Association of Attention Deficit/Hyperactivity Disorder With Events Occurring During Pregnancy and Perinatal Period

Background: The relationship of events occurring during pregnancy and perinatal period with attention deficit/hyperactivity disorder (ADHD) is not clear. Thus, the focus of the current study was to examine the effects of events occurring during pregnancy and perinatal period on ADHD.Methods: A two-phase cross-sectional study was performed across 13 schools in Changsha and Yiyang cities from March to December, 2014. We preliminarily screened all students using CBCL and established the diagnosis using Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). A total of 3,418 questionnaires were effectively completed in this study.Results: History of threatened abortion (TA) [odds ratio (OR): 1.707 (1.201–2.426)] (vs. No-TA) and neonatal asphyxia (NA) [OR: 2.497(1.225–5.09)] (vs. health) showed a positive association with ADHD. On subgroup analysis, TA [OR: 2.216 (1.458–3.369)] (vs. No-TA) was a risk factor for ADHD without comorbidity; instrumental delivery [OR: 2.748 (1.057–7.142)] (vs. natural birth) and NA [OR: 2.789 (1.222–6.361)] (vs. health) were risk factors for ADHD in the subgroup of ADHD with comorbidity; TA (vs. no-TA) and NA (vs. health) were risk factors for ADHD among male students [ORs: 2.232 (1.439–3.462) and 2.808 (1.115–7.068), respectively], while low birth weight (LBW) (vs. normal birth weight) was a risk factor [OR: 2.054 (1.063–3.967)] for ADHD among female students.Conclusion: TA was a risk factor for ADHD in the absence of comorbid conditions; instrumental delivery and NA were risk factors for ADHD in the subgroup of ADHD with comorbidity; TA and NA were risk factors for ADHD among male students. LBW was a risk factor for ADHD among female students.

Risk Factors in Third and Fourth Degree Perineal Tears in Women in a Tertiary Centre: An Observational Ambispective Cohort Study

Objectives: To analyze the main risk factors associated with third and fourth degree postpartum perineal tears in women attended to in our obstetrics service. Methods: An observational, retrospective, hospital cohort study was carried out in women whose deliveries were attended to in the obstetrics service of the Hospital General Universitario Gregorio Marañón de Madrid (HGUGM), during the period from January 2010 to April 2017. Results: During the study period, a total of 33,026 patients were included in the study. For maternal variables, the associated increased risk of severe perineal tearing in nulliparous women is OR = 3.48, for induced labor OR = 1.29, and for instrumental delivery by forceps OR = 4.52 or spatulas OR = 4.35; for the obstetric variable of episiotomy, it is OR = 3.41. For the neonatal variables, the weight of the newborns has a directly proportional relationship with the risk of severe tears, and for birth weights of 3000 g (OR = 2.41), 3500 g (OR = 1.97), and 4000 g (OR = 2.17), statistically significant differences were found in each of the groups (p < 0.05). Conclusion: Primiparity, induction of labor, episiotomy, instrumental delivery with forceps or spatula, and a birth weight of 3000 g or more are significantly associated with an increased risk of third and fourth degree perineal tears.

Risk of Recurrent Adverse Outcomes in Gestational Diabetes: a Retrospective Cohort Study

Objective: Compare the risk of recurrent adverse delivery outcome (ADO) or adverse neonatal outcome (ANO) between consecutive gestational diabetes (GDM) pregnancies. Design: Retrospective cohort Setting: Sydney, Australia Population or Sample: 424 pairs of consecutive singleton GDM pregnancies, 2003-2015 Main Outcome Measures:. ADO: instrumental delivery and emergency Caesarean. ANO: large for gestational age (LGA), small for gestational age (SGA), and composite ANO (LGA/SGA/stillbirth/neonatal death/shoulder dystocia). Methods: Using each pregnancy pair (“index” and “subsequent” pregnancy), we calculated ADO and ANO rates and determined risk factors for subsequent pregnancy outcomes (multivariate regression). Results: Subsequent pregnancies had higher rates of elective Caesarean (30.4% vs 17.0%, p<0.001) and lower rates of instrumental delivery (5% vs 13.9%, p<0.001), emergency Caesarean (7.1% vs 16.3%, p<0.001) and vaginal delivery (62.3% vs 66.3%, p=0.01). ANO rates in index and subsequent pregnancies did not differ. Index pregnancy adverse outcome was associated with a higher risk of repeat outcome: RR 3.09 (95%CI:1.30, 7.34) for instrumental delivery, RR 2.20 (95%CI:1.06, 4.61) for emergency Caesarean, RR 4.55 (95%CI:3.03, 6.82) for LGA, RR 5.01 (95%CI:2.73, 9.22) for SGA and RR 2.10 (95%CI:1.53, 2.87) for composite ANO). The greatest risk factor for subsequent LGA (RR 3.13 (95%CI:2.20, 4.47)), SGA (RR 4.71 (95%CI:2.66, 8.36)) or composite ANO (RR 2.01 (95%CI:1.46, 2.78)) was having the same outcome in the index pregnancy. Conclusions: Women with GDM and an adverse outcome are at very high risk of the same complication in their subsequent GDM pregnancy, representing a high-risk group that should be targeted for directed management over routine care.

COMPARATIVE STUDY OF MATERNALAND NEONATAL OUTCOME OF ELECTIVE INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT AT 40- 40+6 WEEKS OF GESTATION

OBJECTIVES: To compare and analyse in each group- delivery complications like postpartum haemorrhage, obstetric anal sphincter injury at 40-40+6 Week of Gestation. To compare and analyse in each group- perinatal outcomes, mainly perinatal mortality and special care unit admission. METHODS: This prospective comparative observational study was conducted in the Department of Gynaecology & Obstetrics, R. G. Kar Medical College and Hospital. For my study I had taken a total of 276 mothers whom I had subdivided into 2 groups. Group Ahad 138 mothers who had induction of labour (I) by some method. Remaining 138 mothers were allocated to Group B who had only watchful expectancy with monitoring and labeed as expectant management group(EM). RESULT: In group-A (I), 5(3.6%) patients had instrumental delivery in comparison to group B(EM) which had 15(10.9%) of instrumental delivery. LSCS was also higher in group B i.e 36(26.1%) as compared to group A i.e 25(18.1%). 108(78.3%) mothers had vaginal delivery who were induced whereas 87(63.0%) had vaginal delivery in expectant management group. Therefore, induction group had better outcome in terms of mode of delivery.It was also statistically signicant (p=0.0098). The distribution on the basis of APGAR score at 5 minutes of babies in between two groups was signicant. CONCLUSION: Elective induction at 40+ weeks is associated with a lower rate of caesarean delivery and does not increase the risk of major complications for newborns and can be offered to mothers having low risk and crossed their expected date of delivery.The ACOG says elective induction at 40+ weeks is a reasonable option for healthy women. Induction of labour at 40+ weeks should not be routine for women but it is important to counsel them and let them decide whether they want to be induced and when.

Effect of Lunar Cycle on Delivery Rates in a Tertiary Care Hospital in India - A Retrospective Study

BACKGROUND From ancient period, moon has been held responsible for many biological activities. The lunar cycle has long been thought to have many chemical & physical effects on human beings especially women. The menstrual cycle, conception, delivery and even fertility have been closely linked to the moon’s cycles. The relation of lunar phases to the birth rate has been the focus of considerable research with still controversial results. We wanted to study the moon phases with regard to birth rate, relationship between lunar position and the time of delivery, preterm delivery, intrauterine fetal death (IUFD), instrumental delivery, normal vaginal delivery (NVD), lower segment Caesarean section (LSCS) and multiple pregnancy. METHODS Retrospective data from daily antenatal mother admissions, and delivery rates present in the public domain of a tertiary care hospital of Midnapore Medical College, Midnapore, India from 1st Oct 2019 to 30th Sept 2020 was evaluated with one-way analysis of variance (ANOVA). RESULTS Delivery rates were not related to lunar 1 st quarter, full moon, new moon, and last quarter of lunar cycle with total delivery (P < 0.05), LSCS (P > 0.05), NVD (P > 0.05), instrumental delivery (P > 0.05), twin delivery (P > 0.05), and IUFD (P > 0.05). CONCLUSIONS Birth rates do not correlate with phases of the moon. KEYWORDS Lunar Cycle, Birth, Delivery, Pregnancy, Obstetrics

Neonatal Outcomes in Meconium Stained Amniotic Fluid Delivery: A Rural Perspective

Introduction: Presence of meconium in amniotic fluid is a potentially serious sign of foetal compromise and has demonstrated that the incidence of MSAF rises with gestational age. The incidences of admission to Neonatal Intensive Care Unit (NICU) with various neonatal disorders were higher in pregnancies complicated by MSAF. Aim: To study clinical profile and outcomes in neonates born through MSAF at tertiary care hospital in rural area of Andhra Pradesh. Materials and Methods: This cross-sectional, descriptive study included a total of 4462 infants who were admitted in the NICU of Nimra Institute of Medical Sciences and Hospital, Andhra Pradesh from December 2017 to January 2020. All pre-term, term and post-term infants, delivered normally or by caesarean section or instrumental delivery, with MSAF, were included in the study. A detailed ante-natal, natal and postnatal history was taken for the neonates to detect the aetiology of MSAF, type and duration of delivery and any complications Post delivery. All the clinical assessment and lab investigations, X-ray assessments were done for the subjects as and when required. The observations were noted along with the treatment given. Results: Out of 4462 infants admitted in study period, 436(9.78%) had MSAF and 96 (22.01%) developed Meconium Aspiration Syndrome (MAS). MSAF infants born by Normal Vaginal Delivery (NVD) formed 220 (50.46%), Lower Segment Caesarean Section (LSCS) 176 (40.37%) and 40 (9.17%) instrumental delivery. MAS infants born by LSCS formed 38 (21.59%), NVD 52 (23.63%) and instrumental delivery 6 (15%).The mean gestational age was 38-40 weeks. MAS developed in 18 (50%) infants with gestational age >42 weeks, 12 (12%) between 40-42 weeks and 50 (23.36%) between 38-40 weeks (significant relationship, p-value 0.012). The mean birth weight was 2.599±441 kg. MAS developed more in infants of birth weight 2-2.499 kg and least were of birth weight between 1.5-1.999 kg. Male to female ratio was 1.27:1. Thick MSAF was seen in 160 (36.69%) and thin MSAF in 276 (63.31%) infants (p-value 0.001). In MAS infants, 82 had thick and 14 thin MSAF. Among MSAF alone infants (n=340), 142 (41.75%) were associated with birth asphyxia. Among MAS infants, incidence of birth asphyxia was 66 (68.75%). Thirty eight MAS infants developed complications. Pneumothorax was the most common complication. Overall, mortality was 160 (36.69%). MAS contributed to 22.5% of these deaths. A 60 (62.5%) MAS infants were discharged and 36 (37.5%) died. Conclusion: MAS was most consistently associated with thick MSAF. Preventive measures like timely evaluation of high risk factors, preparedness for untoward intrapartum events and close monitoring of MSAF infants can be taken to minimise the mortality and morbidity rates, because it is a global problem especially in under-developed countries.