Usefulness of the Surgical Apgar Score to Predict the Occurrence of Major Complications in the Early Post-Operative Period of Major Surgeries: Experience of Two Second-Category Hospitals in Cameroon

Objective: The Surgical Apgar Score (SAS) is a tool for intraoperative stratification of the risk of serious complications in the early postoperative period. It varies from 0 to 10 points divided into three risk categories (0 to 4 high, 5 to 7 moderate, 8 to 10 low). The aim of the study was to evaluate its relevance in predicting the appearance of these complications. Material and methods: This descriptive and analytical study was carried out at the “Laquintinie” Hospital in Douala and at the Central Hospital in Yaounde, Cameroon. The main data were collected on a population of patients over 18 years old and recorded on a survey form. They consisted of variables of main interest and exposure variables. Univariate and multivariate statistical analysis using top-down logistic regression models made it possible to evaluate the association of each variable of main interest and each exposure variable. The association was significant at P Results: Of the 88 patients studied, the SAS was 3 hours. In multivariate, this link persisted only and strongly for the SAS OR (IC) 0.1 (0.1 - 0.2) and p = 000. Conclusion: The study found a specific and powerful link between the SAS score < 4 and the occurrence of complications in the early postoperative period, in favor of its relevance in predicting them.

Epidemiology and region-specific risk factors for low Apgar scores in China:a nationwide study

Background Neonatal asphyxia is a serious public health issue.This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores,an important proxy for neonatal asphyxia,in China from 2015 to 2016.Methods The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24(out of 34)provinces.Logistic regression analysis was performed to examine the risk factors for a low Apgar score(<7).Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions.The population attributable risk percentage(PAR%)was calculated for each region-specific risk factor.Results A total of 72,073 live births,including 320 births with low Apgar scores,were used for the analysis,giving a weighted rate of 3.9/1000 live births.There was a substantial difference in the incidence of low Apgar scores by geographic region,from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China.Maternal and obstetric factors are the major region-specific risk factors.In Southwest China,hypertensive disorders in pregnancy were more important contributors,with PAR% being 74.47%;in North and Northwest China,pre-pregnancy underweight was a more significant factor,with PAR% of 62.92%;in East China,infants born between 0:00 a.m.and 7:59 a.m.were a key factor,with PAR% of 80.44%.Conclusion Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score

BACKGROUND Gestational diabetes mellitus(GDM)refers to abnormal glucose tolerance during pregnancy,and it is often accompanied by obvious changes in glucose and lipid metabolism,and associated with adverse pregnancy outcomes.The incidence of fetal distress,polyhydramnios,puerperal infection,premature delivery,and macrosomia in pregnant women with GDM are higher than in those without GDM.AIM To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score.METHODS A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected.Among them,377 aged<35 years were selected as the right age group and 206 aged>35 years were selected as the older group.The clinical data of the two groups were collected,and the relationship between age of the pregnant women with GDM and mode of delivery,maternal and neonatal outcomes,and neonatal Apgar score were compared.In the older group,159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes.The related factors of adverse maternal and infant outcomes were analyzed through logistic regression.RESULTS The number of women with assisted pregnancy,≤37 wk gestation,≥2 pregnancies,one or more deliveries,and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group(P<0.05).The natural delivery rate in the right age group was 40.85%,which was higher than 22.33%in the older group(P<0.05).The cesarean section rate in the older group was 77.67%,which was higher than 59.15%in the right age group(P<0.05).The older group had a higher incidence of polyhydramnios and postpartum hemorrhage,and lower incidence of fetal distress than the right age group had(P<0.05).There was no significant difference in neonatal weight between the two groups(P>0.05).The right age group had higher Apgar scores at 1 and 5 min than the older group had(P<0.05).Significant differences existed between the poor and good outcome groups in age,education level,pregnancy mode,≤37 wk gestation,number of pregnancies,and premature rupture of membranes(P<0.05).Logistic regression showed that age,education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants(P<0.05).CONCLUSION Delivery mode and Apgar score of pregnant women with GDM are related to age.Older age increases the adverse outcome of mothers and infants.

Predictability of Surgical Apgar Score for postoperative outcomes in hip fractures: A prospective observational study

Objective:To assess the utility and validation of the Surgical Apgar Score(SAS)in predicting postoperative complications of hip fractures.Methods:This prospective observational study included patients who received operations for hip fractures from 1st March 2017 to 30th June 2018 at the Department of Orthopedic Surgery,Liaquat National Hospital and Medical College.Patients were followed at the outpatient department,and complications and mortality were recorded through phone calls.The predictability of SAS for postoperative complications was assessed.Results:SAS≤4 was found as a significant predictor for postoperative pulmonary(P=0.008)and cardiac complications(P=0.042)as well as blood transfusion required to optimize postoperative hemoglobin(P=0.03)in the patients with hip fractures.Conclusions:SAS provides reliable feedback information about patients'postoperative risk during the surgery.Hip fracture patients with scores≤4 should be monitored for major complications both during the hospital admission and after the discharge.

Utility of the Surgical Apgar Score in pancreatic cancer and modification

Objectives:The Surgical Apgar Score(SAS)can predict the incidence of complications in different surgical fields.However,it is rarely studied in pancreatic cancer.The aim of the present study was to assess the predictive value of the SAS in pancreatic ductal adenocarcinoma(PDAC),and then propose a modified SAS which was more suitable for pancreatic cancer patients.Materials and methods:A prospective cohort study of 160 PDAC patients was concluded.The primary endpoint was 30-day major complications.The SAS was calculated as described.The overall discriminatory power of the score was analyzed using receiver operating characteristic curves and the area under the curve(AUC)with respect to major complications or death.Results:It showed a significant predictive value of SAS in major complications or death in PDAC(p=0.020,AUC=0.606),especially in complication of pneumonia(p=0.022)and pleural effusion(p=0.023).In addition,the SAS exert significant predictive value in distal pancreatectomy group,but it has a weak predictive value for pancreaticoduodenectomy group.On multivariable analyses,occurrence of major postoperative complications was associated with lowest mean arterial pressure,estimated blood loss and operative time.Interestingly,as a characteristic of SAS,lowest heart rate was not involved.The modified SAS we proposed including lowest mean arterial pressure,estimated blood loss and operative time increased AUC from 0.606 to 0.743.Conclusions:The SAS can be a simple,rapid scoring system that effectively predicts major postoperative complications.Besides,the modified SAS we proposed in this study,which included lowest mean arterial pressure,estimated blood loss and operative time,exert a better predictive value in PDAC patients.

Evaluation and Relevance of Indications for Primary Caesarean Section: A Five-Year Experience Report from Nevers Hospital Center

Context: The caesarean section rate continues to increase in our different health structures specially for women who have not had a scar in the uterus. Objectives: The aim of this study was to analyze the key factors and main indications for primary caesarean sections and to find ways to reduce the increasing rates. Patients and Method: This is a longitudinal and retrospective study carried out from June 1, 2018 to July 31, 2022. The study included all patients who had a cesarean-section for the first time (primary caesarean). An anterior uterine scar was a non-inclusion criterion. Data were collected prospectively using Synfonievre and Agopra software via patients’ files and information collection sheet. Data were analyzed with SPSS 21 software, Mac version. Averages were calculated for quantitative data and percentages for qualitative data. The statistical tests used were the Pearson Chi2 test. The observed differences were considered significant when the p-value was less than 0.05. Results: During the study period, we recorded 8832 deliveries and 3148 caesarean sections (35.6%). Primary CS concerned 70% of overall C-section rate. The main indications were FHR Fetal Heart Rate abnormalities (FHRA) (27%), followed by the other indications (including preterm delivery, umbilical cord dystocia, malpresentation of fetus, foetal abnormalities, elective CS, triple gestation, mother abnormalities);dystocia or prolonged labor (18.7%), breech presentation in a twin pregnancy with 11.3% and 9.6% respectively. We recorded more vaginal deliveries with labor induction: 81.4% against 75.2%. An obstetrical audit led to better labor management and a reduction in the cesarean section rate. Conclusion: We need to focus on diagnosis of fetal distress, management of breech presentation during of a twin birth and a singleton. Induction of labor can be an effective alternative in certain indications. An obstetrical audit is needed to reverse the caesarean section rate.

Clinical implication of platelet to lymphocyte ratio in early onset preeclampsia:A single-center experience

BACKGROUND Preeclampsia(PE)is a pregnancy syndrome of undetermined etiology;inflammation was one of the proposed theories for its development.AIM To examine the platelet to lymphocyte ratio(PLR),an inflammatory biomarker,as a marker to predict poor maternal-neonatal outcomes in early-onset PE(EoPE).METHODS A cross-sectional study enrolled 60 pregnant women with EoPE(at 32-30 wk of gestation)at a university hospital.Demographic criteria and hematological indices were collected,including platelet counts and indices(mean platelet volume and platelet distribution width),PLR,and the Doppler study,which calculated estimated fetal weight(EFW),amniotic fluid index(AFI),resistance index(RI),and pulsatility index(PI).Participants were followed until delivery,where maternal outcomes were recorded,including;delivery mode and reason for cesarean section,and neonatal outcomes,including fetal growth restriction(FGR),meconium-stained liquid,the 5-min Apgar score,and admission to the intensive care unit.RESULTS There was a trend of insignificant increases in cesarean sections.Sixty-one-point two percent(37/60)fetuses were admitted to the neonatal care unit;70.0%of admitted fetuses were meconium-stained liquor,and 56.7%of them had FGR.PLR was positively correlated with AFI and EFW as r=0.98,0.97,P<0.001;PLR showed negative correlations with PI and RI as r=-0.99,-0.98,P<0.001.The Apgar score and the number of days admitted to the intensive care unit had a positive and negative correlation(0.69,-0.98),P<0.0001,respectively.Receiver operating characteristic calculated a PLR cutoff value(7.49)that distinguished FGR at 100%sensitivity and 80%specificity.CONCLUSION Strong,meaningful relationships between PLR and FGR parameters and a poor neonatal outcome with a significant P value make it a recommendable biomarker for screening EoPE-related complications.Further studies are suggested to see the impact on maternal-neonatal health.

Admission Cardiotocography: Its Role in Predicting Perinatal Outcome in Term, Uncomplicated (Low Risk) Pregnant Women in Spontaneous Labour

Introduction: Labour admission cardiotocography (CTG) is commonly used non-invasive method of fetal monitoring in Sri Lanka. It may have a potentialto predict perinatal outcome in low-risk term pregnancies. Objectives: Objectives of the study were to determine the perinatal outcomes of normal, suspicious and pathological admission CTGs and role of labour admission cardiotocography as a predictive test for perinatal outcome in low-risk term pregnancies in spontaneous labour. Methods: This study was a prospective observational study done involving 445 low risk, term pregnancies in spontaneous labour. Labour admission CTG was performed in each pregnancy and categorized into normal, suspicious and pathological CTG according to criteria depicted by National Institute of Clinical Excellence (NICE) guideline 2007. Apgar score less than 7 at five minutes, resuscitation at birth, admission to neonatal intensive care unit (NICU), seizure within first 24 hours of birth and meconium-stained amniotic fluid were the primary outcome measures to assess fetal asphyxia. Mode of delivery in each category, nuchal cord at birth were also assessed. Results: Majority of participants were in 25-to-29-year age group and were nulliparous. Frequencies of normal, suspicious and pathological CTG were 74.8%, 18% and 7.2% respectively. Pathological CTG was significantly associated with low Apgar score compared to non-pathological CTG group (p 0.005) while other outcome measures were not significant. Rate of operative delivery was 68% in pathological group and 20.8% in non-pathological CTG group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of labour admission CTG to detect fetal asphyxia were 51.85%, 95.69%, 43.75% and 96.85% respectively. Conclusions: Incidence of pathological labour admission CTG was 7.2%. Apgar score less than 7 at five minutes of birth was significantly associated with pathological CTG group compared to non-pathological CTG (p 0.05). Worsening of CTG from normal to pathological showed increasing rate of operative delivery. Even though sensitivity and positive predictive values of labour admission CTG were low, specificity and negative predictive values were high for detecting low Apgar score. Therefore, labour admission CTG has a value in excluding adverse perinatal outcomes in low-risk term pregnancies in spontaneous labour.

Relation Ship of Maternal Haemoglobin Concentration Measured in Labour with Neonatal Outcome among Sudanese Women

Objective: Data showed that maternal anaemia during pregnancy negatively affects maternal/fetal outcomes. We here attempted to re-confirm this in this specific region of Sudan, with special reference to fetal/neonatal outcome. Methodology: This cross-sectional observational study was carried out at Omdurman Maternity and Khartoum North Teaching Hospitals-Sudan from March 2018 to March 2019, with 246 pregnant women presented in labour enrolled. Maternal characteristics, haemoglobin (Hb) measured after labour initiation and fetal/neonatal outcomes were analyzed. Results: When maternal anemia was defined as Hb less than 10.0 g/dL, 80 (32.5%) had anemia and 166 had not. Anemic women (Hb;8.3 ± 0.31), compared with non-anemic women (Hb;11.4 ± 0.61), were significantly more likely to have low birth weight (LBW) infants (40% vs. 15.7%) and still birth (12.5% vs. 4.8%). There was a correlation between hemoglobin concentration and the followings: LBW, respiratory distress syndrome, neonatal nursery admission, still birth, early neonatal death, and low Apgar score. Conclusions: Maternal aneamia negatively affected fetal/neonatal outcomes. This data may be useful to make health policy in this area.

Quality of Caesarean Sections in Rural Sub-Saharan Africa: A Prospective Study in Cameroon

Introduction: Caesarean section (CS) is a major reproductive health intervention to improve maternal and foetal outcomes if appropriately performed. This study aimed to assess the quality of Caesarean sections (CS) in a rural setting in Cameroon. Materials and Methods: A prospective study conducted in 3 hospitals from February 1st 2020 to April 30th 2020. One hundred and twenty women who had a CS were included. Data were grouped into 5 categories: 1) Sociodemographic and obstetrical characteristics, 2) Geographic and financial access, 3) Diagnostic procedures, 4) Operative parameters and 5) Post-operative parameters. The Dujardin’s model and context-relevant criteria served to construct the quality score. The scale was 0 - 20 and scores ≤ 15 were considered as unacceptable quality while those >15 were considered as acceptable quality CS. Logistic regressions permitted to measure associations. Results: There were 538 deliveries and 120 (22.3%) CS. The mean (SD) gestational age was 38.7 (2.6) weeks with extremes of 31 and 43 weeks. Group 5 of the Robson’s classification was predominant (35.0%). Motorbikes were the mode of transport to the maternity for 72.5% (87/120) of women. No referral was made by ambulance. Only 44 (36.7%) women had paid the full cost of the CS prior to surgery. In addition, 26 (21.6%) women had a complete clinical examination on admission. The surgical team was not complete (<6 staffs) in 56 (43.3%) cases. Anaesthesia was done by nurses in all cases. CS was done by a general practitioner and by nurses in 86 (71.7%) and 14 (11.7%) cases respectively. Overall, mean (SD) quality score (QS) was 16.33 (1.60). Sixty six of the 120 (55.3%) caesarean sections had unacceptable quality CS. Mean (SD) QS was significantly higher in faith-based hospitals than in public hospitals (18.00 (0.91) versus 15.59 (1.24);P < 0.001). Immediate postoperative clinical monitoring was effective only in 66 (55%) of cases. Apgar score was below 7 over 10 in 17 (14.2%) cases of which 6 freshes still births. No maternal death was recorded and maternal complications were recorded in 14 (11.7%) cases. Conclusion: The quality of CS is generally poor in rural settings in West-Cameroon. The quantity and quality of staffs required for Caesarean sections in the hospitals are sometimes insufficient. The poor quality of CS in this region could be addressed using the faith-based hospitals: St Vincent de Paul’s Hospital as a model.

Impact of Epidural Analgesia in Labour on Neonatal and Maternal Outcomes

Aim: To evaluate the effect of epidural analgesia during labour on neonatal-maternal outcomes. Methods: A retrospective cohort study of nulliparous parturients who gave birth in Vasternorrland County, Sweden, over a 2-year period between 2015 and 2016. Neonatal outcomes (Apgar score at 5 min and umbilical cord arterial blood gases), maternal outcomes (perineal injury, total bleeding volume and maternal satisfaction with birth) and labour parameters (mode of delivery and the durations of labour and postpartum hospital stay) were evaluated. Results: The study cohort consisted of 1449 women with singleton pregnancies. Patients were divided into two groups according to whether during labour they were administered epidural analgesia using bupivacaine and sufentanil (EDA group, n = 615) or not (non-EDA group, n = 834). The rate of assisted vaginal delivery was significantly higher in the EDA group than in the non-EDA group (15.6% and 11.3%, respectively, p < 0.05), whereas the rates of caesarean section were similar. The duration of the active phase of labour was significantly longer in the EDA group than in the non-EDA group (489 ± 217 min versus 371 ± 210 min, respectively, p < 0.001). The Apgar score at 5 min and umbilical cord blood pH were lower and the base deficit greater in the EDA group (p < 0.001, p < 0.001 and p < 0.01, respectively). Bleeding volume was similar between the groups after adjusting for gestational age. Women in the EDA group were more satisfied with their labour experience, as measured by the visual analogue scale (p Conclusion: The results of this study suggest that EDA affects delivery and neonatal-maternal outcomes negatively, but increases the mother’s satisfaction with labour.

Clinical Parameters in the First 5 Minutes after Birth Have a Predictive Value for Survival of Extremely Preterm Infants

Extreme preterm infants(<28 weeks'gestation)often require positive pressure ventilation with oxygen during postnatal stabilization in the delivery room.To date,optimal inspired fraction of oxygen(FiO_(2))still represents a conundrum in newborn care oscillating between higher(>60%)and lower(<30%)initial FiO_(2).Recent evidence and meta-analyses have underscored the predictive value for survival and/or relevant clinical outcomes of the Apgar score and the achievement of arterial oxygen saturation measured by pulse oximetry≥85%at 5 minutes after birth.New clinical trials comparing higher versus lower initial FiO_(2)have been launched aiming to optimize postnatal stabilization of extreme preterm while avoiding adverse effects of hypoxemia or hyperoxemia.

The Clinical Value of Artery Umbilical Cord Blood Gas in Predicting Neonate Condition:A Prospective Cohort Study

Objective:To evaluate the predictive ability of neonate condition through the traditional parameters and artery umbilical cord blood gas(aUCBG).Methods:A prospective cohort study was conducted in obstetrics and gynecology department between October 2017 and August 2018 at Tongji Hospital in Wuhan,China,and 360 aUCBG samples were collected.The average age of pregnant women was(29.50±4.42)years,range from 19 to 48 years old.The gestational age range from 28+4 weeks to 41+3 weeks at admission.Logistic regression and area under the curve(AUC)from Receiver operating characteristic curves were used to identify risk factors,such as,premature rupture of membranes(PROM),high blood pressure,premature delivery(PD),low 1-minute Apgar scores(Apgar 1),low 5-minute Apgar scores(Apgar 5),pH,base excess,bicarbonate,neonatal blood sugar(NBS),and so on,to predict neonatal condition and evaluate the predictive ability of traditional and aUCBG parameters.Results:In all cases,PROM,PD,Apgar 1,Apgar 5,pH,base excess,bicarbonate,total carbon dioxide,and neonatal blood sugar were risk factors and were associated with poor condition of neonate.Apgar 1 were an independent risk factor.Combined traditional and aUCBG parameters had higher AUC of 0.895(95%confidence interval(C/):0.830-0.960,P<0.001).In cesarean section subgroup,high blood pressure,PD,and Apgar 1 were risk factors and were associated with poor condition of neonate.Apgar 1 and low pH were the independent risk factors.Combined traditional and aUCBG parameters had highest AUC of 0.940(95%C/:0.886-0.993,P<0.001).In vaginal delivery subgroup,maternal age above 35 years,PROM,PD,Apgar 1,Apgar 5,and male newborn were risk factors and were associated with poor condition of neonate.Maternal age above 35 years was an independent risk factor.Combined traditional and aUCBG parameters had highest AUC of 0.897(95%Cl:0.828-0.965,P<0.001).For pregnant women without comorbidities and complications of pregnancy,aUCBG may not be necessat7.Conclusion:In high-risk pregnancies,especially lower Apgar scores,PD,and maternal age above 35-year old,aUCBG is recommended.Traditional parameters combined with aUCBG might increase the predicting ability of neonate condition.