P. Oxy. LX X VII 5123 and the economic relations between the Apion estate and its coloni adscripticii

Starting from a detailed interpretation of P. Oxy. LXXVII 5123 (ad 555), I argue that the Apion estate favoured a tenancy arrangement with its enapographoi georgoi, the farmers registered on its tax-rolls. Such leases left them with a marketable surplus of the produce in remuneration, which they could sell either to their own estate or to outside parties. Contrary to the now current view of Apionic enapographoi georgoi as directly managed permanent employees or wage labourers, the evidence reviewed suggests that they were not an economically distinct and homogenous labour group.

Can the Robson 10 Group Classification System help identify which groups of women are driving the high caesarean section rate in major private hospitals in eastern Ethiopia? A cross-sectional study

ObjectiveThe rates of caesarean section (CS) in Ethiopian private hospitals are high compared with those in public facilities, and there are limited descriptions of groups of women contributing to these high rates. The objective of this study was to describe the groups contributing to increased CS rates using the Robson classification in two major private hospitals in eastern Ethiopia.DesignCross-sectional study.SettingTwo major private hospitals in eastern Ethiopia.ParticipantsAll women who gave birth from 9 January 2019 to 8 January 2020 in two major private hospitals in eastern Ethiopia.Primary and secondary outcome measuresThe primary outcome was the Robson 10 Group Classification System. The secondary outcome was indication for CS as recorded in the medical files.ResultsOf 1203 births in both hospitals combined during the study period, 415 (34.5%) were by CS. Women with a uterine scar due to previous CS (group 5), single cephalic term multiparous women in spontaneous labour (group 3) and single cephalic term nulliparous women in spontaneous labour (group 1) were the leading groups contributing 33%, 27.5% and 17.1%, respectively. The leading documented indications were fetal compromise (29.4%), previous CS (27.2%) and obstructed labour (12.3%).ConclusionMore than three-fourths of CS were performed among Robson groups 5, 3 and 1, indicating inadequate trial of labour after CS or management of labour among relatively low-risk groups (3 and 1). Improving management of spontaneous labour and strengthening clinical practice around safely providing the option of vaginal birth after CS practice are strategies required to reduce the high CS rates in these private facilities.

Association of first trimester serum level of placental growth factor (PlGF) and cervical length with onset of preterm labour

Background: Preterm labour (PTL) or premature labour is defined as one where labour starts before the 37th completed week. The incidence of preterm birth is around 5-10% and it is the leading cause of perinatal morbidity and mortality. Diagnosis and treatment of PTL is challenging. However, owing to the availability of effective strategies for prevention of preterm birth, risk identification and early prediction is even more essential. This may provide opportunity for intervention and better obstetric care. Various biochemical markers were studied for prediction of preterm labour, but the sensitivity and specificity were found to be low. This study focuses on determining whether serum level of PlGF and ultrasound measure of cervical length at 10 – 14 weeks period of gestation can be used for early prediction of preterm labour.Methods: 296 antenatal women participated in this prospective observational study carried out from Dec 2015 to Sep 2017 at a tertiary care hospital. Serum level of PlGF was determined at 10-14 weeks. In the same sitting, cervical length was measured by transvaginal sonography. All these patients were followed up in antenatal OPD for monitoring the onset of preterm labour.Results: Incidence of preterm labour was 6.76 %. Maternal characteristics and obstetric factors were comparable in cases and controls. Serum PlGF level and cervical length values were lower in preterm labour group than term deliveries. But this result was not statistically significant.Conclusions: Lower levels of PlGF and cervical length were seen in preterm labour group, although it was not found to be statistically significant.

Caesarean section in Palestine using the Robson Ten Group Classification System: a population-based birth cohort study

ObjectiveTo analyse the current situation of caesarean section in Palestine using the Robson Ten Group Classification System (TGCS).DesignA population-based birth cohort study.SettingObstetrical departments in three governmental hospitals in Gaza.ParticipantsAll women (18 908) who gave birth between 1 January 2016 and 30 April 2017.MethodsThe contributions of each group to the study population and to the overall rate of caesarean section were calculated, as well as the rate of caesarean section in each TGCS group. Differences in proportions between study hospitals were assessed by χ2test.Main outcome measuresThe main outcome was the contributions of each group to the overall caesarean section rate.ResultsThe overall rate of caesarean section was 22.9% (4337 of 18 908), ranging from 20.6% in hospital 1 to 24.6% in hospital 3. The largest contributors to the overall caesarean section rate were multiparous women with single cephalic full-term pregnancy who had undergone at least one caesarean section (group 5, 42.6%), women with multiple pregnancies (group 8, 11.6%) and those with single cephalic preterm labour (group 10, 8.1%). Statistically significant differences in caesarean section rates between the study hospitals were observed in group 1 (nulliparous women with single cephalic full-term pregnancy and spontaneous labour), group 4 (multiparous with single cephalic full-term pregnancy with induced labour or prelabour caesarean section), group 5 (multiparous with single cephalic full-term pregnancy with previous caesarean section) and in group 7 (multiparous with breech presentation).ConclusionWomen in groups 5, 8 and 10 were the largest contributors to the overall caesarean section rate in the study hospitals. Efforts to reduce the differences in obstetrical care between hospitals need to be directed towards increasing the proportion of vaginal births after caesarean section and by reducing primary caesarean section in multiple pregnancies and preterm labour.

Prevalence of bacterial vaginosis in preterm and term labour: a one year study

Background: Presence of intra uterine infections is one of the important risk factors for preterm labour. Bacterial vaginosis is one of the commonest genital infections during pregnancy and the prevalence ranges from 4 to 64% depending upon the racial, geographic factors. Most of the cases of bacterial vaginosis during pregnancy are asymptomatic and goes unrecognized. Some of the studies state that treatment of bacterial vaginosis is not associated with reduction in preterm birth rates among mothers with no history of preterm birth. The present was conducted to study the prevalence of bacterial vaginosis in women presenting with preterm labour and term labour and to analyze the causal relationship between bacterial vaginosis and preterm labour. The study also recorded the outcome of maternal and neonatal complications associated with bacterial vaginosisMethods: An observational study was conducted on 100 patients with preterm and term labour. Swabs were collected from all the patients and bacterial vaginosis was diagnosed based on Amsel’s criteria. Pearson’s chi-square test was used to demonstrate the difference between both groups with respect to various categorical data. Independent t- test was used to compare the mean maternal age and mean gestational age at admission in both the groups.Results: The mean maternal age of members in preterm labour was 25.60+4.295 and of term labour was 25.38 ± 4.01 years. Among preterm labour group only 14 cases were suggestive of bacterial vaginosis and 2 cases among 25 cases in labour group. The proportion of cases who were diagnosed as BV positive based on Amsel’s criteria were found more in preterm labour group than term labour group and was found statistically significant (p value = 0.001). Significantly more number of patients in preterm labour group demonstrated culture swab positivity with pathogenic organisms than in term labour group and was found statistically significant with p value=0.048.Conclusions: The present study clearly demonstrates significant association of preterm labour with bacterial vaginosis. Therefore, the screening for bacterial vaginosis as a routine during pregnancy and its prompt treatment may reduce the risk of preterm labour. This will also go a long way in the prevention of neonatal complications due to prematurity.

Feature Extraction and Classification of EHG between Pregnancy and Labour Group Using Hilbert-Huang Transform and Extreme Learning Machine

Preterm birth (PTB) is the leading cause of perinatal mortality and long-term morbidity, which results in significant health and economic problems. The early detection of PTB has great significance for its prevention. The electrohysterogram (EHG) related to uterine contraction is a noninvasive, real-time, and automatic novel technology which can be used to detect, diagnose, or predict PTB. This paper presents a method for feature extraction and classification of EHG between pregnancy and labour group, based on Hilbert-Huang transform (HHT) and extreme learning machine (ELM). For each sample, each channel was decomposed into a set of intrinsic mode functions (IMFs) using empirical mode decomposition (EMD). Then, the Hilbert transform was applied to IMF to obtain analytic function. The maximum amplitude of analytic function was extracted as feature. The identification model was constructed based on ELM. Experimental results reveal that the best classification performance of the proposed method can reach an accuracy of 88.00%, a sensitivity of 91.30%, and a specificity of 85.19%. The area under receiver operating characteristic (ROC) curve is 0.88. Finally, experimental results indicate that the method developed in this work could be effective in the classification of EHG between pregnancy and labour group.

Assessment of Myometrial Concentrations of Oestrogen and Progesterone Receptors in the Lower Uterine Segment of Full-Term Pregnancies in Presence or Absence of Labour

Objective. To assess the concentration of progesterone (PRs) and oestrogen (ORs) receptors of myometrium of full-term pregnant women in the myometrium of lower segment of the uterus in relationship with presence or absence of labour.Methods. This was a cross-sectional prospective study with 21 pregnant women, being 6 in labour (Group I) and 15 without labour (Group II). The biopsy of myometrium was realized during caesarian section, and the excised tissue was stained using immunohistochemical techniques for the quantification of the receptors, and with the aid of image-analysis software, the numbers of receptors for each hormone were determined spectrophotometrically. The Mann-Whitney test was used to compare the pregnant women in each study group with respect to the numbers of ORs and PRs. The Wilcoxon test was used to compare the concentration of ORs and PRs in each group separately.Results. The mean of gestational age was 39 weeks, (range, 37 to 41 weeks). The medians of PRs and ORs in pregnant women in labour (Group I) were 29.3 (range, 24.6–30.2) and 32.3 (range, 22.9–49.0), respectively. The medians of PRs and ORs in pregnant women without labour (Group II) were 43.6 (range, 23.6–70) and 43.9 (range, 18.3–62.6), respectively. We did not observe significant differences of the number of ORs and PRs in both groups ( and 0.37, resp.). The number of ORs was statistically more than that of PRs in Group II (Zcalculated = 16.00).Conclusion. The concentrations of PRs and ORs were similar in the myometrium of the lower uterine segment of pregnant women during and without labour, but the concentration of ORs was more than that of PRs in the myometrium of the lower uterine segment of pregnant women without labour.