scholarly journals Obstetrics Outcomes: A Comparison between Birthing Center and Conventional Labor Ward

2020 ◽  
Vol 3 (2) ◽  
pp. 254-260
Author(s):  
Deepak Raj Kafle
Keyword(s):  
Poor Country ◽  
Low Cost ◽  
Quality Care ◽  
Mode Of Delivery ◽  
Neonatal Outcomes ◽  
Risk Pregnancy ◽  
Labor Ward ◽  
Resource Poor Country ◽  
Significant Difference ◽  
Low Risk Pregnancy

Introduction: Birthing Centers (BC) are increasingly accepted worldwide as an alternate low cost place of birth. The concept is especially relevant for developing countries with limited resources and constraints regarding availability of specialists and hospital beds. The various studies have concluded that when proper risk analyses are conducted and referral rules followed, there is no evidence of increased maternal or perinatal risk at BC compared to standard hospital deliveries. Materials and Methods: This was a prospective, observational and comparative hospital based study done at Paropakar Maternity and Women’s Hospital (PMWH),Kathmandu. The study was conducted on pregnant women without any known risk factors for complications who were admitted in BC and labor ward (LW) for delivery. Details on mode of delivery, genital tract status, Postpartum hemorrhage (PPH) and neonatal outcomes were collected. Descriptive data analysis was done using SPSS. Results: Out of 5132 deliveries, 25.3% had no known risk factor and hence were eligible for study; no statistically significant difference was observed between BC & LW in relation to mode of delivery, perineal trauma, PPH and neonatal outcomes; however, practice of episiotomy was significantly less frequent in BC. Conclusion: When proper risk analyses are conducted and referral rules followed, there is no evidence of adverse obstetrics outcome at BC as compared to standard hospital deliveries. Triaging of low risk pregnancy to a BC is a viable strategy, especially in a resource poor country. This lessens the burden in standard maternity unit so that specialists will be able to provide a quality care to high risk pregnancies.

scholarly journals MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e27-e27
Author(s):  
Sarah McKnight ◽  
Bishal Gautam ◽  
Michael Miller ◽  
Bryan S Richardson ◽  
Orlando da Silva
Keyword(s):  
Caesarean Section ◽  
Preterm Infants ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Significant Difference

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

scholarly journals Short- and long-term results of low cost trauma training in a low-income resource-poor country

MedEdPublish ◽  
2018 ◽  
Vol 7 (3) ◽  
Author(s):  
Ninos Oussi ◽  
Mitra Sadeghi ◽  
Javeria S. Qureshi ◽  
Charles Mabedi ◽  
Peter Elbe ◽  
...  
Keyword(s):  
Low Income ◽  
Poor Country ◽  
Low Cost ◽  
Long Term Results ◽  
Trauma Training ◽  
Resource Poor Country ◽  
Resource Poor ◽  
Short And Long Term

Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor

2019 ◽  
Vol 47 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Katharina Redling ◽  
Sabine Schaedelin ◽  
Evelyn Annegret Huhn ◽  
Irene Hoesli
Keyword(s):  
Mode Of Delivery ◽  
Case Series ◽  
Neonatal Outcomes ◽  
Efficacy And Safety ◽  
Retrospective Case ◽  
Application Form ◽  
Oral Misoprostol ◽  
Vaginal Deliveries ◽  
Significant Difference ◽  
Time To Delivery

Abstract Objectives To compare the oral application form of misoprostol with the misoprostol vaginal insert (MVI) in a Swiss cohort with special regards to the efficacy and safety. Methods We performed a retrospective case series including a historical group induced with oral misoprostol (MO, n=101) and an MVI group (n=101). The primary outcome was time to delivery. Secondary outcomes were mode of delivery, occurrence of tachysystole, use of analgesia and neonatal adverse outcome. Results A total of 202 women were included in the analysis (101 in the MVI as well as in the MO group). Time from start of induction to delivery was significantly shorter in the MVI group compared to the MO group (15.91 h vs. 37.68 h, P<0.001). Within the first 24 h, 78.2% of the women in the MVI group had given birth compared to 28.7% in the MO group (P<0.001). Tachysystole occurred more often in the MVI group (22.8% vs. 5.0%, P<0.001). Women in the MVI group more often needed opioid analgesia during the induction before onset of active labor (31.7% vs. 2.0%, P<0.001). There was no significant difference between neonatal outcomes in the two groups. Conclusion Time to delivery was significantly shorter in the MVI group with a higher rate of vaginal deliveries within the first 24 h. However, patients needed more opioids for pain relief during induction with MVI. There was no difference in neonatal outcomes.

Neonatal outcomes of two‐step delivery in low‐risk pregnancy: A prospective observational study

2020 ◽  
Vol 46 (7) ◽  
pp. 1090-1097
Author(s):  
Kenji Hishikawa ◽  
Takeshi Kusaka ◽  
Takanori Fukuda ◽  
Yutaka Kohata ◽  
Hiromi Inoue
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Low Risk ◽  
Neonatal Outcomes ◽  
Risk Pregnancy ◽  
Low Risk Pregnancy

scholarly journals Comparative evaluation of artificial rupture of membranes and spontaneous rupture of membranes on course of labour and feto-maternal outcomes

2020 ◽  
Vol 9 (10) ◽  
pp. 4160
Author(s):  
Anjali Chauhan ◽  
Bani Sarkar ◽  
Kritika Tanwar
Keyword(s):  
Apgar Score ◽  
Spontaneous Rupture ◽  
Comparative Evaluation ◽  
Low Cost ◽  
Mode Of Delivery ◽  
Cost Effective ◽  
Maternal Outcomes ◽  
Group Outcomes ◽  
Significant Difference ◽  
Nicu Admission

Background: Present study was undertaken to do a comparative evaluation of artificial rupture of membrane (ARM) and spontaneous rupture of membrane (SRM) on the course of labour and feto-maternal outcome.Methods: It was prospective interventional randomized comparative study including 120 primigravidae (60 in ARM and SRM group each) with cervical dilatation ≥3 cm and intact membranes. Amniotomy was performed in ARM group after enrolment while no intervention in SRM group. Outcomes noted were duration of labor, mode of delivery, APGAR score, NICU stay.Results: Significant reduction seen in duration of labour in ARM group (p=0.0001). Mean duration of labor was 5.24 hours in ARM group while 6.94 hours in SRM group. No significant difference noted in mode of delivery (p=0.082). No significant adverse feto-maternal outcomes were seen with amniotomy. APGAR score and NICU admission had no significant difference among the two groups.Conclusions: ARM can be opted as an intervention with shorter duration of labour without adversely affecting the feto-maternal outcomes. It is safe, reliable and cost effective modality when employed in primigravida and may be considered as a low-cost accessible intervention to reduce prolonged labour and its associated complications. 

scholarly journals Short- and long-term results of low cost trauma training in a low-income resource-poor country

2018 ◽  
Vol 55 ◽  
pp. S110
Author(s):  
N. Oussi ◽  
M. Sadeghi ◽  
J. Qureshi ◽  
C. Mabedi ◽  
P. Elbe ◽  
...  
Keyword(s):  
Low Income ◽  
Poor Country ◽  
Low Cost ◽  
Long Term Results ◽  
Trauma Training ◽  
Resource Poor Country ◽  
Resource Poor ◽  
Short And Long Term

scholarly journals Sclerema Neonatorum Treated Successfully with Parenteral Steroids: An Experience from a Resource Poor Country

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Sandeep Shrestha ◽  
Nagendra Chaudhary ◽  
Sujit Koirala ◽  
Ruchi Gupta
Keyword(s):  
Poor Country ◽  
Subcutaneous Tissue ◽  
Low Cost ◽  
Treatment Modalities ◽  
Preterm Neonates ◽  
Preterm Baby ◽  
Poor Countries ◽  
Resource Poor Country ◽  
Resource Poor ◽  
Sclerema Neonatorum

Sclerema neonatorum is a form of panniculitides characterized by diffuse hardening of subcutaneous tissue with minimal inflammation. It usually affects ill and preterm neonates. Prognosis is usually poor in many cases despite aggressive management. Various treatment modalities (antibiotics, intravenous immunoglobulin, steroids, and exchange transfusion) have been explained in literature. Steroids due to its easy availability and low cost can prove to be lifesaving in such cases, especially in resource poor countries. Here, we report a case of sclerema neonatorum in a one-week preterm baby treated successfully with parenteral steroids and antibiotics.

scholarly journals Role of admission cardiotocography and amniotic fluid index on perinatal outcome in low risk pregnancy at term

2021 ◽  
Vol 10 (4) ◽  
pp. 1591
Author(s):  
Manasi Patnaik ◽  
Tejaswini M ◽  
Sudhanshu Kumar Rath ◽  
Shaik Afrah Naaz
Keyword(s):  
Amniotic Fluid ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Well Being ◽  
Low Risk ◽  
Amniotic Fluid Index ◽  
Risk Pregnancy ◽  
Low Risk Pregnancy

Background: Fetal surveillance even in normal or low risk pregnancy is essential to ensure safe parturition with minimum intervention. Cardiotocography (CTG) and clinical estimation of amniotic fluid volume (AFV) measured as amniotic fluid index (AFI) are two tests that are easily available in the labor room and can be used to identify fetal well-being. Our study aimed to evaluate role of admission cardiotocography (CTG) and amniotic fluid index (AFI) on perinatal outcome in low risk pregnancy at term.Methods: The study was conducted as a prospective observational study. All low risk pregnant women at term admitted to the labor ward in early or established labour between September 2018 and August 2020 were included in the study. They underwent admission CTG and AFI assessment using ultrasonography. All parameters including CTG changes, mode of delivery, AFI, presence of meconium, APGAR score at 1 and 5 mins, need for admission in neonatal ICU and perinatal mortality were recorded. Quantitative data was compared using chi square test.Results: A total of 180 patients were included in the study. Majority of the women belonged to the age group of 30-35 years. Abnormal CTG showing fetal distress was seen in 105 (58.33%) cases. Non-reactive CTG was significantly associated with meconium stained liqour, requirement for LSCS, still birth, fetal distress, APGAR <7 at 1 and 5min and NICU admission (p<0.001). The association of low AFI with non-reactive CTG had statistically significant impact on perinatal outcomes like low birth weight, requirement for LSCS, fetal distress, APGAR <7 at 1 and 5 mins and NICU admissions.Conclusions: Admission CTG is a simple non-invasive test that can serve as a screening tool in low risk obstetric population to detect fetal distress already present or likely to develop and prevent unnecessary delay in intervention. Thus, it may help in preventing fetal morbidity and mortality.

scholarly journals A study on maternal and perinatal outcome of oligohydramnios in term low risk pregnancy

2019 ◽  
Vol 8 (11) ◽  
pp. 4346
Author(s):  
Sripreethika Rajavelu ◽  
Vinitra Dayalan ◽  
Surya S.
Keyword(s):  
Birth Weight ◽  
Caesarean Section ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Fetal Distress ◽  
Low Risk ◽  
Risk Pregnancy ◽  
Low Risk Pregnancy ◽  
Nicu Admission

Background: Oligohydramnios is a frequent complication of pregnancy that is associated with increased perinatal morbidity and mortality. Once diagnosed; oligohydramnios should further lead to intensive fetal surveillance including ultrasound evaluation. The aim of the study was to determine obstetric outcome in term low risk pregnancy with AFI less than or equal to 5 and to assess whether antepartum oligohydramnios is associated with adverse perinatal outcome.Methods: 200 patients in third trimester in the hospital with evidence of oligohydramnios (AFI less than or equal to 5) were selected after satisfying inclusion and exclusion criteria and studied prospectively. Observations regarding the outcome of labour in form of maternal and perinatal parameters including AFI value, CTG features, mode of delivery, LSCS rate, meconium stained, APGAR score, birth weight and NICU admission were made.Results: Overall perinatal outcome with respect to CTG, 128 (64%) out of 200 patients had non-reactive CTG and only 72 (36%) had reactive CTG. 128 (64%) of non-reactive CTG delivered by LSCS, 72 (36%) delivered by labour natural. Nil labour natural in the subset of AFI 1 to 2, birth weight (<2.5 kg-8% and >2.5 kg-92%), Apgar score (<7 at 1-5 mins:18%), still birth (1%), meconium (58.5%), NICU admission (6%) and perinatal mortality (2%).Conclusions: AFI measurement of less than 5 cm detected after 37 completed weeks of gestation with a low risk pregnancy is found to be an indicator of adverse pregnancy outcome with higher fetal distress, meconium stained liquor and higher caesarean section rate. AFI assessment serves as an important tool and remains as an effective screening test in predicting fetal distress in labour that requires caesarean section.

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