scholarly journals Assessment of Maternal and Fetal Outcomes According to Induction Methods Following Negative Oxytocin Challenge Test

2022 ◽  
Author(s):  
Okan Aytekin ◽  
Sezin Erturk Aksakal ◽  
Mehmet Metin Altay
Keyword(s):  
High Risk ◽  
Medical Records ◽  
Challenge Test ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Labor Induction ◽  
Induction Method ◽  
Hospital Records ◽  
Apgar Scores ◽  
Risk Patients

Abstract Purpose: To evaluate maternal and perinatal outcomes in high-risk patients who had negative OCTs and to investigate the effects of methods of induction on the development of fetal distress. Methods: The hospital records of patients were reviewed retrospectively. Clinical data were obtained from medical records. Results: OCT was performed in 551 patients and was negative in 447 patients. Among patients with a negative OCT, labor induction was preferred in 427 (95.5%) patients. When fetal distress development was assessed according to the induction method used following a negative OCT, and fetal distress developed in 9.1% of 427 patients who underwent labor induction. Conclusion: When outcomes were considered in pregnant women with a negative OCT, it was observed that there were no fetal deaths and a limited number of newborns with low Apgar scores. Further randomized studies are needed to draw definitive conclusions.

Feasibility of Prophylactic Pancreatojejunostomy in Possible High-Risk Patients for Prevention of Pancreatic Fistula during Enucleation or Limited Pancreatic Resection

2018 ◽  
Vol 84 (1) ◽  
pp. 149-153 ◽  
Author(s):  
Takao Ohtsuka ◽  
Yasuhisa Mori ◽  
Takaaki Fujimoto ◽  
Yoshihiro Miyasaka ◽  
Kohei Nakata ◽  
...  
Keyword(s):  
High Risk ◽  
Pancreatic Fistula ◽  
Pancreatic Resection ◽  
Medical Records ◽  
Operation Time ◽  
Postoperative Pancreatic Fistula ◽  
Postoperative Hospital Stay ◽  
High Risk Patients ◽  
Risk Patients ◽  
Related Mortality

The aim of this study was to assess the feasibility of prophylactic pancreatojejunostomy after enucleation or limited pancreatic resection regarding the risk of postoperative pancreatic fistula (PF). We retrospectively reviewed the medical records of 32 patients who underwent enucleation or limited pancreatic resection and compared the clinical parameters between patients with ( n = 10) and without ( n = 22) prophylactic pancreatojejunostomy. Prophylactic pancreatojejunostomy was performed in patients with a possible high risk ofPF. No operation-related mortality occurred. Operation time was significantly longer ( P < 0.01) and blood loss significantly greater ( P < 0.01) in patients with pancreatojejunostomy. Overall complications were more frequent ( P = 0.02) and postoperative hospital stay was significantly longer ( P = 0.02) in patients with pancreatojejunostomy. However, other assessed factors including the prevalence of postoperative PF did not differ between groups. In conclusion, prophylactic pancreatojejunostomy is feasible, and its efficacy in preventing PF after enucleation or limited pancreatic resection in high-risk patients will require further study.

scholarly journals Evaluation of glucose challenge test using cut off values 130mg/dl and 140 mg/dl for gestational diabetes mellitus screening

2018 ◽  
Vol 7 (3) ◽  
pp. 801 ◽  
Author(s):  
Tulasa Basnet ◽  
Neelam Pradhan ◽  
Poonam Koirala ◽  
Kesang D. Bista
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
High Risk ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Challenge Test ◽  
Perinatal Outcomes ◽  
High Risk Group ◽  
High Risk Women ◽  
Glucose Challenge

Background: Gestational Diabetes Mellitus (GDM) is associated with several adverse maternal and perinatal outcomes. Thus, screening for early detection of GDM and its treatment is important.Methods: This was hospital based descriptive study done over one year in department of Obstetrics and Gynecology, TUTH, Nepal. Six hundred ninety-seven women fulfilling the inclusion criteria were enrolled at 18-22 weeks of gestation. High risk factors were assessed and GCT was performed in women with risk factors during enrollment. Diagnostic OGTT was performed in women who screened positive (GCT ≥130mg/dl). Screen negative high-risk women were re-screened at 24-28 weeks. In women without known risk factors, GCT was performed at 24-28 weeks and OGTT was performed when screen positive. The diagnosis of GDM was made according to Carpenter and Coustan criteria.Results: Out of 697 enrolled women, 12 were excluded for various reasons and 685 women were analyzed. Women having risk of GDM were 28.9%. The prevalence of GDM was 2.92% and 2.48% with GCT cut off 130 mg/dl and 140 mg/dl respectively. Lowering the threshold to 130 mg/dl identified three extra cases (p=0.010). The prevalence among high risk group was 8.58% and 7.07% with the cut off value 130 mg/dl and 140 mg/dl respectively with three extra cases detected on taking cut off value 130 mg/dl (p=0.014). Among low risk women the prevalence of GDM was same i.e. 0.61% with both the cut off values.Conclusions: Lowering threshold of GCT to 130 mg/dl could identify significant percentage of extra cases of GDM especially in high risk women.

scholarly journals Admission test cardiotocography in labour as a predictor of foetal outcome in high risk pregnancies

2019 ◽  
Vol 8 (4) ◽  
pp. 1331 ◽  
Author(s):  
Anvesha Kumar ◽  
Purshottam Bantaklal Jaju
Keyword(s):  
High Risk ◽  
Fetal Distress ◽  
Chi Square ◽  
Uterine Contractions ◽  
Non Invasive ◽  
Chi Square Test ◽  
Risk Patients ◽  
Foetal Outcome ◽  
Nicu Admission

Background: Continuous fetal heart monitoring in all pregnant women in labour has gained prominence in obstetric practice in the recent years. The aim of this study was to emphasize on the role of admission cardiotocography (CTG) in labour as a predictor of foetal outcome in high risk pregnancies.Methods: This was a prospective observational study done on 340 high risk patients admitted in labour with a period of gestation of ≥37 weeks. An admission CTG which consists of a 20-minute recording of FHR and uterine contractions was taken and the foetal outcome was correlated with it. The non-parametric Chi-square test was used for statistical calculations and a p valve of <0.05 was considered to designate statistical significance.Results: The admission CTG was reactive in 69.4% of all patients, equivocal in 22.2% and pathological in 8.4% of the 340 recruited patients. A total of 37.5% of the patients were post-dated followed by 20.6% of pregnancy incuded hypertensive patients. The neonatal outcomes in terms of fetal distress, meconium stained liquor, NICU admission were considerably higher in pathological test. The specificity of the test was 53.3%, and the negative predictive was    86.49%.Conclusions: Admission CTG is a simple, useful screening test and serves as a non-invasive tool in forecasting the adverse foetal outcomes in high risk pregnancies.

scholarly journals A study of fetomaternal outcome in induction of labour in third trimester oligohydramnios

2019 ◽  
Vol 8 (11) ◽  
pp. 4196
Author(s):  
Nalini Sharma ◽  
Hanslata Gehlot
Keyword(s):  
Amniotic Fluid ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Labor Induction ◽  
Operative Delivery ◽  
Amniotic Fluid Index ◽  
Gestational Age At Delivery ◽  
A Prospective Study

Background: The Induction of labor in oligohydramnios poses a dilemma for obstetrician. Studies are limited with variable results. This study aims at finding whether isolated oligohydramnios is an indication for operative delivery or labor induction followed by vaginal delivery is possible.Methods: A prospective study carried out on females delivered in study duration in Umaid Hospital, Jodhpur, Rajasthan. Outcomes studied were gestational age at delivery, colour of amniotic fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery, Apgar score at one minute and five minutes, birth weight, admission to Neonatal Intensive Care Unit (NICU), perinatal morbidity and perinatal mortality. Descriptive statistics were applied and data was represented on frequency tables, graphs and diagrams.Results: 40% of subjects had amniotic fluid index (AFI) <5 cm and 60% demonstrated AFI between 5-7 cm. 60% of patients induced delivered vaginally with (38.33%) having AFI <5 cm. Operative delivery was resorted to in 40% of patients. Perinatal outcomes resulted in total 97% of babies discharged in healthy condition.Conclusions: Labor induction is feasible in idiopathic oligohydramnios. Fetal distress is the most feared and predicted outcome with labor induction in oligohydramnios. This study deduced that in majority- reason for c-sections was failed labor induction due the poor Bishop's score, not fetal reasons. We hope by putting at rest apprehensions of obstetrician regarding this notion rate of c-sections could be reduced.

scholarly journals Management Costs of Febrile Neutropenia in Oncology Patients in Colombia

2021 ◽  
Author(s):  
Mauricio Lema ◽  
Beatriz Preciado ◽  
Diana Quiceno ◽  
Sara Mora ◽  
Natalia Castano Gamboa ◽  
...  
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Solid Tumors ◽  
Medical Records ◽  
First Line ◽  
High Risk Patients ◽  
Main Driver ◽  
Risk Patients ◽  
The Cost ◽  
Official Sources

Abstract Purpose: To describe the clinical characteristics, resource utilization, and direct cost of febrile neutropenia (FN) in a healthcare institution in Colombia for patients seen between 2017-2019.Methods: A descriptive and retrospective study of a cohort of patients hospitalized due to FN. Costs were extracted from the review of medical records from diagnosis of FN until discharge or death, and official sources were used to estimate the cost. Results: Forty-four FN episodes were included. Median age was 61 years (IQR: 53-72). Solid tumors accounted for 68.8%. In first-line treatment were 14 (31.8%), same in proportion in adjuvant/neoadjuvant, and 5 (11.4%) in second-line. FN occurred in 15 (34.0%) high-risk patients. Mean LOS per episode was 5.1 ± 2.5 days. All patients were discharged alive. The median overall cost was $925 ± $783 per episode, with hospital stay being the main driver-cost.Conclusion: FN occurred mainly in advanced-stage solid tumors and in low-risk group. Higher costs in this cohort were found in long length of stay and high-risk patients.

Abstract 636: Conduction Delay in Right Ventricle as a Marker for Identifying High-Risk Patients in Brugada Syndrome

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Atsushi Doi ◽  
Masahiko Takagi ◽  
Keiko Maeda ◽  
Hiroaki Tatsumi ◽  
Kenji Shimeno ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Stratification ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Brugada Syndrome ◽  
Challenge Test ◽  
Conduction Delay ◽  
High Risk Patients ◽  
Coupling Interval ◽  
Risk Patients

BACKGROUND In Brugada syndrome (BS), abnormal conduction delay in right ventricle has been reported. However, the meaning of the conduction delay for risk stratification in BS is still unclear. OBJECTIVES To evaluate the significance of conduction delay in patients with BS as a marker for risk stratification. METHODS Twenty-four patients with BS in whom pilsicainide challenge test was performed (documented VF: N = 7, syncope: N = 7, and asymptomatic: N = 10) were paced from right ventricular apex (RVA), using a basic cycle length of 500ms (8 beats) and a single extrastimulus. A 2.5-French 16-electrode catheter was positioned into the coronary sinus and the great cardiac vein to record intracardiac electrograms on the epicardial sites in right ventricular outflow tract area (RVOT) and lateral left ventricle (l-LV). We measured the conduction time from the stimulus artifact at RVA to the epicardial ventricular electrogram at RVOT or l-LV. The conduction delay between RVA and RVOT (CD-RV) or between RVA and l-LV (CD-LV) was defined as the time interval between the ventricular response at RVOT (RV-V1V2) or at l-LV (LV-V1V2) and the stimulus coupling interval (S1S2) at RVA, respectively (CD-RV; RV-V1V2 minus S1S2, and CD-LV; LV-V1V2 minus S1S2). We also measured 12-lead ECG parameters at baseline and after pilsicainide challenge test, and evaluated the differences of the ECG parameters before and after pilsicainide challenge test. RESULTS Max CD-RV was significantly larger than max CD-LV in all patients (28±9 vs 19±7 ms, p<0.05). Max CD-RV in patients with documented VF was significantly larger than that in patients without (35±10 vs 25±7 ms, p<0.05). However, there was no significant difference in max CD-RV and CD-LV between patients with induced VF and those without (30±9 and 20±5 vs 26±7 and 21±7 ms, p=NS). There was significant positive correlation between max CD-RV and the differences in QRS duration in leads V1, V2, and V6 after pilsicainide administration (r = 0.51, 0.53, and 0.48, respectively, p<0.05). CONCLUSIONS The conduction delay in right ventricle (RV) was a useful marker for identifying high-risk patients in BS. The conduction delay at RV may be related to depolarization abnormality due to sodium channel dysfunction in BS.

Fetal cerebro-placental ratio and adverse perinatal outcome: systematic review and meta-analysis of the association and diagnostic performance

2016 ◽  
Vol 44 (2) ◽  
Author(s):  
Ahmed Abobakr Nassr ◽  
Ahmed M. Abdelmagied ◽  
Sherif A.M. Shazly
Keyword(s):  
At Risk ◽  
Diagnostic Accuracy ◽  
Perinatal Outcome ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Apgar Scores ◽  
Neonatal Complications ◽  
Adverse Perinatal Outcome ◽  
Adverse Perinatal Outcomes

AbstractThe objective of this meta-analysis is to assess the value of fetal cerebro-placental Doppler ratio (CPR) in predicting adverse perinatal outcome in pregnancies with fetal growth restriction (FGR).Three databases were used: MEDLINE, EMBASE (with online Ovid interface) and SCOPUS and studies from inception to April 2015 were included. Studies that reported perinatal outcomes of fetuses at risk of FGR or sonographically diagnosed FGR that were evaluated with CPR were considered eligible. Perinatal outcomes include cesarean section (CS) for fetal distress, APGAR scores at 5 min, neonatal complications and admission to neonatal intensive care unit (NICU). Pooled data were expressed as odds ratio (OR) and confidence intervals (CI), and the summary receiver operating characteristic (SROC) curve was used to illustrate the diagnostic accuracy of CPR.Seven studies were eligible (1428 fetuses). Fetuses with abnormal CPR were at higher risk of CS for fetal distress (OR=4.49, 95% CI [1.63, 12.42]), lower APGAR scores (OR=4.01, 95% CI [2.65, 6.08]), admission to NICU (OR=9.65, 95% CI [3.02, 30.85]), and neonatal complications (OR=11.00, 95% [3.64, 15.37]) than fetuses who had normal CPR. These risks were higher among studies that included fetuses diagnosed with FGR than fetuses at risk of FGR. Abnormal CPR had higher diagnostic accuracy for adverse perinatal outcomes among “sonographically diagnosed FGR” studies than “at risk of FGR” studies.Abnormal CPR is associated with substantial risk of adverse perinatal outcomes. The test seems to be particularly useful for follow up of fetuses with sonographically diagnosed FGR.

scholarly journals A New Approach in the Induction of Labor with Misoprostol Vaginal Insert in High-Risk Pregnancy Obese Women

2020 ◽  
Author(s):  
Valentin Nicolae Varlas ◽  
Georgiana Bostan ◽  
Bogdana Adriana Nasui ◽  
Nicolae Bacalbasa ◽  
Anca Lucia Pop
Keyword(s):  
High Risk ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Labor Induction ◽  
Induction Of Labor ◽  
High Risk Pregnancy ◽  
Obese Patients ◽  
Obese Women ◽  
Cross Sectional ◽  
Risk Pregnancy

Background and objectives: Induction of labor (IOL) is an event that occurs in up to one-quarter of pregnancies; less is known about the outcomes and safety of IOL in obese pregnant woman; no data is available on misoprostol vaginal insert (MVI) IOL in high-risk pregnancy obese women. Objectives: (1) to evaluate the rate of successful IOL with 200 &mu;g MVI in obese (Body Mass Index - BMI over 30 kg/m2) high-risk pregnant women: late-term pregnancy, hypertension or diabetes, compared to obese non-high-risk ones; (2) to evaluate the safety profile of MVI in high-risk pregnancy obese patients. Study design: We conducted a cross-sectional study in "Filantropia" Clinical Hospital, Bucharest, Romania, from June 2017 to September 2019 (28 months). From a total of 11,096 registered live births, IOL was performed in 206 obese patients; 74 obese high-risk pregnant patients matched the inclusion criteria; of these, 33.8% pregnancies (n=25) were late-term (41 &ndash; 41+6 weeks), 43.2% (n=32) had associated pathologies (hypertension and diabetes); labor induction was guided using a standardized protocol. We evaluated the maternal and gestational age, parity, fetal tachysystole, hyper-stimulation, initial cervical status, time from induction to delivery, drug side effects, mode of delivery, and neonatal outcomes. Results: (a) The overall successful labor induction rate, evaluated by the vaginal delivery rate, was 71.6% (n=53), spontaneously or instrumentally assisted; 28.4% (n=21) births were unsuccessful MVI IOL, converted into caesareans. (b) No significant differences were found regarding the maternal outcomes; in terms of perinatal outcomes of safety, four cases of high-risk pregnancies vaginally delivered were associated with neonatal intensive care unit (NICU) admissions and a one-minute Apgar score under seven (5.4%). Most cases with adverse effects of misoprostol have been managed conservatively, except for three emergency C-section cases. Conclusions: Misoprostol vaginal insert is a safe choice in IOL in obese high-risk pregnancies with good maternal and perinatal outcomes.

scholarly journals Anaesthesia Management of Caesarean Section in Two Patients with Eisenmenger's Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
G. Fang ◽  
Y. K. Tian ◽  
W. Mei
Keyword(s):  
High Risk ◽  
Caesarean Section ◽  
Epidural Anaesthesia ◽  
Multidisciplinary Team ◽  
Post Partum ◽  
Perioperative Period ◽  
The Other ◽  
Apgar Scores ◽  
Eisenmenger’S Syndrome ◽  
Risk Patients

Recently two parturients with Eisenmenger's syndrome underwent caesarean section at our hospital. They were managed by a multidisciplinary team during their perioperative period. The caesarean sections were uneventfully performed, one under general anaesthesia and one with epidural anaesthesia, with delivery of two newborns with satisfactory Apgar scores. One patient died in the post-partum period, and the other did well. We discuss the anaesthetic considerations in managing these high-risk patients.

CSF Lactate Levels in High Risk Neonates with and without Asphyxia

PEDIATRICS ◽  
1980 ◽  
Vol 66 (2) ◽  
pp. 224-227
Author(s):  
Oommen P. Mathew ◽  
Harold Bland ◽  
Stuart B. Boxerman ◽  
Elizabeth James
Keyword(s):  
Statistical Analysis ◽  
High Risk ◽  
Fetal Distress ◽  
Cerebral Hypoxia ◽  
Term Infants ◽  
Apgar Scores ◽  
Csf Lactate ◽  
Lactate Levels ◽  
Elevated Lactate

Determination of CSF lactate levels were performed in 150 nonasphyxiated and 46 asphyxiated high risk neonates. Statistical analysis of log lactate levels of nonasphyxiated infants showed significant relationship to gestational and postnatal ages (P &lt;.0001 and &lt;.0002, respectively). CSF lactate elevation was seen in 16/29 infants studied within eight hours of asphyxia in contrast to 0/17 infants studied after eight hours (P &lt;.001). Higher incidence of CSF lactate elevation was seen in term infants (7/8), infants with fetal distress (13/17), and very low Apgar scores (11/18). Seven of eight infants with markedly elevated lactate levels had both fetal distress and very low Apgar scores. CSF lactate determination in the immediate postasphyxial period appears to be an objective way of assessing the severity of cerebral hypoxia.

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