Serum Melatonin as a Biomarker for Assessment of Late-term and Postterm Pregnancies in Women without Spontaneous Onset of Labor

We conducted a prospective study to assess serum melatonin as a biomarker to predict the development of late-term and postterm pregnancies and spontaneous beginning of labor in women with term pregnancies. Population of this prospective study included pregnant women with late-term and postterm pregnancies and term pregnancies as controls. In these study groups, serum melatonin concentrations were measured in women with or without labor and their perinatal data were collected. In the postterm pregnancies without labor, the lowest median melatonin concentrations were measured (p<0.05). In the late-term and postterm pregnancies with and without labor, the median serum melatonin concentrations were significantly lower than term ones (p<0.05). In the term pregnancies with labor, the highest median melatonin concentration was measured (p<0.05). A serum melatonin concentration≤34 pg/mL as a cut-off value determines late-term and postterm pregnancy with a sensitivity of 80.4% and a specificity of 81.4%. A serum melatonin concentration>29.35 pg/mL as a cut-off value determines presence of labor with a sensitivity of 82.1% and a specificity of 55.0%. In women with term pregnancies, with the measurement of serum melatonin, it is possible to predict the development of late-term and postterm pregnancies and whether these pregnancies undergo spontaneous labor. With further studies, these findings need to be supported before their routine clinical use.

Prevalence and Factors Associated with Meconium-Stained Amniotic Fluid in a Tertiary Hospital, Northwest Ethiopia: A Cross-Sectional Study

Background. Fetal bowel could pass meconium, a green viscous fluid, before or during labour and most intrauterine passage of meconium is associated with several fetomaternal factors that lead to increased risk of perinatal morbidity and mortality. Given that there is a paucity of data, this study was conducted to assess the proportion and associated factors of meconium-stained amniotic fluid (MSAF) in women who came for labour and delivery service in a tertiary hospital. Methods. A cross-sectional study was conducted from 1 June to 31 August 2018 among 606 labouring mothers at Felege Hiwot Referral Hospital, northwest Ethiopia. Study participants were selected using a systematic random sampling technique. Data were collected using an interviewer-administered pretested questionnaire and data checklist. Factors associated with MSAF were explored using multivariable logistic regression analysis. Results. MSAF occurred in 24.6% (149/606) of pregnancies. Nonreassuring fetal heart rate patterns (Adjusted Odds Ratio [AOR]: 21.9, 95% Confidence interval [95% CI]: 10.96–43.83), postterm pregnancy (AOR: 4.54, 95% CI: 2.24–9.20), duration of labour more than 15 hours (AOR: 2.83, 95% CI: 1.76–4.53), pregnancy-induced hypertension (AOR: 2.43, 95% CI: 1.45–4.05), oligohydramnios (AOR: 2.53, 95% CI: 1.25–5.12), interpregnancy interval less than 2 years (AOR: 2.24, 95% CI: 1.12–4.51), and monthly family income less than 5000 Ethiopian Birr (185 USD) (AOR: 2.03, 95% CI: 1.18–3.51) were significantly associated with MSAF. Conclusions. In this study, the proportion of MSAF was at 24.6% which was higher than a previous report in Ethiopia. Nonreassuring fetal heart rate pattern, postterm pregnancy, duration of labour more than 15 hours, pregnancy-induced hypertension, oligohydramnios, interpregnancy interval less than 2 years, and monthly family income less than 5000 Ethiopian Birr were factors associated with an increased risk for MSAF. Therefore, interventions aimed at detecting MSAF early should consider these factors.

Stillbirth in term and late term gestations in Stockholm during a 20-year period, incidence and causes

Introduction The incidence of stillbirth has decreased marginally or remained stable during the past decades in high income countries. A recent report has shown Stockholm to have a lower incidence of stillbirth at term than other parts of Sweden. The risk of antepartum stillbirth increases in late term and postterm pregnancies which is one of the factors contributing to the current discussion regarding the optimal time of induction of labor due to postterm pregnancy. Material and methods This is a cohort study based on the Stockholm Stillbirth Database which contains all cases of stillbirth from 1998-2018 in Stockholm County. All cases were reviewed systematically and the cause of death was evaluated according to the Stockholm Stillbirth Classification. Stillbirths diagnosed between gestational week (GW) 37+0 and 40+6 n = 605 were compared to stillbirths diagnosed from GW 41+0 and onwards n = 157, according to the cause of stillbirth and pregnancy and maternal characteristics. The aim was to evaluate the incidence of stillbirth over time and the incidence of stillbirth diagnosed from GW 41+0. Results In Stockholm County the overall incidence of stillbirth has decreased from 4.6/1000 births during the period 1998-2004 to 3.4/1000 births during the period 2014-2018, p-value <0.001. When comparing the same time periods, the incidence of stillbirth diagnosed from GW 41+0 and onwards has decreased from 0.5/1000 births to 0.15/1000 births, p-value <0.001. Among women still pregnant at GW 41+0 the incidence of stillbirth has decreased from 1.8/ 1000 to 0.5/ 1000. When comparing stillbirths diagnosed at GW 37+0-40+6 with stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of stillbirth in the latter group. Conclusion In Stockholm County there was a decreasing incidence of stillbirth overall and in stillbirths diagnosed from 41+0 weeks of gestation and onwards during the period 1998-2018. In stillbirths diagnosed from GW 41+0 and onwards infection was a more common cause of death compared to stillbirths diagnosed between GW 37+0 and 40+6.

Post-term Pregnancy: Epidemiology, Outcomes, and Management

The term pregnancy ranges from 37 and 0/7 weeks’ gestation to 41 6/7 weeks’ gestation; a pregnancy that progresses to 42 weeks and beyond is deemed a postterm pregnancy. Such pregnancies are uncommon, in well dated pregnancies, likely less than 3-5 percent. However, because of induction of labor, in the United States it is less than 1%. Postterm pregnancy is associated with a number of complications including stillbirth, meconium, both fetal growth restriction and fetal macrosomia, birth injury, preeclampsia, cesarean delivery, operative vaginal delivery, chorioamnionitis, and postpartum hemorrhage. One of the primary reasons for induction of labor prior to 42 weeks is that it has been associated with a lower risk of many of these complications including cesarean delivery. In women who do not wish to undergo induction of labor, antenatal testing is indicated certainly by 41 weeks of gestation and is commonly used at earlier gestations. This review contains 1 table, 2 figures and 83 references Key words: cesarean, induction, late term, acrosomia, meconium, postterm, stillbirth, term

Determinants of Maternal and Neonatal Outcomes of Oligohydramnios After 37+0 Weeks of Gestation in Mekelle Public Hospitals, Northern Ethiopia

Background Oligohydramnios is a state of deficient amniotic fluid defined objectively using ultrasound measurements as single deepest vertical pocket less than 2 centimeters and/or amniotic fluid index less than 5 centimeters. It has been correlated with conditions that threaten both maternal and fetal health. The aim of this stuy is to assess determinants of adverse maternal and perinatal outcome in women with oligohydramnios after 37+0 weeks in Ayder Comprehensive Specialized Hospital and Mekelle General Hospital from April 1, 2018 – March 31, 2019.Methods This was prospective observational study. Total population purposive sampling method was employed to collect data prospectively. Result During the study period, there were a total of 10,451 deliveries, of which 273 were complicated with oligohydramnios, making the prevalence of term oligohydramnios 2.6%. The composite adverse perinatal and maternal outcomes were 38.1% and 89.4% respectively. Primigravidity, degree of oligohydramnios, presence of intrauterine growth restriction and postterm pregnancy were associated with adverse perinatal outcome. Degree of oligohydramnios and hypertensive disorders of pregnancy were found to be predictor of composite adverse maternal outcome. Conclusion Appreciation of determinants of composite adverse maternal and neonatal outcome can aid prompt interventions and mobilization of resources for resuscitation and early transfer to neonatal intensive care unit. Knowledge of determinants of maternal outcome can serve as a tool for patient counseling and for anticipation of maternal complications.

Término del embarazo de las adolescentes atendidas en el Hospital Verdi Cevallos Balda

El embarazo en adolescentes es un problema de salud pública mundial que altera la salud física, emocional, la condición educativa y económica de los futuros padres; asimismo, frecuentemente se afecta también al producto de la gestación. La investigación fue de tipo retrospectiva, correlacional y cuantitativa. La muestra fue 461 embarazadas adolescentes atendidas en el Hospital “Verdi Cevallos Balda” de la ciudad de Portoviejo durante el 2016. Los resultados de este estudio mostraron que la mayor tasa de embarazo en adolescentes se produjo en primigestas (88,72 %) de 18 años. La desproporción céfalo-pélvica fue el factor materno-fetal que ocupó el primer lugar como causa de cesárea, seguida de factores fetales como distocia de presentación y ruptura prematura de membranas. Palabras clave: Parto espontáneo, cesárea, pretérmino, postérmino, embarazo. Abstract Teenage pregnancy is a global public health problem that alters the physical, emotional, educational and economic condition of future parents; likewise, the gestation product is frequently affected. The research was retrospective, correlational and quantitative. The sample was 461 adolescent pregnant women treated at the Hospital "Verdi Cevallos Balda" of the city of Portoviejo during 2016. The results of this study showed that the highest rate of adolescent pregnancy occurred in first-time pregnant women (88.72 %) of 18 years. Cephalopelvic disproportion was the maternal-fetal factor that ranked first as a cause of caesarean section, followed by fetal factors such as presenting dystocia and premature rupture of membranes. Keywords: Spontaneous delivery, cesarean section, preterm, postterm, pregnancy.