Sweeping of the fetal membranes and its effect on duration of pregnancy in low risk cases

Background: This study aimed to determine effectiveness of sweeping of membranes on the duration of pregnancy at term, and its effect on maternal and neonatal outcomes.Methods: In this prospective study, 145 women with uncomplicated pregnancy at 39 weeks or more gestation who were attending regular ANC clinic, were recruited for study, out of them 60 were cases (sweeping group) and 85 were control (no sweeping group). Primary outcome measure was occurrence of spontaneous labour and total duration of pregnancy. Other outcome measures included were interval of onset of labour from membrane sweeping, incidence of premature rupture of membranes, total duration of active labour, mode of delivery, rate of caesarean section and causes, and neonatal and maternal outcome.Results: There were no statistically significant differences between the two groups regarding maternal age, parity and bishops score at recruitment. There was a significant difference observed in spontaneous labour rate and interval time between recruitment to delivery in groups. There was no significant difference regarding mode of delivery, maternal and fetal outcomes.Conclusions: Membrane sweeping is a safe procedure that reduces the incidence of post-term pregnancies if applied at term.

Study of glucose levels in newborn with reference to hypoglycemia

Background: Hypoglycemia is one of the common metabolic problems in neonatal medicine. Early diagnosis and treatment of neonatal' hypoglycemia is important as many studies found that, hypoglycaemic episodes in neonates lead to neurodevelopmental and physical growth deficits. In this study, blood glucose levels at different time points were assessed and the influence of maternal blood glucose, mode of delivery, gestational age on neonatal blood glucose levels were studied.Methods: Blood glucose levels were low at 0 and 6th hour and maximum at 24th hour. The blood glucose levels ranged from 27 mg/dl to 140 mg/dl. Neonates with high maternal blood glucose were hypoglycaemic, showing a negative correlation.Results: The mean blood glucose levels were low in pre-term and post term babies compared to term and the range was wide in pre-term and term babies compared to post-term. The mean blood glucose levels were high and range was wide in babies delivered vaginally at all the time points compared to the babies delivered by LSCS. 17% babies were hypoglycaemic at birth but none of them had signs. The major signs noted were jitteriness (88%), high cry (88%), lethargy (55%), tremors (55%), limpness (22%), apathy (22%), weak cry (11%) and poor feeding (11%).Conclusions: 0 and 6th hour are the vulnerable time points for hypoglycaemia. Neonates with high maternal blood glucose, pre-term, post-term and babies delivered by LSCS were more prone for hypoglycaemia requiring blood glucose monitoring. There is a wide variation in signs of hypoglycaemia and babies showing signs require monitoring.

Embarazo abdominal postérmino: Reporte de un caso / Post-term abdominal pregnancy, a case report

Abdominal ectopic pregnancy is a dramatic situation for the woman's health. It is a rare pathology that proves to be a difficult test even for the most experienced gynecologists in diagnostic ability, decision-making and surgical technique. We present the case of a hospitalized post-term ectopic abdominal pregnancy with a dead fetus inside the chorioamniotic sac and the placenta implanted on vital abdominal viscera. We describe the clinical data, operative findings and conservative management of the retained placenta, followed by a bibliographic review on the subject.

El embarazo ectópico abdominal representa una situación dramática para la salud de la mujer. Al ser una patología poco frecuente, resulta al ginecólogo una prueba difícil para habilidad diagnóstica, capacidad de decisión y técnica quirúrgica, incluso para el más experto. Se presenta un caso de embarazo ectópico abdominal postérmino, que llegó con óbito fetal dentro de la bolsa corioamniótica y la placenta implantada sobre vísceras abdominales. Se describe los datos clínicos, hallazgos operatorios y el manejo conservador de la placenta retenida, y se hace una revisión bibliográfica del tema.

Birth weight patterns by gestational age in Brazil

BACKGROUND AND OBJECTIVES: We present an updated birth weight-for-gestational-age portrait, based on nearly 8 million observations of an ethnic-mixed population. It comprises the first comprehensive charts with Brazilian data. This contribution intends to assist clinicians in classifying fetal growth, to provide a reference for investigations of predictors and to show the consequences of small and large patterns for gestational age delivery. Most of the reference data for assessing birth weight for gestational age deal with insufficient sample size, especially at low gestational age. Population-based studies with considerably large sample size refer to data collected more than 15 years ago. METHODS: We accomplished a population-based study on births in all the Brazilian states from 2003 to 2005. Results were based on 7,993,166 singletons. We constructed the 3rd, 5th, 10th, 25th, 50th, 90th, 95th and 97th smoothed percentiles curves and gender-specific tables from 22 to 43 completed weeks. RESULTS: The resulting tables and graphical representation provide a gender-specific reference to access the birth weights distribution according to the gestational age in the Brazilian population. CONCLUSIONS: This is the first population-based reference constructed on a developing country data. These charts could provide an important tool to improve clinical assessment of growth in newborns.

BACKGROUND E OBJETIVOS: Apresentamos um retrato atualizado de peso-por-idade-gestacional, baseado em quase 8 milhões de observações em uma população etnicamente misturada. Estas constituem as primeiras tabelas com dados brasileiros. Esta contribuição pretende dar assistência aos clínicos na classificação do crescimento fetal, e prover uma referência para pesquisas de prognósticos e consequências em partos com padrões pequenos e grandes para a idade gestacional. A maior parte dos dados de referência para estimar peso-por-idade-gestacional sofre de tamanho de amostra insuficiente, especialmente em baixa idade gestacional. Os estudos populacionais com uma amostra de tamanho considerável se referem a dados coletados há mais de 15 anos. MÉTODOS: Nós realizamos um estudo populacional baseado em nascimentos em todos os estados brasileiros de 2003 a 2005. Os resultados foram baseados em 7.993.166 nascimentos de gravidez única. Nós construímos curvas suavizadas e tabelas gênero-específicas de 22 a 43 semanas completas para os percentiles 3°, 5°, 10°, 25°, 50°, 90°, 95° e 97°. RESULTADOS: As tabelas e representações gráficas resultantes proveem uma referência gênero-específica para acessar a distribuição de peso ao nascimento de acordo com a idade gestacional na população brasileira. CONCLUSÕES: Esta é a primeira referência populacional construída com dados de um país em desenvolvimento. Estas tabelas podem prover uma importante ferramenta para melhorara avaliação clínica do crescimento em recém-natos.

Post-term pregnancy and associated social factors among pregnant women in Jiaxing city, China, 1993 to 2000 / 中华流行病学杂志

Objective To understand the status of post-term pregnancy and associated social factors among pregnant women in Jiaxing city, from 1993 to 2000. Methods The study population consisted of 16 033 women who had delivered singleton live births in Jiaxing city, Zhejiang province, from 1993 to 2000. Chi-square test was employed to test the difference of proportions between respective groups. Multivariate logistic regression was conducted to examine the factors associated with post-term pregnancy. Results The incidence rates of post-term pregnancy were 8.7%, 10.6%, 9.4%, 7.4%, 4.3%, 2.6%, 3.3% and 4.0% from 1993 to 2000, respectively. Women who received premarital health care serviees had lower (5.6%) post-term incidence than those who did not (7.8%). Women who received county or above level health care services had lower (4.3%) post-term incidence than women who receive township level service (8.5%). Women who had primary school education had higher (11.5%) post-term incidence than women who received junior higher school education (6.8%), senior high school education (3.8%), or college education (2.9%), (P< 0.001). Farmers had higher (9.5%) post-term incidence than workers in the rural areas (8.9%), in urban areas (4.3%) or women with other professions (4.2%). Women whose husbands were rural workers had higher (9.8%) post-term incidence than farmers (9.4%), urban workers (5.0%)or with other professions (3.6%, P<0.001). Data from multivariate logistic regression showed that the risk of post-term pregnancy was associated with the length and the level of using health care services together with schooling and occupation. Conclusion The incidence of post-term pregnancy was decreasing in Jiaxing city during the period from 1993 to 2000 and the risk was associated with the length and level of health care service as well as the level of education and occupation of those women.

The clinical practice pattern of postterm pregnancy in Korea / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to survey the clinical practice pattern of postterm pregnancy in Korea. METHODS: A questionnaire was mailed to 1114 physicians who are registered in Korean Society of Obstetrics and Gynecology (KSOG) and work in primary and secondary hospital as well as tertiary care center. The questions included information about the practice pattern implicating definition of postterm pregnancy, the time and the method of routine fetal surveillance and induction of labor as well as demographic information such as age, sex, location, professional part and the number of delivery. We got 23.2% (258/1114) of surveys returned and analyzed the data. RESULTS: Seventy-four percent (73.6%) of the respondents define 42 weeks gestation or greater to be postterm. However, 84.5% consider induction of labor at 41 weeks of gestation. Sixty-eight percent (68.3%) of the respondents start postterm pregnancy fetal testing at 40 weeks and 59.3% of them perform testing every week. For fetal surveillance testing, 85.7% of the respondents use NST and 39.5% of them use modified BPP. As for induction of labor, 65% of practitioners use oxytocin and 45% of them use prostaglandins (misoprostol and dinoprostone) when inducing both nulliparous and multiparous women with unfavorable cervix. CONCLUSION: Most of the respondents (84.5%) routinely induce low-risk singleton pregnancy at 41 weeks gestation, whereas the majority of them (73.6%) define postterm pregnancy beyond 42 weeks gestation.

Risk of Cesarean Section Delivery after Induction of Labor at Postterm Pregnancy in Nulliparous Women / 대한주산의학회잡지

OBJECTIVE: The purpose of this study was to evaluate the risk of cesarean section in nulliparous women who undergone induction at postterm pregnancy. METHODS: The retrospective study was conducted from March, 1997 to March, 2005 by reviewing 331 nulliparous patients more than 41 weeks' gestation delivered after induction at our Hospital. The evaluated variables to assess the risk of cesarean section were maternal age, body mass index (BMI), gestational age (GA), Bishop scores (BS), fetal body weight (FBW), fetal head circumference (FHC) and fetal sex. t-test and x2-test were used to compare these categorical variables. RESULTS: The study included 331 nulliparous singleton pregnant women undergoing elective induction for postterm pregnancy: 127 (38.4%) delivered babies by cesarean section due to induction failure, progression failure and fetal distress, whereas 204 (61.6%) delivered vaginally. The mean maternal ages were 27.59+/-2.57 in cesarean delivery group and 26.99+/-2.61 in vaginal delivery group. The average values of BMI at postterm in cesarean and vaginal delivery groups were 26.70+/-2.82 and 25.75+/-2.67 kg/m2. GA was 41.36+/-0.27 weeks in cesarean delivery group, whereas 41.20+/-0.19 weeks in vaginal delivery group. The average FBW and FHC were 3460.31+/-358.22 g and 34.59+/-1.18 cm in cesarean delivery group, compared to 3363.95+/-361.22 g and 34.03+/-1.34 cm in vaginal delivery group. CONCLUSION: The BMI, FBW and FHC have linked to the risk of cesarean delivery in nulliparous women who underwent elective induction. Thus, these information would provide the useful tools to assess the risk of cesarean section in postterm nulliparous patients for planning an induction.

Study on method to estimate post-term pregnancies

192 pregnancy were hospitalized to monitor post-term infant with fetal age over 42 weeks and fetal condition suffered from Clifford syndrome. The results showed that: fluid index examination by ultrasound are selective method to diagnose fetal suffered from early Clifford syndrome. The cut-off value of 40 mm amniotic fluid index is considered as a Clifford’s syndrome marker. This is a good method of choice for monitoring the postterm infant

Fetal Growth Restriction was a Major Cause of Increased Perinatal Mortalities of Postterm Pregnancies / 대한산부인과학회잡지

OBJECTIVE: Perinatal mortality rates were higher in postdate than in term pregnancies. Previous study showed the risk to be greater in postterm newborns weighing less than 2500 grams at birth. This study is designed to examine the effect of gestational age and fetal growth restriction (FGR) on the perinatal mortalities of the postterm pregnancies. METHODS: Maternal and perinatal database of Yonsei University Medical Center from 1961 to 1990 was reviewed. After excluding pregnancies with known medical or obstetrical complications, we compared perinatal mortality rates of 39,631 singleton pregnancies delivered between 37 weeks and 44 weeks of gestational age according to the birthweight percentile. Birth weight percentile were grouped as FGR1 (10 percentile). Mortalities were compared using Chi-square statistics. RESULTS: Mean birth weight increased up to 42 weeks of gestation. Perinatal mortalities increased after 42 weeks of gestation. FGR1 group showed higher perinatal mortality rate compared with AGA group at 41 weeks of gestation (135/8, p<0.01). At 42 weeks of gestation, both FGR1 and FGR2 showed increased perinatal mortality rates (130/10 p<0.01, 56/10 p<0.01). Among AGA group, mortality increase was not obvious up to 42 weeks of gestation. CONCLUSION: Fetal growth restriction was a major cause of increased perinatal mortalities in postterm pregnancies.

The Course of Delivery and Perinatal Outcomes for Postterm Pregnancy / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to evaluate of course of delivery & perinatal outcomes for postterm pregnancy compared with fullterm pregnancy. METHODS: This study included 360 cases of postterm pregnancy out of 16,992 cases delivered at Department of Obstetrics and Gynecology from January 1, 1993 to December 31, 1997. 16,143 cases of full term deliveries of 38 to 42 gestational weeks conducted in same period were used as the control group. Postterm pregnancy was defined as a pregnancy that it exceeds 295 days calculated from first day of the last menstrual period. RESULTS: The incidence of postterm pregnancy was 2.13% with the highest incidence occurring in the 26 ~30 years age group. This study group was significantly different from the control group in the incidence of fetal distress (10.28% vs. 2.20%), large fetus (10.83% vs. 6.95%), perinatal death (1.67% vs. 0.27%). CONCLUSIONS: Adverse perinatal outcomes were increased markedly as the gestational weeks to be prolonged. Therefore, careful prenatal care, accurate determination of delivery date is very important.

Amniotic Fluid Index and Preinatal Outcome in Postterm Pregnancy / 대한주산의학회잡지

A pregnancy is considered postterm if it is beyond 294 days (42 complete weeks). Several investigators have demonstrated that postterm pregnancy may be accompanied by a rise in perinatal morbidity and/or mortality. Abnormalities such as meconium staining, cringenital anomalies, intrauterine growth retardation, postmaturity syndrome, fetal asphyxia have been reported in some cases of reduced amniotic fluid volume (oligohyramnios) which is commonly observed in postterm pregnancies. Amniotic fluid volume has been shown to decrease significantly as gestational age advances beyond term. Oligohydramnios has particular relevance to postterm pregnancies. Poor perinatal outcomes of oligohydramnios on postterm pregnancy have been reported by several authors. To date, however, the relationship between oligohydramnios in pastterm pregnancy and fetal outcome is debatable. The purpose of this clinical study was to evaluate the relationship between oligohydr- amnios and perinatal outcome in 64 cases of postterm pregnancies. Amniotic fluid index(AFI) values were measured semiweekly in 64 good dated, uncomplicated singleton pregnancies. AFI values were categorized into 2 groups. The group 1; patients whose final AFI value was above 5.0 cm; Group 2, patients whose AFI value fell below 5.0 cm. Adverse fetal outcome was defined by the presence of meconium staining, fetal heart rate decelerations, cesarean delivery for fetal distress, low Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, and perinatal mortality. The fetal outcome was compared group 1 with group 2 and results obtained were as follows: 1. The incidence of oligohydramnios in postterm pregnancy was 54.7 %. The average diminution of amniotic fluid index was from 8.2 1.8 cm to 5.6+2.2 cm/week. 2. The incidence of meconium-staining in amniotic fluid was 40.6 % (Group 1: 20.7 %, Group 2: 57.1 %) and showed statistically significant difference between the two groups(p= 0.003). 3. The incidence of Apgar score less than 7 was 23.4% in 1 minute (Group 1: 13.8 %, Group 2: 31.4 %) and 4.7 % in 5 minutes(Group 1: 3.4%, Group 2: 5.7 %), respectively and showed no statistically significant difference between the two groups (p=0.140, p=1.000). 4. I'he incidence of cesarean delivery due to fetal distress was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). 5. The incidence of admission to NICU was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). Adverse fetal outcome was not uniformly observed in postterm pregnancies with oligohydramnios. Amniotic fluid index in oligohydramnios group as a single independent guide was not enough to predict fetal outcomes in postterm pregnancy without specific pathologic condition of fetus.