Ultrastructural changes of the placenta in cases of preeclampsia

The placenta plays vital roles during fetal development and growth. The ultrastructure of the placenta together with remodeling of the uterine spiral arteries are very important to maintain the utero-placental blood flow. Preeclampsia (PE) is a multifactorial disorder with abnormal placentation affecting the mother and fetus. The aim of this study was to study the ultrastructural abnormalities of the placenta in cases of PE. The placentas of 10 PE women and 10 controls were studied. Women of PE group were delivered by caesarian section while seven control women were delivered vaginally, and three by caesarian section. Placental samples were studied both morphologically and histologically by light and transmission electron microscopy. Light microscopic study of control placentas showed numerous microvilli, few syncytial knots, thin-walled blood vessels. PE placentas showed reduced number of microvilli with numerous syncytial knots, thick-walled vessels, edematous spaces, fibrotic areas and fibrinoid degeneration. Electron microscopic study of the control placentas showed a thick layer of syncytiotrophoblast (Sy), numerous microvilli and a thin layer of cytotrophoblast (Cy). PE placenta showed hypertrophy of Cy with atrophy of Sy and scarce microvilli. The trophoblast showed edematous vacuoles and glycogen storage areas. The villous core had congested capillaries, edematous spaces, glycogen storage areas and widespread areas of fibrosis. All the changes in PE placentas were attributed to hypoxia and oxidative stress and reduced utero-placental flow due to abnormal remodeling of the uterine spiral arteries that was aggravated by the thick placental barrier and the presence of edema, fibrosis and glycogen storage areas.

Prevalence and associated factors of caesarian section in Ethiopia: a multilevel analysis of the 2019 Ethiopia Mini Demographic Health Survey

Background Caesarian section is a vital emergency obstetric intervention for saving the lives of mothers and newborns. However, factors which are responsible for caesarian section (CS) were not well established in the country level data. Therefore, this study aimed to assess the prevalence and associated factors of caesarian section in Ethiopia. Methods Data from the Ethiopian Mini Demographic and Health survey 2019 were used to identify factors associated with the caesarian section in Ethiopia. We applied multi-level logistic regression and a p-value of <0.25 to include variables before modeling and a p-value<0.05 with 95% confidence interval (CI) for final results. Result The prevalence of caesarian section in Ethiopia was 5.44% (95% CI; 0.048-0.06) in2019. Women in age group of 30-39 and 40-49 years had a higher odd of caesarian section (AOR = 2.14, 95%CI = 1.55-2.94) and (AOR = 2, 95%CI = 1.20-3.97) respectively compared to women in age group of 15-29 years. Women with secondary and higher educational level had higher odds of caesarian section (AOR = 2.15, 95%CI = 1.38-3.34) and (AOR = 2.8, 95%CI = 1.73-4.53) compared to those in no education category. Compared to Orthodox, Muslims and Protestant religions had lower odds of caesarian section with AOR of 0.50 (0.34-0.73) and 0.53 (0.34-0.85). Having <2 births was also associated with the low caesarian section 0.61(0.52-1.22). Using modern contraceptive methods, having ANC visits of 1-3, 4th, 5 plus, and urban residence were associated with higher odds of caesarian section as 1.4 (1.05-1.80]), 2.2 (1.51-3.12), 1.7 (1.12-2.46), and 2.4 (1.65-3.44) 1.6(1.04-2.57) respectively. Conclusion Although evidence indicates that the caesarian deliveries increased both in developed and underdeveloped countries, the current magnitude of this service was very low in Ethiopia which might indicate missing opportunities that might costing lives of mothers and newborns. Women’s age, religion, educational status, parity, contraceptive method, and ANC visit were individual level factors influenced caesarian section. whereas, region and place of residence were community level factors affected caesarian section in the country. Depending on these factors, the country needs policy decisions for further national level interventions.

Pregnancy-related pelvic vein thrombosis

Pregnancy is a hypercoagulable state due to pro-hemostatic changes in the activity of coagulation factors and fibrinolysis and due to progressively increasing pressure on the iliac veins from the growing uterus. Thus, it is not surprising that there is an increased risk for thrombotic events and especially in the pelvic veins. With the trauma of delivery, and particularly caesarian section, the risk is accentuated in the early days postpartum. Multiparity seems to be another risk factor, which may be due to the older age of the patient. The epidemiology, risk factors, diagnosis, management and prognosis of iliac, ovarian and uterine vein thrombosis will be reviewed here, with emphasis on the relation to pregnancy.

Performance evaluation of linear discriminant analysis and support vector machines to classify cesarean section

Currently the hospital is a place that is very vulnerable to the transmission of Covid-19, so giving birth in a hospital is very risky. In addition, the hospital currently only accepts cesarean deliveries, while mothers who can give birth vaginally are recommended to give birth in a midwife because the chances of being exposed to Covid-19 are much lower. In general, this study aims to examine the performance of the LDA-SVM method in predicting whether a prospective mother needs to undergo a C-section or simply give birth normally. The aims of this study are: 1) to determine the best parameters for building the detection model; 2) to determine the best accuracy from the model; 3) to compare the accuracies with the other methods. The data used in this study is the dataset of caesarian section. This data consists of the results of 80 pregnant women following C-section with the most important characteristics of labor problems in the clinical field. Based on the results of the experiments that have been carried out, several parameter values that provide the best results for building the detection model are obtained, namely σ (sigma) –5.9 for 70 % training data, σ=4, –6.1 and ‑6.6 for 80 % training data and σ=4 and 16 for 90 % training data. Besides, the results obtained show that the LDA-SVM method is able to classify the C-section method properly with an accuracy of up to 100 %. This research is also able to surpass the methods in previous studies. The results show that LDA-SVM for this case study generates an accuracy of 100.00 %. This method has great potential to be used by doctors used as an early detection to determine whether a mother needs to go through a C-section or simply give birth vaginally. So that mothers can prevent the transmission of Covid-19 in the hospital

Alobar Holoprosencephaly with Cebocephaly in a Neonate Born to an HIV-Positive Mother in Eastern Uganda

Background. Holoprosencephaly (HPE) is a rare cerebrofacial abnormality resulting from the complete or partial failure of the diverticulation and cleavage of the primitive forebrain. It has an incidence at birth of 1:16000. Case Presentation. We report a case of a 2600 g newborn female delivered by an HIV-infected mother in whom an antenatal ultrasound scan at 34 weeks’ gestation reported features of fetal alobar holoprosencephaly. The neonate was born with cebocephaly, a monkey-like head, and did not survive for more than 30 minutes following delivery by caesarian section despite oxygen therapy. Conclusion. Alobar HPE with cebocephaly remains incompatible with life. In this resource-limited setting, the diagnosis was made clinically, and only an ultrasound scan was performed to confirm the diagnosis. Chromosomal analysis could have given more information.

Effect of intrathecal Dexmedetomidine on preventing shivering after spinal anesthesia in caesarian section

Background Shivering is among the common troublesome complications of spinal anesthesia (SA), and causes discomfort and discontentment in parturients undergoing cesarean section (CS). Objective to investigate the effects of intrathecal dexmedetomidine (DEX) as an adjuvant to heavy bupivacaine in the prevention of shivering in those who underwent CS under SA. Methods A prospective double-blind conducted at Ain Shams University hospitals on 100 parturients who are undergoing CS under Spinal anesthesia over a period of six months starting from December 2018 to May 2019 at Ain shams university hospitals. Patients were randomly subdivided into 2 groups of 50 patients each, Group BD: 5 micrograms DEX was added to 12.5 mg 0.5% heavy bupivacaine. Group BN: 0.5 mL 0.9% normal saline was added to the 12.5mg 0.5% of heavy bupivacaine. Results The incidence of shivering was significantly higher in the BN group (56%) than the BD group (24%). Likewise, the intensity of shivering was significantly higher in the BN group than the BD group. Conclusion Intrathecal DEX in conjugation with heavy bupivacaine reduced the incidence and intensity of shivering in patients undergoing cesarean section after spinal anesthesia and did not increase the incidence of hypotension or bradycardia.

P14.51 Can patients with a suspected high-grade glioma receive tumor treatment during pregnancy safely?

BACKGROUND Diagnosis of a glioma during pregnancy has ethical and medical dilemmas; treatment of the mother may harm the unborn child, but a too conservative approach towards tumor treatment can compromise the survival of the mother. In patients with a suspected high-grade glioma, postponing tumor treatment is undesirable. We collected published cases to describe the given treatments during pregnancy and the outcomes for mother and child. METHODS From Pubmed, Embase and Web of Science, 122 cases were extracted from 65 reports published between 1999 and 2020. We added 7 cases from our center. Cases came from: North-America (54/129), Europe (47/129), Asia (13/129), Middle-East (3/129) and one from Oceania and Africa each; 10 cases were from an unspecified country. The data were analysed with descriptive statistics. RESULTS The median age of the pregnant women was 30 (range 17–48) years; at the time of publication 42% of mothers had deceased. Most frequent symptoms at presentation were high intracranial pressure (35%), seizures (30%) or focal deficits (19%). Patients were diagnosed in each phase of the pregnancy - 30% in the first, 35% in the second and 35% in the last trimester. Twenty-two women decided to terminate the pregnancy (North America 9; Europe 9; international unspecified, Africa, Asia and Middle-East each one case). In sixty-seven percent of women, tumors were operated while pregnant, 70% of those were planned surgery, while in 30% surgery was in performed in an emergency setting. Most women received a resection. In 6 patients tumor surgery was combined with a caesarian section. Histological diagnosis of the tumor was available in 112 patients: anaplastic oligodendroglioma (n=10), anaplastic astrocytoma (n=30), glioblastoma (n=66) or high-grade glioma NOS (n=6). In 10 patients there was a suspected high grade glioma based on MRI imaging. Only 20 patients were treated after surgery whilst still pregnant with either radiotherapy (15/20, 75%), chemotherapy (2/20, 10%) or a combination of radiotherapy and chemotherapy (3/20, 15%) Other patients received additional treatment after delivery (109/129; 84%). Delivery method was a caesarian section in 60% and vaginal delivery in 21%- in 19% delivery method was not described. In 63% of cesarean sections were brought forward either because of rapid maternal deterioration or to enable maternal treatment after delivery. In 92% a healthy child was born, 7% had a intrauterine fetal death and 1% the child was stillborn. None of the patients who experienced intrauterine fetal death had received radio- or chemotherapy during pregnancy. CONCLUSIONS The majority of pregnant women continue their pregnancy when facing a diagnosis of a high grade glioma. Tumor surgery seemed safe during pregnancy. No adverse events were reported in the limited patients who received radiotherapy (n=15) during pregnancy. For chemotherapy we could not draw any conclusions.