Kathmandu Univ Med J 2010;8(4):415-19

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Maternal and fetal outcome in oligohydramnios after 34 weeks of gestation

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184515 ◽

2018 ◽

Vol 7 (11) ◽

pp. 4604

Author(s):

Mahantappa A. Chiniwar ◽

Joe Kaushik M. ◽

Sharada B. Menasinkai

Keyword(s):

Amniotic Fluid ◽

Fetal Outcome ◽

Morbidity And Mortality ◽

Research Centre ◽

Control Group ◽

P Value ◽

Study Group ◽

Perinatal Morbidity ◽

Amniotic Fluid Index ◽

Chi Square

Background: Oligohydramnios is one of the major causes of maternal and perinatal morbidity and mortality. It is a clinical condition characterized by Amniotic Fluid Index (AFI) ≤5 cm by sonographic assessment. The aim of present study is to know the maternal and fetal outcome in oligohydramnios after 34 weeks of gestation compared with women who had normal volume of amniotic fluid.Methods: Study was done for the period of 21 months from November 2014-July 2016 at Adichunchanagiri Institute of Medical Sciences, Hospital and Research Centre Bellur. 50 antenatal cases with > 34 weeks of gestation with AFI ≤5 cm by ultrasonographic estimation were included as study group and 50 women with normal AFI were included as control group. Maternal and fetal outcome of the women with oligohydramnios were analyzed and compared with control group.Results: Results were analyzed statistically using parameters like mean, SD, Chi Sq test, P value. Amniotic fluid was clear in 32% in study and 78% in control group, thin meconium stained in 30% in study group and 14%in control group and was thick meconium stained in 38% in study group and 8% in control group (Chi square =22.31, p<0.0001). Induction of labour was done in 54% in study group and 20% in control group. Cesarean delivery was done in 58% in study group women and 28% in control group women. Regarding the birth weight of babies 62% were < 2.5 kg in study group and 18% in control group with p<0.001. 10% of babies in study group required NICU admission and perinatal mortality was 2%.Conclusions: Due to increased perinatal morbidity and mortality and increased rate of LSCS, timely decision during labour is important to reduce perinatal morbidity and mortality.

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Abstract 2471: Contemporary Results of Isolated Aortic Valve Replacement in High-Risk Patients in the Context of Emerging Percutaneous Approaches

Circulation ◽

10.1161/circ.116.suppl_16.ii_544-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Pierre Voisine ◽

Siamak Mohammadi ◽

Josep Rodés-Cabau ◽

Patrick Mathieu ◽

Jean Perron ◽

...

Keyword(s):

High Risk ◽

Aortic Valve ◽

Survival Benefit ◽

Control Group ◽

Perioperative Mortality ◽

High Risk Patients ◽

All Cause Mortality ◽

Risk Patients ◽

Related Mortality ◽

Parsonnet Score

Percutaneous aortic valve replacement (AVR) is emerging as an alternative therapeutic approach for high-risk surgical patients, but criteria for patient selection are not clearly established. We sought to evaluate the perioperative and mid-term outcomes in a contemporary cohort of high-risk patients undergoing isolated AVR. Between 1997 and 2006, 855 consecutive patients underwent isolated AVR at our institution. High-risk patients (n=162, 19%) were defined by a preoperative Parsonnet score ≥ 30 or Euroscore ≥ 9. The remaining 693 patients (81%) composed the control group for comparison of perioperative mortality and mid-term freedom from all-cause and cardiac-related mortality. Mean follow up was 2.9±2.1 years. Perioperative mortality was 8.6% in the high-risk and 2.9% in the control group (p=0.0007), lower than that predicted by both scores (p<0.05). Freedom from all-cause mortality at 1 and 5 years were 94% and 82% for the control group and 87% and 65% for high-risk patients (p<0.0001). Freedom from cardiac-related mortality was also higher in the control (96% at 1 year, 91% at 5 years) than the high-risk (89% and 82%, p=0.0003) group. When considering patients who survived the 3-month perioperative period (537 in control, 114 in high-risk group), freedom from all-cause mortality was still higher in the former group at 1 and 5 years (99% vs 99% and 85% vs 75%, respectively, p=0.005), but freedom from cardiac-related mortality was not different (99% vs 100% and 94% vs 92%, respectively, p=0.3). By multivariate analysis, chronic renal failure, emergent procedures and reoperations were identified as independent predictors of mortality in high-risk patients. Contemporary perioperative mortality for isolated AVR in high-risk patients is lower than predicted by the Parsonnet score and Euroscore. Five-year survival in these patients is acceptable, and survivors of the operation experience the same cardiac-related survival benefit as those with standard perioperative risk. The perioperative survival benefit of percutaneous approaches for high-risk patients undergoing AVR remains to be demonstrated and, if present, should be weighed against mid-term outcome benefits of conventional surgical AVR.

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Polysaccharide hemostatic powder to prevent bleeding after endoscopic submucosal dissection in high risk patients: A randomized controlled trial

Endoscopy ◽

10.1055/a-1312-9420 ◽

2020 ◽

Author(s):

Da Hyun Jung ◽

Chan Hyuk Park ◽

Hee Seok Moon ◽

Jun Chul Park

Keyword(s):

High Risk ◽

Endoscopic Submucosal Dissection ◽

Controlled Trial ◽

Gastric Neoplasms ◽

Control Group ◽

High Risk Patients ◽

Randomized Controlled ◽

Submucosal Dissection ◽

Risk Patients ◽

Hemostatic Powder

Background and aims: Bleeding after endoscopic submucosal dissection (ESD) is a severe adverse event. Several methods to prevent post-ESD bleeding (PEB) have been introduced; however, they have not been widely used because of technical difficulties. We aimed to investigate whether polysaccharide hemostatic powder (PHP), which is very easy to apply, can prevent early PEB, especially in patients with high risk of PEB. Methods: This was a prospective, multicenter, randomized, open-label, controlled trial. Patients with a high risk for PEB were enrolled. Patients with gastric neoplasms in whom the resected specimen size was expected to be >40 mm and those who were regularly taking antithrombotic agents were defined as high-risk patients. Patients were randomly assigned to the PHP or control group. Results: Between May 2017 and September 2018, 143 patients were enrolled (PHP group: 73, control group: 70). The total PEB rate was 6.3% (PHP group: 5% vs. control group: 7.1%, P=0.742). There was no bleeding within 7 days after ESD in the PHP group. Continued antithrombotic use was an independent risk factor of PEB. In subgroup analysis excluding patients who continued to take antithrombotics (n=129) during ESD, the rate of PEB was tended to be lower in the PHP group than in the control group (0% vs. 6.3%, P=0.058). Conclusion: PHP did not demonstrate a significant effect on the prevention of PEB in this study. Further larger-scale, randomized controlled trials are needed to confirm this.(ClinicalTrials.gov 03169569)

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Comparison of Amniotic Fluid Index and Single Deepest Vertical Pool method for predicting fetal outcome

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v13i4.16893 ◽

2017 ◽

Vol 13 (4) ◽

pp. 401-405

Author(s):

Rajiv Shah ◽

Paban Sharma

Keyword(s):

High Risk ◽

Data Collection ◽

Amniotic Fluid ◽

Mode Of Delivery ◽

Well Being ◽

Fluid Volume ◽

Study Group ◽

Amniotic Fluid Index ◽

Amniotic Fluid Volume ◽

Significant Difference

Background & Objectives: The measurement of amniotic fluid volume (AFV) has been an important component of antenatal evaluation of fetal well being. The most commonly used methods are by amniotic fluid index technique (AFI) and single deepest pool method (SDVP). Both the methods employ ultrasound for AFV measurement. The objective of this study is to compare the usefulness of AFI and SDVP method in assessing amniotic fluid volume for predicting adverse perinatal outcome.Materials & Methods: This is a hospital based prospective comparative study. The patient whose amniotic fluid was measured by SDVP technique was study group and that by AFI was comparison group. Any case with high risk factor was excluded from the study. First case was decided by lottery and then alternately one case was kept in study group and the other in comparative group. If the women did not deliver within 1 week the measurements was retaken and the final values was used for analysis.AFI was estimated as described by Phelan and colleagues and SDVP as described by Manning. Data collection was started after the approval of Institution review board. This study was conducted at Patan Academy of Health Sciences. Duration of data collection was 3 months, Asadh –Bhadra, 2071.Results: A total of one hundred and fifty four cases which met the inclusion criteria were taken. Incidence of oligohydramnios by SDVP method was 10.4 % by SDVP technique and by AFI method it was 18.2 %. There was no statistical significant difference between the two groups in terms of rate of induction, mode of delivery, meconium staining of liquor, fetal heart rate tracings, APGAR score at 5 mins and admission to special care baby unit.Conclusion: In non-high risk pregnancy AFI technique detects slightly more number of oligohydramnios as compared to SDVP technique without apparently any difference in perinatal outcome.

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