Role of mifepristone in pre-induction cervical ripening: a double blind placebo-controlled study

Background: Mifepristone has been used for cervical priming and labour induction for long with modest success. This double-blind study compares mifepristone with placebo in causing cervical ripening and inducing spontaneous labour in women past their expected date of delivery.Methods: 200 women at 40 weeks gestation received mifepristone or placebo after Bishop score was assessed. 48 hours later, cervical score was rechecked. Improvement in Bishop score was noted as primary outcome measure. Incidence of spontaneous labour, cesarean delivery and meconium staining of liquor during labour was also monitored.Results: 16 women went into labour before 48 hours and 184 were evaluable. Improvement in Bishop score was noted in significantly more women in mifepristone group (82/94 versus 42/90, p<0.0001). Mean change in Bishop score was 3.22 in mifepristone group and 1.61 in placebo group. This advantage in cervical ripening with mifepristone did not translate into better obstetric outcome. The incidence of spontaneous labour (64/94 mifepristone versus 60/90 placebo), cesarean section (4/94 versus 12/90) and MSL (8/94 versus 10/90) was comparable in the two groups and did not reach statistical significance.Conclusions: Mifepristone has a beneficial effect on cervical ripening in term pregnancies but does not offer obstetric advantage in terms of higher rates of spontaneous labour or vaginal delivery.

PSVI-3 Effect of feeding resistant starch on sow and piglet farrowing performance and blood parameters

Hyperprolific sows can have a long duration of farrowing, negatively impacting piglet survival and vitality. This study’s objective was to assess the effect of a diet containing 6.6% resistant starch (RS) on sow and piglet farrowing performance. We hypothesized that a diet containing RS would decrease sow farrowing duration and improve piglet survival. Forty-two sows were balanced for parity and randomly assigned to 1 of 2 treatments: standard lactation diet (n = 21) or diet containing RS (n = 21). Sows were fed their respective diets from approximately 7d prefarrowing throughout lactation. Sow blood was drawn at three time points on d106±1.0 and d113±1.0 of gestation (pre-feeding, 2 and 6 h post-feeding) and during farrowing to measure blood glucose. Piglet umbilical blood (~3/litter; beginning, middle, end of birth order) was collected at birth and analyzed for glucose, lactate, pH, PCO2, PO2, TCO2, HCO3, BE, and sO2. Piglets were visually assessed at birth to score meconium staining. Data collected included farrowing duration, piglet birthing intervals, number of stillborn piglets/litter, sow and piglet weights, piglet mortality, and sow feed and water intake. Average litter sizes post-crossfoster for control and RS were similar, 12.1±0.4 and 11.6±0.4 piglets, respectively. Litter weight gain was similar between control and RS (44.97 vs. 47.54 kg, P = 0.33), respectively. Feeding resistant starch had no effect on number of stillborn piglets or pre-weaning survival (P &gt; 0.75). Farrowing duration (178.9±17.6 min vs 165.2±18.0 min, P = 0.59) and piglet birth intervals (16.57±1.7 min and 14.89±1.8 min, P = 0.51) did not differ between control and RS, respectively. There was difference in sow blood glucose between diets (P = 0.02), day of sample (P &lt; 0.0001), time point (P &lt; 0.0001), and a day by time point interaction (P &lt; 0.0001). Feeding RS to sows prefarrowing can modify sow blood glucose, but did not result in reduced farrowing duration or improved piglet survival.

Supplementary Tryptophan Fed to Sows Prior to and after Farrowing to Improve Piglet Growth and Survival

Tryptophan indirectly increases plasma calcium levels, which may improve sow health, and melatonin production, which may improve piglet survival when supplemented during late gestation and lactation. It was hypothesised that tryptophan would increase piglet survival and increase sow circulating melatonin and calcium. Seventy-two multiparous (Landrace x Large White) sows were allocated to either control (0.16% tryptophan; n = 24), low tryptophan (0.42%; n = 24) or high tryptophan (0.56%; n = 24). Piglet viability measures consisted of weights, behaviour, meconium staining, rectal temperature, blood glucose and serum immunoglobulin G concentration. Blood samples collected from sows were analysed for melatonin (two daytime and three night-time samples; n = 17) and calcium (two samples pre- and post-farrowing; n = 14). Both tryptophan treatments increased piglet survival compared to the control group (p < 0.001). Tryptophan had no effect on piglet viability (p > 0.05) and no effect on sow plasma melatonin and calcium concentrations compared with the control group (p > 0.05) except at 21:00 when low tryptophan sows had higher melatonin concentration compared with high tryptophan (p = 0.011). Further research to understand the mediating effects of tryptophan (particularly 5-hydroxytryptophan) on piglet survival, including sow behaviour, is warranted.

Umbilical cord coiling index as a marker of perinatal outcome

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.

Effect of body mass index on fetal outcome in pregnancy

Maternal body mass index during pregnancy is one of the important parameter which gives us the clue regarding fetal complications. The objectives of this study were to study distribution of antenatal patients in underweight, normal, overweight (and obese) categories according to booking BMI, to examine the association of BMI with perinatal outcomes in singleton pregnancies. This prospective Study was conducted over a period of 1 year from July 2019 to June 2020 on antenatal women attending O.P.D in the Department of Obstetrics and Gynecology in LLRM Medical College. The enrolled patients were divided into three equal groups(n=50) according to their BMI. In all the groups perinatal outcome was assessed. The mean baby birth weight for whole study group was 2.807 kg with standard deviation of 0.44. Birth weight found to be related to maternal BMI and mother with low BMI have babies with low birth weight and vice versa.14% of babies born to mothers belonging to underweight BMI group required NICU admission due to reasons like meconium staining, low birth weight, birth asphyxia. 10% babies born to mothers who were overweight were admitted in NICU while 0% of babies born to women with normal BMI got admitted in NICU. Higher prevalence of complications to fetus when BMI is not in the recommended normal range.

PERINATAL OUTCOME OF MECONIUM STAINED LIQUOR IN TERM, PRE-TERM & POST-TERM PREGNANCY

Introduction: Meconium aspiration is commonly dened as the presence of meconium below the vocal cords. Meconium aspiration is more common if the meconium is thick rather than thin. This may be a reection of the fact that oligohydramnios (and therefore thick undiluted meconium) is more likely to lead to fetal hypoxia due to cord compression and consequently increased fetal breathing. Aim: To determine the incidence of cases having meconium stained liquor during labour. To classify the total no. of cases with meconium stained liquor in labour on the basis of gestational duration (term, pre-term and post-term), as well as mode of delivery. To correlate the perinatal outcome with incidence of meconium staining of liquor during labour. To reduce perinatal mortality & morbidity. Materials And Methods: The present study was conducted at Darbhanga Medical College and Hospital, during the period of December 2018 to November 2020. During the study period, total number of deliveries was 3500, the number of cases selected for the study were 1680. Intrapartum meconium stained liquor was present in 165 cases (11.01%). Cases with clear liquor in the intrapartum period 1495 cases (88.99%) were taken as controls. Result: No signicant correlation was noted between maternal age and meconium staining of liquor. The incidence of staining was higher i.e. 17.1% in higher gestational age of foetus i.e. 41-42 weeks. Our study also yielded results of rising incidence of low –birth weight babies(less than 2.5kg) in meconium stained liquor cases. Instrumental vaginal deliveries and caesarean sections were found to be more prevalent in these cases. Mean Apgar Scores were signicantly lower in cases complicated with thick stained liquor than in thin stained liquor or clear liquor. Conclusion: It can be said that our study has revealed some results that further establishes some well-known facts about meconium stained liquor. Meconium stained liquor is a very common complication during labour and its incidence is 11.01% as per this study. Incidence of instrumental vaginal delivery and caesarean section is signicantly increased when liquor is meconium stained during labour.

PREDICTION OF SHORT-TERM PERINATAL OUTCOME IN OLIGOHYDRAMNIOS AT TERMROLE OF UMBILICAL CORD ARTERIAL BLOOD LACTATE LEVELS

Objective: Investigating the perinatal outcome in pregnant patients with oligohydramnios at term. Study Design: Prospective observational study. Place and Duration of Study: Department of Obstetrics and Gynaecology, Pakistan Naval Ship (PNS) Shifa Hospital Karachi, from Mar to Oct 2020. Methodology: The investigation comprised of 60 parturient ladies with gestational amenorrhoea of 37-42 weeks and no associated medical illnesses. Collection A consisted of 30 patients with maximum vertical pocket (MVP) <2cm or amniotic fluid index (AFI) ≤5cm. Collection B involved 30 pregnant women having normal amniotic fluid index >5cm. The 2 collections were tallied with respect to demographic characteristics and perinatal outcome particularly low birth weight, delivery mode, poor APGAR score, umbilical artery acidosis and meconium staining. Neonatal future stands upon evaluation of levels of lactate found in umbilical cord arterial blood. Results: According to our findings, commonest mode of childbirth 37 (61.7%) was Caesarean section. No statistical difference was found between the two aggregations of low weight at birth i.e. 4 (13.3%). Based on our study, meconium staining at birth was prevalent in 8 (13.3%) of neonates however no meconium aspiration was seen, umbilical artery acidosis was apparent in 27 (45%) and only 5 (8.3%) accounted for poor APGAR scores. Conclusion: Detrimental pregnancy aftermath and elevated perinatal morbidity correlates with oligohydramnios.

Observation of dose dependent intravaginal Prostaglandin E2 application in free farrowing sows during parturition – a pilot study

The duration of birth is an important factor influencing the survival of piglets and the health of sows. A prolonged parturition is usually treated with oxytocin, even though several undesirable side effects are described. Therefore, the aim of this study was to evaluate the safety and efficacy of Prostaglandin E2 (PGE2) of different concentrations as an intravaginal applied gel after the birth of the fourth piglet in sows. Twelve sows were randomly allocated to one of four treatment groups: Group I (control group) application of placebo gel; Group II application of 0.5 mg; Group III application of 1.0 mg PGE2; Group IV PGE2 application of 2.0 mg PGE2. Total duration of parturition (time between first piglet and last placenta), piglet interval before and after treatment and placenta expulsion duration (time between first and last placenta) were recorded, and each piglet was scored for meconium staining and vitality. Furthermore, stillborn piglets were categorized into ante-partum and intra-partum deaths.A significant dose-dependent effect of PGE2 after the fourth piglet in a linear regression model with group I, II and III on the total duration of parturition and the placenta expulsion duration was detected. An increase of the PGE2 dosage from 0 to 1 mg significantly reduced the total duration of parturition (group I: 553.7 ± 114.2; group II:456 ± 167.9; group III: 284.7 ± 40.5; p-value: 0.02) and placenta expulsion duration (group I: 364 ± 120; group II: 289 ± 144.1; group III: 119 ± 46.13; p-value: 0.03). Although no further significant differences between the groups using ANCOVA and a linear regression model including all groups were detected, severe meconium staining in more than 10% of piglets was observed in group II and IV. Moreover, piglets of group IV showed oedematous and haemorrhagic umbilical cords, lethargy and anoxia after treatment, and intra-partum deaths were recorded.The best outcome for the sows and piglets was achieved using the 1 mg PGE2 dosage, whereas the other dosages showed more negative side effects, impairing the health and welfare of the animals. The results of this study can be used for further studies with larger sample sizes.

The Prenatal Diagnosis~ What should we do? What can we do?

Purpose: Prenatal diagnostic accuracy has improved; however, the pediatric surgeon’s role remains unclear. This paper aimed to determine the prenatal diagnoses made and the role of pediatric surgeons. Methods: A 6-year retrospective review of 904 pregnancies managed at our institute was conducted. They were classified as a normal pregnancy (NP, n=194), abnormal pregnancy maternal factor (MF, n=449), or abnormal pregnancy fetal factor (FF, n=261). Results: In the FF group, the identified conditions were twin pregnancies (n=75), intrauterine growth restriction (IUGR) (n=49), breech presentation (n=26), arrested development (n=19), hypoamnion (n=42), fetal distress (n=16), hydramnios (n=10), abnormal heart sounds (n=5), meconium staining (n=5), surface anomaly (n=4), calcification (n=2), fetal hydrops (n=2), fetal death (n=2), bowel dilatation (n=2), abdominal mass (n=1) and diaphragmatic hernia (n=1). Case of twin pregnancies, breech presentation, arrested development, IUGR, hypoamnion, abnormal heart sounds, meconium staining and fetal hydrops did not require surgery. Of the 16 cases of fetal distress, 1 had biliary atresia. Of the 10 cases of hydramnios, 1 had meconium peritonitis. Of the 4 with surface anomalies, 3 had gastroschisis. Of the 2 with calcification, 1 had meconium peritonitis. Of the two fetal deaths, 1 had anal atresia suggesting a chromosomal abnormality. Of the 2 cases of bowel dilatation, 1 had bowel atresia. The abnormal mass was caused by adrenal bleeding. These diagnoses were made at an average of 27.4 gestational weeks; however, 2 cases of gastroschisis, suggesting a body stalk anomaly; diaphragmatic hernia; and brain cysts were diagnosed before 20 weeks and were aborted. After delivery, the mortality rate was 0% in neonates treated by pediatric surgeons and neonatologists. Conclusion: Fetal abnormalities are rare; however, early aggressive management with the cooperation of obstetricians and parents is crucial for pediatric surgeons to minimize the effects of anomalies.