Effects of pre-pregnancy body mass index on pregnancy and perinatal outcomes in women based on a retrospective cohort

To investigate the prevalence of underweight, overweight and obesity as defined by pre-pregnancy body mass index (BMI) and the relationship between pre-pregnancy BMI and pregnancy and perinatal outcomes in women based on a retrospective cohort. Women registered via the Free Pre-pregnancy Health Check (FPHC) program from 2017 to 2019 in Hunan Province, China, were included to the study cohort. The data regarding maternal characteristics, pregnancy outcomes, and infant characteristics were retrieved from the surveillance system of the FPHC program. Logistic regressions were performed to calculate odds ratios (ORs) and adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) to assess the associations between pre-pregnancy BMIs and the outcomes. Among a total of 398,368 women, 54,238 (13.62%) were underweight (BMI < 18.5 kg/m2), 51,251 (12.87%) were overweight (24.0 kg/m2 ≤ BMI < 28.0 kg/m2), and 10,399 (2.61%) were obese (BMI ≥ 28.0 kg/m2). Underweight occurred more commonly in the 20–24 years old (17.98%), Han Chinese (13.89), college-educated (16.09%), rural (13.74%), and teacher/public servant/office clerk (16.09%) groups. Obesity occurred more often in the older than 35-year-old (4.48%), minority (3.64%), primary school or below (4.98%), urban (3.06%), and housewife (3.14%) groups (P < 0.001). Compared with the normal BMI group, underweight was associated with increased risk of low birth weight (LBW) (AOR = 1.25) and small-for-gestational age (SGA) (AOR = 1.11), but protected against gestational hypertensive disorder (GHD) (AOR = 0.85), gestational diabetes mellitus (GDM) (AOR = 0.69), macrosomia (AOR = 0.67), post-term pregnancy (AOR = 0.76), and cesarean-section (AOR = 0.81). Overweight and obesity were associated with increased risk of GHD (AOR = 1.28, 2.47), GDM (AOR = 1.63, 3.02), preterm birth (AOR = 1.18, 1.47), macrosomia (AOR = 1.51, 2.11), large-for-gestational age (LGA) (AOR = 1.19, 1.35), post-term pregnancy (AOR = 1.39, 1.66), and cesarean- section (AOR = 1.60, 2.05). Pre-pregnancy underweight is relatively common in Hunan Province, China. Pre-pregnancy underweight to some extent is associated with better maternal outcomes, but it has certain adverse effects on neonatal outcomes. Pre-pregnancy overweight, especially obesity, has a substantial adverse effect on pregnancy and perinatal outcomes.

Combined method of preparing the cervix uteri for labor in pregnant women with a lack of birth preparedness and a tendency to post-term pregnancy

Objective. Development of an effective method for preparing the cervix in pregnant women with a tendency to overmaturity against the background of a lack of biological readiness for childbirth, as well as reducing the time for preparing the soft birth canal for childbirth in order to conduct subsequent labor excitation. Material and methods. The patients were divided into 3 groups depending on the method of preparing the cervix for childbirth: in the 1st group (n = 50) only laminaria was used; in group 2 (n = 50), a Foley catheter was used in combination with mifepristone; in group 3 (n = 50), only mifepristone was used. Inclusion criteria: gestational period 41 weeks 41 weeks and 4 days inclusive, immature cervix (baseline score on the Bishop scale 0-2 points), singleton pregnancy, cephalic presentation, whole fetal bladder, vaginal cleanliness I-II, satisfactory fetal condition (normal type of curve according to CTG and the absence of fetal hemodynamic disorders according to Doppler data). Statistical processing of the obtained data was carried out using the STATISTICA 10.0 program. Research results. The patients of the three groups were comparable in age, gestational age, and did not differ in the parity of childbirth and body mass index. With the combined preparation of the cervix for childbirth with mifepristone and a Foley catheter, the dynamics of the assessment of the cervix on the Bishop scale is higher and achieved faster than when preparing for childbirth only with laminaria or only antigestagens. When combining mifepristone with a catheter Foley, it is possible to reduce the time interval from the onset of pre-induction to the development of labor in comparison with pre-induction of labor only with mifepristone or only with the help of laminaria, as well as reduce the frequency of caesarean section due to the lack of effect from induction of labor compared with pre-induction of labor only with mifepristone or only with the help of laminaria. The undoubted advantage of this combined method of preparing the cervix for childbirth is its effectiveness, low risk of uterine hyperstimulation, fetal distress syndrome, as well as the absence of a high risk of developing infectious complications. Conclusion. The combined method of preparing the body for childbirth with a tendency to post-term pregnancy is effective, safe and allows you to reduce the preparation time of the soft birth canal for childbirth against the background of a lack of biological readiness for childbirth with a tendency to post-term pregnancy.

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.

Indications of Labor Induction at Delivery Room of Maternity Teaching Hospital in Erbil City

Background and objectives: Induction of labour means stimulation of contractions before the birth starts spontaneously, with or without ruptured membranes. The most common indications include oligohydramnios, pre-labour rupture of the membranes, high blood pressure during pregnancy, severe fetal growth restriction, post-term pregnancy, and var-ious maternal medical conditions such as chronic hypertension and diabetes. The aim of the study was to find out the different indications of labour and associated obstetrical factors in a local tertiary hospital. Methods: A cross-sectional study was conducted among 120 parturient women who attended a delivery room in the Maternity Teaching Hospital in Erbil City from the period of 2nd June to 2nd October 2020. After reviewing the literature, a questionnaire was pre-pared to obtain socio-demographic data, data related to reproductive characteristic and data related to the indications for labour induction. The data were analyzed using descrip-tive and inferential statistical approaches. Results: The study included 120 patients with the highest percentage of the patients (49.1%) were 16 to 23 years old and more than half of the sample (51.6%) had a post-term pregnancy, gestational hypertension and pre-eclampsia (15%). There were highly significant statistical differences between parity, gestational age and indication of labour induction, and significant differences between gravidity and antenatal care visits and indi-cations for labour induction. Conclusions: The majority of the sample had a post-term pregnancy of 40 and 42 weeks as an indication for induction of labour followed by gestational hypertension and pre-eclampsia, oligohydramnios and pre-labour rupture of membrane. There was a statistical-ly significant difference between the antenatal care visit and parity with the induction of labour.

Determine the Outcome of Newborn in Post-Term Pregnancy

Objective: The objective of this study was to assess the outcome of newborn among pregnant females who deliver after prolonged pregnancy. Study Design: Descriptive study Place and Duration: Obstetrics & Gynaecology department of Shahida Islam Teaching Hospital, Lodhran for duration of six months from September 2020 to February 2021. Materials and Methods: 100 patients with pregnancy of >40 weeks were included in study. The patients were not included in this study with medical disorders, intrauterine demise or pregnancy complications. Identification of parameters regarding poor neonatal outcome was done. Variable e.g. gestational age, parity, fetal movement, age, mode of delivery, ultrasound, admission cardiotocogram (CTG) and past prolonged pregnancy were studied. Results: Most of the patients i.e. 39 (39%) were between twenty to twenty five years of age. In this study group multigravida were found in 60 (60%). Emergency caesarean section 65 (65%). Most of babies 64% were admitted to neonatal intensive care unit (ICU). Meconium aspiration syndrome was most general among complications which were found in 67 (67%). No fetal mortality was observed. Conclusion: Pregnancy should be managed before 42 weeks of gestation and should not allow to go post-term due to high rate of neonatal mortality and morbidity. Key words: Neonate, Post-term Pregnancy, Gestational Age, Meconium Aspiration, NICU, Mortality

Feasibility study protocol of a pragmatic, randomised controlled pilot trial: membrane sweeping to prevent post-term pregnancy—the MILO Study

Background Post-term pregnancy is associated with an increased risk of maternal complications, respiratory distress and trauma to the neonate. Amniotic membrane sweeping has been recommended as a simple procedure to promote the spontaneous onset of labour. However, despite its widespread use, there is an absence of evidence on (a) its effectiveness and (b) its optimal timing and frequency. The primary aim of the MILO Study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. We will also assess the acceptability and feasibility of the proposed trial interventions to clinicians and women (through focus group interviews). Methods/design Multicentre, pragmatic, parallel-group, pilot randomised controlled trial with an embedded factorial design. Pregnant women with a live, singleton foetus ≥ 38 weeks gestation; cephalic presentation; longitudinal lie; intact membranes; English speaking and ≥ 18 years of age will be randomised in a 2:1 ratio to membrane sweep versus no membrane sweep. Women allocated randomly to a sweep will then be randomised further (factorial component) to early (from 39 weeks) versus late (from 40 weeks) sweep commencement and a single versus weekly sweep. The proposed feasibility study consists of four work packages, i.e. (1) a multicentre, pilot randomised trial; (2) a health economic analysis; (3) a qualitative study; and (4) a study within the host trial (a SWAT). Outcomes to be collected include recruitment and retention rates, compliance with protocol, randomisation and allocation processes, attrition rates and cost-effectiveness. Focus groups will be held with women and clinicians to explore the acceptability and feasibility of the proposed intervention, study procedures and perceived barriers and enablers to recruitment. Discussion The primary aim of the MILO Study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. Results will inform whether and how the design of the definitive trial as originally envisaged should be delivered or adapted. Trial registration ClinicalTrials.gov NCT04307199. Registered on 12 March 2020

Feasibility study protocol of a pragmatic, randomised controlled pilot trial: Membrane sweeping to prevent post-term pregnancy: The MILO Study

Background Post-term pregnancy is associated with an increased risk of maternal complications, respiratory distress and trauma to the neonate. Amniotic membrane sweeping has been recommended as a simple procedure to promote the spontaneous onset of labour. However, despite its widespread use, there is an absence of evidence on a) its effectiveness and b) its optimal timing and frequency. The primary aim of the MILO study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. We will also assess the acceptability and feasibility of the proposed trial interventions to clinicians and women (through focus group interviews).Methods/Design Multicentre, pragmatic, parallel group, pilot randomised controlled trial with an embedded factorial design. Pregnant women with a live, singleton fetus ≥ 38 weeks gestation, cephalic presentation, longitudinal lie, intact membranes, English speaking and ≥18 years of age will be randomised in a 2:1 ratio to:Membrane sweep versus no membrane sweep Women allocated randomly to a sweep will then be randomised further (factorial component) to:early (from 39 weeks) versus late (from 40 weeks) sweep commencement; and a single verses weekly sweep The proposed feasibility study consists of four work packages i.e., (1) a multicentre, pilot randomised trial, 2) a health economic analysis and 3) a qualitative study (4) a study within the host trial (a SWAT). Outcomes to be collected include: recruitment and retention rates, compliance with protocol, randomisation and allocation processes, attrition rates and cost-effectiveness. Focus groups will be held with women and clinicians to explore the acceptability and feasibility of the proposed intervention, study procedures and perceived barriers and enablers to recruitment.Discussion The primary aim of the MILO study is to inform the optimal design of a future definitive randomised trial to evaluate the effectiveness (including optimal timing and frequency) of membrane sweeping to prevent post-term pregnancy. Results will inform whether and how the design of the definitive trial as originally envisaged should be delivered or adapted.Trial Registration ClinicalTrials.gov, ID: NCT04307199. Registered 12th March 2020. https://clinicaltrials.gov/ct2/show/NCT04307199?id=NCT04307199&draw=2&rank=1

Management of Post-Term Pregnancy

This article provides a summary of a landmark study in the field of obstetrics. Should patients with post-term pregnancies undergo induction of labor or be managed with serial antenatal monitoring? The article describes the basics of the study, including funding, study location, who was studied, how many patients, study design, endpoints, results, and criticism and limitations. The article also reviews other relevant studies and implications and concludes with a clinical case for application.