Decision of elective delivery and the incidence of severe respiratory distress at term in a developing country

This study was planned to determine the contribution of elective delivery to severe respiratory distress syndrome [RDS] on a weekly basis from 37-40 weeks' gestation in our hospital. Chart reviews confirmed gestational age, delivery reason, and primary diagnosis of all inborn neonates with RDS requiring mechanical ventilation delivered at 37 - < 41 weeks' gestation in a three-year period. Exclusion criteria were sepsis, pneumonia, meconium aspiration, asphyxia, pulmonary hemorrhage, hydrops, chromosomal abnormality, or congenital malformations affecting respiration. Twenty-seven thousand and thirty-one deliveries occurred from 37 - 41 weeks; 14 [0.05%] had RDS requiring mechanical ventilation. Seven infants delivered at 37 - <38 weeks, [OR for RDS = 38.5; 95% CI = 8.3, 178.3], five delivered at 38 - <39 weeks, [OR for RDS = 13.3; 95% CI = 2.8, 64.0], and two delivered at 39 - <41 weeks. Six of 14 infants were electively delivered without documented lung maturity. Infants born at 37 - <39 weeks are at significantly increased risk for severe RDS

Effect of cleansing the birth canal with antiseptic solution on maternal and neonatal mortality in Alexandria

The objective of this study was to determine if cleansing the birth canal with an antiseptic at delivery reduces infections in mothers and babies postnataly. The design was that of a clinical trial; two months of no intervention were followed by three months of intervention and a final month of no intervention. The study took place at El-Shatby University Maternity Hospital [tertiary care hospital], Alexandria, Egypt. A total of 1742 women giving birth in a six month period and their 1790 babies. Cleansing was done as a manual wipe of the maternal birth canal with a 0.25% chlorhexidine solution at every vaginal examination before delivery. Babies born during the intervention were also wiped with chlorhexidine. The Main outcome measures were the effects of the intervention on neonatal and maternal morbidity and mortality. The results showed that 909 women giving birth to 936 babies were enrolled in the intervention phase and 833 women giving birth to 854 babies were enrolled in the non-intervention phase. There were no adverse reactions related to the intervention among the mothers or their children. Among infants born in the intervention phase, overall neonatal admissions were reduced [158/936] [16.9%] v 165/854 [19.3%], P< 0.01], as were admissions for neonatal sepsis [7.5 v 17.6 per 1000 live births, P<0.002], overall neonatal mortality [28.9 v 37.5 per 1000 live births, P<0.06], and mortality due to infectious causes [2.1 v 7.0 per 1000 live births, P<0.005]. Among mothers receiving the intervention, admissions related to delivery were reduced [30.0 v 40.8 per 1000 deliveries, P<0.02], as were admissions due to postpartum infections [2.2 v 4.8 per 1000 deliveries, P<0.02] and duration of hospitalization [Wilcoxon P=0.008]. Cleansing the birth canal with chlorhexidine reduced early neonatal and maternal postpartum infectious problems. The safety, simplicity, and low cost of the procedure suggest that it should be considered as standard care to lower infant and maternal morbidity and mortality