Maternal complications and the utilisation of maternal health care services with special reference to West Bengal, India

The study aims to examine maternal complications in the eastern states of India. Further, an attempt is also made to understand the socioeconomic factors that determine the utilization of health care services during maternity in the state of West Bengal. The data used for the study are District Level Household Survey (DLHS) 2007-08, which reveals wide regional variations in maternal complications in India. But the state of West Bengal depicts a unique picture. It has the dubious distinction of achieving low fertility and mortality with high maternal complications. The utilisation of health care services in West Bengal was never near completion. Full utilisation of ANC which is essential for safe motherhood is just above national average. A large number of deliveries still take place out of the institution and are unsafe. Analysis reveals that higher age at motherhood increases the probability of utilising maternal health care services. Social groups, years of schooling, wealth index and place of residence also show significant relationship. The findings of the study provide an insight that efforts should be made to create awareness among socially and economically disadvantaged groups of the society about the benefits of utilisation of health care services. Further it also addresses the issue of creating awareness about MDG’s.

Hypertensive Pathologies in Peripartum: Complications and Maternal and Neonatal Outcome

Introduction: Among the hypertensive pathologies of pregnancy, preeclampsia remains the entity responsible for pregnancy complications. Objective: The aim of this work was to determine the frequency of hypertensive pathologies in the peripartum, to determine the maternal and neonatal morbidity factors associated with preeclampsia on the one hand, and on the other hand, to other forms of hypertension in the peripartal period. Patients and methods: This is a cross-sectional study of hypertensive pathologies in per partum over a period of 15 months?which have been included any pregnant, parturient and hypertensive childbirth. The data was analyzed using SPSS software version 21.0. Data positioning and dispersion parameters were studied. The factor analysis?was?performed by determining the odds ratio with a 95% confidence interval and a significance level set at p?≤ 0.05. Results: 142 cases of hypertension were collected from a total of 2988 deliveries,?i.e.?a frequency of hypertension of 4.8%. The main form of high blood pressure (HBP) was the isolated HBP at 51.4%. 60.3% of primiparas were preeclamptic [OR 2.47 (CI 1.25 - 4.91)], 63.2% of preeclampsia did not follow prenatal consultations?[OR 2.43 (CI 1.06 - 5.62)], 63.6% of preeclampsia had moderate and severe threat premature delivery [OR 4.57 (CI 2.11?-?9.99)], neonatal hypoxia in the fifth minute was found in 34.4% of newborns of preeclamptic mothers [OR 3.02 (CI 1.44?-?6.34)], hypotrophy was observed in 41.4% of the cases in the preeclamptic patients [OR 5.41 (IC 1, from 55 to 19.57)]. Conclusion: Preeclampsia is significantly associated with maternal and neonatal morbidity.

Maternal and Perinatal Complications of Severe Preeclampsia in Three Referral Hospitals in Yaoundé, Cameroon

Objective: The aim of this study was to determine maternal and perinatal complications of pregnancies complicated by severe preeclampsia in three tertiary care centers in Cameroon. Methods: We carried out a descriptive cross sectional study from the 1st of June 2012 to the 31th of June 2014, among pregnant women with severe preeclampsia followed up in three tertiary level hospitals in Yaoundé, Cameroon: the Yaoundé General Hospital, the Yaoundé Central Hospital, and the Yaoundé University Hospital. Statistical analysis was performed using EPI 3.5.5. Data were described as means ± standard deviation, percentages and numbers. Chi-square and Fisher exact tests were used where appropriate. Results: Of the 2500 deliveries registered during the study period, 111 cases (8.49%) were managed as severe preeclampsia. Four patients refused to participate and were excluded from the study. Most of these patients were non workers (58.0%), pauciparous (61.7%) and young (median age of 27.47 years ± 6.46). Eclampsia (12.14%), abruptio placentae (11.21%) and hypertensive retinopathy (7.47%) were the most frequent maternal complications. Two cases (1.86%) of maternal deaths occurred in patients who had eclampsia. Prematurity (48.6%), intra uterine fetal death (13.1%) and oligoamnios (11.2%) were the most frequent fetal complications. All four neonatal deaths occurred in women in whom the diagnosis of severe preeclampsia was done between 28 and 33 weeks of gestation. Conclusion: Pregnancies complicated by severe preeclampsia had significantly high maternal and perinatal morbidity and mortality in Cameroon. The complications of severe preeclampsia can be prevented by more widespread use of antenatal care, education of primary medical care personnel, prompt diagnosis of high-risk patients and timely referral to tertiary medical centers.

Obstetrical Complications of Female Genital Mutilation: Management Maternal-Fetal Medical Care and Prognosis, Obstetrical Gynecology Regional Hospital, Unit of N'zérékoré

Introduction: Female Genital Mutilation (FGM) is a public health problem. There are 100 to 140 million girls and women who suffer every year in the world [1]. The aim of this study is to improve the medical care and reduce complications of FGM at the Regionalhospital of N’zérékoré, to determine their frequency, and to evaluate the maternal-fetalprognosis. Methods: The study was conducted at the Regional Hospital of N’zérékoré. This was a cross-sectional, descriptive and analytic study of 6 months, from 1 September 2016 to 28 February 2017, including all pregnant women admitted for childbirth who had a complication of female genital mutilation. Results: A total of 1295 women gave birth in the service, of which 1204 women were women with female genital mutilation. Given a frequency of 92.97%, of these 1204 mutilated women, 223 presented obstetrical complications during their delivery, a proportion of 17.22%. They were mostly young patients, mostly housewives who were not in school. Type II FGM was the most common (53.06%). Obstetric complications were dominated by complicated perinatal tears (54.08%), and hemorrhages (40.81%). The catch was dominated by perineorrhaphy. Conclusion: The frequency of FGM was 92.97% and that of their obstetric complications 17.22%. Most were house-wives, not in school. There was FGM type II. The abandonment of FGM would reduce maternal and perinatal morbidity and mortality.

Maternal Complications of Caesarean Section in a Resource-Limited Country: The Case of the Maternity Unit of Kankan Regional Hospital, Guinea

Introduction: Innovations in surgical and anaesthetic techniques to provide a good maternal and child safety have made the cesarean section a routine intervention in obstetrics. However, its complications, especially the short or long term per and postoperative maternal ones, are not exceptional and can affect mothers’ vital prognosis. The objectives of this study were to describe the maternal per and postoperative complications encountered during the cesarean section. Patients and method: This is a prospective, descriptive and analytical study carried out at the maternity ward of Kankan Regional Hospital over a 6 month period from January 1, 2018 to June 30, 2018. Results: During this period, out of a total of 2229 deliveries, 319 caesarean sections were performed i.e. a rate of 12.51%. Complications concerned 111 patients (34.79%). The average age was 28 with extremes of 15 and 45. Non-medical transportation concerned 71.17% of our patients. The cesarean section was performed in emergency situations in 82.8% of cases. Indications were dominated by the fetopelvic disproportion. There was a statistically significant relationship between labour duration and the occurrence of complications. Intraoperative complications were dominated by bleeding (25.22% of all complications and 8.77% of total cesarean sections). Post-operative complications were dominated by parietal suppurations (94.49% of all complications and 34.79% of the total number of cesarean sections). In most cases, patients simultaneously developed several complications. Conclusion: The maternal complications of cesarean sections remain considerable. If the increase in the rate of caesarean sections has contributed to the improvement of the mother-fetal prognosis, the surgical procedure itself is not without complications, which encourages us to review its indications for a better management. Hemorrhagic and infectious complications were the most frequent. These results call for increased asepsis measures in our operation theaters to reduce infectious complications. The increase in Caesarean section rates over the years is faced with increased maternal morbidity in the short and long term. Its indications should be well thought out and should include the responsibility of an experienced obstetrician.

Maternal Perception on Obesity;Its Complications and Gestational Weight Gain in Pregnant Mothers Presenting to Antenatal Clinics in a South Asian Teaching Hospital (De Soyza Hospital for Women Colombo—DSHW)

The rates of overweight and obesity are rising to epidemic proportions globally, especially among women. Obesity is increasingly common in the obstetric population as well. Sri Lanka is not an exception to this regard. There is limited published data on maternal perceptions on obesity in pregnancy, gestational weight gain and its complications. The current study aimed to describe the maternal perception on obesity, their knowledge on complications of obesity in pregnancy and gestational weight gain in pregnant mothers. Hospital based descriptive cross sectional study was conducted among a systematic sample of 416 pregnant women registered for antenatal clinic care at De Soyza Maternity Hospital. Pre-tested interviewer administered questionnaire was used for data collection. Maternal BMI at booking visit was taken from the pregnancy record to assess the overweight/obesity prevalence among the study population. Nearly one third (32.2%) of the study population were overweight and 11.8% were obese. Fifty three percent (53%) of overweight women identified themselves as such, but 45% of them considered themselves to be normal weight. Most of the pregnant women in the study sample (59.6%) were unable to estimate the recommended weight gain in pregnancy. Women’s knowledge on the specific risks associated with maternal obesity was poor. Pregnant mother’s knowledge on obesity, gestational weight gain and its consequences were unsatisfactory. Bridging this knowledge gap is an important step towards improving perinatal outcomes for all pregnant mothers in the current obesity epidemic.

Clinical Manifestations and Maternal and Infant Outcomes of Pregnancy Complicated with Thrombocytopenia

Objective:To explore the clinical manifestations as well as maternal and infant outcomes of pregnancy complicated with thrombocytopenia.Methods:A total of 478 pregnant women with thrombocytopenia,treated in Shaanxi Provincial People's Hospital from July 2019 to June 2021,were selected as the research group,while 200 nonnal pregnant women,treated during the same period,were selected as the control group to analyze gestational thrombocytopenia(GT),idiopathic thrombocytopenic purpura(ITP),pregnancy-induced hypertension(PIH),adverse maternal and infant outcomes,etc.Results:Among the 478 patients in the research group,the main causes of pregnancy complicated with thrombocytopenia were GT,ITP,and PIH,accounting for 75.51%,6.49%,and 8.79%,respectively,while other causes accounted for 9.21%.There was no significant difference between the research group and the control group in the amoxmt of intrapartum bleeding,premature delivery,stillbirth,thrombocytopenia,and neonatal asphyxia,but there was significant difference in the mode of delivery(P<0.05)・Conclusion:The traditional indexes of coagulation function are not abnormal with decreased platelets in pregnant women with thrombocytopenia,but the indexes of thromboelasticity are abnormal and can reflect the changes of coagulation function.The cesarean section rate of patients with thrombocytopenia in pregnancy increases with the decrease of platelet count,but the mode of delivery should be determined in consideration of specific conditions.

Early complications after excision with hepaticoenterostomy for infants and children with choledochal cysts

Objective: To retrospectively study the early compli- cations of excision with hepaticoenterostomy for in- fants and children with choledochal cysts. Methods: We analyzed 16 patients with early posto- perative complications out of 173 patients with con- genital choledochal cysts aged 27 days to 14 years (mean 2.4 years) who had undergone excisional pro- cedures and biliary tract reconstruction. Results: The early complications included bile leak- age (10 patients), abdominal wall dehiscence (3), and hepatic failure, pancreatic juice leakage and postoperative intussusception (each in 1) respective- ly. Three patients died from bile leakage and 1 from postoperative hepatic failure. No statistical differen- ces were observed between the procedures of biliary tract reconstruction with jejunal segment interposi- tion hepaticoduodenostomy and Roux-en-Y hepatico- jejunostomy (P>0.75). The morbidity was signifi- cantly higher in infants below 1 year than in children (P<0.005). Prevention and treatment of the com- plications were discussed. Conclusion: Bile leakage and abdominal wall dehis- cence are major early postoperative complications. The morbidity of cholechal cysts is higher in infants than in children. Exploratory laparotomy should not be delayed when biliary leakage with diffuse peritoni- tis appears. The 'tension suture in the fascial space of the abdominal wall' is useful to prevent and treat wound dehiscence.

Maternal Vascular Dysfunction in Congenital Heart Defects

Background:Research on fetal congenital heart defect(CHD)mostly focuses on etiology and mechanisms.However,studies on maternal complications or pathophysiology are limited.Our objective was to determine whether vascular dysfunction exists in pregnant women carrying a fetus with congenital heart defects.Methods:We conducted a case-control study.27 cases of pregnant women carrying a fetus with major CHD admitted to our hospital for delivery between April 2021 and August 2022 were selected.Every case was matched with about 2 pregnant complication-free controls without fetal abnormalities.The proangiogenic and anti-angiogenic factors and pregnancy outcomes were compared.Results:The proangiogenic factors include vascular endothelial growth factor(VEGF)and placental growth factor(PlGF).The anti-angiogenic factors involve soluble fms-like tyrosine kinase 1(sFlt-1)and soluble endoglin(sEng).No differences were found in maternal plasma concentrations of PlGF,VEGF,and sFlt-1 between case-control groups when analyzed at 36 weeks≤gestational age(GA)<39 weeks and 39 weeks≤GA≤41 weeks.The concentrations of sEng in maternal plasma in the fetal CHD group were significantly higher than those in the control group:0.60(0.77)vs.0.32(0.26)ng/ml at 36 weeks≤GA<39 weeks,p=0.001 and 0.75(0.55)vs.0.28(0.27)ng/ml at 39 weeks≤GA≤41 weeks,p<0.001.Conclusion:Vascular dysfunction exists in pregnant women with fetal congenital heart defects,manifesting significantly elevated sEng concentration at delivery.

Maternal mental disorders in pregnancy and the puerperium and risks to infant health

Prenatal and postnatal period presents the highest prevalence of mental disorders in women's lives and depression is the most frequent one,affecting approximately one in every five mothers.The aggravating factor here is that during this period psychiatric symptoms affect not only women's health and well-being but may also interfere in the infant's intra and extra-uterine development.Although the causes of the relationship between maternal mental disorders and possible risks to a child's health and development remain unknown,it is suspected that these risks may be related to the use of psychotropic drugs during pregnancy,to substance abuse and the mother's lifestyle.Moreover,after delivery,maternal mental disorders may also impair the ties of affection(bonding) with the newborn and the ma-ternal capacity of caring in the post-partum period thus increasing the risk for infant infection and malnutrition,impaired child growth that is expressed in low weight and height for age,and even behavioral problems and vulnerability to presenting mental disorders in adulthood.Generally speaking,research on this theme can be divided into the type of mental disorder analyzed: studies that research minor mental disorders during pregnancy such as depression and anxiety find an association between these maternal disorders and obstetric complications such as prematurity and low birth weight,whereas studies that evaluate severe maternal mental disorders such as schizophrenia and bipolar disorder have found not only an association with general obstetric complications as well as with congenital malformations and perinatal mortality.Therefore,the success of infant growth care programs also depends on the mother's mental well being.Such findings have led to the need for new public policies in the field of maternal-infant care geared toward the population of mothers.However,more research is necessary so as to confirm the association between all factors with greater scientific rigor.

Clinical effect of spleen aminopeptide on improving liver function damage and immune function in children with infant hepatitis syndrome

BACKGROUND Infant hepatitis syndrome(IHS)is a clinical syndrome in infants less than one year of age with generalized skin jaundice,abnormal liver function,and hepato-megaly due to various etiologies such as infection.AIM To investigate the effect of IHS patients,after treatment with arsphenamine-based peptides,on patients'liver function damage and immune function.METHODS Of 110 patients with IHS treated in our hospital from January 2019 to January 2021 were grouped according to the randomized residual grouping method,with 5 cases in each group shed due to transfer,etc.Ultimately,50 cases remained in each group.The control group was treated with reduced glutathione,and the treat-ment group was treated with sesquiterpene peptide based on the control group.Observe and compare the differences in indicators after treatment.RESULTS The comparison of serum total bilirubin,direct bilirubin,and serum alanine transferase after treatment was significantly different and lower in the treatment group than in the control group(P<0.05).The comparison of CD4+,CD3+,CD4+/CD8+after treatment was significantly different and higher in the treatment group than in the control group,and the comparison was statist-ically significant(P<0.05).The complication of the two groups showed that the rash,cough and sputum,elevated platelets,and gastrointestinal reactions in the treatment group were significantly lower than those in the control group,and the differences were statistically significant by test(P<0.05).CONCLUSION The comparative study of IHS treated with arsphenamine combined with reduced glutathione is more effective.

A Case Study on the Impact of Mother-to-Mother Support Groups on Maternal, Infant and Young Child Nutrition and Care Practices in Habaswein and Wajir South Districts of North Eastern Kenya

Only about 25% of babies are exclusively breast fed until six months of age in developing countries though they are at a greater risk of infection and infant mortality. The Global Strategy for Maternal, Infant and Young Child Feeding (MI- YCF) Strategy developed by WHO/UNICEF in 2002 was to revitalize world attention to the impact of feeding practices on the nutritional status, growth, development, health and survival of infants and children. The data for this case study was collected through key informant interviews, observations and review of Save the Children nutrition programme reports and surveys. This information was then organized to produce a detailed description of the maternal, infant and young child nutrition programme in Habaswein and Wajir South districts or sub-counties. The maternal and infant young child nutrition (MIYCN) programme was launched in Habaswein and Wajir South districts in January 2012. The MIYCN programme followed recommendations of a Knowledge, Practice and Coverage (KPC) survey report in July 2012. To date, the programme has formed 48 Mother-to-mother Support Groups (MTMSGs), which are actively promoting the uptake of the recommended MIYCN practices in the community. MIYCN indicators have been markedly improved between July 2011 and February 2013 when surveys were conducted. The uptake of kitchen gardening has picked up significantly at Meri site and some mothers now have a changed attitude towards unskilled home deliveries and are conducting referrals for skilled births. The marked improvements in the performance of MIYCN indicators between July 2011 and February 2013 inWajir South and Habaswein districts can be partly attributed to the MIYCN programme established in January 2012. However, a randomized community trial is still required to provide conclusive results on the impact of care support groups on maternal, infant and young child feeding in this region.

Maternal and infant health in urban and rural areas in Morocco: Analysis of the preliminary results of the National Survey on Population and Family Health (EPSF 2011)

Background: The last Moroccan population and family health survey (EPSF 2011) was carried out between November 2010 and March 2011. The final report and the whole database are not yet accessible while a preliminary report was released early March 2012. The information given so far does not allow for a complete evaluation of the present health situation in Morocco. However, a partial equity analysis can be devoted to the comparison of health indicators in terms of gender and urban-rural gaps. Method: 1) Questionnaires: a household questionnaire dealt with household characteristics, general health, housing condition and anthropometric data for children less than six years of age. A second questionnaire was devoted specifically to ever married women and dealt with their resources, marriage, reproductive health, family planning, AIDS/SIDA, healthcare and nutrition. 2) Data collection: data were collected through the national survey using a three-stage stratified sampling design to select 640 clusters covering the 16 Moroccan regions. A total of 15,577 households were randomly drawn, providing a sample of 75,061 individuals (51.1% females and 48.9% males) for investigation. 3) Analysis: in this short report, we relied only on partial data released by the Ministry of Health in a preliminary report. We used absolute differences and relative ratios to study the evolution of gender and urban-rural gaps on the basis of socioeconomic indicators. Results and Discussion: The Moroccan population seems to be in the last phase of its demographic transition. The total fertility rate decreased from 5.6 children per woman in 1980 to 2.5 in 2011. The mean age of first marriage went from 24 years for men and 17.5 years for women in 1960 to 31.5 years and 26.3 in 2011 for men and women respectively. The age structure is showing a trend of ageing population. Generally, health indicators related to reproductive and women’s health improved noticeably and consequently, maternal and infant mortality also decreased. However, while these achievements are praiseworthy as national averages, they remain insufficient in terms of equitable healthcare and access to health services since there is still a long way to go in order to reduce the huge gender gaps and rural-urban disparities. Conclusion: In this short report, we showed that, as averages, health indicators improved noticeably during the last decade but gender inequality and urban-rural disparities are still challenging health decision makers. Moroccan health decision makers are urged to adopt an equitable health strategy, starting by giving access to data for analysis, monitoring and evaluation.

Relationship between maternal pathology and infant social withdrawal: Analysis of a 268-outpatient population

Objective: Sustained withdrawal is a sign of infant distress and may be determined by extreme conditions like organic pathology or relationship problems. The Alarm Distress Baby Scale is the best instrument to identify withdrawal in infants between 2 and 24 months of age. The aim of this study was to assess the association between infant social withdrawal behavior and maternal pathology in the perinatal period. Method: The target sample of the study was 134 mother-child couples examined at the Policlinico Agostino Gemelli General Pediatric Outpatient Clinic and Psychiatric Outpatient Clinic, in Rome. We analyzed the relationship between withdrawal behavior and psychological and organic prenatal/postnatal pathology, using the Chi Square exact test. Results: When the mother suffers from both organic and psychological pathologies in the perinatal period, the risk of withdrawal is increased: the probability of infant withdrawal behavior is increased by maternal organic postnatal pathology by 14 times, by maternal psychological postnatal pathology by 9 times, and by maternal psychological postnatal depression, measured by Edinburgh Postnatal Depression Scale, by almost 4 times. Conclusion: Increased or sustained withdrawal reactions can be observed in unsatisfactory mother-child interaction. Maternal risk factors should be strictly considered in the pediatric clinical evaluation.

Second-child Policy Boosts Maternal and Infant Industry

The past year witnessed the contraction of capital flow into start-ups,the strong fluctuation of the world stock market and a decline in economic growth rate.Almost every industry has been affected by capital shortage.Although the whole market environment is very depressed,the maternal and infant industry has become a light at the end of the tunnel.

Efficacy of Danshen Injection Combined with Phosphocreatine Disodium in Treating Frequent Premature Contractions during Pregnancy and Its Effects on Maternal and Infant Outcomes

[Objectives]To explore the efficacy of Danshen Injection combined with phosphocreatine disodium in treating frequent premature contractions during pregnancy and its effect on maternal and infant outcomes.[Methods]A total of 200 pregnant women with normal pregnancy and frequent premature contractions who were treated in the outpatient department of internal medicine in Women and Children's Hospital of Hubei Province and Xinzhou District People's Hospital of Wuhan Central Hospital during September 2015 and October 2018 were selected and randomly divided into the control group and observation group,100 cases for each group.The observation group was treated with Danshen Injection combined with phosphocreatine disodium,and the control group was treated with phosphocreatine disodium alone.The course of treatment in both groups was one week.During the treatment,the changes of heart rate,heart rhythm,electrocardiogram and 24-h dynamic electrocardiogram(DCG)of both groups were observed.[Results]After treatment,the clinical efficacy of the observation group was better than that of the control group,and the difference was statistically significant(P<0.01).There were no adverse drug reactions in both groups.However,in the control group,non-sustained ventricular tachycardia(NSVT)was found in 24-h dynamic electrocardiogram(DCG)of 2 pregnant women with premature ventricular contraction.The pregnancy process was smooth,with full-term natural delivery and no fetal malformation.There was no significant difference in gestational age and neonatal weight between the two groups(P>0.05).However,there was a statistically significant difference in Apgar score between the two groups(P<0.05).During the 6-month postpartum follow-up,the mother and child were unharmed,and examination of repeated electrocardiograms showed that the conditions were normal.[Conclusions]Danshen Injection combined with phosphocreatine disodium has better efficacy in the treatment of frequent premature contractions during pregnancy and the maternal and infant outcomes than the treatment with phosphocreatine disodium alone,and it has good safety and can prevent premature contractions from progressing to tachyarrhythmias.

Relationship between Uricemia and Other Biochemical Markers with the Materno-Fetal Complications during Pre-Eclampsia

Goal: Determining the place of Uricemia associated with other biochemical makers in the prediction of fetal-maternal complications during preeclampsia. Material and method: This is a prospective, cross-sectional study of 75 pre-eclamptic women in three maternities in Kinshasa, Democratic Republic of Congo, during the January to December 2013. The values of the following biochemical markers: uricemia, proteinuria and creatinemia were correlated with maternal and fetal prognosis. Results: This study showed that hyper uricemia associated with massive proteinuria and a high creatinine level correlated with an unfavorable pregnancy outcome and the occurrence of major materno-fetal complications such as eclampsia (X-squared = 24.3598, ddl = 2, p-value = 0.000005) and low birth weight (p = 0.001, R2 = 0.08). Conclusion: In view of these results, it appears necessary to ensure these biochemical markers systematically in the monitoring of pre-eclampsia.

Effect of insulin in combined with Chinese medicine formulae on the serum Mg2+ and visfatin levels, maternal and infant outcome in pregnant women with gestational diabetes mellitus

Objective:To explore the effect of insulin in combined with Chinese medicine formulae on the serum Mg2+ and visfatin levels, maternal and infant outcome in pregnant women with gestational diabetes mellitus (GDM).Methods:A total of 108 pregnant women with GDM who were admitted in our hospital were included in the study and randomized into the observation group (n=55) and the control group (n=53). The patients in the two groups were given diet control, exercise therapy, and subcutaneous injection of insulin. On this basis, the patients in the observation group were given self-made Chinese medicine formulae, continuously for 2 weeks. The blood sugar level, and serum Mg2+ and visfatin (VF) levels before treatment and before delivery in the two groups were detected. The maternal and infant outcome in the two groups was evaluated.Results:The serum HbA1c, FPG, 1 h PBG, 2 h PBG, and VF levels before delivery in the two groups were significantly reduced when compared with before treatment (P<0.05), while the serum Mg2+ level was significantly elevated when compared with before treatment (P<0.05). The improvement of the above indicators before delivery in the observation group was more significant when compared with the control group (P<0.05). The occurrence rate of cesarean section, premature delivery, gestational hypertension, fetal distress, and macrosomia in the observation group was significantly lower than that in the control group (P<0.05).Conclusions:Insulin in combined with self-made Chinese medicine formulae can effectively control the blood sugar level in pregnant women with GDM, and improve the maternal and infant outcome.

Some of the experimental and clinical aspects of the effects of the maternal diabetes on developing hippocampus

Diabetes mellitus during pregnancy is associated with an increased risk of multiple congenital anomalies in progeny.There are sufficient evidence suggesting that the children of diabetic women exhibit intellectual and behavioral abnormalities accompanied by modification of hippocampus structure and function.Although,the exact mechanism by which maternal diabetes affects the developing hippocampus remains to be defined.Multiple biological alterations,including hyperglycemia,hyperinsulinemia,oxidative stress,hypoxia,and iron deficiency occur in pregnancies with diabetes and affect the development of central nervous system(CNS) of the fetus.The conclusion from several studies is that disturbance in glucose and insulin homeostasis in mothers and infants are major teratogenic factor in the development of CNS.Insulin and Insulin-like growth factor-1(IGF-1) are two key regulators of CNS function and development.Insulin and IGF-1 receptors(IR and IGF1 R,respectively) are distributed in a highly specific pattern with the high density in some brain regions such as hippocampus.Recent researches have clearly established that maternal diabetes disrupts the regulation of both IR and IGF1 R in the hippocampus of rat newborn.Dissecting out the mechanisms responsible for maternal diabetes-related changes in the development of hippocampus is helping to prevent from impaired cognitive and memory functions in offspring.

Mode of delivery and its associated maternal and neonatal outcomes

Aim: To determine the association between the mode of delivery and selected neonatal and maternal morbidities and outcomes in NSW, during 1998-2008. Methods: This study is a retrospective review of NSW Midwives Data Collection (MDC) of 981,178 deliveries during 1998-2008. Maternal condition and neonatal outcomes were compared for different modes of delivery. Results: The annual rate of caesarean section has steadily increased from 19% to 31.1% with a mean of 25.9% during the study period. The risk of neonatal death was higher for forceps-assisted delivery compared to vacuum-assisted delivery (adjusted odds ratio 0.85%, 95% CI 0.52 - 1.37), caesarean section (adjusted odds ratio 1.14%, 95% CI 1.01 - 1.3) and normal vaginal delivery. Operative vaginal delivery and caesarean section had significantly increased risk for maternal mortality compared to normal vaginal delivery. Conclusions: There is an association between maternal and neonatal outcome and mode of delivery. Mothers and babies with normal vaginal delivery achieved better outcomes in this community. Caesarean section and operative vaginal delivery are associated with significant maternal and neonatal risk. Breech vaginal delivery carries a significant neonatal risk. More future prospective analyses, such as multicentre controlled studies, should be designed to determine whether and how much the adverse pregnancy outcomes were caused by unnecessary surgical and operative vaginal delivery.