scholarly journals Obstetric Cholestasis: Comparison of Maternal and Perinatal Outcome of Ursodeoxycholic Acid versus Placebo

2020 ◽  
pp. 28-33
Author(s):  
Faiza Safdar ◽  
Shabana Kalsoom ◽  
Noreen Majeed ◽  
Khair-un Nisa ◽  
Shazia Rafique ◽  
...  
Keyword(s):  
Ursodeoxycholic Acid ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Parallel Group ◽  
Acid 500Mg ◽  
Serum Transaminases ◽  
Meconium Staining ◽  
Nicu Admission

Objectives: Objective: To compare the maternal and perinatal outcomes of ursodeoxycholic acid with placebo in obstetric cholestasis. Method: It was an open randomized parallel-group study with convenient sampling, conducted at Pakistan ordinance factories hospital (POF Hospital) Wah Cantt, from 1st June 2016-30th May 2019. Patients with obstetric cholestasis of pregnancy, diagnosed between 24-34 weeks of gestation, were randomized to receive either ursodeoxycholic acid 500mg twice daily or placebo one capsule twice daily for 4 weeks. The data was collected on a pre-designed proforma. The data of 84 patients, who full fill the inclusion criteria were analyzed using SPSS vs 19. Maternal outcomes measured were a relief in pruritus and a decrease in hepatic alanine aminotransferase levels (ALT) at the end of 2 weeks and 4 weeks of treatment. The mode of delivery was noted. Fetal outcomes measured were meconium staining of amniotic fluid and the need for neonatal intensive care unit (NICU) admission. Results: The results showed significant improvement in maternal itch score (P=0.001) and serum transaminases level (p=0.001) in patients using UDCA as compared to placebo. Although there were less number of caesarean sections (p=0.36), meconium-stained liquor (p=0.29) and NICU admissions (P=0.33) in the UDCA group the differences were not statistically significant. Conclusion: Treatment with UDCA in obstetric cholestasis improved maternal complaint of itching and decreased raised transaminases levels but did not affect significantly the mode of delivery, incidence of meconium-stained liquor and NICU admissions. Keywords: Obstetric cholestasis, Ursodeoxycholic acid, perinatal outcome, Pruritus.

scholarly journals Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome

2014 ◽  
Vol 6 (1) ◽  
pp. 25-27 ◽  
Author(s):  
Anita Singh ◽  
Shaheen LNU ◽  
Imam Bano ◽  
Ibne Ahmad
Keyword(s):  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Predictive Values ◽  
Adverse Perinatal Outcome ◽  
Cerebroplacental Ratio ◽  
Adverse Perinatal Outcomes ◽  
Meconium Staining ◽  
Nicu Admission

ABSTRACT Objective This study was done to assess the Doppler cerebroplacental ratio (CPR) in the prediction of adverse perinatal outcome especially in growth restricted pregnancies. Materials and methods In this study, 62 antenatal women were subjected to Doppler studies at 34 to 42 weeks of gestations. CPR was calculated and less than 1 was taken as predictor of adverse perinatal outcome. Adverse perinatal outcomes was evaluated by mode of delivery, meconium staining, 1 and 5-minute Apgar scores, birth weight, admission to NICU and other neonatal complications. Results Of 62 antenatal women, with an abnormal CPR had higher incidence of meconium, clinical fetal distress, operative delivery, low Apgar score (5 mins), NICU admission and neonatal death, 42.88, 47.62, 26.57, 76.19, 66.17 and 66.67% respectively as compared to women with normal CPR who had 4.88, 2.88, 2.88. 2.88, 12.19, 17.07 and 0% respectively. With the use of an abnormal CPR, the sensitivity, specificity, and positive and negative predictive values for predicting an adverse outcome were 62, 80, 62 and 80%, respectively, with an odds ratio (95% confidence interval). Conclusion An abnormal CPR is associated with adverse perinatal outcomes, especially in growth-restricted fetuses. How to cite this article Shaheen S, Bano I, Ahmad I, Singh A. Doppler Cerebroplacental Ratio and Adverse Perinatal Outcome. J South Asian Feder Obst Gynae 2014;6(1):25-27.

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 Study of perinatal outcome of foetuses with nuchal cord

2018 ◽  
Vol 7 (9) ◽  
pp. 3507
Author(s):  
Misbah M. Inamdar ◽  
Asmita N. Patil
Keyword(s):  
Perinatal Outcome ◽  
Demographic Data ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Common Finding ◽  
Chi Square ◽  
Cross Sectional ◽  
Nuchal Cord ◽  
Chi Square Test ◽  
Meconium Staining

Background: Entanglement of the umbilical cord around the foetal neck (nuchal cord) is a common finding at delivery, but its clinical relevance is not entirely clear. Nuchal cords have generally been considered to be rather benign. However, the insufficiency in data regarding the role of nuchal cord in foetal morbidity and mortality is a source of anxiety and frustration to both parturient and healthcare professionals. Considering the above facts the present study was taken up to establish the incidence of nuchal cord at delivery in the existing setup.Methods: This was a cross sectional comparative study conducted over a period of one year from May 2013 to April 2014. A total of 362 women were selected for the study. These women were briefed about the nature of the study and a written informed consent was obtained. The demographic data and obstetrical history were documented on predesigned proforma. The data obtained was analysed using percentages and comparison done using chi-square test for discrete variables.Results: Incidence of Nuchal Cord was 17.7% among study cases. Based on this study gestational age may have an effect on the presence of nuchal cord (p<0.05). Out of 64 cases with nuchal cord’, 11.4% of cases had meconium stained liquor present. 9.8% of cases with nuchal cord had FHR irregularity, which was significantly less as compared to 20.0% of cases who did not show FHR irregularity. This was statistically significant. (p=0.032). 18.7% of mother who showed presence of nuchal cord had delivery by caesarean section. 22.7% of cases with nuchal cord had NICU admissions, which was insignificantly more as compared to 17.0% of cases who did not have NICU admissions.Conclusions: Intrapartum events such as meconium staining of liquor and foetal heart rate irregularities were more commonly associated with nuchal cord but it did not affect the perinatal outcome. However, the mode of delivery was independent of the presence of nuchal cord, thereby reducing the morbidity to the mother. Hence nuchal cord is not associated with adverse perinatal outcomes and the presence of a nuchal cord per se is not found to be an indication of operative delivery.

scholarly journals A study on eclampsia and its maternal and perinatal outcome

2019 ◽  
Vol 8 (12) ◽  
pp. 4990
Author(s):  
Devika J. Kamat ◽  
Guruprasad Pednecar
Keyword(s):  
Antenatal Care ◽  
Perinatal Outcome ◽  
Health Centre ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Tertiary Care Centre ◽  
Neonatal Deaths ◽  
Nicu Admission ◽  
A Prospective Study

Background: Eclampsia is one of the major causes of maternal and perinatal mortality in India. Here authors present a prospective study which was conducted in a tertiary health centre to study the cases of eclampsia, the mode of presentation and the maternal and perinatal outcomes.Methods: A total 95 women were diagnosed as eclampsia during the period of 2 years. Various parameters and their effects on maternal and perinatal morbidity and mortality were studied. Maternal outcomes were assessed based on parameters like antenatal care received, mode of delivery, complications associated with eclampsia. Perinatal outcomes were noted depending upon the period of gestation, NICU admission, stillbirths and neonatal deaths.Results: Authors found the incidence of eclampsia to be 0.9%. 52.7% women had irregular antenatal follow up at any nearby health centre. A total 76.8% women had antepartum eclampsia. 56.8% delivered by caesarean section while 7.4% required operative vaginal delivery. 61.1% women delivered within 10 hours of onset of convulsion. Authors had 02 deaths in the study group, one due to ARDS with DIC and the other attributed to pulmonary oedema. There were 51.6% preterm deliveries. 21 neonates required NICU admission with 5 neonatal deaths and 11 stillbirths.Conclusions: Due to inadequate antenatal care, most of the cases of pre-eclampsia go unnoticed increasing the referrals to tertiary care centre for intensive care. Thus, it is necessary to emphasise on timely interventions and availability of blood bank, ICU and NICU facilities at the closest referral centre for better maternal and perinatal outcome.

scholarly journals Isolated oligohydramnios: effects on obstetric and perinatal outcome

2018 ◽  
Vol 7 (2) ◽  
pp. 635
Author(s):  
Ashwini Vishalakshi L. ◽  
Reddi Rani P.
Keyword(s):  
Caesarean Section ◽  
Perinatal Outcome ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Controlled Study ◽  
Control Group ◽  
Study Group ◽  
Significant Difference ◽  
Nicu Admission ◽  
And Control

Background: Outcome of oligohydramnios has been studied at a large. Varying results have been projected in each study. This study has been done to establish the obstetric and perinatal outcome in pregnancy associated with oligohydramnios as compared to women with normal liquor.Methods: This was a prospective case controlled study done which included 100 women with oligohydramnios who were compared with 100 women with normal liquor. Maternal and perinatal outcome was compared between the two groups.Results: There was a significant difference in the obstetric and perinatal outcomes among the study and control groups. Significant variation was seen in the obstetric outcome with regards to the incidence of induction of labor and mode of delivery (by caesarean section). Both were increased among the study group as compared to the control group. CTG changes, meconium stained liquor, neonatal admissions and observations were more among the study group as compared to control group.Conclusions: Athough there is an increased rate of caesarean section, NICU admission and observation, thick meconium stained liquor and NST changes there is no significant increase in the perinatal morbidity and mortality.

Amniotic-Umbilical-to-Cerebral Ratio – A Novel Ratio Combining Doppler Parameters and Amniotic Fluid Volume to Predict Adverse Perinatal Outcome in SGA Fetuses At Term

2020 ◽  
Author(s):  
Florian Matthias Stumpfe ◽  
Florian Faschingbauer ◽  
Sven Kehl ◽  
Jutta Pretscher ◽  
Julius Emons ◽  
...  
Keyword(s):  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Perinatal Outcomes ◽  
Fetal Distress ◽  
Adverse Perinatal Outcome ◽  
Adverse Perinatal Outcomes ◽  
Nicu Admission ◽  
Singleton Pregnancies

Abstract Purpose Introduction of a novel ratio – the amniotic-umbilical-to-cerebral ratio (AUCR) – to predict adverse perinatal outcome in SGA fetuses at term and comparison of its predictive accuracy with established parameters. Materials and Methods This retrospective cohort study included 165 singleton pregnancies with SGA fetuses (birth weight < 10th percentile) at term. Cases with planned vaginal delivery and documented pulsatility indices (PI) of the umbilical artery (UA), middle cerebral artery (MCA), and single deepest pocket (SDP) were included. CPR was calculated as the ratio between MCA PI and UA PI, UCR as the ratio between UA PI and MCA PI. AUCR was defined as follows: SDP/(UA PI/MCA PI). Adverse perinatal outcomes were defined as operative intervention (OI), OI due to fetal distress, admission to the neonatal intensive care unit (NICU), and composite adverse perinatal outcome (CAPO). Associations between Doppler parameters and these outcomes were estimated using regression analyses. Results OI was statistically significantly associated with UCR, SDP, and AUCR, whereas no association was observed for UA PI, MCA PI, and CPR. Fetuses requiring OI due to fetal distress revealed a significantly higher UA PI and UCR as well as a lower MCA PI, CPR, and AUCR. With regard to NICU admission and CAPO, a significantly higher UA PI and lower CPR were found. Furthermore, a significant association was shown for SDP, UCR, and AUCR. AUCR achieved the best area under the curve for all outcome parameters. Conclusion AUCR leads to an improvement in the prediction of unfavorable outcome in SGA fetuses at term. Furthermore, results of our study show that UCR might be superior to CPR.

scholarly journals Umbilical cord coiling index as a marker of perinatal outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 323-327
Author(s):  
Pragati Jain ◽  
Monika Aggarwal ◽  
Meenu V Ahuja ◽  
Surbhi Gupta
Keyword(s):  
Umbilical Cord ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Perinatal Outcomes ◽  
Well Being ◽  
Ponderal Index ◽  
Amniotic Fluid Index ◽  
Meconium Staining ◽  
Nicu Admission ◽  
In Pregnancy

The umbilical cord is very important for the well-being and survival of the fetus, however this is susceptible to compressions, kinking, traction and torsion which may influence the perinatal outcome and an abnormal umbilical coiling index has been related to adverse fetal and pregnancy outcomes. To determine the umbilical cord coiling index (UCI) and compare its association with perinatal outcome in normal and complicated pregnancies.It was a prospective observational study done on 200 patients at term (after 37 weeks) pregnancy, delivered either vaginally or by cesarean section. The umbilical cord coiling index was calculated. The mean coiling index of our study was 0.256+0.07 per cm. The outcomes measured were maternal age, parity, body mass index, hypertension in pregnancy, diabetes in pregnancy, amniotic fluid index, meconium staining of liquor, neonatal birth weight, Apgar score at birth, ponderal index, NICU admission. The coils were then divided into three categories on the basis of UCI and their association with the maternal and fetal outcomes were analyzed. Hypocoiled cords were those having UCI less than 10th centile, and hypercoiled cords those having UCI more than 90th centile. Statistical analysis was done by chi square test, Fishers exact test and the t test where applicable. Hypocoiled cords (UCI &#60;10th centile) were associated with pregnancy induced hypertension (PIH), diabetes mellitus, meconium staining of liquor, low Apgar score, growth restricted fetus and NICU admission. Hypercoiled cords were associated with liquor abnormalities and low ponderal index. Abnormal umbilical cord coiling index was associated with adverse perinatal outcomes.

scholarly journals Study of perinatal outcomes in normal and borderline oligamnios

2019 ◽  
Vol 9 (1) ◽  
pp. 279
Author(s):  
Divya R. Prasad ◽  
Neelima V. Nair
Keyword(s):  
Heart Rate ◽  
Caesarean Section ◽  
Amniotic Fluid ◽  
Fetal Heart Rate ◽  
Perinatal Outcome ◽  
Fetal Heart ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Amniotic Fluid Index ◽  
Meconium Staining

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome.

scholarly journals Perinatal Outcome of the Second Twin

2015 ◽  
Vol 10 (1) ◽  
pp. 89-93
Author(s):  
R Joshi ◽  
G Baral
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Neonatal Intensive Care Unit ◽  
Apgar Score ◽  
Perinatal Outcome ◽  
Neonatal Intensive Care ◽  
Mode Of Delivery ◽  
Admission Rate ◽  
Second Twin

Aims: The purpose of this study was to determine the perinatal outcome of the second twin compared to the first one. Methods: This is a hospital based comparative study of 60 pregnant women with twin pregnancy at Paropakar Maternity and Women’s Hospital, Kathmandu from 14 January 2013 to13 April 2013. Apgar score and admission to neonatal intensive care unit of the first and the second twins were studied in relation to the gestational age, chorionicity, mode of delivery, inter-delivery interval and birth weight. Mc Nemars test was used with 0.05 as the level of significance. Results: Among 60 sets of twins, Apgar score of the second twin was found to be lower than the first one (p=0.02) in general and in preterm gestation (p=0.049), dichorionic diamniotic chorionicity (p=0.012), vaginal delivery (p<0.001), inter-delivery interval of <30 minutes (p=0.007) and birth weight discordance of <30 % (p=0.014). Admission to neonatal intensive care unit was not significant (p=0.5). Conclusions: Second twin had low Apgar score and the neonatal admission rate was similar for both twins. 

Selective IUGR in dichorionic twins: what can Doppler assessment and growth discordancy say about neonatal outcomes?

2018 ◽  
Vol 46 (9) ◽  
pp. 1028-1034 ◽  
Author(s):  
Paola Algeri ◽  
Matteo Frigerio ◽  
Maria Lamanna ◽  
Petya Vitanova Petrova ◽  
Sabrina Cozzolino ◽  
...  
Keyword(s):  
Intrauterine Growth Restriction ◽  
Neonatal Intensive Care ◽  
Neonatal Resuscitation ◽  
Perinatal Outcomes ◽  
Growth Restriction ◽  
Abdominal Circumference ◽  
Doppler Study ◽  
Umbilical Artery Doppler ◽  
Nicu Admission ◽  
Twin Pregnancies

Abstract Objective: The aim of the present study was to assess, in a population of dichorionic twin pregnancies with selective growth restriction, the effect of inter-twin differences by use of Doppler velocimetry and fetal growth discordancy on perinatal outcomes. Methods: This was a retrospective study including dichorionic twin pregnancies from January 2008 to December 2015 at the Department of Obstetrics and Gynecology of Fondazione MBBM. Only dichorionic twin pregnancies affected by selective intrauterine growth restriction (IUGR) delivering at ≥24 weeks were included in the study. Results: We found that twin pregnancies with inter-twin estimated fetal weight (EFW) discordance ≥15% were significantly associated with a higher risk of preterm delivery before 32 (P=0.004) and 34 weeks (P=0.04). Similarly, twin pregnancies with inter-twin abdominal circumference (AC) discordance ≥30° centiles were associated with a higher rate of neonatal intensive care unit (NICU) admission (P=0.02), neonatal resuscitation (P=0.02) and adverse neonatal composite outcome (P=0.04). Of interest, when comparing twin pregnancies according to Doppler study, growth restricted twins had a higher rate of composite neonatal outcome and in multivariate analysis, an abnormal Doppler was an independent risk factor for this outcome. Conclusions: Our study associated growth discrepancy with specific pregnancy outcomes, according to defined cut-offs. In addition, we demonstrated that an abnormal umbilical artery Doppler is independently associated with a composite neonatal adverse outcome in growth restricted fetuses.

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