Mitigation of Risk and Associated Complications of Diagnostic Amniocentesis during Second Trimester of Pregnancy (15-22 Weeks)

Introduction: Amniocentesis is a procedure in which amniotic fluid is collected from the amniotic cavity for testing or treatment. Amniotic fluid is the fluid that surrounds and protects a baby during pregnancy. Amniotic fluid contains fetal cells and various proteins and provides valuable information about baby's health. Aim: To evaluate the risk and associated complications during diagnostic amniocentesis. Methods: This prospective study was conducted by performing amniocentesis among pregnant ladies of early second trimester at Dhaka CMH, and Aklima General Hospital Limited, Mirpur, Dhaka from July 2016 to June 2019. A total of 50 patients were selected by age of the patient, history of previous pregnancy outcome, parental haemoglobinopathy and few other factors triggered these cases to be put under this study. Results: No major complications have been observed during and after the procedure because of appropriate pre-operative and post-operative management. Conclusion: There are some common and known risks which are associated with amniocentesis like miscarriage, amnionitis, fetal trauma etc. Through skilled execution with the help of real-time ultrasound guidance and proper pre-operative and post-operative care, we can avoid complications and get benefit from amniocentesis. JAFMC Bangladesh. Vol 15, No 1 (June) 2020: 42-45

Newborns in intensive care: Apgar score predicts in fifth minute

Apgar Score (AS) < 7 is a predictor of mortality. Survival is shorter in newborns, with AS5min < 7 and the use of invasive mechanical ventilation (IMV). Thus, the objective of this study was to analyze whether maternal, obstetric, anthropometric, and postnatal variables of newborns admitted to the neonatal intensive care unit (NICU) may be associated with AS5min < 7. If this score is a predictor of morbidity and mortality, and if factors most associated with the worse AS interfere with survival. This observational, retrospective, and quantitative study used a descriptive and inferential approach to analyze the medical records of patients of both sexes treated in the NICU of a tertiary hospital which is a recognized reference center of maternal and child health, during 2017. Data were collected to verify the relationship between AS values ​​(AS5min < 7 and AS5min ≥ 7). AS5min < 7 was associated with hypertensive disorders of pregnancy (HDP), premature rupture of the amniotic membrane, vaginal delivery, fetal trauma at birth, abdominal perimeter, and ventilatory support. Among these, HDP and the use of IMV were predictors of lower survival. Conclusion: AS5min was associated with maternal, obstetric, anthropometric, and postnatal variables of neonates admitted to the NICU. Specific maternal and postnatal variables interfered with the survival of these newborns.

Adverse gestational events associated with prenatal, perinatal and postnatal variables in the Neonatal ICU

Objective: To analyze whether maternal, obstetric, anthropometric and postnatal variables of neonates admitted to the neonatal intensive care unit (NICU) are different in pregnant women who had adverse gestational events (AGE). In addition, it seeks to analyze whether AGE are predictors of mortality. Methods: Observational, retrospective and quantitative study, with a descriptive and inferential approach based on the medical records of patients seen at the tertiary reference hospital in health located in a municipality in Pará, during 2017. Data were collected to verify the relationship between present and absent AGE. Results: AGE (+) were associated with alcoholism, loss of amniotic fluid, premature labor, breench presentation, increased capillary glycemia and pneumonia. AGE (-) were associated with absent prenatal care, intact amniotic membrane, amniotic fluid with thick meconium and fetal trauma at birth. The other data were not significant. Conclusion: Maternal, obstetric, anthropometric and postnatal variables in neonates admitted to the nicu are associated with AGE (+). The events analyzed did not increase the chances of death.

Breech Presentation: Vaginal Versus Cesarean Delivery, Which Intervention Leads to the Best Outcomes?

Introduction: The best route of delivery for the term breech fetus is still controversial. We aim to compare maternal and neonatal outcomes between vaginal and cesarean term breech deliveries.Material and Methods: Multicentric retrospective cohort study of singleton term breech fetuses delivered vaginally or by elective cesarean section from January 2012 - October 2014. Primary outcomes were maternal and neonatal morbidity or mortality.Results: Sixty five breech fetuses delivered vaginally were compared to 1262 delivered by elective cesarean. Nulliparous women were more common in the elective cesarean group (69.3% vs 24.6%; p < 0.0001). Gestational age at birth was significantly lower in the vaginal delivery group (38 ± 1 weeks vs 39 ± 0.8 weeks; p = 0.0029) as was birth weight (2928 ± 48.4 g vs 3168 ± 11.3 g; p < 0.0001). Apgar scores below seven on the first and fifth minutes were more likely in the vaginal delivery group (1st minute: 18.5% vs 5.9%; p = 0.0006; OR 3.6 [1.9 - 7.0]; 5th minute: 3.1% vs 0.2%; p = 0.0133; OR 20.0 [2.8 - 144.4]), as was fetal trauma (3.1% vs 0.3%: p = 0.031; OR 9.9 [1.8-55.6]). Neither group had cases of fetal acidemia. Admission to the Neonatal Intensive Care Unit, maternal postpartum hemorrhage and the incidence of other obstetric complications were similar between groups.Discussion: Although vaginal breech delivery was associated with lower Apgar scores and higher incidence of fetal trauma, overall rates of such events were low. Admission to the neonatal intensive care unit and maternal outcomes were similar.Conclusion: Both delivery routes seem equally valid, neither posing high maternal or neonatal complications’ incidence.