scholarly journals Maternal Exercise Uncovers Placental Insufficiency in Diabetic Mothers

2019 ◽  
pp. 91-93
Author(s):  
Petrikovsky BM ◽  
Zharov EV ◽  
Plotkin D ◽  
Petrikovsky E
Keyword(s):  
Gestational Diabetes ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Fetal Monitoring ◽  
Well Being ◽  
Adverse Outcomes ◽  
Exercise Regimen ◽  
Maternal Exercise ◽  
Nicu Admission ◽  
Diabetic Mothers

Regular physical activity during pregnancy improves or maintains physical fitness, helps with weight management, reduces the risk of gestational diabetes, and enhances patient’s psychological well-being. We studied the possibility to use maternal exercise to test placental reserves in diabetic mothers. We used a motorized treadmill in a moderate exercise regimen (15-minute fast walk at a speed of 3 mph with an incline of 15-25 degrees). Fetal monitoring was provided by using standard Phillips equipment (Avalon CTS and FM40). Adverse fetal outcomes were considered if one or more of the following were present: Category III Fetal Heart Rate (FHR) tracing, 5-minute Apgar score of less than 7, admission to the neonatal intensive care nursery, fetal growth restriction, and fetal and early neonatal death. A total of 819 fetal assessments were performed: 160 patients had gestational diabetes, 80 had pregestational diabetes. The most common complication in fetuses with positive prenatal test results was abnormal FHR in labor (36%) followed by low Apgar score (21%) and need for NICU admission (19%). Most of the adverse outcomes had good correlation with positive results of the exercise test. In conclusion, it appears that maternal exercise causes changes in FHR, which may be used to assess placental and fetal reserves.

Fetal Doppler Parameters at Term in Pregnancies Affected by Gestational Diabetes: Role in the Prediction of Perinatal Outcomes

2018 ◽  
Vol 41 (06) ◽  
pp. 675-680 ◽  
Author(s):  
Alessandra Familiari ◽  
Caterina Neri ◽  
Chiara Vassallo ◽  
Giulia Di Marco ◽  
Serafina Garofalo ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Apgar Score ◽  
Adverse Outcome ◽  
Small Sample Size ◽  
Perinatal Outcomes ◽  
Expectant Management ◽  
Well Being ◽  
Good Clinical Practice ◽  
Small Sample ◽  
Fetal Doppler

Abstract Objective The timing of delivery for women affected by gestational diabetes (GDM) is still controversial. Good clinical practice often suggests offering induction of labor at term in order to reduce the complications associated with this condition, while recent evidence supports expectant management. Fetal Doppler parameters represent a validated tool for testing fetal well-being at term and can select pregnancies that need increased surveillance. The aim of the present study was to evaluate the role of fetal Doppler parameters at term for the prediction of pregnancy outcomes in patients affected by GDM. Methods Prospective cohort study in a single center. Evaluation of umbilical artery (UA) PI, middle cerebral artery (MCA) PI, cerebroplacental ratio (CPR) and umbilical-to-cerebral ratio (UCR) at > 37 weeks of gestation in singleton, morphologically normal pregnancies affected by GDM, was performed in order to estimate the association between ultrasound measurements at term and perinatal outcome. Regression linear analysis was used to estimate the association between fetal Doppler parameters and neonatal pH, neonatal Apgar score, neonatal weight and a composite adverse outcome. The receiver operating characteristic (ROC) curve was used to estimate the possible predictive value of the above association. Results Our results on 130 women showed MCA PI to be the best predictor of perinatal outcomes in terms of low Apgar score at the 1st minute (p = 0.00), pH (p = 0.02) and composite adverse outcome (p = 0.05). UCR showed a significant correlation with neonatal pH (p = 0.02). No significant correlations for UA PI and CPR MoMs have been demonstrated in our population. However, the small sample size is a limitation of the study. Conclusion Evaluation of MCA Doppler and eventually UCR at term can be a useful tool to discriminate pregnancies affected by GDM that can benefit from IOL before 41 weeks in order to reduce complications related to this condition.

scholarly journals THE CORRELATION OF ARTERIAL CORD BLOOD GAS VALUES AND APGAR SCORES IN TERM BABIES WITHOUT FETAL DISTRESS AND THEIR EFFECTS ON NICU ADMISSIONS

2021 ◽  
Author(s):  
ASLAN YILMAZ ◽  
Nesrin Kaya ◽  
Ipek Ulkersoy ◽  
Zeynep Alp Ünkar ◽  
Hazal Cansu ACAR ◽  
...  
Keyword(s):  
Cord Blood ◽  
Neonatal Intensive Care ◽  
Umbilical Artery ◽  
Fetal Distress ◽  
Well Being ◽  
Blood Gas ◽  
Threshold Values ◽  
Apgar Scores ◽  
Nicu Admission ◽  
Two Parameters

Abstract Background Umbilical artery cord blood gas (UACG) values and Apgar scores (AS) are the two parameters that provide the fastest information about the well-being of a baby after birth. We hypothesized that AS may not be sufficient for a complete and correct evaluation of the newborns and UACG should be used routinely for all births even without any signs of fetal distress. Material-methods In this retrospective study, the data of 1781 babies born between January 2018 and December 2019 at Cerrahpasa Faculty of Medicine were analyzed. Newborn with fetal distress, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at UACG), and pre and postterm newborns are excluded. The UACG and the 1 and 5-minute AS data of 1438 cases were evaluated. Mild acidemia was accepted as a pH between 7.1 and 7.2. Following UACG threshold values were accepted as abnormal pH <7.2, BE <-6 mmol/l, lactate ≥5 mmol/l, HCO3 <18 mmol/l, pCO2 ≥50 mmHg. We evaluated the correlation between UACG and 1 and 5-minute AS and their effects on admission to neonatal intensive care unit (NICU). Results There was a significant correlation between both 1 and 5-minute AS and UACG values such as pH, lactate, and pCO 2 (p<0.001). In addition, significant correlation was found between the 5-minute AS below 7 and some UACG abnormal threshold values (pH, HCO 3 , base excess) (p<0.001). We found that some cases with mild acidemia had a normal 1 and 5-minute Apgar scores (AS≥7) in %1.9 and %2 of cases, respectively. A significant correlation was found between admissions to NICU with 1 and 5-minute AS of <7 (p<0.001). Conclusions The 5-minute AS of 7 or higher may not be sufficient to verify the well-being of a newborn. Relying only on AS, may create the risk of missing some newborns with mild metabolic acidosis. 1 and 5-minute AS could be used as a predictive value for NICU admission. We propose that routine UACG should be evaluated for each birth at term, even without any signs of fetal distress and normal AS.

Fetal and Maternal Outcome Asymptomatic vs. Symptomatic Covid Positive Pregnant Women

2021 ◽  
Vol 15 (10) ◽  
pp. 3423-3425
Author(s):  
Amna Najam ◽  
Samreen Fakeer Muhammad ◽  
Samia Saifullah ◽  
Maryam Shoaib ◽  
Maria Anwar
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cesarean Section ◽  
Pregnant Women ◽  
Apgar Score ◽  
Adverse Outcomes ◽  
Maternal Outcomes ◽  
Group A ◽  
Nicu Admission ◽  
Group B

Objective: The aim of this study is to compare the fetal and maternal outcomes in between asymptomatic and symptomatic COVID positive pregnant women. Study Design: Retrospective cohort study Place and Duration: The study was conducted at Gynae and Obs department of Sandeman Provincial Hospital, Quetta for duration of six months from November 2020 to April 2021. Methods: One hundred and ten pregnant women with ages 18-45 years had corona virus disease were presented. Informed written consent was taken from all patients for detailed demographics. COVID -19 was diagnosed by PCR. 55 patients had symptoms of coronavirus were included in group A and 55 patients did not show symptoms were included in group B. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Maternal adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were calculated among both groups. Fetal outcomes perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. SPSS 20.0 version was used to analyze all data. Results: Mean age of the patients in group A was 28.47±3.18 years with mean BMI 24.03±5.24 Kg/m2 and in group B mean age was 27.99±4.17 years with mean BMI 24.44±6.41 Kg/m2. Maternal outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor,) in symptomatic group were significantly higher than that of asymptomatic group. Fetal outcomes, perinatal mortality in group A 9 (16.4%) and in group B was 5 (9.1%), low birth weight in group A was among 21 (38.2%) and in group B was 10 (18.2%), low apgar score in group A was 11 (20%) and in group B was 8 (14.4%), 15 (27.3%) in group A went to NICU admission and 3 (5.5%) patient in group II admitted to NICU. Conclusion: In this study we concluded that adverse outcomes among symptomatic COVID pregnant women were higher than that of asymptomatic coronavirus pregnant women in terms maternal and perinatal outcomes. Keywords: Pregnant women, Coronavirus, Symptomatic, Asymptomatic, Adverse Outcomes

Perinatal outcome in gestational diabetes according to different diagnostic criteria

2019 ◽  
Vol 47 (5) ◽  
pp. 553-557 ◽  
Author(s):  
Lina Salman ◽  
Anat Pardo ◽  
Eyal Krispin ◽  
Galia Oron ◽  
Yoel Toledano ◽  
...  
Keyword(s):  
Gestational Diabetes ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Challenge Test ◽  
Perinatal Outcomes ◽  
Tolerance Test ◽  
Oral Glucose ◽  
Neonatal Hypoglycemia ◽  
Glucose Challenge ◽  
Nicu Admission

Abstract Objectives To evaluate whether gestational diabetes mellitus (GDM) diagnosed by different criteria impacts perinatal outcome. Methods This was a retrospective study of deliveries with a diagnosis of GDM (2014–2016). Perinatal outcomes were compared between patients with: (1) GDM diagnosed according to a single abnormal value on the 100-g oral glucose tolerance test (OGTT); (2) two or more abnormal OGTT values; and (3) a 50-g glucose challenge test (GCT) value ≥200 mg/dL. Results A total of 1163 women met the inclusion criteria, of whom 441 (37.9%) were diagnosed according to a single abnormal OGTT value, 627 (53.9%) had two or more abnormal OGTT values and 95 (8.17%) had a GCT value ≥200 mg/dL. Diet-only treatment was significantly higher in the single abnormal value group (70.3% vs. 65.1% vs. 50.5%) and rates of medical treatment were significantly higher in the GCT ≥ 200 mg/dL group (P < 0.05). Women in the GCT ≥ 200 mg/dL group had higher rates of neonatal intensive care unit (NICU) admission (10.5% vs. 2.7% vs. 2.8%, P < 0.001) and neonatal hypoglycemia (5.3% vs. 0.5% vs. 0.8%, P < 0.001). On multivariate logistic regression, GCT ≥ 200 mg/dL was no longer associated with higher rates of NICU admission and neonatal hypoglycemia (P > 0.05). Conclusion No difference was noted in the perinatal outcome amongst the different methods used for diagnosing GDM.

scholarly journals A Comparative Study of Maternal and Fetal Outcome in Obese Non- Obese Pregnant Women

2021 ◽  
Vol 15 (10) ◽  
pp. 3397-3399
Author(s):  
Anisa Saleem ◽  
Bushra Mehmood ◽  
Amna Aslam ◽  
Rubina Kausar
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Apgar Score ◽  
Post Partum ◽  
Obese Patients ◽  
Obese Women ◽  
Group I ◽  
Post Partum Haemorrhage ◽  
Group Ii ◽  
Nicu Admission

Objective: The aim of this study is to determine the adverse pregnancy outcomes in obese and non- obese women. Study Design: Randomized controlled trial Place and Duration: Department of Gyne & Obs, Shahida Islam Teaching Hospital Lodhran, during from 01-07-2020 to 31-07-2021. Methods: Total one hundred and eighty patients were enrolled in this study. Patients were aged between 18- 50 years. Patients detailed demographics were recorded after taking written consent. Patients were equally divided into two groups I and II. 90 obese patients were included in group I and equally non-obese patients were included in group II. Frequency of pre-eclampsia, gestational diabetes mellitus and post-partum haemorrhage were calculated. Adverse outcomes (cesarean section, instrumental delivery, induction of labor and prolong labor, hypertensive disorder) were also calculated among both groups. Fetal outcomes were perinatal mortality, Low birth weight, Low Apgar score and NICU admission were observed. Complete data was analyzed by SPSS 24.0 version. Results: Mean age of the patients in group I was 34.12±4.59 years with mean BMI 31.12±8.67 Kg/m2 and in group II mean age was 26.13 ±5.78 years with mean BMI 23.03±9.48 Kg/m2. Frequency of pre-eclampsia in obese group I were high among 40 (44.4%) patients as compared to group II 9 (10%) patients , frequency of gestational diabetes mellitus in group I was among 21 (23.3%) patients and 6 (6.7%) patients were in group II, post partum haemorrhage was seen in 57 (63.3%) cases in group I and 29 (32.2%) cases in group II. Fetal outcomes, perinatal mortality in group I 5 (5.5%) and in group II was 4 (4.4%), low birth weight in group I was among 21 (23.3%) and in group II was 45(50%), low apgar score in group I was 14 (15.5%) and in group II was 9 (10%), 43 (47.8%) in group I went to NICU admission and 28 (31.1%) patient in group II admitted to NICU. Conclusion: Pregnancy-related complications such as gestational diabetes, pre-term labour, and pre-eclampsia are more likely in obese women, according to our data. Having a baby with a woman who is obese might lead to serious difficulties for both mother and baby. Maternal obesity is connected with an increased risk of feto-maternal morbidity and mortality. Keywords: Pre-eclampsia, Gestational diabetes, Partum haemorrhage, Apgar score, NICU

scholarly journals Detection of Preventable Fetal Distress During Labor From Scanned Cardiotocogram Tracings Using Deep Learning

2021 ◽  
Vol 9 ◽  
Author(s):  
Martin G. Frasch ◽  
Shadrian B. Strong ◽  
David Nilosek ◽  
Joshua Leaverton ◽  
Barry S. Schifrin
Keyword(s):  
Deep Learning ◽  
Fetal Monitoring ◽  
Fetal Distress ◽  
Well Being ◽  
Adverse Outcomes ◽  
Care Providers ◽  
Learning Framework ◽  
Uterine Contractions ◽  
Neuroprotective Treatment ◽  
Pattern Information

Despite broad application during labor and delivery, there remains considerable debate about the value of electronic fetal monitoring (EFM). EFM includes the surveillance of fetal heart rate (FHR) patterns in conjunction with the mother's uterine contractions, providing a wealth of data about fetal behavior and the threat of diminished oxygenation and cerebral perfusion. Adverse outcomes universally associate a fetal injury with the failure to timely respond to FHR pattern information. Historically, the EFM data, stored digitally, are available only as rasterized pdf images for contemporary or historical discussion and examination. In reality, however, they are rarely reviewed systematically or purposefully. Using a unique archive of EFM collected over 50 years of practice in conjunction with adverse outcomes, we present a deep learning framework for training and detection of incipient or past fetal injury. We report 94% accuracy in identifying early, preventable fetal injury intrapartum. This framework is suited for automating an early warning and decision support system for maintaining fetal well-being during the stresses of labor. Ultimately, such a system could enable obstetrical care providers to timely respond during labor and prevent both urgent intervention and adverse outcomes. When adverse outcomes cannot be avoided, they can provide guidance to the early neuroprotective treatment of the newborn.

scholarly journals Perinatal Outcome of Twins Delivered Vaginally in a Tertiary Care Hospital

2021 ◽  
Vol 25 (1) ◽  
pp. 66-71
Author(s):  
Ayesha Zulfiqar ◽  
Maliha Sadaf ◽  
Amina Abbasi ◽  
Sabeen Ashraf ◽  
Omair Ashraf
Keyword(s):  
Intensive Care ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Descriptive Study ◽  
Obstetrics And Gynaecology ◽  
Nicu Admission ◽  
Twin Pregnancies ◽  
Second Twin

Objective: To determine the perinatal outcome of first and second twin delivered vaginally in terms of frequency of poor APGAR score and NICU admission in the patient at term in a tertiary care health facility.Introduction: This study aims to improve the perinatal outcome of twin pregnancies through awareness of the need for antenatal care, the recommendation of regular antenatal visits, early recognition of complications, and the presence of neonatal intensive care facilities to improve neonatal outcome by knowing the burden of adverse outcomes in our population.Materials and Methods: This is a descriptive study, conducted at the Department of Obstetrics and Gynaecology at DHQ Hospital, Rawalpindi from January 2019 to June 2019.A total of 91 individuals (female pregnant ladies) who delivered twins (Dichorionic Diamniotic) babies through normal vaginally were selected for descriptive study in the Department of Obstetrics and Gynaecology, DHQ hospital Rawalpindi. All consecutive patients admitted in the labour ward with twin pregnancies were included. Before delivery, the fetal wellbeing of both the twins was evaluated also by ultrasonography. Data collection was done by interview schedule from the patients. Data were analyzed using descriptive statistics using SPSS version 17. For all the quantitative variables like age, gestational age and intertwine interval in seconds.Results: Out of 6278 deliveries during the study period, 91 twin births gave a frequency of 15.16/1000 births. Patients' mean age was 30.14+2.64 years, and mean gestational age was 37.47+0.72 weeks. The mean inter twin delivery interval (mins) in the study was 23.74+4.75. Perinatal outcome of first and second twin in terms of frequency of poor APGAR score and NICU admission in a patient at term was 09 (9.9%) and 27 (29.7%), (p<0.001) respectively.Conclusion: The study concludes that there was a high risk of perinatal outcomes in the second twin as compared to the first twin delivered vaginally. Poor Apgar score and neonatal intensive care admission were more so for the second twin.  

scholarly journals A prospective clinical study of foetomaternal outcome in relation to oligohydramnios in pregnancies beyond 36 weeks of gestation

2020 ◽  
Vol 9 (6) ◽  
pp. 2342
Author(s):  
B. S. Meena ◽  
Nimisha Gupta ◽  
Oby Nagar ◽  
Swati Trivedi
Keyword(s):  
Respiratory Distress ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Meconium Aspiration Syndrome ◽  
Vital Role ◽  
Prospective Clinical Study ◽  
Meconium Aspiration ◽  
Pregnant Females ◽  
Nicu Admission

Background: Amniotic fluid is contributed by both mother and foetus. It plays a vital role in foetal growth. The main purpose of this study was to evaluate the foetomaternal outcome in pregnant females with oligohydramnios beyond 36 weeks of gestation.Methods: This study was conducted on 230 pregnant females beyond 36 weeks of gestation with decreased liquor clinically and confirmed sonographically. It was conducted from May 2018 to May 2019. Females with leaking per vaginum, patients who did not give consent and with intrauterine foetal death were excluded. Complete labour record was made. Assessment of maternal outcome was done in terms of mode of delivery and foetal outcome was done in terms of birth weight, Apgar score at one and five-minute, respiratory distress, meconium aspiration, seizures in first 24 hours of life, congenital malformations, neonatal intensive care unit admission and death of baby.Results: A total of 230 pregnant females met the inclusion criteria who were having AFI <5. 121 (53%) females were primigravida and 119 (52%) underwent for caesarean section. Most common indication of LSCS was foetal distress. Apgar score at 1 minute was <7 in 97 (42%) babies and after 5 minutes, it was <7 in 93 (40%) babies. Other neonatal outcome results were IUGR in 59 (26%) babies, meconium aspiration syndrome in 52 (23%) babies, respiratory distress in 92 (40%) babies, congenital malformation in 6 (3%) babies, NICU admission of 93 (40%) babies and neonatal death of 11 (5%) babies.Conclusions: Oligohydramnios increases the chances of maternal morbidity and perinatal morbidity and mortality.

scholarly journals Meconium stained liquor and perinatal outcome

2018 ◽  
Vol 7 (12) ◽  
pp. 5056
Author(s):  
Aruna Biradar ◽  
Shreedevi Kori ◽  
Neelamma Patil ◽  
S. R. Mudanur
Keyword(s):  
Apgar Score ◽  
Fetal Heart Rate ◽  
Neonatal Intensive Care ◽  
Fetal Heart ◽  
Birth Asphyxia ◽  
Meconium Aspiration Syndrome ◽  
P Value ◽  
Operative Interference ◽  
Nicu Admission ◽  
Meconium Stained Amniotic Fluid

Background: The aim of this study is to know the association between the meconium stained amniotic fluid and its association with the perinatal outcome.Methods: All the patients coming to present hospital for delivery with meconium stained liquor during the study period were included in the study.Results: 163 cases with meconium stained liquor (MSAF) were included in the study, 124(76.1%) and 39(23.9%) had thin and thick MSAF respectively. Among these cases, thick MSAF was more associated with high fetal heart rate (FHR) variability (p value- 0.030), associated with increased rate of operative interference (64.1%; p value- 0.001), abnormal Apgar score (p value-0.003 at 1min and 0.001 at 5min) and increased neonatal intensive care unit (NICU) admission (33.3%; p value - <0.001).Conclusions: Present study showed that thick meconium is associated with more complications like increased operative interference, birth asphyxia, meconium aspiration syndrome, low Apgar score, prolonged NICU stay and overall increased perinatal mortality compared to thin meconium stained liquor. As the gestational age increased the incidence of meconium increased and a greater number of thick meconium had abnormal CTG.

Unexpected Term Neonatal Intensive Care Unit Admissions and a Potential Role for Centralized Remote Fetal Monitoring

2021 ◽  
Author(s):  
Jane K. Martin ◽  
Eboni G. Price-Haywood ◽  
Mariella M. Gastanaduy ◽  
Daniel G. Fort ◽  
Mary K. Ford ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Multivariable Analysis ◽  
Fetal Monitoring ◽  
Exposed Group ◽  
Univariable Analysis ◽  
Unexposed Group ◽  
Nicu Admission

Objective Centralized remote fetal monitoring (CRFM) has been proposed as a method to improve the performance of intrapartum fetal heart rate (FHR) monitoring and perinatal outcomes. The purpose of this study is to determine whether CRFM was associated with a reduction in unexpected term neonatal intensive care unit (NICU) admissions. Study Design A pre–post design was used to examine the effectiveness of CRFM which was implemented in stages across five hospitals. The exposure group was all women who underwent intrapartum monitoring via CRFM. The unexposed group was of women who delivered at the same hospitals prior to implementation of CRFM. Pregnancies with expected NICU admissions, gestational age <37 weeks, birth weight <2,500 g, or major fetal anomalies detected prenatally were excluded. The primary outcome was unexpected term NICU admission; secondary outcomes were cesarean and operative vaginal delivery (OVD), and 5-minute Apgar score of <7 rates. Maternal and delivery characteristics were examined with Student's t, Wilcoxon's, Chi-square, and Fisher's exact tests. Multivariable logistic regression was performed to control for potential confounders. Results There were 19,392 live births included in this analysis. In the univariable analysis, the odds of unexpected term NICU admission was lower among the CRFM exposed group compared with the unexposed group (odds ratio [OR] = 0.86, 95% confidence interval [CI]: 0.75–0.99; p = 0.038). In multivariable analysis, this did not reach statistical significance (OR = 0.92, 95% CI: 0.79–1.06; p = 0.24). Cesarean and OVD were less likely in the exposed group (OR = 0.91, 95% CI: 0.85–0.97; p = 0.008) and (OR = 0.70, 95% CI: 0.59–0.83, p < 0.001), respectively, in univariable analysis. When adjusted for potential confounders, the effect remained statistically significant for cesarean delivery (OR = 0.92, 95% CI: 0.85–0.98; p = 0.012). When adjusted for hospital, OVD rate was lower at the highest volume and highest acuity site (OR = 0.48, 95% CI: 0.36–0.65, p < 0.001). Conclusion In some practice settings, utilization of a CRFM system may decrease the risk of unexpected term NICU admission, cesarean, and OVD rate. Key Points

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