Manejo expectante en preeclampsia severa remota del término (24-33,6 semanas): experiencia en centro de alta complejidad / Expectant management in severe preeclampsia remote from term (24-33.6 weeks): experience in a high complexity center

Resumen Introducción: la preeclampsia severa antes de 34 semanas de gestación tiene alto riesgo de complicaciones maternas y fetales. El manejo expectante, pudiera reducir el riesgo de complicaciones de un parto prematuro. Objetivo: evaluar la efectividad comparativa del manejo expectante en la prevención de desenlaces adversos maternos y perinatales de las pacientes con preeclampsia severa remota del término. Metodología: estudio de cohorte retrospectivo en gestantes con preeclampsia severa entre la 24 a 33,6 semanas, admitidas en un centro de alta complejidad colombiano entre 2011 y 2019. Se compararon medidas descriptivas según el manejo expectante o intervencionistas como grupo de referencia y, de asociación con los desenlaces compuestos maternos y neonatales, además se ajustó por edad gestacional menor a 28 semanas al parto. Resultados: se analizaron 134 pacientes, 110 con manejo expectante y 24 con intervencionista. El manejo expectante tuvo menor probabilidad de cesárea (RR 0,79 IC95% 0,69-0,91) y de resultado compuesto materno (RR 0,67 IC95% 0,57-0,79), que no persistió luego del ajuste. El manejo expectante presentó menor probabilidad de APGAR <7 al minuto (21,6% vs. 40%, RR 0,53 IC95% 0,29-0,97) y de resultado neonatal compuesto (60% vs. 83,3%, RR 0,72 IC95% 0.57-0.90). Al realizar ajuste con edad menor a 28 semanas al parto, el manejo expectante mostró menor probabilidad de APGAR menor a 7 al minuto (RR 0,43 IC95% 0,24-0,75), resultado perinatal adverso compuesto (RR 0,62 IC95% 0,48-0,81), muerte neonatal (RR 0,26 IC95% 0,29-0,71), síndrome de dificultad respiratoria (RR 0,65 IC95% 0,48-0,88), hemorragia intraventricular (RR 0,31 IC95% 0,11-0,89) e ingreso a unidad de cuidados intensivos neonatales (RR 0,80 IC95% 0,70-0,92). Conclusión: la preeclampsia severa remota del término es una patología grave y compleja que enfrenta los intereses maternos y los fetales. Debido al controversial enfoque, su manejo debe realizarse en centros de alta complejidad, con participación interdisciplinaria y anteponiendo la individualidad de cada binomio; nuestros hallazgos sugieren que el manejo expectante es razonable cuando las condiciones maternas y fetales lo permiten, especialmente para gestaciones menores a 28 semanas en favor de mejorar los desenlaces fetales sin detrimento de los desenlaces maternos.

Abstract Introduction: severe preeclampsia before 34 weeks of gestational age has a high risk of maternal and fetal complications. Expectant management could decrease the risk of complications associated with premature birth. Objective: to evaluate the efficacy of expectant management in the prevention of maternal and perinatal adverse events of patients with severe preeclampsia remote from term. Methodology: a retrospective cohort study in pregnant women diagnosed with severe preeclampsia between 24 and 33.6 weeks of gestational age who were admitted in a Colombian high complexity medical center between 2011 and 2019 was carried out. Descriptive measurements of the expectant management and the interventionist management were compared and the association with maternal and neonatal composite outcomes. Results were adjusted by gestational age under 28 weeks of delivery. Results: 134 patients were analyzed; 110 patients with expectant management and 24 interventionist management. Expectant management had a lower probability of cesarean section (RR 0.79 CI95% 0.69-0.91) and maternal composite result (RR 0.67 CI95% 0.57-0.79) that did not persist after the adjustment. Expectant management had a lower probability of APGAR <7 the first minute (21.6% vs. 40%, RR 0.53 CI95% 0.29-0.97) and neonatal composite result (60% vs. 83.3%, RR 0.72 CI95% 0.57-0.90). When adjusting the age under 28 weeks of delivery, the expectant management showed a lower probability of APGAR under 7 at minute one (RR 0.43 CI95% 0.24-0.75), composite outcome of perinatal adverse events (RR 0.62 CI95% 0.48-0.81), neonatal death (RR 0.26 CI95% 0.29-0.71), respiratory distress syndrome (RR 0.65 CI95% 0.48-0.88), intraventricular hemorrhage (RR 0.31 CI95% 0.11-0.89) and admission to the neonatal intensive care unit (RR 0.80 CI95% 0.70-0.92). Conclusion: severe preeclampsia remote from term is a severe and complex disease which faces maternal and neonatal interests. Due to approach controversies, management should be performed in high complexity centers with a multidisciplinary approach individualizing each binomial; our findings suggest expectant management is reasonable when both maternal and fetal conditions allow it, especially in pregnancies under 28 weeks of gestational age to improve fetal outcomes without risking maternal outcomes.

Effectiveness Of Self-Instructional Module (Sim) On Paternal Attitude Of Expectant Fathers And Maternal Satisfaction On Perinatal Outcome

Introduction: Paternal involvement (PI) has been recognized to have an impact on pregnancy and in-fant outcomes. The mother抯 satisfaction during the birthing process is the most frequently reported in-dicator in the evaluation of the quality of maternity services. The aim of the study is to assess the effec-tiveness of self-instructional module on paternal attitude towards perinatal outcome and maternal satis-faction on paternal attitude. Methodology: A cross-sectional study was conducted on 320 expectant fathers attending antenatal clin-ic. A five-point rating scale was used to assess the attitude of paternal on pregnancy and labour outcome and check list to assess the postnatal mother satisfaction. Results: The scores improved significantly after intervention, in experiment group, the pre-test, mean score was 78.61 and the post-test mean score was 120.56, whereas in the control group, the pre-test mean score of 79.43 and the post-test mean score was 80.25. In the experimental group, 81.88% of mothers were satisfied whereas 18.12% were not satisfied. In control group, 48.75% were satisfied, while 51.25% were not satisfied. Conclusion: Most fathers were very positive about their partner抯 pregnancy. They, however, need to be motivated to use that knowledge into practice.

Retrospective evaluation of patients treated for ectopic pregnancy: Experience of a tertiary center

Abstract Objective In recent years, there has been an increase in the incidence of ectopic pregnancies; therefore, it is important for tertiary centers to report their approaches and outcomes to expand and improve treatment modalities. The aim of the present study was to evaluate the general characteristics, treatment and outcomes of cases diagnosed with ectopic pregnancy. Methods In total, 432 patients treated for ectopic pregnancy between February 2016 and June 2019 were retrospectively evaluated. Results Overall, 370 patients had tubal pregnancy, 32 had cesarean scar pregnancy, 18 had pregnancy of unknown location, 6 had cervical pregnancy, and 6 had interstitial pregnancy. The most important risk factors were advanced age (> 35 years; prevalence: 31.2%) and smoking (prevalence: 27.1%). Thirty patients who did not have any symptoms of rupture and whose human chorionic gonadotropin (β-hCG) levels were ≤ 200 mIU/ml were followed-up with expectant management, while 316 patients whose β-hCG levels were between 1,500 mIU/ml and 5,000 mIU/ml did not have an intrauterine gestational sac on the transvaginal or abdominal ultrasound, did not demonstrate findings of rupture, and were treated with a systemic multi-dose methotrexate treatment protocol. In total, 24 patients who did not respond to the medical treatment, 20 patients whose β-hCG levels were > 5,000 mIU/ml, 16 patients who had shown symptoms of rupture at the initial presentation, and 6 patients diagnosed with interstitial pregnancy underwent surgery. Patients with cervical and scar pregnancies underwent ultrasound-guided curettage, and no additional treatment was needed. Conclusion The fertility status of the patients, the clinical and laboratory findings, and the levels of β-hCG are the factors that must be considered in planning the appropriate treatment.

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

Comparison of outcome in medical versus expectant management in unruptured tubal pregnancy with β-hCG 1000-3000 IU/L

Background: Ectopic pregnancy (EP) is an important cause of maternal morbidity as well as mortality in the 1st trimester. This study was done to compare outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hCG 1000-3000 IU/L.Methods: In this randomized controlled trial, 82 (41 in each group) women with tubal ectopic pregnancy (TEP) having β-hCG levels between 1000-3000 IU/L and 18 to 40 years of age were enrolled. Women having non-tubal pregnancy, ruptured ectopic pregnancy, heterotopic pregnancy, hypersensitivity to methotrexate were excluded. Included women were randomly assigned to either Group-A (expectant management) or Group-B (medical management). Outcome was measured after one week and considered successful if patient had β-hCG levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac).Results: Overall mean age was 30.65±6.37 years. The mean gestational age in Group-A was 7.12±2.12 weeks and 7.63±2.41 weeks in Group-B. The mean β-hCG levels in Group-A was 1984.63±515.81 IU/L and 1937.33±519.68 IU/L in Group-B. Outcome was successful in 90.24% in Group-A and 63.41% in Group-B (p-value=0.004).Conclusions: Expectant management is associated with better outcome as compared to medical management in tubal ectopic pregnancy having β-hCG between 1000-3000 IU/L.

Long-Term Results of Expectant Management of First Episode of Primary Spontaneous Pneumothorax: Is it a Safe Therapeutic Option?

Introduction: Expectant treatment in clinically stable patients with small primary spontaneous pneumothorax (PSP) remains in discussion, partly due to the described increased recurrence rate compared to patients treated with pleural drainage. Objective: To present the experience in the management of grade I PSP, comparing long- and short-term results of patients treated with pleural drainage with those treated expectantly. Methods: We present a retrospective study of patients diagnosed with small asymptomatic or mildly symptomatic PSP. Results: 34 out of 69 patients were treated with pleural drainage and 35 underwent expectant treatment with outpatient management. Both groups were comparable regarding sex, side, size of pneumothorax and history of tobacco smoking. As for the short-term results, there weren't any differences between groups in success therapy, but there were significant differences related to hospital stay, where patients treated with pleural drainage presented longer length of stay. Regarding long-term results, there weren't significant differences in terms of recurrence between both groups. Conclusion: The expectant management of clinically stable patients with small primary spontaneous pneumothorax with strict ambulatory control follow-up and those who comply with treatment recommendations and can obtain prompt emergency medical care presents acceptable long- and short-term results and should be the first choice of treatment.

Coronavirus (COVID 19) Infection in Pregnancy / Coronavirus (COVID 19) Infección en el embarazo

Abstract Coronavirus illness 2019 (COVID-19) is an airways infection caused by the new coronavirus (SARS-CoV-2) which has been quickly disseminated all over the world, affecting to the general population including women in pregnancy time. As being a recent infection, the evidence that supports the best practices for the management of the infection during pregnancy is limited, and most of the questions have not been completely solved yet. This publication offers general guidelines focused on decision-making people, managers, and health's teams related to pregnant women attention and newborn babies during COVID-19 pandemic. Its purpose is to promote useful interventions to prevent new infections as well as prompt and adequate attention to avoid serious complications or deaths, trying to be adapted to the different contexts in which attention to expectant mothers is provided. Guidelines are set within a well-scientific evidence and available recommendations up to date.

Resumen La enfermedad por coronavirus 2019 (COVID-19) es una infección de las vías respiratorias causada por un nuevo virus (SARS-CoV-2) que se ha diseminado rápidamente en el mundo, afectando a la población general, incluida la población de mujeres cursando un embarazo. Por ser una infección de aparición reciente, la información que soporta las mejores prácticas para el manejo de la infección durante la gestación es escasa y muchas de las preguntas no están completamente resueltas. Esta publicación brinda lineamientos generales orientados a tomadores de decisión, gerentes y equipos de salud en relación con el cuidado de mujeres gestantes y recién nacidos durante la pandemia por COVID 19. Su finalidad es promover intervenciones beneficiosas para prevenir nuevos contagios, y la atención oportuna y adecuada de la gestante para evitar complicaciones graves y/o muertes, adecuándose a los distintos contextos en los que se proporciona atención médica. Los lineamientos se enmarcan en la mejor información científica y las recomendaciones disponibles hasta la fecha.

Elective induction of labour at 39 weeks versus expectant management up to 41 weeks in a tertiary care centre

Background: The timing of delivery and effective management of labour at term makes a huge difference in the obstetric and perinatal outcome. There have always been controversies between choosing the elective induction of labour at 39 weeks versus expectant management up to 41/42 weeks which can result in placental ageing, reduced liquor, non-assuring fetal heart tracings, meconium stained amniotic fluid and fetal macrosomia.  our objective was to perform a comparative effectiveness analysis of elective induction of labor at 39 weeks gestational age among nulliparous women with uncomplicated singleton pregnancies as compared to expectant management up to 41 weeks.Methods: 120 primigravidae with singleton pregnancies with fetus in cephalic presentation were recruited into the study and divided into 2 groups of 60 each A: Patients were induced electively using dinoprostone gel (maximum 3 doses 8 hours apart) B: They were managed expectantly up to 41 weeks allowing for spontaneous onset of labour, induction or cesarean section was done for obstetric indications between 39 and 41 weeks and pregnancy was  terminated by induction for those who continued up to 41 weeks. Their obstetric and perinatal outcome were noted.Results: The cesarean section rates were higher in the expectantly managed group (21%) when compared to the electively induced group (16%). The same was with instrumental delivery rates (15% versus 10%). The perinatal outcome was poorer for the expectantly managed group with 20% NICU admissions and 5% perinatal deaths compared to the electively induced group which had 12% NICU admissions and 3.3% perinatal deaths. The expectantly managed group also resulted in respiratory distress in a larger number of fetuses and resulted in problems due to reduced liquor.Conclusions: Elective induction at 39 weeks gestational age was found to be a better option compared to expectant management up to 41 weeks in terms of obstetric and perinatal outcomes.

Diagnóstico y manejo oportunos del síndrome HELLP

El síndrome HELLP (SH) es una complicación severa del embarazo caracterizada por hemólisis, enzimas hepáticas elevadas y plaquetopenia. Es una de las situaciones más graves del embarazo, provocando tasas elevadas de morbimortalidad maternoperinatal. La complicación más frecuente del SH es la hemorragia, necesitándose transfusión de sangre y/o hemoderivados para corregir la hipovolemia, anemia o coagulopatía, siendo la complicación más catastrófica el hematoma hepático espontáneo. El parto es el único tratamiento efectivo para el SH. La mortalidad perinatal está relacionada directamente con la edad gestacional. No se ha logrado consenso sobre el manejo del SH que ocurre antes de las 34 semanas de gestación, cuando las condiciones maternas y fetales son estables. El objetivo de la presente revisión es resumir la información existente sobre el manejo oportuno del SH. Se concluye que la vía del parto dependerá de las condiciones cervicales y la estabilidad materno-fetal. Se necesitan estudios adecuados para determinar si hay beneficio con el manejo expectante en gestaciones pretérmino, y la administración de corticoides para mejorar el recuento de plaquetas en el SH.

HELLP syndrome (HS) is a severe complication of pregnancy characterized by hemolysis, elevated liver enzymes and low platelets. It is one of the most serious maternal complications and is associated with high maternal and perinatal morbidity and mortality. Childbirth is the only effective treatment against HS. The most frequent complication of HS is hemorrhage, requiring blood transfusions and/or blood products to correct hypovolemia, anemia or coagulopathy; spontaneous liver hematoma is the most catastrophic problem. Perinatal mortality is directly related to gestational age. There is no consensus on HS management occurring before 34 weeks of gestation when maternal and fetal conditions are stable. The purpose of this review is to summarize the existing information about the timely management of HS. It is concluded that the birth route will depend on cervical conditions and maternal and fetal stability. Appropriate studies are needed to determine if there is benefit in expectant management in preterm pregnancies and in corticosteroids administration to improve platelet count in HS.

Control preconcepcional y diabetes gestacional. Revisión sistemática y estado del arte / Preconceptional control and gestational diabetes. Systematic review and state of the art

Introducción: La diabetes mellitus gestacional se manifiesta con una intolerancia a los carbohidratos, ocasionada por una alteración en la secreción de insulina, con descontrol de los niveles de glucosa en sangre, caracterizada por ser una condición temporal y que se desarrolla por primera vez durante el embarazo; suele desaparecer después del parto, pero puede desarrollarse diabetes mellitus en un futuro. Metodología: Se realizó un estudio investigativo tipo documental, sistematizada, descriptiva, prospectiva en un periodo de revisión de cinco años, del 2013 a 2018. Discusión: Entre los trastornos más comunes en el feto esta la macrostomia, posterior al nacimiento se puede desarrollar hipoglu-cemia. Por parte de la madre también se han documentado complicaciones que pueden percutir al momento del parto como la preeclampsia y el síndrome metabólico. Conclusiones: La diabetes gestacional puede cursar asintomática, por lo que se recomienda realizar pruebas de medición de glucosa en sangre durante las semanas 24 y 28 de gestación. Hay factores que pueden incrementar los riesgos de desarrollar diabetes gestacional, como: la edad avanzada de la madre, sobrepeso u obesidad, antecedentes familiares de diabetes mellitus, entre otros. Por lo tanto, someterse a la prueba de tamizaje sigue siendo el método más seguro de detección.

Introduction: Gestational diabetes mellitus manifests itself with a carbohydrate intolerance, caused by an alteration in insulin secretion, with uncontrolled blood glucose levels, characterized by being a temporary condition, which develops for the first time during pregnancy; It usually disappears after childbirth, although diabetes mellitus may develop later. Methodology: A documentary, systematic, descriptive, prospective research study was conducted in a five-year review period, from 2013 to 2018. Discussion: Among the most common disorders in the fetus is macrostomia, hypoglycemia may develop after birth. On the part of the mother complications have also been documented that can affect the moment of delivery such as preeclampsia and metabolic syndrome. Conclusions:Gestational diabetes can be asymptomatic, so it is recommended to perform blood glucose measu-rement tests during weeks 24 and 28 of gestation. There are factors that can increase the risks of developing gestational diabetes, such as: the mother's advanced age, overweight or obesity, family history of diabetes mellitus, among others. Therefore, undergoing the screening test remains the safest method of detection

Programmed labour compared with expectant management: is it truly a need of new millennium?

Background: The mechanism triggering the initiation of human parturition is still an enigma. At term a series of complex physiological, biochemical and physical processes cascade resulting in delivery of the fetus. This study deals exclusively with comparison of normal labour, induction of labour with prostaglandin, and with augmentation by intracervical insertion of PGE2 tablets, amniotomy and smooth muscle relaxant. Advantages and disadvantages of each of the above methods are compared with expectant management of labour. Aim of this study was to compare pros and cons of programmed labour that to with expectant management.Methods: Study was conducted in Department of Obstetrics and Gynaecology, Bharati Hospital and Research Centre, Pune. It was a prospective randomized clinical trial. 100 pregnant full term women, were selected for each group. At 0 hour primiprost tablet is inserted into the vagina close to the cervix. Frequency of repetition of tablet will be at three hours interval. Patient will be monitored.Results: The youngest one being of age 17 years and the eldest being of age 29 years. In this, we observed those primi and 2nd gravida patients 2-2 tablets each in latent phase and 1-1 tablets in active phase. The induction delivery Interval in primigravida was observed to be of average of 9 hours. While in II Gravida was 6.5 hours, in III Gravida 5.5 hours and in IV Gravida 4 hours.Conclusions: It has been proved beyond doubt that by programmed labour, the patient definitely can get the benefit of decrease in duration of labour.

A Comparitive Study On Induction Of Labour Versus Expectant Management In Term Premature Rupture Of Membranes In Tertiary Care Hospital,Visakhapatnam.

Premature rupture of membranes (PROM), also called Prelabour Rupture Of Membranes, is classically dened as rupture of membranes before labour and accounts for 0.8-0.9% of all pregnancies at term. this study was conducted over a period of 14 months ( from March 2018 to May 2019) in a tertiary care medical college . A total of 100 term PROM patients were recruited in our study – and divided into two groups randomly--50 (Group A) patients were managed conservatively and 50 (Group- B) patients underwent induction of labour. Both these patient groups were studied to compare the feto-maternal outcome. Group-A (conservative management group) patients were observed to await the spontaneous onset of labour pains for at least 24 hours. Patients in group B were induced with either - PGE1 tab (misoprostol) 25 μgm 4 hourly orally or iv oxytocin infusion. the PROM-delivery interval was < 12 hours in 72 % of induced groups (Group B) and 10% (5) in group- A (conservative or expectant group). LSCS rate was 10 % in group-A (expectant group) & 15 % in group –B (induced group). Sepsis rate, maternal and fetal, hospital stay, NICU admission & duration of NICU stay were notably higher in group – A (expectant management group). therefore, from our study we concluded that immediate induction of labour in term PROM cases shortens the PROM- delivery interval, hospital stay, NICU stay and reduction in both maternal & neonatal sepsis.

Study of Type and Severity of Anemia in Antinatal Cases in a Mountanous Hilly Region of J&K India.

Introduction: Anemia in expectant women is a seriousworld-wide public health problem with adverse pregnancyoutcomes. It remains one of the India’s major public healthproblem irrespective of the fact that it is preventable andeasily treatable. The present study was being done to assessthe severity and type of anemia in a hilly mountaneous regionof J&K India in GMC Doda.Material and methods: The present study was conductedamong the pregnant women coming for antenatal check-up inrural hilly mountanous region of J&K in GMC Doda.In thisstudy of two months duration, A total of 700 pregnant womenwere included in our study in the reproductive age group from18 to 45 years. Hb estimation was done with Sahli,s method.Anemia in this study was defined by using World HealthOrganisation and was classified into mild anemia (Hb 10-10.9g/dl), moderate anemia (Hb 7-9.9g.dl) and severe anemia(Hb <7g/dl). A peripheral smear was also made to study thetype of anemia as normocytic normochromic, microcytichypochromic, macrocytic or dimorphic anemia.Results: Out of total 700 cases, 574(82%) cases were foundto be anemic. The hemoglobin concentration ranged from5-12.5gm/dl with a median of 8.7gm/dl. Majority of thepregnant females were less than 30 years of age . Out of theanemic cases, 60% were moderately anemic followed by28% mildly anemic cases and 12% severely anemic cases.Morphological subtyping showed that majority of the caseshad microcytic hypochromic anemia (43%). Normocyticnormochromic anemia was 25% followed by dimorphicanemia in 27% and 5% cases showed macrocytic anemiaConclusion: The high prevalence of anemia in our study hintstowards more strict measures in investigating and screeningof pregnant women. Screening and treatment of parasiticinfections should also be encouraged. Health educationtalks on nutrition needs, education of mothers should alsobe carried out. Therefore to reduce the deleterious effect onhealth of mother and child early intervention by clinicians isalso needed.

A randomized controlled study on expectant management of incomplete abortions caused by self medication

Background: Medical method of termination of pregnancy is a very effective method when used as per recommended regimen and under proper supervision. Self-administration of these drugs has become a very common practice these days, resulting in incomplete abortion because of improper use. Traditionally surgical curettage has been the preferred mode of treatment for these cases but is associated with very high complication rates. Expectant management of incomplete abortion has been recently adopted as a better method of management of incomplete abortions worldwide. Present study compares expectant management with surgical curettage in cases of incomplete abortions caused by self medication.Methods: It was one-year prospective randomized controlled study. Total of 220 patients were recruited for the study out of which 103 were randomized to undergo expectant management while 117 to undergo surgical curettage. Results were compared using chi square test..Results: Success rate of expectant and surgical management was found to be 82% and 95% respectively. Complication rate was found to be comparable in both the group while acceptability of expectant management was found to be much higher in expectant group. However, significantly more unplanned admissions and unplanned surgical curettage occurred after expectant management than surgical management.Conclusions: Expectant management is a safe and efficacious option in carefully selected cases. If used properly it can avoid complications associated with surgical management and therefore should be utilized whenever suitable.

A comparative study of maternal and fetal outcomes following induction of labour versus expectant management in mild gestational hypertension at term

Background: To compare the maternal and neonatal outcomes between planned induction of labour and expectant management in women with mild gestational hypertension at term.Methods: A prospective hospital based observational study. The 120 pregnant women with mild gestational hypertension were randomized in a 1:1 ratio either to receive immediate induction of labour (group A comprising 60 women) or expectant management (group B comprising 60 women). Primary outcomes were incidence of any maternal mortality, renal failure, pulmonary oedema, need for ICU care or post-partum eclampsia and also composite maternal morbidity like severe gestational hypertension, pre-eclampsia, eclampsia, abruption and PPH. Secondary outcomes were mode of delivery, need for antihypertensives and MgSO4.Results: Though there were no maternal death or renal or pulmonary complications in any group, progression to severe hypertension was more in group B (expectant management) compared to group A (immediate induction) (18.33% vs. 3.33%). Increased incidence of pre-eclampsia and eclampsia were noted in group B (15% and 3%) as compared to group A (0%). Incidence of Abruption and PPH was less in group A 1.67% and 5% compared to group B 3.33% and 10 % respectively. Spontaneous vaginal delivery rate was low and caesarean section rates were high in group A (61.67% and 31.67%) compared to group B (68.33% and 25% respectively). Need for antihypertensive and MgSO4 were less in group A (3.33% each) compared to group B (18.33% and 16.66% respectively).Conclusions: Requirement of antihypertensive, progression to severe hypertension, pre-eclampsia, eclampsia, use of MgSO4, incidence of abruption, PPH were less in group A compared to group B. However, induction at completion of 37 weeks may be associated with increased incidence of operative deliveries.

Third stage of labour: expectant versus active management-a comparative study in local low risk population

Background: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality, accounting for about 35% of all maternal deaths. These deaths have a major impact on the lives and health of the families affected. Thus, anticipation as well as proper management of 3rd stage of labour is mandatory. The objective of this study was to compare expectant and active management of third stage of labour in preventing post-partum blood loss and having impact on prevention of maternal mortality in local population. Advantages and disadvantages of both techniques might be over estimated.Methods: Prospective comparative study carried out in Obstetrics and Gynecology department of SBKSMIRC (Shrimati Bhikhiben Kanjibhai Shah Medical Institute and Research Centre), Dhiraj general hospital, comprising of 200 laboring women admitted directly or from OPD to labour room for expected vaginal delivery. They were randomly allocated to group A (expectant management) and group B (active management). Labour progress was charted on partograph and interventions recorded. Statistical analysis of data was done after compiling and tabulation of data. Mean±SD for descriptive variables were calculated and appropriate statistical tests applied to determine significance.Results: Average PPBL (post-partum blood loss) was 360.5ml in group A as compared to 290.6ml in group B. 12 patients in group A had blood loss more than 500ml while none in group B. 66% cases in group B had duration of third stage of labour less than 5 min as compared to only 22% in group A. the mean duration of third stage was 13.46±8.3 in group A while 5.32±3.05 in group B. these differences were statistically significant.Conclusions: Active management of the third stage of labour is associated with less blood loss as well as a shorter duration of third stage compared with expectant management. It is reasonable to advocate this regime.

Different management for women in the third stage of labour / 中国实用护理杂志

Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping, controlled cord traction and uterine massage. Active management of the third stage, as the main package of procedure to prevent postpartum hemorrhage, can effectively shorten the third stage of labor and reduce the incidence of severe postpartum hemorrhage, this is a major cause of women dying in developing countries. In developed countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries for several decades. The most common complications of active management of the third stage of labor are pain and side effects of oxytocin, in addition to serious complications such as inversion of uterus and retained placental. Therefore, in recent years, a variety of interventions have been adopted in the third stage of labour, especially for low-risk pregnant women, which have been questioned and the evidence for using active management for all women is insufficient. The purpose of this article is to compare the effectiveness and variations of different management of the third stage of labour, and provide the basis for reasonable and individualized management of the third stage of labour, ultimately promote the natural labour.

Different management for women in the third stage of labour / 中国实用护理杂志

Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping, controlled cord traction and uterine massage. Active management of the third stage, as the main package of procedure to prevent postpartum hemorrhage, can effectively shorten the third stage of labor and reduce the incidence of severe postpartum hemorrhage, this is a major cause of women dying in developing countries . In developed countries, severe bleeding occurs much less often, yet active management has become standard practice in many countries for several decades. The most common complications of active management of the third stage of labor are pain and side effects of oxytocin, in addition to serious complications such as inversion of uterus and retained placental. Therefore, in recent years, a variety of interventions have been adopted in the third stage of labour, especially for low-risk pregnant women, which have been questioned and the evidence for using active management for all women is insufficient. The purpose of this article is to compare the effectiveness and variations of different management of the third stage of labour, and provide the basis for reasonable and individualized management of the third stage of labour, ultimately promote the natural labour.

Type II and III selective fetal growth restriction: perinatal outcomes of expectant management and laser ablation of placental vessels

OBJECTIVES: To describe the perinatal outcomes of type II and III selective fetal growth restriction (sFGR) in monochorionic-diamniotic (MCDA) twin pregnancies treated with expectant management or laser ablation of placental vessels (LAPV). METHODS: Retrospective analysis of cases of sFGR that received expectant management (type II, n=6; type III, n=22) or LAPV (type II, n=30; type III, n=9). The main outcomes were gestational age at delivery and survival rate. RESULTS: The smaller fetus presented an absent/reversed "a" wave in the ductus venosus (arAWDV) in all LAPV cases, while none of the expectant management cases presented arAWDV. The median gestational age at delivery was within the 32nd week for expectant management (type II and III) and for type II LAPV, and the 30th week for type III LAPV. The rate of at least one twin alive at hospital discharge was 83.3% and 90.9% for expectant management type II and III, respectively, and 90% and 77.8% for LAPV type II and III, respectively. CONCLUSION: LAPV in type II and III sFGR twins with arAWDV in the smaller fetus seems to yield outcomes similar to those of less severe cases that received expectant management.

Prevalence And Incidence Of Hepatitis B Virus Among Expectant Mothers In Lagos Island General Hospital, Nigeria

Hepatitis B Virus (HBV) is an infection characterized as one of the major public health problems in the globe, particularly in Nigeria. This may be because of unguided sexual intercourse and inadequate knowledge of the disease. The study examined prevalence and incidence of HBV among expectant mothers in Lagos Island general hospital, Nigeria. Descriptive survey research design was used for the study. Hat and draw sampling technique was adopted for study location while volunteer sampling method was used to draw a hundred subjects. Instrument used was a revalidated questionnaire using test-retest method of reliability coefficient and the result yielded 0.89. The instrument was factor loaded using exploratory factor analysis setting nunnally criterion at 0.6. Hypotheses were tested using X2 statistics at 0.05 alpha level. Findings showed significant relationships in incidence of HBV based on unsafe sexual activity (X2= 62.8,p<0.05) and inadequate knowledge (X2=53.6,p<0.0). The practice of safe sex and being knowledgeable about HBV may prevent its incidence among expectant mothers. A significant relationship also exists in terms of managing the occurrence of HBV among expectant mothers (X2=47.6, p<0.05). This indicates that though there exist HBV, it can still be managed. The study concluded that inadequate knowledge, unsafe sexual activity may lead to HBV infection.