New Interpretation of Neonatal Outcomes by Phenotypically Classified Preterm Syndrome:A Retrospective Cohort Study

Objective:The global aim to lower preterm birth rates has been hampered by the insufficient and incomplete understanding of its etiology,classification,and diagnosis.This study was designed to evaluate the association of phenotypically classified preterm syndromes with neonatal outcomes;to what extent would these outcomes be modified after the obstetric interventions,including use of glucocorticoid,magnesium sulfate,and progesterone.Methods:This was a retrospective cohort study conducted at Tongji Hospital(composed of Main Branch,Optical Valley Branch and Sino-French New City Branch)in Wuhan.A total of 900 pregnant women and 1064 neonates were retrospectively enrolled.The outcomes were the distribution of different phenotypes among parturition signs and pathway to delivery,the association of phenotypically classified clusters with short-term unfavorable neonatal outcomes,and to what extent these outcomes could be modified by obstetric interventions.Results:Eight clusters were identified using two-step cluster analysis,including premature rupture of fetal membranes(PPROM)phenotype,abnormal amniotic fluid(AF)phenotype,placenta previa phenotype,mixed condition phenotype,fetal distress phenotype,preeclampsia-eclampsia&hemolysis,elevated liver enzymes,and low platelets syndrome(PE-E&HELLP)phenotype,multiple fetus phenotype,and no main condition phenotype.Except for no main condition phenotype,the other phenotypes were associated with one or more complications,which conforms to the clinical practice.Compared with no main condition phenotype,some phenotypes were significantly associated with short-term adverse neonatal outcomes.Abnormal AF phenotype,mixed condition phenotype,PE-E&HELLP phenotype,and multiple fetus phenotype were risk factors for neonatal small-for gestation age(SGA);placenta previa phenotype was not associated with adverse outcomes except low APGAR score being 0-7 at one min;mixed condition phenotype was associated with low APGAR scores,SGA,mechanical ventilation,and gradeⅢ-Ⅳintraventricular hemorrhage(IVH);fetal distress phenotype was frequently associated with neonatal SGA and mechanical ventilation;PE-E&HELLP phenotype was correlated with low APGAR score being 0-7 at one min,SGA and neonatal intensive care unit(NICU)admission;multiple fetus phenotype was not a risk factor for the outcomes included except for SGA.Not all neonates benefited from obstetric interventions included in this study.Conclusion:Our research disclosed the independent risk of different preterm phenotypes for adverse pregnancy outcomes.This study is devoted to putting forward the paradigm of classifying preterm birth phenotypically,with the ultimate purpose of defining preterm phenotypes based on multi-center studies and diving into the underlying mechanisms.

International Outcomes of COVID-19 during Pregnancy and a Literature Review on Maternal and Neonatal Outcomes

Since the first report of COVID-19 in December 2019, our knowledge and treatment modalities have evolved at great pace understanding its impact on the maternal and neonatal outcomes. Whilst pregnant patients are not more susceptible to acquiring the infection as compared to the general population, they may be at higher risk of developing severe symptoms given the physiological changes, relative immune-compromised state of pregnancy, and their neonates at risk of consequent iatrogenic preterm deliveries. Our review article discusses outcomes of pregnant women and neonates with COVID-19 from several countries including the UK, USA, France, Italy and China and provides a narrative review of literature from November 2019 till December 2020.

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.

Prevalence, Aetiology, Maternal and Neonatal Outcome of Term Mothers with Anaemia, Presenting to a Tertiary Care Unit for Confinement in Sri Lanka

Objective: To describe the proportion of women presenting with undiagnosed anaemia at confinement and to explore associations between anaemia and socio economic factors, dietary pattern and compare maternal and neonatal outcome among term mothers with anaemia compared to non-anaemic pregnant women at a tertiary care centre in Sri Lanka. Method: A comparative cross-sectional study was performed by recruiting anaemic and non-anaemic term mothers who delivered at the Teaching Hospital Peradeniya during the period March 2018-March 2019. Pregnant mothers whose haemoglobin level was less than 10.5 g/dl were considered as anaemic and compared with the mothers whose haemoglobin level was above this level. With written consent, demographic data, etiological factors, maternal and neonatal outcomes of term mothers were evaluated by an interview and blood samples were withdrawn to carry out anaemia related investigations. Results: Among 2854 pregnancies, a total of 234 (8.19%) term pregnant mothers were anaemic and they were and compared with 199 non-anaemic mothers. Out of the anaemic mothers (Hb < 105 g/l), 133 (56.76%) had moderate anaemia, 100 (42.79%) had mild anaemia and 1 mother (0.45%) had severe anaemia. Low monthly family income was significantly associated with the incidence of anaemia. Anaemia was also associated with low weekly consumption of red meat (OR 8.994;95% CI, 5.74 - 14.09, p < 0.05) and high weekly tea intake (OR 0.217;95% CI 0.144 - 0.327, p < 0.05). Among anaemic mothers, 215 (67.44%) had low serum ferritin (<30 ng/mL) while most of them were diagnosed with iron deficiency anaemia (58.24%) (n = 113) based on haemoglobin. Most anaemic mothers had undergone elective caesarean section (46.26%) while vaginal deliveries (33.33%) were common among non-anamic group. Conclusions: A moderate prevalence of anaemia among term pregnant women in Peradeniya, Sri Lanka was observed and was associated with low socio economic status, low consumption of tea and poor nutrition lacking in red meat.

Maternal and Neonatal Outcome of Teenage Pregnancy at Al-Galaa Maternity Teaching Hospital, Cairo, Egypt

Backgrounds: Teenage pregnancies are generally considered as a high-risk however, sufficient data is lacking in the area, Cairo Egypt. We attempted to determine whether teenage pregnancies show poorer outcomes than adult-age pregnancies. Objectives: Finding out the prevalence of teenage pregnancy and its maternal and fetal outcome in comparison. Subjects and methods: A retrospective analytical case-control study was conducted on patients who had attended for delivery at Al-Galaa Maternity Teaching Hospital during the period of one year from March 2015 to February 2016. A total of included 538 patients aged 16 - 19 years as study group and adult age group: included 609 patients aged 25 - 29 years as the control group. The only primigravid was enrolled. The study records were retrieved for review. Comparisons were made between the two groups regarding maternal demographics, socioeconomic status, medical disorders, major antenatal complications, the outcome of labor, mode of delivery, and perinatal complications. Results: The prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered the significant prevalence of teenage pregnancy, was 46.9%. Teenage group, compared with the adult group, P-value < 0.05 was considered significant. Teenagers had a lower antenatal care attendance (63.8% vs 76.7%;P = 0.001), a higher incidence of Eclampsia (2.1% vs 0%;P = 0.000), vaginal deliveries (70.1% vs 51.9%;P = 0.000). And a higher maternal ICU admission (1.4% vs 0.0.7%), and maternal death (0.5% vs 0%),especially in low socioeconomic. On the other hand, the adult group pregnancies had a higher incidence of gestational hypertension, gestational diabetes, and cesarean delivery. Conclusions: Teenager primigravid women should be considered as a high-risk pregnancy and thus require special medical attention to avoid adverse maternal and neonatal outcomes.

Neonatal Outcome of Induced Prematurity for Severe Preeclampsia in Four Great Kinshasa Maternities

Severe preeclampsia (SPE) is associated with fetal complications including intrauterine growth retardation (IUGR), prematurity and in utero fetal death. Its treatment remains child birth that often is planned before term. However, this attitude can lead to fetal complications related to prematurity. Several studies on preeclampsia have already been studied in the DRC and several aspects have already been realized, but to date, the neonatal outcome has not yet been addressed. Methods: This is cross-sectional study performed in four public hospitals in Kinshasa (Democratic Republic of Congo). We included 400 cases of induced prematurity (IP) for SPE;the analysis compared pregnant women who gave birth before 34 weeks of amenorrhea (WA) and those after 34 WA. The comparison of the proportions was made by the Chi-square test and the calculation of Means by the Student’s test. The significance level was set at P < 0.05. Objective: To determine the frequency of induced prematurity for severe preeclampsia (SPE), to identify the indications and to evaluate neonatal outcome. Results: The IP frequency for SPE was 46.2%. The retro placental hematoma was the most indication in pregnancies before 34 WA 24.9%, while high blood pressure 54.5% in the after 34 WA group. In utero death was more common in pregnant women who gave birth before 34 weeks 25.4%;chronic fetal distress was elevated in the after 34 WA group 19.5%. Neonatal infection was more common in the group after 34 WA 49.4%, while respiratory distress 39.6%, intra and periventricular hemorrhage 19.5% and neonatal death 39.6% were more in group before 34 WA. Conclusion: Prematurity induced for SPE is related to a poor neonatal prognosis.

Effects of Misoprostol and Oxytocin Combined with Calcium Gluconate on Delivery Time of Parturient with High-risk Postpartum Hemorrhage and Neonatal Outcomes

Objective:To investigate the effect of misoprostol and oxytocin combined with calcium gluconate on parturient with high-risk postpartum hemorrhage.Methods:The clinical data of 80 parturient with high-risk postpartum hemorrhage who were treated in our hospital from July 2016 to July 2019 were retrospectively analyzed.According to different treatment methods,they were divided into control group(treated with misoprostol combined with oxytocin,40 cases)and observation group(treated with misoprostol and oxytocin combined with calcium gluconate,40 cases),compared the clinical efficacy,delivery time,postpartum hemorrhage 2 hour after delivery,postpartum hemorrhage 24 hours after delivery and Apgar score of the newborns at 1min after birth.Results:The total effective rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).The third delivery stage in the observation group was shorter than that in the control group,and the postpartum hemorrhage volume was less than that in the control group.The difference was statistically significant(P<0.05).There was no significant difference in Apgar score of the two groups of newborns(P>0.05).Conclusion:Misoprostol and oxytocin combined with calcium gluconate is effective in treating high-risk postpartum hemorrhage parturient,which not only can effectively reduce postpartum hemorrhage and shorten the delivery time,but also is beneficial for neonatal outcome and worthy of clinical application.

Late Αntepartum Ηemorrhage and Neonatal Outcome: A Retrospective Study

To retrospectively evaluate the causes, the management and neonatal outcome in pregnancies complicated with late antepartum hemorrhage (APH), defined as vaginal bleeding during the third trimester of pregnancy. Methods: We retrospectively identified all eligible patients at a single institution from January 1990 to December 2012. A thorough research was made through patients’ medical and obstetrical records. The various causes of late APH were compared to each other regarding the parameters of the neonatal outcome. Multiple regression models were applied for gestational age (GA) at birth, birth weight, Apgar score at first and fifth minute and selection of modus of delivery. Results: 480 patients were included in the study, in a total of 7221 pregnancies. The causes of APH were: cervical dilatation (n = 54, 11.3%), central placental abruption (n = 57, 11.9%), peripheral placental abruption (n = 59, 12.3%), placenta previa (n = 140, 29.2%), others non-related to pregnancy (n = 42, 8.8%), uterine rupture (n = 2, 0.4%) and unknown etiology (n = 126, 26.3%). Overall, 253 neonates (52.7%) were born prematurely at gestational age below 37th week. 37 pregnancies (7.7%) resulted in giving birth prior to 32 weeks of gestation. In multivariable analysis, the cause of hemorrhage was found to be an important independent predictive factor for gestational age (GA) at birth, birth weight, Apgar scores at first and fifth minute and modus of delivery. Preeclampsia, diabetes, thyroid disorder and smoking were associated with decrease of GA at birth. Birth weight below 1500 gr and GA at birth was found to be significant independent factors for Apgar score at first and fifth minute respectively. Modus of delivery did not significantly alter Apgar score. Conclusions: Late APH required immediate evaluation of the general condition of the pregnant woman and the fetus. The cause of APH was important in the prognosis of the neonatal outcome. As long as maternal and fetal status were ensured, expectant management, instead of emergency CS, seemed to be more beneficial even for late preterm neonates.

Maternal and Neonatal Outcome for Singleton and Twin Pregnancies in Emergency Cesarean Section vs.Urgent Cesarean Section in a Retrospective Evaluation from 2003-2012

Objectives: Emergency cesarean is performed, when a situation requires immediate action in order to reduce the risk to mother and/or child, while urgent cesarean is done if a non-life threatening but compromising situation occurs. The aim of the study was to investigate the maternal and fetal outcome for emergency and urgent cesarean. Study Design: A retrospective case-control study was performed;cases underwent emergency cesarean section, while controls underwent urgent cesarean section. We included 303 cases of women and 336 cases of children, and controls were matched. Maternal and fetal outcome parameters for singleton and twin pregnancies were investigated using the Wilcoxon test and the Chi-square-test. Results: Maternal outcome: Higher?blood loss (cases: mean 383.12 ± 232.89, range 100 - 2500 vs. controls: 336.06 ± 129.19, range 100?- 1000, p = 0.008), hemorrhage (34 vs. 11, p < 0.001) and puerperal anemia (30 vs. 10, p < 0.001). Neonatal outcome: One, five, and ten minutes Apgar levels and umbilical cord pH values are lower for cases (p < 0.001 and p < 0.001, respectively). Twins had lower five and ten minutes Apgar levels (p = 0.040 and 0.002), but higher umbilical cord pH values than singletons (p < 0.001). The perinatal mortality among singletons was 3.8%, among twins 8.1%. For cases the perinatal mortality among singletons was 5.7% and 17.14% for twins (control group 1.41% and 2.63%, respectively). Conclusion: The maternal and fetal outcome is poorer in emergency cesarean section. Especially the perinatal mortality is high in emergency cesarean section, particular for twins.

Pregnancy,childbirth and neonatal outcomes associated with adolescent pregnancy

Objective:To assess the obstetric and neonatal outcomes associated with adolescent pregnancy in Iran.Methods:We retrospectively assessed women who gave birth between January 1st,2020,and January 1st,2022.These pregnant women were separated into two groups:(1)women aged 19 and younger;(2)women aged 20-34 years.Main outcome measures include preterm birth,maternal comorbidities,preeclampsia,eclampsia,low birth weight(LBW),intrauterine growth restriction(IUGR),placenta abnormalities,placenta abruption,cho-rioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacer-ations,postpartum hemorrhage,childbirth trauma,shoulder dystocia,congenital malformation,and unfavorable maternal and neonatal outcome.Logistic regression models were used to determine the influence of teenage pregnancy on adverse pregnancy and childbirth outcomes.Results:Of 7033 deliveries,92.4%of women were adults,and 7.6%were adolescents.Adolescents residing in rural districts were more common than adults(42.3%vs.33.7%).However,access to prenatal facility care was the same as the majority of women had 6-10 prenatal care visits during their pregnancy.There was no difference in the risk of preeclampsia,placenta abruption,placenta previa,fetal distress,preterm labor,shoulder dystocia,perineal lacerations,childbirth trauma,congenital malformation,postpartum hemorrhage,intensive care unit admission,maternal death,and unfavorable neonatal outcome including stillbirth,neonatal intensive care unit admission,neonatal death in adolescent pregnancies compared to adults.Adolescents had a significantly higher risk of LBW(OR:1.47,95%CI:1.01-2.73),IUGR(OR:1.96,95%CI:1.31-2.45),and meconium fluid(OR:1.74,95%CI:1.41-2.32),however,there was no statistically significant difference after adjusting the confounding factors.Compared with adults,adolescents had a significantly lower risk of CS(aRR:0.67,95%CI:0.51-0.77)and a lower risk of gestational diabetes(aRR:0.78,95%CI:0.51-0.95).Conclusions:Although we found no serious consequences of adolescent pregnancy,more research is needed to reach a more accurate conclusion about teenage pregnancy.

Does cesarean section prevent adverse neonatal outcomes associated with meconium amniotic fluid?

Background Making decisions regarding the mode of delivery in the cases of meconium amniotic fluid(MAF)presents a challenge for healthcare providers.We aimed to compare the neonatal outcome of MAF cases delivered via cesarean section(CS)versus those delivered vaginally to determine if CS is a protective factor against the adverse neonatal outcomes.Methods In this retrospective study,we assessed singleton pregnant mothers diagnosed with MAF who gave birth at a tertiary hospital in Bandar Abbas,Iran,between January 2020-2022.Mothers with certain adverse pregnancy conditions were excluded from the study.These conditions included:abnormal fetal heart rate and pattern,bloody amniotic fluid,malpresentation,abnormal placentation,chorioamnionitis,intrauterine growth restriction,intrauterine fetal death,obstructed labor,and maternal comorbidities.The MAF mothers were divided into two groups based on the method of delivery:those who had CS and those who had a normal vaginal delivery(NVD).Demographic factors,obstetrical factors,and neonatal outcomes were compared between the two groups.Results Out of 746 MAF mothers,213(28.5%)underwent CS,while 533(71.4%)had NVD.There were no significant differences between the groups in terms of demographic characteristics.Among MAF mothers who had CS,66.2%were primiparous,and 33.8%were multiparous.For those who had NVD,35.1%were primiparous,and 64.9%were multiparous.The first and 5-min Apgar values,rates of asphyxia,neonatal intensive care unit(NICU)admission,and neonatal death were not statistically different between the two delivery modes.The rate of newborns who breastfed within the first hour did not differ depending on the mode of delivery.Although initial resuscitation steps were required more frequently in MAF mothers with NVD than in those with CS(11.1%vs.2.3%),no correlation was found between the mode of delivery and the need for resuscitation using logistic regression.Conclusions Our research findings suggest that there were no superior neonatal outcomes in terms of CS compared to NVD in MAF mothers.Further studies are needed to provide more substantial evidence to support this conclusion.

Advanced maternal age and adverse obstetrical and neonatal outcomes of singleton pregnancies

Objective:To assess the impact of advanced maternal age on pregnancy and childbirth outcomes of singleton pregnancies.Study design:We retrospectively assessed singleton pregnant mothers who gave birth at Khaleej-e-Fars Hospital in Bandar Abbas,Iran,from January 2020 to January 2022.Demographic and obstetrical factors include educational level,medical insurance,residency place,access to prenatal care facilities,number of prenatal care visits,smoking status,gestational age,parity,infertility,maternal comorbidities,preeclampsia,eclampsia,preterm birth,low birth weight(LBW),intrauterine growth restriction(IUGR),macrosomia,placenta abnormalities(previa/acreta),placenta abruption,chorioamnionitis,meconium fluid,fetal distress,methods of delivery,rate of cesarean section(CS),perineal lacerations,postpartum hemorrhage,childbirth injury,shoulder dystocia,congenital malformation,neonatal asphyxia,and unfavorable maternal and neonatal outcome were compared between two groups.The Chi-square test assessed the relationship between categorical factors and maternal age groups.The influence of advanced maternal age on the risk of unfavorable pregnancy outcomes was evaluated using bivariate and multivariate logistic regression.Results:Of 8354 singleton deliveries,22.2%belonged to advanced-age mothers.Advanced-age mothers had less education than those aged 20–34 years old.Chronic hypertension,cardiovascular disease,overt diabetes,and thyroid dysfunction were more prevalent among advanced-age mothers.Compared with mothers aged 20–34 years,mothers aged 35 years and higher had a significantly higher risk of gestational diabetes(aOR:3.18,95%CI:1.56–6.95),preeclampsia(aOR:2.91,95%CI:1.35–4.72),placenta abnormalities(aOR:1.09,95%CI:0.77–1.94),CS(aOR:3.16,95%CI:1.51–3.87),postpartum hemorrhage(aOR:1.94,95%CI:1.24–2.61),intensive care unit admission(aOR:1.36,95%CI:1.15–1.99),LBW(aOR:1.35,95%CI:0.97–2.96),preterm birth(aOR:2.36,95%CI:1.65–4.83),stillbirth(aOR:1.18,95%CI:1.01–3.16),and neonatal intensive care admission(aOR:2.09,95%CI:0.73–3.92).According to bivariate regression,the risk of meconium fluid was lower in advanced-age mothers;however,the result of multivariate logistic regression found no correlation between advanced age and the Incidence of meconium fluid.Conclusion:Advanced-age mothers are at increased risk of adverse pregnancy and childbirth outcomes,which persist even after adjusting for several potential confounders.

Timing of Elective Repeat Cesarean Delivery at 38 Weeks versus 39 Weeks: Rate of Spontaneous Onset of Labor before Planned Cesarean Section and Impact on Maternal Outcome: A Retrospective Cohort Study

Background: The timing of elective repeat cesarean delivery at 38 weeks versus 39 weeks is still a debatable subject, both regarding maternal and neonatal outcomes. In the Saudi context, there is lack of local data to aid decision-making regarding the timing of elective repeat cesarean delivery. Objectives: To estimate the rate of spontaneous onset of labor before the planned gestational age for repeat cesarean section in women who were booked at gestational age of (39 0/7 - 39 6/7) weeks (W39) versus (38 0/7 - 38 6/7) weeks (W38) and to compare the rate of maternal composite outcome between these groups. Design: Retrospective cohort. Setting: This study was conducted at King Abdulaziz Medical City, Jeddah, KSA. Method: Delivery registry books were reviewed to identify all deliveries from 1 January 2014 to 31 December 2016 (3 years). All low-risk pregnant women who had 2 or more cesarean deliveries and who met the inclusion criteria were included. Results: A total of 440 women were included of whom 318 (72.3%) were planned for elective cesarean section at W38 gestational age and 122 women at W39 gestational age. Mothers planned at W39 had higher rate of emergency cesarean deliveries versus those planned at W38 (18.0% versus 10.4%, p = 0.030;RR = 13.06), most frequently due to early onset of contractions (16.4% versus 8.2%, p = 0.012;RR = 12.17) or cervical dilatation (11.6% versus 5.4%, p = 0.024, RR = 16.15). No difference in the incidence of individual or composite maternal complications was noted between the two groups. Mother’s age (OR 0.93, p = 0.018) and schedule date at W39 (OR = 1.94, p = 0.028) were independently associated with spontaneous onset of labor before the scheduled gestational age, while no association was found with parity, previous number of spontaneous vaginal deliveries, number of previous cesarean deliveries or interval from last cesarean delivery. Conclusion: Elective cesarean section scheduled at 39 weeks of gestation or beyond carries a higher risk of emergency cesarean section, with no significant increase in maternal complications. The identification of factors associated with spontaneous onset of labor before the planned gestational age should be carefully identified to determine the optimal timing.

Feto-Maternal Outcome and Complications of Emergency Caesarean Section among the Patients Admitted at a Tertiary Care Hospital in Dhaka City

Background: Caesarean Section done in emergency basis can result some adverse outcome to both the fetus & mother & complications may arise. Objective: The purpose of the present study was to see the fetal & maternal outcome or any complications among the pregnant woman who had undergone emergency caesarean section. Methodology: This descriptive type of cross sectional study was conducted in the Department of Gynaecology & Obstetrics at Dhaka Medical College Hospital during the period from July 2006 to December 2006. The patients underwent emergency caesarean section for any indication during the mentioned period of study was selected as study population. Among them, 100 cases were recruited in this study. Result: Among the cases, maternal morbidity was as high as 64% which were due to haemorrhage, post-operative infection, rise of blood pressure and other complications. Regarding fetal outcome, 92% babies were born with normal birth weight, 33% babies were developed complications which were mostly due to birth asphyxia and prematurity. Conclusion: In conclusion, emergency caesarean section has maternal morbidity as well as fetal and neonatal adverse outcome.

Clinical Outcomes of Positive Newborns for COVID-19 in Rio de Janeiro, Brazil

The disease caused by the SARS-CoV-2 virus has spread very rapidly throughout the world, causing various clinical manifestations and affecting several organs and systems. However, the possibility of vertical transmission of COVID-19 in symptomatic pregnant women has been questioned. The aim of this work was to report cases of possible vertical transmission in pregnant women affected by the SARS-CoV-2 virus, as well as its clinical repercussions on the newborn. In this paper, we conducted a cross-sectional retrospective study by analyzing medical records of pregnant women admitted at the military hospital, in Rio de Janeiro, Brazil, diagnosed with COVID-19 and who had positive newborns. To evaluate epidemiological data, clinical manifestations, laboratorial and histopathological changes were related to such vertical transmission. Only six tested newborns were positive for COVID-19. The mothers had no respiratory symptoms, and the gestational age was at term, except for one newborn born prematurely due to detection of pericadial effusion. Three neonates had respiratory symptoms, requiring ventilatory support. None of the mothers or newborns died. During the pandemic, possible vertical transmission cases of infected pregnant women in the third trimester of pregnancy were observed. According to the case reports published in the literature, they illustrate phenotypes of neonatal involvement with varied clinical manifestations and severity;however, further scientific studies are needed to prove the effective vertical transmission of SARS-CoV-2 in positive pregnant women.

全身麻醉下剖宫产术的单中心回顾性队列研究（英文）

Objective Neuraxial block is the most common anesthesia method for cesarean section(CS).However,for some urgent and high-risk cesarean delivery,general anesthesia(GA)also plays a very important role.We aimed to find out the reasons of choosing GA for CS in our center and the factors that may be related to the maternal and fetal outcomes.Methods We retrospectively selected parturients who had CS procedures under GA in Peking Union Medical College Hospital from January 1,2014 to December 31,2016.Clinical data(baseline maternal status,preoperative status,perioperative information,maternal and fetal outcomes)of parturients and neonates were collected and analyzed.We summarized the common reasons for applying general anesthesia,and compared the back-to-ICU ratio and hospital stay time between parturients with different maternal American Society of Anesthesiologists(ASA)grade,gestational weeks and intraoperative blood loss,as well as the fetal one-minute Apgar score between different maternal ASA grade and gestational weeks.Results There were 98 cases of CS under GA enrolled in the study.Among the maternal and fetal factors,pregnancy with internal or surgical diseases is the most common reason(59 cases,60.2%)for choosing GA,followed by the placenta and fetal membrane abnormalities(38 cases,38.8%)and the pregnancy-specific disorders(36 cases,36.7%).ASA gradeⅢ-Ⅳof parturients(χ2=44.3,P<0.05),gestation period<37 weeks(χ2=23.4,P<0.05),and blood loss>800 ml(χ2=5.5,P<0.05)were related to the higher postoperative intensive care unit(ICU)rate in parturients.ASA gradeⅢ-Ⅳof parturients(t=-2.99,P<0.05),gestation period<37 weeks(t=2.47,P<0.05)were related to the longer hospital stay.ASA gradeⅢ-Ⅳof parturients(t=2.21,P=0.01)and gestation period<37 weeks(t=-3.21,P=0.002)were related to the lower one-minute Apgar score of neonates.Conclusion Pregnancy with internal or surgical diseases is the most common reason for choosing GA for CS.High ASA grade and short gestation period were the related factors of high postoperative ICU ratio for parturients and low one-minute Apgar score for neonates.

Clinical and Evolutionary Characteristics of Pregnant and Postpartum Women with COVID-19 Admitted to a Hospital in the Central Region of Brazil

Objective: To describe the demographic and evolutionary characteristics of pregnant and postpartum women with coronavirus disease 2019 (COVID-19) admitted to a medium-sized hospital in Brazil. Method: This is a descriptive and retrospective study, collected from medical records, from March 2020 to October 2021 in a hospital located in Cuiabá (MT). Results: Pregnant and puerperal women with COVID-19 who needed hospitalization were mixed-race, from the metropolitan area, and carriers of moderate and severe forms of the disease. The primary risk condition found was overweight/obesity, and pre-gestational diabetes, hypertension, asthma, and autoimmune disease were the most prevalent comorbidities in the group. Elevated lactate dehydrogenase (LDH), c-reactive protein (CRP), and D-dimer were relevant laboratory findings in this group of patients. The most frequent maternal outcomes were respiratory failure, invasive ventilatory support, thromboembolic phenomena, sepsis, and preterm labor. Maternal death occurred in 6.4% of pregnant women. Most maternal deaths were of women who lived in the interior of the state, and the minority arrived on adequate ventilatory support. Prematurity and the need for neonatal intensive care unit (NICU) were significant complications for neonates. Stillbirth/neonatal mortality occurred in 11.0%. Conclusion: The clinical conditions at hospitalization were associated with worse living conditions and lack of access to health care, resulting in increased chances of severity and worsening outcomes in this group of women and neonates.

The Impact of Spontaneous Labor Before Elective Repeat Cesarean Delivery on Pregnancy Outcome:A Prospective Cohort Study

and neonatal outcomes.Methods:This was a prospective cohort study.All consecutive ERCDs,occurring at≥37 weeks of gestation between July 1,2017 and December 31,2019 in Makassed General Hospital,were evaluated.The maternal and neonatal outcomes of 183 laboring women undergoing unscheduled repeat cesarean delivery(URCD)group were compared with those of 204 women undergoing cesarean delivery(CD)without spontaneous labor(ERCD)group.Primary outcomes were“composite adverse maternal outcome”and“composite adverse neonatal outcome.”Fisher’s exact and Student’s t tests were used to assess the significance of differences in dichotomous and continuous variables,respectively.Two logistic regression models were constructed to identify risk factors with most significant influence on the rate of composite adverse maternal and neonatal outcomes.Results:“Composite adverse maternal outcome”was significantly more common in women who underwent spontaneous labor((40/183)21.9%vs.(19/204)9.3%,P=0.001,relative risk(RR):2.7,95%confidence interval(CI):1.50–4.90).Similarly,“composite adverse neonatal outcome”was significantly increased in the URCD group((24/183)13.1%vs.(12/204)5.9%,P=0.014,RR:2.4,95%CI:1.18–4.98).These adverse effects persisted after adjustment for confounders.Multivariate regression models revealed that,besides labor,CD-order impacted maternal outcome(RR:1.5,95%CI:1.02–2.30,P=0.036),while CD-order and teenage pregnancy influenced neonatal outcome(RR:2.1,95%CI:1.29–3.38,P=0.003,and RR:16.5,95%CI:2.09–129.80,P=0.008,respectively).Conclusion:In our study,spontaneous labor before ERCD,including deliveries at term,was associated with adverse maternal and neonatal outcomes,indicating that it is preferable to conduct ERCD before the onset of labor.Screening women with MRCD may identify those at increased risk for spontaneous labor for whom CD could be scheduled 1–2 weeks earlier.Further large prospective studies to assess the effects of such an approach on maternal and neonatal outcomes are strongly warranted.

Impact of Early versus Late Amniotomy on Induction of Labor in Nulliparous Women after Vaginally Administered Misoprostol: A Randomized Clinical Trial

Objective::To investigate the effect of early versus late amniotomy after induction of labor(IOL)with vaginally administered misoprostol.Methods::This randomized clinical trial was conducted at the Department of Obstetrics and Gynecology,Menoufia University,from May 2019 to March 2020,and included 120 nulliparous women at term(≥37 weeks’gestation)undergoing IOL.Computer-generated randomization was used to randomize the participants into either the early amniotomy group(3 cm cervical dilatation;n=60)or the late amniotomy group(7 cm cervical dilatation;n=60).All participants received misoprostol(25μg)vaginally to induce labor.The primary outcome was the induction-to-delivery interval,defined as the time from the initiation of IOL to the time of delivery.Results::Women in the early amniotomy group had a shorter duration of labor(12.60±5.36 h)than those in the late amniotomy group(16.67±7.26 h).The mean time from rupture of the fetal membrane to delivery was significantly shorter in the late(2.51±0.36 h)than in the early amniotomy group(3.1±0.89 h).There was no statistically significant difference between the groups in terms of maternal complications(fever,nausea,vomiting,and uterine hyperstimulation)or neonatal complications(meconium-stained liquor,APGAR score<7 at 1 and 5 min,and neonatal intensive care unit admission).Conclusions::IOL using vaginally administered misoprostol followed by early amniotomy was accompanied by a shorter duration of labor and decreased use of oxytocin.There was no significant difference between the early and late amniotomy groups in terms of the rate of cesarean section or maternal and neonatal complications.

Prior Preterm Birth and Birthweight Below the 5 th Percentile are Independent Risk Factors for Recurrence of a Small for Gestational Age Neonate

Objective::This study aimed to determine:(1)whether recurrent deliveries of a small for gestational age(SGA)neonate are associated with increased obstetrical or neonatal complications;(2)whether the risk factors that can predict small for gestational age(SGA)recurrence.Methods::This study was based on Soroka Medical Center's Obstetrics electronic database.The database consisted of 109022 women who had 320932 deliveries between the year 1988-2014.The study cohort included 6.8%(7368/109022)of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery.The study population was divided into two groups according to the outcome of the subsequent delivery:(1)women with sporadic SGA who delivered a non-SGA neonate(n=5416);(2)women with recurrent SGA(n=1952).SGA defined as birthweight<10 th percentile.Maternal and neonatal complications were compared between the two groups.Logistic regression was used to determine independent risk factors for SGA recurrence.Results::The prevalence of birthweight<5 th percentile was higher among the recurrent SGA group in the first delivery(P<0.001).Bedouin ethnicity was more prevalent in the recurrent SGA group(P<0.001).The rate of preterm delivery was higher in the first delivery of the recurrent SGA group(P=0.015).The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy(P=0.017).The rate of severe hypertension(P=0.005),polyhydramnios,meconium-stained amniotic fluid,nonreassuring fetal heart rate and total perinatal mortality(P<0.001)were higher in the second delivery of the recurrent SGA group.In a logistic regression model,preterm delivery and birthweight<5 th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth(relative risks:1.530,confidence interval:1.249-1.875;relative risks:1.826,confidence interval:1.641-2.030,respectively).Conclusion::Women with recurrent SGA neonates have specific clinical characteristics.Among women who deliver an SGA neonate,preterm delivery,and birthweight<5 th percentile are independent predictors for its recurrence.