Influence of Prenatal Surveillance on Maternal and Perinatal Prognosis: A Prospective Study over 6 Months at the Maternity Ward of the Owendo University Hospital (Gabon)

Introduction: The occurrence of pregnancy in women is a risky situation. Prenatal care is necessary, which is not often the case in our context. Aim: To analyze the influence of antenatal surveillance on maternal and perinatal prognosis. Patients and Method: Preliminary longitudinal and analytical survey at the Owendo University Hospital (OHU) over 6 months. It focused on prenatal surveillance. The study population consisted of parturients who gave birth within 24 hours and we studied sociodemographic characteristics, variables related to antenatal contact, those of delivery as well as maternal and newborn outcomes. Results: 2485 deliveries were recorded and 1300 patients were retained according to the inclusion criteria. No prenatal contact (ANC0) was performed in 93 (7.15%), insufficient (ANCI) in 943 patients (72.5%), and sufficient (ANCS) in 264 patients (20.30%). Patients with low school level were significantly found when the NPC was not performed or insufficient and the same was true for the group of patients who were not employed and those who were single (p < 0.005). The caesarean section rate and perinatal mortality are high in this case. Conclusion: The quality of prenatal contact is insufficient in our context. The absence or inadequacy of the latter has a strong negative impact on maternal and perinatal morbidity and mortality.

Perinatal Morbidity, Mortality, and Neurodevelopmental Outcomes of Neonates with Fetal Growth Restriction

Objective: This study aimed to assess perinatal morbidity, mortality rates, and neurodevelopmental outcomes in the management of fetal growth restriction (FGR) at a single tertiary institute. Methods: Among 2465 deliveries between 2013 and 2019, 109 cases of FGR were reviewed retrospectively for causes, indications for pregnancy termination, perinatal death, overall neonatal outcomes, and long-term prognosis. Results: Excluding FGR due to congenital anomalies (n = 17), the mortality rate was 3.3% (3/92). One neonate delivered at 23 weeks developed cerebral palsy (1.1%). Retinopathy of prematurity occurred in four neonates (4.3%). Neurodevelopmental disorders were present in six neonates (6.5%), all of whom were delivered at 32 - 38 weeks. Significantly lower gestational age at delivery, lower birth weight, and higher umbilical artery resistance indices were observed in neonates with neurodevelopmental disorders. Conclusions: Intact survival before 27 weeks of gestation at delivery with FGR is uncommon. Neurodevelopmental disorders may still develop after delivery at 32 - 38 weeks;consideration should be given to the timing of delivery usingfetal ductus venosus Doppler waveforms measurements to reduce neurodevelopmental disorders.

Serum Calcium Ionised Rate and Materno-Perinatal Prognosis in Arterial Hypertension in Pregnancy at the Reference General Hospital of Panzi

Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries. Hypertensive disorders of pregnancy are among the leading causes of severe maternal morbidity and mortality, particularly in developing countries, maternal hypocalcaemia being a factor favouring the onset of arterial hypertension during pregnancy. The aim was to determine the maternal and perinatal prognosis of patients with hypertensive disorders of pregnancy as a function of serum ionised calcium levels. Material and Methods: A cross-sectional analytical study of 114 patients with arterial hypertension during pregnancy or during pregnancy or in the postpartum period at the HGR/Panzi from 1 January 2021 to 30 June 2022, text was entered using Microsoft Office Word 2010 and the tables were analysed using Excel 2010. The data was analysed using SPSS version 20.0 and Stata 14.0. The associations of the variables were calculated using Pearson's chi-square test, with a significance threshold set at a value of p < 0.05. Study of risk factors, Odds ratios and their confidence intervals were estimated in a univariate analysis. The most determining factors were identified by multivariate analysis using the Forward conditional logistic regression model. Results: The mean gestational age was 34.43 ± 4.327 amenorheas weeks, 46.6% of patients had a vaginal delivery, 66.65% of which were indicated for maternal prognosis, maternal complications were associated with maternal hypocalcaemia in 81, 82% (P = 0.043) and an OR = 3.255 (P = 0.0158) threefold risk that the patient presenting with a complication is likely to be in a state of hypocalcaemia at 95% confidence index, and fetal prognosis was not significantly related to maternal calcaemia. Conclusion: Maternal hypocalcaemia is one of the factors that can influence maternal-foetal complications maternal-fetal complications, early management and prevention of this pathology is pathology is important to reduce maternal-fetal morbidity and mortality.

Banking of perinatal mesenchymal stem/stromal cells for stem cellbased personalized medicine over lifetime:Matters arising

Mesenchymal stromal/stem cells(MSCs)are currently applied in regenerative medicine and tissue engineering.Numerous clinical studies have indicated that MSCs from different tissue sources can provide therapeutic benefits for patients.MSCs derived from either human adult or perinatal tissues have their own unique advantages in their medical practices.Usually,clinical studies are conducted by using of cultured MSCs after thawing or short-term cryopreserved-then-thawed MSCs prior to administration for the treatment of a wide range of diseases and medical disorders.Currently,cryogenically banking perinatal MSCs for potential personalized medicine for later use in lifetime has raised growing interest in China as well as in many other countries.Meanwhile,this has led to questions regarding the availability,stability,consistency,multipotency,and therapeutic efficiency of the potential perinatal MSC-derived therapeutic products after longterm cryostorage.This opinion review does not minimize any therapeutic benefit of perinatal MSCs in many diseases after short-term cryopreservation.This article mainly describes what is known about banking perinatal MSCs in China and,importantly,it is to recognize the limitation and uncertainty of the perinatal MSCs stored in cryobanks for stem cell medical treatments in whole life.This article also provides several recommendations for banking of perinatal MSCs for potentially future personalized medicine,albeit it is impossible to anticipate whether the donor will benefit from banked MSCs during her/his lifetime.

Very early onset perinatal constipation:Can it be cow’s milk protein allergy?

Delayed passage of meconium or constipation during the perinatal period is traditionally regarded as a signal to initiate further work up to evaluate for serious diagnoses such as Hirschsprung’s disease(HD),meconium ileus due to Cystic Fibrosis,etc.The diagnosis of HD particularly warrants invasive testing to confirm the diagnosis,such as anorectal manometry or rectal suction biopsy.What if there was another etiology of perinatal constipation,that is far lesser known?Cow’s milk protein allergy(CMPA)is often diagnosed in infants within the first few weeks of life,however,there are studies that show that the CMPA allergen can be passed from mother to an infant in-utero,therefore allowing symptoms to show as early as day one of life.The presentation is more atypical,with perinatal constipation rather than with bloody stools,diarrhea,and vomiting.The diagnosis and management would be avoidance of cow's milk protein within the diet,with results and symptom improvement in patients immediately.Therefore,we discuss whether an alternative pathway to address perinatal constipation should be further discussed and implemented to potentially avoid invasive techniques in patients.This entails first ruling out CMPA with safe,noninvasive techniques with diet modification,and if unsuccessful,then moving forward with further diagnostic modalities.

Comparison of protective effects of electroacupuncture and moxibustion at Zusanli(ST 36)on perinatal nicotine exposure-induced lung phenotype in rat offspring

Objective:To compare the effects of electroacupuncture(EA)and moxibustion at Zusanli(ST 36)on the lung phenotype of rat offspring exposed to nicotine during the perinatal period.Methods:Pregnant Sprague-Dawley rats were randomly divided into 4 groups:the control group(saline only),the model group(nicotine only),the EA group(nicotine+EA at ST 36 acupoints bilaterally),and the moxibustion group(nicotine+moxibustion at ST 36 acupoints bilaterally).n=6 rats per group.On postnatal day 21,the body weight,lung weight,and pulmonary function were determined and lung morphometry was performed.Peroxisome proliferator-activated receptor gamma andβ-catenin levels in the lung tissue of offspring were also determined.Results:Perinatal nicotine exposure(PNE)results in decreased body and lung weights of offspring rats,abnormal lung tissue morphology,and significantly altered pulmonary function,showing an increase in total airway resistance and a decrease in tidal volume,minute ventilation,total airway compliance,and peak expiratory flow.Bilateral EA at ST 36 acupoints could block all of these perinatal nicotine-induced effects.Although moxibustion also had protective effects in nicotine-induced offspring lungs,some of these effects did not reach statistical significance,e.g.,protection against the upregulation ofβ-catenin,the downregulation of PPARγsignaling,and the increase in peak expiratory flow.Conclusion:Maternal EA at ST 36 blocked the PNE-induced changes in key developmental signaling pathways,prevented the PNE-induced changes in lung morphology,and protected pulmonary function.Moxibustion at ST 36 showed similar but weaker protective effects against the PNE-induced changes in the exposed offspring.It is important to note that the mechanism underlying the protective effects of moxibustion at ST 36 may be different from those of EA at ST 36,and further research is needed to understand these differences.

Evaluation of Perinatal and Developmental Outcomes in Neonates with Abstinence Syndrome Admitted to NICU

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.

Reducing psychiatric illness in the perinatal period:A review and commentary

This brief overview highlights the global crisis of perinatal psychiatric illness(PPI).PPI is a major contributor to many adverse pregnancy,childbirth,and childhood development outcomes.It contributes to billions of dollars in spending worldwide each year and has a significant impact on the individual,their family,and their community.It is also highly preventable.Current recommendations for intervention and management of PPI are limited and vary considerably from country to country.Furthermore,there are several significant challenges associated with implementation of these recommendations.These challenges are magnified in number and consequence among women of color and/or minority populations,who experience persistent and negative health disparities during pregnancy and the postpartum period.This paper aims to provide a broad overview of the current state of recommendations and implementation challenges for PPI and layout a framework for overcoming these challenges.An equityinformed model of care that provides universal intervention for pregnant women may be one solution to address the preventable consequences of PPI on child and maternal health.Uniquely,this model emphasizes the importance of managing and eliminating known barriers to traditional health care models.Culturally and contextually specific challenges must be overcome to fully realize the impact of improved management of PPI.

Socio-Medical and Demographic Factors Associated with Perinatal Mortality in a Southern Benin Health Zone Hospital in 2020: A Case-Control Study

Background: Perinatal mortality remains a major public health concern in developing countries such as Benin. To better steer response interventions, this study was carried out in southern Benin with the aim of identifying the demographic and socio-medical factors linked to perinatal mortality. Methods: The case-control study, held from January 1 to December 31, 2020, covered 154 targets, including 77 cases of neonates deceased within the perinatal period and 77 live-born control neonates selected on a one-for-one basis. Univariate analysis using the McNemar test and logistic regression were used to identify risk factors for perinatal mortality, at a 5% threshold of significance. Results: Sahoué/mina ethnicities, only associated socio-demographic characteristic, increased the risk of perinatal death by 2.47 times (p = 0.008). Mother’s age, education, occupation, marital status, and household size were not associated (p > 0.05). Risk of death was increased 2.5 times when the mother was referred (p = 0.007), 3.3 times when she came from a hard-to-reach locality (p Conclusion: Although attention must also be paid to referral and access to care, this study identifies antenatal consultation as the main target of any intervention to reduce perinatal mortality.

Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for Perinatal Outcomes

Background and Aim: Delivery of a fetus with SGA is associated with increased risk of perinatal morbidity and mortality. Evidence is limited for the accuracy of Oligohydramnios to predict substantive perinatal morbidity and mortality in non–anomalous SGA fetuses monitored with normal Doppler studies. The aim of this study is to determine the association between amniotic fluid index and adverse perinatal outcomes in term SGA fetuses with normal Doppler studies. Method: This is a prospective observational study carried out by 340 pregnant women who were admitted to obstetrics unit, Sri Jayewardenepura from January 2019 to January 2023. Singleton pregnancies at term who were diagnosed with SGA (EFW 10th centile or AC 10th centile) with normal umbilical artery and middle cerebral artery Doppler studies were included. AFI was assessed predelivery and data were collected according to demographic details, mode of delivery, time of delivery, intrapartum events, and neonatal outcomes. Results: A total of 340 term pregnant women were studied. Out of them, 44% were in AFI more than 10 groups and 37% and 19% were in AFI 5 - 10 and less than 5 groups respectively. More obstetrics interventions were reported in AFI 5 groupa in terms of induction of labor (P 0.04) and emergency caesarean sections (P 0.003). No significant deference in immediate neonatal outcome was detected between each group. (Meconium-stained liquor (P 0.634), 1 minute APGAR (P 0.575) and 5-minute APGAR P 0.165)). Neonatal unit admission (P 0.001) and long-term neonatal complications were

Mesenchymal stromal cells from human perinatal tissues: From biology to cell therapy

Cell-based regenerative medicine is of growing interest in biomedical research. The role of stem cells in this context is under intense scrutiny and may help to define principles of organ regeneration and develop innovative therapeutics for organ failure. Utilizing stem and progenitor cells for organ replacement has been conducted for many years when performing hematopoietic stem cell transplantation. Since the first successful transplantation of umbilical cord blood to treat hematological malignancies, non-hematopoietic stem and progenitor cell populations have recently been identified within umbilical cord blood and other perinatal and fetal tissues. A cell population entitled mesenchymal stromal cells (MSCs) emerged as one of the most intensely studied as it subsumes a variety of capacities: MSCs can differentiate into various subtypes of the mesodermal lineage, they secrete a large array of trophic factors suitable of recruiting endogenous repair processes and they are immunomodulatory.Focusing on perinatal tissues to isolate MSCs, we will discuss some of the challenges associated with these cell types concentrating on concepts of isolation and expansion, the comparison with cells derived from other tissue sources, regarding phenotype and differentiation capacity and finally their therapeutic potential.

Short and long term prognosis in perinatal asphyxia: An update

Interruption of blood flow and gas exchange to the fetus in the perinatal period, known as perinatal asphyxia, can, if significant, trigger a cascade of neuronal injury, leading on to neonatal encephalopathy(NE) and resultant long-term damage. While the majority of infants who are exposed to perinatal hypoxia-ischaemia will recover quickly and go on to have a completely normal survival, a proportion will suffer from an evolving clinical encephalopathy termed hypoxic-ischaemic encephalopathy(HIE) or NE if the diagnosis is unclear. Resultant complications of HIE/NE are wide-ranging and may affect the motor, sensory, cognitive and behavioural outcome of the child. The advent of therapeutic hypothermia as a neuroprotective treatment for those with moderate and severe encephalopathy has improved prognosis. Outcome prediction in these infants has changed, but is more important than ever, as hypothermia is a time sensitive intervention, with a very narrow therapeutic window. To identify those who will benefit from current and emerging neuroprotective therapies we must be able to establish the severity of their injury soon after birth. Currently available indicators such as blood biochemistry, clinical examination and electrophysiology are limited. Emerging biological and physiological markers have the potential to improve our ability to select those infants who will benefit most from intervention. Biomarkers identified from work in proteomics, metabolomics and transcriptomics as well as physiological markers such as heart rate variability, EEG analysis and radiological imaging when combined with neuroprotective measures have the potential to improve outcome in HIE/NE. The aim of this review is to give an overview of the literature in regards to short and longterm outcome following perinatal asphyxia, and to discuss the prediction of this outcome in the early hours after birth when intervention is most crucial; looking at both currently available tools and introducing novel markers.

Perinatal nutritional programming of health and metabolic adult disease

Data indicate that perinatal nutritional insults not onlyhave short-term consequences on the growth velocity of the fetus/neonate but also sensitize to the development of metabolic adult diseases.The pathophysiological mechanisms involved in the so-called "Developmental Origin of Health and Adult Diseases" are still largely unknown and depend on the type of alteration (nutritional,psychological,endocrine disruptors,etc.),its intensity and duration,species,sex and the time during which it is applied.Perinatal stress,via disturbances of both hy-pothalamo-pituitary-adrenal (HPA) axis and sympathoadrenal-system (SAS),as well as brain-adipose axis and pancreas alterations could play a crucial role.Interestingly,it has been demonstrated that perinatal insults may be transmitted transgenerationally,suggesting that these long-term consequences may be inherited via epigenetic mechanisms.Finally,since the placenta has been demonstrated to be sensitive to perinatal nutritional manipulations,the identification of placental markers may thus represent an important new avenue to identify the more susceptible babies prone to developing meta-bolic diseases.

Increased syndecan-1 and glypican-3 predict poor perinatal outcome and treatment resistance in intrahepatic cholestasis

Background:Intrahepatic cholestasis of pregnancy(ICP)increases the risk of adverse pregnancy outcomes.This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid(UDCA).Methods:This prospective,case control study included 88 pregnant women(44 women with ICP and 44 healthy controls).The primary end points were the perinatal outcome and the response to UDCA therapy.A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy.Results:Women with ICP had significantly higher serum syndecan-1(1.27±0.36 ng/m L vs.0.98±0.50 ng/m L;P=0.003),glypican-3(1.78±0.13 ng/m L vs.1.69±0.16 ng/m L;P=0.004),AST(128.59±1.44 vs.13.29±1.32 U/L;P<0.001),and ALT(129.84±1.53 vs.8.00±3.67 U/L;P<0.001)levels compared with the controls.The increased levels of syndecan-1(OR=4.715,95%CI:1.554–14.310;P=0.006),glypican-3(OR=8.465,95%CI:3.372–21.248;P=0.007),ALT(OR=1.382,95%CI:1.131–1.690;P=0.002),and postprandial bile acid(PBA)(OR=3.392,95%CI:1.003–12.869;P=0.026)were correlated to ICP.The adverse neonatal outcome was related to increased glypican-3(OR=4.275,95%CI:2.726–5.635;P=0.039),and PBA(OR=3.026,95%CI:1.069–13.569;P=0.037).Increases of syndecan-1(OR=7.464,95%CI:2.130–26.153,P=0.017)and glypican-3(OR=6.194,95%CI:2.951–13.002;P=0.025)were the risk factors of decreased response to UDCA treatment.Conclusion:Syndecan-1 and glypican-3 might be powerful determinants in predicting adverse perinatal outcome in patients with ICP,and they can be used to predict the response to the UDCA treatment.

Effects of Perinatal Undernutrition and Massage Stimulation upon the Ambiguus Nucleus in the Rat Prior to Weaning

Undernutrition produces morphological brain alterations and cognitive deficiencies in children of underdeveloped countries. The central nervous system (CNS) alterations mainly interfere with the anatomical organization of areas undergoing a phase of intense postnatal cell proliferation, disrupting plastic processes like learning, memory, and phonation. In the rat pup, prenatal malnutrition interferes with the elaboration of ultrasonic vocalizations (USVs) by poorly understood mechanisms. The neuronal caudal portion of the nucleus ambiguus (Ambc) innervates the laryngeal intrinsic muscles to produce phonation, a basic USV communication system. During postnatal development, enhanced plasticity phenomena play a fundamental role in improving brain function. Thus, the massage stimulation (MS) may accelerate growth and induce neurogenesis in different areas of the brain. The current study analyzed the effects of a daily 10-min MS on the dendritic tree and perikarya measurements of Ambc multipolar motoneurons (Golgi-Cox) of perinatally underfed (U), control (C), control massage-stimulated (CMS), and underfed massage-stimulated (UMS) groups at postnatal days (PDs) 8, 12, and 15. The data indicated that the dendritic scores were reduced (p < 0.05) in both number and density at PD8 and PD15 in the U subjects and that MS increased the values of these parameters (p < 0.05). In addition, MS induced body weight gain in both U and CMS groups, and it enhanced the dendritic density in CMS subjects. These results show that MS during the pre-weaning period restores the plastic properties of the Ambc over the hypoplastic multipolar motoneuron after the alterations caused by perinatal undernutrition.

Perinatal stem cells: A promising cell resource for tissue engineering of craniofacial bone

In facing the mounting clinical challenge and suboptimal techniques of craniofacial bone defects resulting from various conditions, such as congenital malformations, osteomyelitis, trauma and tumor resection, the ongoing research of regenerative medicine using stem cells and concurrent advancement in biotechnology have shifted the focus from surgical reconstruction to a novel stem cell-based tissue engineering strategy for customized and functional craniofacial bone regeneration. Given the unique ontogenetical and cell biological properties of perinatal stem cells, emerging evidence has suggested these extraembryonic tissue-derived stem cells to be a promising cell source for extensive use in regenerative medicine and tissue engineering. In this review, we summarize the current achievements and obstacles in stem cell-based craniofacial bone regeneration and subsequently we address the characteristics of various types of perinatal stem cells and their novel application in tissue engineering of craniofacial bone. We propose the promising feasibility and scope of perinatal stem cell-based craniofacial bone tissue engineering for future clinical application.

Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries

Objectives:To investigate the magnitude of effect nurse staffing had on decreasing the newborn mortality rates in member countries of Organisation for Economic Co-operation and Development(OECD).Methods:The statistical technique of panel data analysis was applied to explore the possibility of association between the number of nurses'density per 1,000 population and infant,neonatal and perinatal mortality rates(IMR,NMR and PMR)per 1000 births.The observations of 35 OECD countries were collected over the period of 2000 through 2016.Results:There were significant associations between nurse staffing and IMR,NMR and PMR i.e.a 1%increase in nurse-staffing level reduced IMR,NMR and PMR by 0.98%,0.97%and 0.96%,respectively.Furthermore,the role of nursing-related services in declining the average of newborn mortality rates were investigated at the highest level in Slovenia(-5.50),Sweden(-3.34),Iceland(-2.51),Czech Republic(-1.86),Japan(-1.64)and Finland(-1.64).Moreover,if the current relationship between nursestaffing level and newborn mortality rates are disturbed with nursing shortage(e.g.in Slovak Republic and Israel),then it takes about 17 years for the mortality rates to reduce and restore back to the previous equilibrium.Conclusions:A higher proportion of nurses'density per 1,000 population is associated with lower newborn mortality rates.In addition,the nursing-related services of Slovenia,Sweden,Iceland,Czech Republic,Japan and Finland with the highest impact on improving the health level of newborns would be good patterns for other developed countries in maternity and child health care.

Maternal and perinatal outcomes of induction of labor at term in the university clinics of Kinshasa, DR Congo

Objective: This paper aims at assessing outcomes following induction of labor and characteristics likely to predict vaginal delivery. Study design: This is a descriptive retrospective cohort study including all women with singleton pregnancies who delivered at term in the university clinics of Kinshasa, DR Congo, from January 01, 2006 until December 31, 2010. Induction was initiated regardless of cervical status. Methods of induction included: oxytocin perfusion, vaginal Misoprostol, intracervical insertion of the Foley catheter and amniotomy. Results of induction were compared in terms of failure of labor, cesarean section, fetal distress, and neonatal distress. Logistic regression was used to seek for independent contributing factors for adverse outcomes. Results: During the period of the study 115 patients at term (3.2%) were concerned with induction of labor. Means for maternal age, gestational age and weight at confinement were 30.5 ± 5.7 years, 37.95 ± 1.54 weeks and 69.3 ± 15.1 kg, respectively. The mean parity and gravidity were 2.4 ± 1.9 and 2.9 ± 1.9, respectively. The mean Bishop score was 6.2 ± 1.5 at the first induction, with 66 women (57.3%) having less than 7. Indications for induction were: preeclampsia (52 = 54.1%), premature rupture of membranes (34 = 29.5%), post term (17 = 14.6%), gestational diabetes (5 = 4.3%), stillbirth (5 = 4.3%), polyhydramnios (3 = 2.6%) and cardiopathy (1 = 0.8%). Methods of induction at the first attempt included: oxytocin (86 = 74.7%), vaginal misoprostol (20 = 17.3%), transcervical Foley catheter balloon (14 = 12.1%), and amniotomy (1 = 0.8%). Failure to induce uterine contraction at the first attempt was noted in 9/115 (7.8%) women. Vaginal delivery occurred in 78 (66.9%) women, and cesarean section in 34 (29.6%). The majority of cesarean sections were performed at the primary induction, most of them (29/34 = 85.3%) in women with bad Bishop score. Failure of induction was more likely to occur in association with high maternal weight (OR 6.8;CI 1.2 - 39.7), and somewhat birth weight (OR 2.1 but CI containing 1). Risk for cesarean section was increased in association with induction of labor in cases of high maternal weight (OR 10.3, CI 16.0 - 67.0), and somewhat of high birth weight (OR 2.3, but CI containing 1). Fetal distress was associated only with maternal weight (OR 15.7, CI 1.3 - 187.8), and neonatal distress only with Bishop score (OR 10.9, CI 1.1 - 108.0). Conclusion Induction of labor in our setting in order to get vaginal delivery is affected of a high risk of adverse outcomes such as failure of induction, cesarean delivery, fetal and neonatal distress. This risk is significantly influenced by maternal weight, birth weight and Bishop score. Lack of worse outcomes between the first and the subsequent attempts to induce labor can be regarded as a reason to try induction even in the presence of unfavorable cervix.

Perinatal transmission in infants of mothers with chronic hepatitis B in California

AIM To evaluate maternal hepatitis B virus(HBV) DNA as risk for perinatal HBV infection among infants of HBVinfected women in California.METHODS Retrospective analysis among infants born to hepatitis B surface antigen(HBs Ag)-positive mothers who received post vaccination serologic testing(PVST) between 2005 and 2011 in California. Demographic information was collected from the California Department of Public Health Perinatal Hepatitis B Program databaseand matched to birth certificate records. HBV DNA level and hepatitis B e antigen(HBe Ag) status were obtained from three large commercial laboratories in California and provider records if available and matched to mother infant pairs. Univariate analysis compared infected and uninfected infants. Multivariate analysis was restricted to infected infants and controls with complete maternal HBV DNA results using a predefined high HBV DNA level of > 2 × 107 IU/ml,a 5:1 ratio of cases to controls and a two-sided confidence level of 95%.RESULTS A total of 17687 infants were born to HBs Ag positive mothers in California between Jan 1 2005 and Dec 31,2011. Among 11473 infants with PVST,only 125(1.1%) were found to be HBV infected. Among these infected infants,lapses in Advisory Committee on Immunization Practices recommended post exposure prophylaxis(PEP) occurred in only 9 infants. However,PEP errors were not significantly different between infected and uninfected infants. Among the 347 uninfected and infected infants who had maternal HBe Ag and HBV DNA level,case-control analysis found HBe Ag positivity(70.4% vs 28.9%,OR = 46.76,95%CI: 6.05-361.32,P < 0.001) and a maternal HBV DNA level ≥ 2 × 107 IU/ml(92.6% vs 18.5%,OR = 54.5,95%CI: 12.22-247.55,P < 0.001) were associated with perinatal HBV infection. In multivariate logistic regression,maternal HBV DNA level ≥ 2 × 107 IU/ml was the only significant independent predictor of perinatal HBV infection. CONCLUSION In California,transmission is low and most infected infants receive appropriate PEP and vaccination. Maternal HBV DNA ≥ 2 × 107 IU/ml is associated with high risk of perinatal infection.

Predicting adverse maternal and perinatal outcome after threatened miscarriage

Objectives: Threatened miscarriage is the most common complication of pregnancy, occurring in 20% - 25% of ongoing pregnancies. The purpose is to study maternal and perinatal outcome in women with threatened miscarriage. Methods: A prospective study was conducted over a period of 20 months in the Department of Obstetrics and Gynaecology, Pannadhay Mahila Chikitsalaya, a tertiary care center in Udaipur, India. It included a cohort of pregnant patients with a history of threatened miscarriage during the first twenty weeks of pregnancy. They were registered, followed up prospectively at antenatal clinics and delivered in the same hospital. For the purpose of comparison, another group of booked patients (controls) without a history of threatened miscarriage were recruited, similarly scanned and followed throughout pregnancy and labour. All women were matched for age, parity, social class, BMI and gestational age at booking. Discrete variables were taken as counts (or frequencies) and were evaluated by Chi-square test. Continuous variables with normal distribution were presented as mean ± standard deviation (SD) and were compared by unpaired Student’s t test. Data were fed into a Microsoft Excel worksheet and were analyzed by using the SPSS ver.17 (SPSS Inc., Chicago, IL, USA). p-value > 0.05 was considered statistically significant. Results: Out of 62 cases, 13 (21%) patients spontaneously aborted after diagnosis of threatened miscarriage. Women with threatened miscarriage had a significantly higher incidence of low lying placenta (p = 0.02) when compared with those without firsttrimester bleeding. They were more likely to experience PROM (p = 0.02), preterm delivery (p = 0.02) and to have babies with low Birthweight (p = 0.03). Conclusion: Pregnancies complicated by threatened miscarriage are at a higher risk for obstetric complications.