Pregnancy outcomes in COVID-19-infected pregnant women in a tertiary care hospital of Mysuru – A retrospective approach

Background: The infection due to the COVID-19 virus has shown to cause diverse set of manifestations and effects in various people across the world. Pregnancy being a dynamic, physiological condition of the human body, nudges one to question what happens if a pregnant woman is infected with the COVID-19 virus? Hence, the study aims to probe this very question. Aim and Objectives: The aim of this study was to study the effect of COVID-19 virus infection on pregnancy and its outcomes. Materials and Methods: We did a retrospective review of medical records of 28 pregnant ladies who were admitted in the tertiary care hospital, Mysuru between March 2020 and February 2021. All 28 pregnant ladies were tested positive for severe acute coronavirus disease by use of quantitative RTPCR on samples obtained from nose and throat. The procedure was followed according to ICMR guidelines of collection of samples and reporting of COVID-19 infection. The clinical findings, laboratory findings, and the fetal and maternal outcomes of 28 pregnant ladies were obtained from medical record section of the institution. The reports were entered in excel sheet and subjected to statistical analysis using SPSS version 20. Results: One out of 28 showed maternal death during COVID-19 pandemic. There was one case with abortion which was reported. Twenty out of 28 had normal deliveries and three women had LSCS. Neonatal outcomes seem to be within normal limits with no adverse complications as a consequence of COVID-19 maternal infection. Conclusion: It is seen that COVID-19 infection behaves in a similar fashion to general population and that morbid states may trigger adversity in mother rather than the fetus. It is also noted that due to the effect of the chaos caused by the pandemic, documentation of the cases was incomplete. Transfer of cases depending on status of infection to other hospitals hindered the tracking of these cases. Discharge against medical advice was also observed due to panic of being in a hospital during an ongoing pandemic.

Maternal and neonatal outcomes among women with gestational diabetes mellitus treated with metformin in a tertiary hospital: A retrospective cohort study

Background@#Gestational diabetes mellitus (GDM) is a common disorder associated with both maternal and fetal complications. Treatment for GDM requires lifestyle modification, as well as insulin and oral anti-diabetes medications to prevent unwarranted fetal and maternal outcomes.@*Objective@#To determine the feto-maternal outcomes of GDM patients treated with either metformin-monotherapy, insulin- monotherapy, and with insulin plus metformin (combination) therapy in a private tertiary hospital in Metro Manila.@*Methods@#This is a retrospective cohort study involving 209 GDM patients admitted from January 2017 to December 2019. Census and chart reviews were done for demographic and clinical data. These were divided into 3 groups: metformin-monotherapy, insulin-monotherapy, and combination treated groups. Analysis of Variance was used to compare the average capillary blood glucose (CBG) levels of patients. Chi-square and Fisher’s Exact tests were used for nonparametric data.@*Results@#Birthweight was significant across all groups: metformin-monotherapy group highest with large-for-gestational- age (LGA) at 25%, small-for-gestational-age (SGA) highest on the insulin-monotherapy group (11.3%) and appropriate-for- gestational-age (AGA) highest in the combination therapy group (84.6%). Age of gestation (AOG) at delivery (p=0.005), maternal CBG during labor (p=0.007), and chronic hypertension (p=0.001) were statistically significant across all groups. Multiple comparisons showed the following statistically significant results as well: chronic hypertension between metformin and combination group (p <0.01), AOG during delivery between metformin vs insulin group (p=0.004), maternal CBGs during labor between metformin vs insulin group (p=0.022), and insulin vs combination treatment group (p=0.029). Average maternal CBG levels were also showed statistically significant difference between the metformin vs insulin group (p=0.029).@*Conclusion@#Metformin may be used in controlling CBG levels in GDM patients. Although metformin may be comparable to insulin, more long-term studies need to be done to determine its long-term effects on neonates.

Effect of Chorionicity， Gestational Age at Birth and Birth Weight Discordance on Neonatal Outcomes in Twin Pregnancies / 中山大学学报(医学科学版)

ObjectiveTo investigate the effect of chorionicity， gestational age at birth and birth weight discordance on neonatal outcomes in twin pregnancies. MethodsWe conducted a population-based retrospective study of monochorionic diamniotic （MCDA） twin pregnancies and dichorionic diamniotic （DCDA） twin pregnancies who were admitted in the First Affiliated Hospital， Sun Yat-sen University from January 2015 to December 2020. A total of 1504 live-born twins were included， with 386 cases in MCDA group and 1118 cases in DCDA groups， respectively. The comparison of neonatal outcomes between MCDA and DCDA twins was performed using t-test， Wilcoxon rank sum test， Chi-square test or Fisher’s exact test. Logistic regression was performed to evaluate the effects of chorionicity， gestational age at birth， birth weight discordance and sex on neonatal outcomes. There were 168 live-born twins affected by inter-twin birth weight discordance≥25%， with 96 cases in MCDA group and 72 cases in DCDA groups， respectively. Logistic regression was performed to evaluate the effects of chorionicity， gestational age at birth， birth weight light or heavy （small twin or large twin） of the twin and sex on neonatal outcomes. ResultsAmong the 1 504 newborns， gestational age at birth was lower in MCDA group compared with DCDA group （P = 0.000）， and the degree of birth weight discordance was higher in MCDA group than that of the DCDA group （P = 0.001）. Birth asphyxia， respiratory distress syndrome （RDS）， bronchopulmonary dysplasia （BPD）， and sepsis were more frequency in MCDA group compared with DCDA group （P = 0.000， P = 0.000， P = 0.000， P = 0.000）. Low gestational age at birth was an independent risk factor for birth asphyxia， RDS， BPD， sepsis， necrotizing enterocolitis （NEC）≥stageⅡ， acute kidney injury （AKI）， retinopathy of prematurity （ROP）， and neonatal death respectively （P = 0.000， P = 0.000， P = 0.000， P = 0.000， P = 0.011， P = 0.000， P = 0.000， P = 0.000）. High degree of birth weight discordance was an independent risk factor for birth asphyxia， RDS， BPD， sepsis and ROP respectively （P = 0.045， P = 0.000， P = 0.000， P = 0.004， P = 0.017 ）. Chorionicity was not an independent risk factor for neonatal morbidity and death （P > 0.05）. Among the 168 twins with birth weight discordance ≥25%， low gestational age at birth was an independent risk factor for birth asphyxia， RDS， BPD， sepsis and ROP， respectively （P = 0.000， P = 0.000， P = 0.000， P = 0.000， P = 0.000）； small twin was an independent risk factor for birth asphyxia and BPD， respectively （ P = 0.013， P = 0.001）； chorionicity was not an independent risk factor for neonatal morbidity （P > 0.05）. ConclusionChorionicity was not an independent risk factor for adverse neonatal outcome in twin births. Low gestational age at birth and high degree of birth weight discordance were independent risk factor for adverse neonatal outcome in twin births. Small twins had increased risk of adverse neonatal outcome in twins with birth weight discordance ≥25%.

Perinatal Transmission and Outcomes of SARS-CoV-2 Infection

Maternal SARS-CoV-2 infection can adversely afect the birth and neonatal outcomes. The authors prospectively enrolled 196 neonates born to 193 SARS-CoV-2–positive mothers to determine the rate of mother-to-baby transmission of SARSCoV-2 and its efect on short-term neonatal outcomes in Indian population. Nineteen babies turned out to be RT-PCR– positive for SARS-CoV-2, carrying a perinatal transmission rate of 9.8%. Rates of prematurity and low birth weight were 12.8% and 18.9% in the neonatal group, respectively. On comparing SARS-CoV-2–positive (n=19) and negative (n=177) neonatal groups, rate of prematurity, hospital admission rate, and death rate were higher in the former group. The placental positivity rate for SARS-CoV-2 was 8.1%, but no relation was found between placental and neonatal infection.

¿Son útiles los antimicrobianos en pacientes con trabajo de parto prematuro, espontáneo, membranas intactas e infección bacteriana ascendente? Una revisión narrativa

El parto prematuro (PP) es la principal causa de morbilidad/mortalidad perinatal y frecuentemente es espontáneo, con membranas intactas (MI). La infección intrauterina es su causa más común en un hospital público de Chile. Existe evidencia que la infección bacteriana ascendente desde la vagina es responsable de la infección/inflamación intraamniótica, del PP y de los resultados adversos maternos y perinatales. Esta revisión narrativa incluye ensayos controlados aleatorizados (ECAs), publicados en PubMed, Cochrane, Embase, Scielo, Science Direct, Wiley Online Library, sobre los mecanismos que intervienen en el ascenso de la infección vaginal, los factores infecciosos que participan en el resultado adverso materno-perinatal y la eficacia de los antimicrobianos en estos casos. Estos trabajos no recomiendan usar antimicrobianos profilácticos porque producen daño a corto y largo plazo en los hijos. Pero este resultado tiene sesgo porque no se evaluó la presencia de infección/inflamación subclínica, lo que disminuye el grado de recomendación. También existen ECAs, que erradican la infección/inflamación intraamniótica, reducen la morbilidad/mortalidad neonatal, pero son trabajos aislados, obtenidos de subanálisis, con bajo nivel de evidencia. Se requieren revisiones sistemáticas y metaanális de ECAs con estudio de infección/inflamación subclínica para evaluar si son útiles los antimicrobianos en el PP espontáneo con MI.

Preterm labor (PL) is the leading cause of perinatal morbidity/ mortality and is frequently spontaneous with intact membranes (IM). Intrauterine infection is its most common cause in a public hospital in Chile. There is evidence that ascending bacterial infection from the vagina is responsible for intraamniotic infection/inflammation, PL, and adverse maternal and perinatal outcomes. This narrative review includes randomized controlled trials (RCTs), published in PubMed, Cochrane, Embase, Scielo, Science Direct, Wiley Online Library on the mechanisms involved in the rise of vaginal infection, the infectious factors involved in adverse maternal-perinatal outcomes, and the efficacy of antibiotics in these cases. They do not recommend the use of prophylactic antibiotics because they cause short and long-term damage to children. But this result is biased because the presence of subclinical infection/inflammation was not evaluated, which lowers the degree of recommendation. There are also RCTs that eradicate intra-amniotic infection/inflammation, reduce neonatal morbidity/ mortality, but they are isolated studies, obtained from subanalyses, with a low level of evidence. Systematic reviews and meta-analyses of RCTs with subclinical infection/inflammation study are required to assess whether antibiotics are useful in spontaneous PL with IM.

Desfechos obstétricos e neonatais na vigência da infecção por SARS-CoV-2: o que sabemos até agora? Uma revisão não-sistemática da literatura / Obstetric and neonatal outcomes in the presence of SARS-CoV-2 infection: What do we know so far? A non-systematic literature review

Introdução: A pandemia causada pelo SARS-CoV-2, responsável pela COVID-19, tem impactado a saúde de milhares de pessoas e contabilizado um número expressivo de infectados e de mortes. A população idosa e com comorbidades são os grupos de maior risco para as formas graves da doença. Dados sobre a infecção por SARS-CoV-2 em grávidas e recém nascidos ainda são limitados. Essa revisão objetiva analisar a literatura existente acerca dos resultados obstétricos, perinatais e neonatais da COVID-19. Síntese dos dados: Sobre as formas de infecção, não se exclui a possibilidade da transmissão vertical apesar da infecção ocorrer mais comumente após o parto. Os desfechos obstétricos mais encontrados foram uma maior porcentagem de cesárea e nascimento pré-termo. Quanto aos desfechos perinatais, sugere-se uma maior prevalência de baixo peso ao nascer e maior admissão em UTI. A maioria dos recém-nascidos com COVID-19 eram assintomáticos, constatando-se baixa mortalidade. O risco de infecção por SARS-CoV-2 pelo aleitamento materno parece ser pequeno, e esse permanece sendo recomendado. Conclusões: Apesar dos diversos estudos disponíveis, evidências em relação aos desfechos obstétricos e pediátricos da COVID-19 ainda são escassas. Sugere-se que o risco de infecção por SARS-COV-2 em neonatos é pequeno, e a transmissão pós parto parece ser a forma mais comum de infecção dos recém-nascidos, ainda que não se possa descartar a transmissão vertical. A infecção por COVID-19 pode estar associada a maior risco de morbidades maternas e neonatais. É fundamental que as gestantes e os neonatos sejam monitorados quanto a alterações clínicas precoces visando evitar complicações da doença.

Introduction: The pandemic caused by SARS-CoV-2, responsible for COVID-19, has impacted the health of thousands of people and accounted for a significant number of infected people and deaths. The elderly population and those with comorbidities are the groups at greatest risk for severe forms of the condisease. Data on SARS-CoV-2 infection in pregnant women and newborns are still limited. This review aims to analyze the existing literature on obstetric, perinatal and neonatal outcomes of COVID-19. Summary of the data: Regarding the forms of infection, the possibility of vertical transmission is not excluded, although the infection occurs more commonly after childbirth. The most common obstetric outcomes were a higher percentage of cesarean sections and preterm birth. Regarding perinatal outcomes, a higher prevalence of low birth weight and greater ICU admission are suggested. Most newborns with COVID-19 were asymptomatic, with low mortality. The risk of SARS-CoV-2 infection through breastfeeding appears to be small, and this remains recommended. Conclusions: Despite the many studies available, evidence regarding obstetric and pediatric outcomes of COVID-19 is still scarce. It is suggested that the risk of SARS-COV-2 infection in newborns is small, and postpartum transmission seems to be the most common form of infection in newborns, although vertical transmission cannot be ruled out. COVID-19 infection may be associated with an increased risk of maternal and neonatal morbidities. It is essential that pregnant women and newborns are monitored for early clinical changes in order to avoid complications of the disease.

Beneficios de los antibióticos en la rotura prematura de membranas de pretérmino y factores que intervienen en la eficacia del tratamiento: revisión narrativa / Benefits of antibiotics in preterm premature rupture of membranes and factors involved in the efficacy of the treatment: narrative review

Resumen El parto prematuro es la principal causa de morbilidad y de mortalidad perinatal, y hasta un tercio de los casos presentan rotura prematura de membranas. La infección intrauterina que asciende desde la vagina es su principal causa en un hospital público de Chile. Esta revisión narrativa mediante búsqueda en PubMed, Cochrane, Embase, Scielo, Science Direct y Wiley Online Library incluye estudios publicados sobre los diferentes factores infecciosos que intervienen en el resultado adverso perinatal y la eficacia de los antibióticos en la rotura prematura de membranas de pretérmino. Además, contiene recomendaciones de sociedades científicas sobre el uso de antibióticos en estos casos. Los ensayos concluyen que los antimicrobianos prolongan el embarazo, disminuyen la corioamnionitis clínica y reducen variadas morbilidades neonatales, pero no reducen la mortalidad perinatal ni las secuelas tardías en la infancia. Los resultados adversos obstétricos, especialmente los neonatales, y las secuelas dependen de la existencia de invasión microbiana de la cavidad amniótica o de infección cérvico-vaginal, de la virulencia de los microorganismos aislados, del compromiso inflamatorio/infeccioso de la placenta (corioamnionitis histológica, funisitis) y de la respuesta inflamatoria fetal. Para mejorar los resultados adversos obstétricos neonatales en la rotura prematura de membranas de pretérmino, los esquemas de antibióticos deben ser eficaces, cubriendo el amplio espectro microbiológico existente y actuando sobre los factores infecciosos implicados en la gravedad de la infección. Además, deben administrarse de manera intensiva y prolongada hasta el parto.

Abstract Preterm birth is the leading cause of perinatal morbidity and mortality, and up to a third of them have premature rupture of membranes. Intrauterine infection that rises from the vagina is its main cause in a public hospital in Chile. This narrative review by searching PubMed, Cochrane, Embase, Scielo, Science Direct and Wiley Online Library includes published studies of the different infectious factors involved in perinatal adverse outcome and of the efficacy of antibiotics in preterm premature rupture of membranes. It also contains recommendations from scientific societies on the use of antibiotics in these cases. These trials conclude that antimicrobials prolong pregnancy, decrease clinical chorioamnionitis, and reduce various neonatal morbidities, but do not reduce perinatal mortality or infant sequelae. Obstetric and especially neonatal adverse outcomes in these patients depend on the existence of microbial invasion of the amniotic cavity and/or cervicovaginal infection, of the virulence of the isolated microorganisms, of inflammatory/infectious involvement of the placenta (histological chorioamnionitis, funisitis) and fetal inflammatory response. To improve adverse neonatal obstetric outcomes in preterm premature rupture of membranes, antibiotic regimens must be effective, covering the wide existing microbiological spectrum and acting on infectious factors responsible for the severity of the infection. In addition, they must be administered aggressively and for a long time until delivery.

Is there a role for antenatal corticosteroids in term infants before elective cesarean section?

Abstract Objective Cesarean section (CS) delivery, especially without previous labor, is associated with worse neonatal respiratory outcomes. Some studies comparing neonatal outcomes between term infants exposed and not exposed to antenatal corticosteroids (ACS) before elective CS revealed that ACS appears to decrease the risk of respiratory distress syndrome (RDS), transient tachypnea of the neonate (TTN), admission to the neonatal intensive care unit (NICU), and the length of stay in the NICU. Methods The present retrospective cohort study aimed to compare neonatal outcomes in infants born trough term elective CS exposed and not exposed to ACS. Outcomes included neonatal morbidity at birth, neonatal respiratory morbidity, and general neonatal morbidity. Maternal demographic characteristics and obstetric data were analyzed as possible confounders. Results A total of 334 newborns met the inclusion criteria. One third of the population study (n=129; 38.6%) received ACS. The present study found that the likelihood for RDS (odds ratio [OR]=1.250; 95% confidence interval [CI]: 0.454-3.442), transient TTN (OR=1.,623; 95%CI: 0.556-4.739), and NIUC admission (OR=2.155; 95%CI: 0.474-9.788) was higher in the ACS exposed group, although with no statistical significance. When adjusting for gestational age and arterial hypertension, the likelihood for RDS (OR=0,732; 95%CI: 0.240-2.232), TTN (OR=0.959; 95%CI: 0.297--3.091), and NIUC admission (OR=0,852; 95%CI: 0.161-4.520) become lower in the ACS exposed group. Conclusion Our findings highlight the known association between CS-related respiratory morbidity and gestational age, supporting recent guidelines that advocate postponing elective CSs until 39 weeks of gestational age.

Cáncer de mama y embarazo. Estudio retrospectivo y descriptivo en la ciudad de Rosario / Breast cancer and pregnancy in Argentina: A retrospective, descriptive study in the city of Rosario

Introducción: el cáncer de mama (CM) es el cáncer más frecuente diagnosticado durante el embarazo (PABC, del inglés Pregnancy Associatied Breast Cancer), con una incidencia de 1:3.000 embarazos. Objetivo: detallar las características clínicas e histopatológicas del PABC. Comparar estadios clínicos y detallar la sobrevida de las pacientes embarazadas y puérperas. Analizar el tratamiento durante el embarazo, los resultados obstétricos y neonatales. Material y método: estudio observacional, descriptivo y retrospectivo de PABC, en el período de enero de 2008 a julio de 2019 en los hospitales públicos y privados de la ciudad de Rosario. Resultados: del total 22 pacientes, 11 se encontraban embarazadas y 11 cursando el puerperio. La edad promedio fue de 37.3 años. La edad gestacional (EG) promedio al momento del diagnóstico fue de 16.8 semanas. En cuanto al subtipo histológico; el 72.72% (16 casos) ductal, 9.1% (2 casos) lobulillar, 4.54% (1 caso) medular, 4.54% (1 caso) cribiforme y 9.1% (2 casos) sin datos. El perfil inmuhohistoquímico mostró un 36.4% (8 casos) de triple negativos, 22.73% (5 casos) de Luminales A, 22.73% (5 casos) de Luminales B, 13.64% (3 casos) Her2 positivos y 4.5% (1 caso) sin dato. Los estudios clínicos al comparar las pacientes embarazadas y puérperas fueron similares. Estadios I y II: 7 pacientes en ambos grupos, estadios III: 2 pacientes en ambos grupos y estadios IV: 2 pacientes en ambos grupos. En el seguimiento medio de las pacientes (52.8 meses) se observó el fallecimiento de 5 de ellas (2 con diagnóstico de CM durante el puerperio y 3 durante el embarazo) y una recidiva locoregional de una paciente diagnosticada en el embarzo. Durante el embarazo, 2 pacientes realizaron cirugía conservadora y linfadenectomía seguida de quimioterapia, 1 paciente quimioterapia neoadyuvante seguida de cirugía conservadora y linfadenectomía, 3 pacientes quimioterapia y 1 paciente mastectomía y linfadenectomía. En 2 casos se difirió el tratamiento luego del parto. 2 pacientes realizaron la interrupción del embarazo en el primer trimestre. La quimioterapia fue administrada finalizando el primer trimestre. La radioterapia (RT) y la hormonoterapia se difirieron posparto, ninguna paciente realizó tratamiento anti Her2 durante la gestación. Los recién nacidos (RN) expuestos a quimioterapia intraútero (6 casos) nacieron vigorosos y sanos, ninguno presentó malformaciones. Se presentó un solo caso de bajo peso para la EG. El 44.4% (4 casos) de los embarazos fue finalizado a término, mientras que la finalización pretérmino representó el 55.6% (5 casos), con una EG medio de 34.4 semanas. En el 100% de los RN pretérmino la finalización del embarazo fue programada. Conclusiones: los subtipos más frecuentes fueron los tumores luminales. Se observó mayor frecuencia de tumores biológicamente más agresivos como el triple negativo comparado con la población general. No se encontraron diferencias al comparar los estadios clínicos al momento del diagnóstico de pacientes embarazadas vs puérperas. La quimioterapia administrada luego del primer trimestre es segura para el feto. Se debe evitar el parto prematuro, dado el pronóstico negativo de la prematuridad en el desarrollo cognitivo de los RN.

Introduction: breast cancer (BC) is the most common cancer diagnosed during pregnancy with an incidence of 1:3.000 pregnancies. Objetive: to detail the clinical and histopathological charactersitics of Pregnancy-associatied Breast Cancer (PABC). To compare clinical stages and to detail the survival of pregnant and postpartum patients. To analyze the treatment during pregnancy, and the obstetric and neonatal outcomes. Material and method: a retrospective, descriptive, and observational study of PABC was carried otu from january 2008 to july 2019 in the state and private hospitals of the city of Rosario. Results: of a total of 22 patients, 11 were pregnant and 11 were in the postpartum period. The patient´s average age was 37.3 years old. The average gestational age (GA) at the time of diagnosis was 16.8 weeks. As for the hitological subtype; 72.72% (16 cases) ductal, 9.1% (2 cases) lobular, 4.54% (1 case) cribriform and 9.1% (2 cases) without data. The immunohistochemical profile showed 36.4% triple negative, 22.73% of Luminal A, 22.73% of Luminal B, 13.64% HER2 positive, and 4.5% without data. The clinical stages when comparing pregnant and postpartum patients were similar. Stages I and II: 7 patients in both groups, stage III: 2 patients in both groups and stage IV: 2 patients in both groups. In the mean follow-up of the patients (52.8 moths), the death of 5 of them was detected (2 with a dignosis of BC during the puerperium and 3 during pregnancy) and a locoreginal recurrence of a patient diagnosed in pregnancy. During pregnancy, 2 patients underwent conservative surgery and lymphadenectomy followed by chemotherapy, 1 patient neoadjuvant chemotherapy followed by conservative surgery and lymphadenectomy, 3 patients chemotherapy and 1 patient underwent mastectomy and lymphadenectomy. In 2 cases, treatment was postponed after delivery. 2 patients performed the termination of pregnancy in the firts trimester. Chemotherapy was performed after the firts trimester. Radiotherapy (RT) and hormone therapy were postpartum deferred. None of the patients underwent anti-Her2 treatment during pregnancy. Newborns exposed to intrauterine chemotherapy (6 cases) were born vigorous and healthy, none of them presented malformations. Only one case presented low weight for gestational age. 44.4% of the pregnancies were due on term, while 55.6% were preterm births, with and average gestational age of 34.4% weeks. In 100% of preterm born infants, the end of the pregnancy was scheduled. Conclusions: the most frequent subtype were lumianl tumors. A preponderance of biologically more aggresive tumors such as triple negative was observed. The clinical stages at the time of diagnosis of pregnant and postpartum patients were similar. Chemotherapy after the first trimester is safe for the fetus. If possible, preterm bith should be avoided, giver the negative pronostic effect of prematurity on cognitive development.

Maternal and Neonatal Clinico-Demographic profile and outcomes during the COVID-19 Pandemic at the Chinese General Hospital and Medical Center

Background@#COVID-19 is an ongoing health concern that hospitals have struggled to keep up with, given its increasing burden with the passage of time. Considerations for the management of COVID-19 should be made especially for pregnant patients and their neonates.@*Objectives@#To determine COVID-19 prevalence and the clinical profile of mothers admitted for childbirth at Chinese General Hospital and Medical Center from May 2020 to July 2020. The profile and outcomes of neonates born to these mothers were likewise studied. @*Materials and Method@#A descriptive cross-sectional study was done that included mothers admitted for childbirth who had SARS-CoV-2 RT PCR swab test and their neonates. A total of 408 medical records of mother and neonate dyads were reviewed. Relevant variables such as the patients’ demographic profile, clinical characteristics, co-morbidities and the maternal and neonatal outcomes were obtained. Frequency distributions were made to assess the prevalence of COVID-19 among the patients, as well as maternal and neonatal outcomes. @*Results@#Twenty-two (5.39%) mothers tested positive for COVID-19, while all neonates (n = 22) that underwent RT-PCR swab at the 24th hour of life had negative results. Of the 22 COVID-19 positive mothers, 2 (9.09%) were symptomatic upon admission while 20 (90.09%) were asymptomatic. The following were the key trends among those mothers who tested positive for COVID-19: (1) 81.82% were from ages 20-39 years old, (2) 72.73% were multigravida mothers, (3) 54.55% had normal spontaneous delivery, (4) diabetes mellitus was the only noted comorbidity. Key findings on the neonatal outcomes observed in the study population of both COVID-19 positive and negative cases, include: (1) majority of neonates had an APGAR score of greater than 7 at 1st and 5th minute of life; (2) higher frequency of neonates with Ballard’s score of more than 37 weeks AOG; (3) more male neonates as compared to female neonates; (4) a normal birth weight for majority of cases; (5) 45.45% of neonates born to COVID positive mothers had a length of stay of <48 hours as compared to 72.8% of neonates born to COVID negative mothers; and (6) neonatal pneumonia as the most common comorbid condition in both cases. @*Conclusion@#This study noted a prevalence of 5.39% COVID-19 positive mothers. SARS-CoV-2 virus was not detected in all of the neonates born to COVID-19 affected mothers. Neonates delivered to COVID-19 positive mothers had similar trends in the neonatal outcomes when compared to neonates delivered to mother who were COVID-19 negative.

Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City, Tanzania in October 2020

Every year more than 20 million neonates worldwide are born with low birth weight (LBW) per year. Ninety-five percent of LBW births occur in developing countries. The aim of this study was to determine Immediate Seven Day Outcomes and Risk Factors of Low Birth Weight Neonates at Referral Hospitals in Mwanza City. MATERIALS AND METHODS This was a hospital based observational prospective cohort study of neonates with LBW whom were followed up for seven days in the neonatal wards at referral hospitals in Mwanza city. Maternal social-demographic, newborns clinical data and vitality outcomes were collected. Categorical and continuous variables were summarized and presented in tables or bar charts. Any p-value of < 0.05, at 95% confidence interval was regarded as statistically significant. RESULTS Total of 200 neonates with median age of 0.8 days at baseline were enrolled. Amongst 148 (74 %) had prolonged hospitalization; due to sickness 88 (59%), and 60 (40%) due to poor weight gain. Whereas, the remaining 42 (21%) were discharged and 10 (5%) died within seven days. Prolonged hospitalization was associated with family income (p-value= <0.001) and place of delivery (p-value = <0.001). African Journal of Health Sciences Volume 34, Issue No.4, July- August 2021 452 Neonatal death was associated with family income (p-value =0.035) and birth weight (p-value = 0.019). Early discharge associated with gestational age at first antenatal visit, family income, mode of delivery, APGAR score at one minute, time interval between delivery and admission and timing of medication initiation. CONCLUSION LBW neonates are at high risk of death and prolonged hospitalization due to sickness or due to poor weight gain. Associated factors of these outcomes were family income, place of delivery, birth weight, gestation age during first antenatal visit, mode of delivered and low APGAR score.

Impact of HPV infection on vaginal microecology and maternal and neonatal outcomes / 中南大学学报(医学版)

OBJECTIVES@#Human papillomavirus (HPV) is a kind of spherical DNA virus, which is related to many factors such as immune status and pregnancy. Due to the decrease of immunity, pregnant women are more likely to have HPV infection, which causes serious imbalance of vaginal microecology and is not beneficial to pregnancy outcome. Therefore, this study focuses on the impact of HPV infection on vaginal microecology and maternal and neonatal outcomes.@*METHODS@#A total of 140 pregnant women with HPV infection during pregnancy, who received obstetric examination in the First Affiliated Hospital of Hainan Medical College from November 2017 to July 2019, were selected as a HPV infection group, and 150 normal pregnant women with HPV negative in the same period were selected as a control group. Vaginal secretions were collected from all the pregnant women at 28-34 weeks of gestation to evaluate vaginal pH, cleanliness and microecological status, and to record pregnancy outcomes for all pregnant women.@*RESULTS@#The proportions of vaginal pH>4.5, constituent ratio of flora density and diversity of I-II, positive detection rate of vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) in HPV infected pregnant women were significantly higher than those in the control group (all @*CONCLUSIONS@#Pregnant women with HPV infection during pregnancy are more likely to have vaginal microecological disorders, and can increase the risk of adverse pregnancy outcomes such as premature delivery and chorioamnionitis.

The influence of preeclampsia, advanced maternal age and maternal obesity in neonatal outcomes among women with gestational diabetes / A influência da pré-eclâmpsia, idade materna avançada e obesidade materna em desfechos neonatais entre mulheres com diabetes gestacional

Abstract Objective The present study aims to analyze adverse fetal or neonatal outcomes in women with gestational diabetes, including fetal death, preterm deliveries, birthweight, neonatal morbidity and mortality, as well as the synergic effect of concomitant pregnancy risk factors and poor obstetric outcomes, as advanced maternal age, maternal obesity and pre-eclampsia in their worsening. Methods The present cohort retrospective study included all pregnant women with gestational diabetes, with surveillance and childbirth at the Hospital da Senhora da Oliveira during the years of 2017 and 2018. The data were collected from the medical electronic records registered in health informatic programs Sclinico and Obscare, and statistical simple and multivariate analysis was done using IBM SPSS Statistics. Results The study participants included 301 pregnant women that contributed to 7.36% of the total institution childbirths of the same years, in a total of 300 live births. It was analyzed the influence of pre-eclampsia coexistence in neonatal morbidity (p = 0.004), in the occurrence of newborns of low and very low birthweight (p < 0.01) and in preterm deliveries (p < 0.01). The influence of maternal obesity (p = 0.270; p = 0.992; p = 0.684) and of advanced maternal age in these 3 outcomes was also analyzed (p = 0,806; p = 0.879; p = 0.985).Using a multivariate analysis, the only models with statistic significance to predict the three neonatal outcomes included only pre-eclampsia (p = 0.04; p < 0.01; p < 0.01). Conclusion Only coexistence of pre-eclampsia showed an association with adverse neonatal outcomes (neonatal morbidity, newborns of low and very low birthweight and preterm deliveries) and can be used as a predictor of them in women with gestational diabetes.

Resumo Objetivo O presente estudo tem como objetivo analisar desfechos fetais ou neonatais adversos em mulheres com diabetes gestacional, incluindo morte fetal, partos prematuros, peso ao nascimento, morbilidade neonatal e mortalidade, bem como o efeito sinérgico de fatores de risco e maus desfechos concomitantes da gravidez, como idade materna avançada, obesidade materna e pré-eclâmpsia no seu agravamento. Métodos O presente estudo retrospetivo de coorte incluiu todas as gestantes com diabetes gestacional, com vigilância e parto no Hospital da Senhora da Oliveira durante 2017 e 2018. Os dados foram obtidos dos registos clínicos eletrônicos dos programas informáticos de saúde Sclinico e Obscare, e a análise estatística simples e multivariada foi feita utilizando o IBM SPSS Statistics. Resultados Os participantes do estudo incluíram 301 gestantes que contribuíram para 7,36% do total de partos da instituição, num total de 300 nados vivos. Foi analisada a influência da coexistência de pré-eclâmpsia na morbilidade neonatal (p = 0,004), na ocorrência de recém-nascidos de baixo e muito baixo peso ao nascimento (p < 0,01) e em partos prematuros (p < 0,01). Também foi analisada a influência da obesidade materna (p = 0,270; p = 0,992; p = 0,684) e da idade materna avançada nesses 3 desfechos (p = 0,806; p = 0,879; p = 0.985).Usando uma análise multivariada, os únicos modelos com significância estatística para predizer os três desfechos neonatais incluíram apenas a pré-eclâmpsia (p = 0,04; p < 0,01; p < 0,01). Conclusão Apenas a coexistência de pré-eclâmpsia mostrou associação com desfechos neonatais adversos (morbilidade neonatal, recém-nascidos de baixo e muito baixo peso e partos prematuros) e pode ser utilizada como preditor destes em mulheres com diabetes gestacional.

A cross sectional study on out born neonate referral pattern and factors influencing the neonatal outcomes among the out born neonates admitted to sick newborn care units of a government teaching hospital

Background: Neonatal mortality rate (NMR) is one of the major contributors to infant mortality rate. The neonatal mortality depends on many factors birth weight, gestational age, post-natal care; it also depends on maternal social and environmental conditions which contribute to the social determinants of maternal health. This study was taken up to identify maternal social determinants contributing to outcome among outborn neonates in order to reduce neonatal deaths. The present was conducted to assess the outcome among the outborn neonates and assess the maternal social determinants of health affecting the outcome.Methods: A cross sectional study conducted in sick newborn care units (SNCU), Hassan Institute of Medical Sciences, Hassan among all out born neonates. After taking prior written consent, all mothers/bystanders of outborn neonates were interviewed using predesigned, pretested semi-structured proforma. Social factors, environmental conditions and antenatal care affecting the maternal health were collected. Neonatal outcome data was collected from SNCU register. The mothers/bystanders of outborn neonates not willing to give consent and re-admitted neonates were excluded from the study. Data analysis was done using SPSS V20.0.Results: Of 353 outborn neonates admitted, 16.1% was mortality rate. Number of antenatal care visits, consumption of iron tablets, gestational age, high risk mother, staff attending delivery, birth weight, referral time (at p≤0.5) and distance from hospital, passive smoking exposure, maternal services utilization (at p-value <0.1) were significantly associated with poor outcome among outborn neonates.Conclusions: There is need for establishment of SNCUs at sub-divisional levels.

A study of fetomaternal outcome in induction of labour in third trimester oligohydramnios

Background: The Induction of labor in oligohydramnios poses a dilemma for obstetrician. Studies are limited with variable results. This study aims at finding whether isolated oligohydramnios is an indication for operative delivery or labor induction followed by vaginal delivery is possible.Methods: A prospective study carried out on females delivered in study duration in Umaid Hospital, Jodhpur, Rajasthan. Outcomes studied were gestational age at delivery, colour of amniotic fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery, Apgar score at one minute and five minutes, birth weight, admission to Neonatal Intensive Care Unit (NICU), perinatal morbidity and perinatal mortality. Descriptive statistics were applied and data was represented on frequency tables, graphs and diagrams.Results: 40% of subjects had amniotic fluid index (AFI) <5 cm and 60% demonstrated AFI between 5-7 cm. 60% of patients induced delivered vaginally with (38.33%) having AFI <5 cm. Operative delivery was resorted to in 40% of patients. Perinatal outcomes resulted in total 97% of babies discharged in healthy condition.Conclusions: Labor induction is feasible in idiopathic oligohydramnios. Fetal distress is the most feared and predicted outcome with labor induction in oligohydramnios. This study deduced that in majority- reason for c-sections was failed labor induction due the poor Bishop's score, not fetal reasons. We hope by putting at rest apprehensions of obstetrician regarding this notion rate of c-sections could be reduced.

Maternal and neonatal outcome in pregnancy at 40 years and beyond in a tertiary care center: a retrospective case control study

Background: Obstetric outcome in women with advanced maternal age (AMA) is not usually studied especially in India.Methods: This study was a case control study. The cases were pregnancy in 100 women at 40 years of age and beyond and there were two control arms of 100 each of ages 20-29 years and 30-39 years. The demography, maternal complications, delivery outcomes and neonatal outcomes were compared.Results: Women with AMA were mostly multiparous and had higher Body Mass Index (BMI). Hypertensive disease in pregnancy was more common in AMA but the difference was statistically significant. Women with AMA were more likely to have gestational diabetes (p ≤0.011), more likely to have anemia (p=0.038), more likely to have preterm birth (p=0.001), other medical complications compare to the control group (p=0.005). They were also more likely to have Lower Segment Caesarean Section (LSCS) (p ≤0.001) and have postpartum complications. The birth weight of the neonate was significantly decreased in the AMA group (p <0.001). The neonates were also more likely to be admitted to Neonatal Intensive Care Unit (NICU) (p ≤0.006).Conclusions: Adverse maternal and neonatal outcomes were seen despite individualized and optimal obstetric care. Thus, these women need preconceptional counselling.

Obstetrical and perinatal outcome in adolescent pregnancy: a retrospective study at a tertiary care center in rural India

Background: Adolescent pregnancy is a serious health and social problem worldwide. The aim of this study was to determine the obstetrical and perinatal outcomes of nulliparous adolescent pregnancies in a tertiary care centre in rural India.Methods: This is a retrospective study conducted between April 2017 and March 2018.Adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. The factors under study included obstetric complications and neonatal outcomes. The association was considered significant at P-value <0.05.Results: 450 women were included in the study group and 460 to the control group. The incidence of adolescent pregnancy was 18.3% during the study period. The adolescent mothers had a significantly higher incidence of preeclampsia (12.8 % vs 8.4 %; p = 0.03), eclampsia (3.5% vs 1.5%; p = 0.01), preterm delivery (18.6% vs 10.8%; p = 0.0009), low birth weight (39.1 % vs 24.2 %; p = 0.00001),very low birth weight babies (13.7 % vs 8.7 %; p = 0.01) compared to control group. There was higher proportion of NICU admissions in adolescent group (20.8% vs 12.3 %; p = 0.0005) compared to control group. No significant difference was found regarding postpartum complications and still birth.Conclusions: Adolescent pregnancy is associated with poorer feto-maternal outcomes. Regular antenatal visits, adequate nutritional supplementation and early detection of high-risk factors may contribute in decreasing the obstetric risk of childbirth in adolescent mothers.

Elective caesarean section and neonatal outcome: an observational study from a tertiary hospital in Mysore, Karnataka, India

Background: Globally 18.6 percent of all births occur by Caesarean Section (CS) and the trend is increasing. In India CS rates have risen from 2.9% in 1992 to 17.2% in 2015. The optimal timing of CS is still being investigated. Data with regard to elective CS and neonatal outcome from India is sparse and this study aimed to obtain the same in the setting of a South Indian Hospital. The objective was to evaluate neonatal outcome and NICU admissions in elective CSMethods: This was a retrospective study conducted at a tertiary care referral hospital and data collected was of deliveries conducted from Jan 2017 to July 2018. All term singleton pregnancies (>37 gestational weeks) scheduled for elective CS were included in the study.Results: A total of 3174 Caesarean Sections were performed during the study period of which 1087 were elective CS and 2087 were done on an emergent basis. Of these elective CS, 425 (39%) were performed at early term (37+0 until 38+6) and 662 (61%) were performed at full term (>39 weeks). Analysis of adverse neonatal outcomes revealed that a significantly higher rate of NICU admission, low birth weight, respiratory complications in newborns delivered at early term than in those delivered at full term.Conclusions: In the present study newborns delivered at 37- 38 weeks of gestation had a higher rate of NICU admission, low birth weight and respiratory complications compared to newborns delivered after 39 weeks of gestation. Neonatal outcome was found to be better in those elective CS done after 39 weeks in comparison to those delivered at early term (< 39 weeks).

Obstetric outcomes among syrian refugees: A comparative study at a tertiary care Maternity Hospital in Turkey

Abstract Objective The aim of this study was to analyze and compare obstetric and neonatal outcomes between Syrian refugees and ethnic Turkish women. Methods Retrospective, observational study. A total of 576 Syrian refugees and 576 ethnic Turkish women were included in this study, which was conducted between January 2015 and December 2015 at a tertiary maternity training hospital in Ankara, Turkey. The demographic characteristics, obstetric and neonatal outcomes were compared. The primary outcomes were pregnancy outcomes and cesarean rates between the groups Results The mean age was significantly lower in the refugee group (p< 0.001). Mean gravidity, proportion of adolescent pregnancies, proportion of pregnant women aged 12 to 19 years, and number of pregnancies at < 18 years were significantly higher among the refugee women (p< 0.001). Rates of antenatal follow-up, double testing, triple testing, gestational diabetes mellitus (GDM) screening, and iron replacement therapy were significantly lower in the refugee group (p< 0.001). The primary Cesarean section rate was significantly lower in the refugee group (p= 0.034). Pregnancies in the refugee group were more complicated, with higher rates of preterm delivery (< 37 weeks), preterm premature rupture of membranes (PPROM), and low birth weight (< 2,500 g) when compared with the control group (4.2% versus 0.7%, p< 0.001; 1.6% versus 0.2%, p= 0.011; and 12% versus 5.8%, p< 0.001, respectively). Low education level (odds ratio [OR] = 1.7, 95% confidence interval [CI] = 0.5-0.1), and weight gain during pregnancy (OR = 1.7, 95% CI = 0.5-0.1) were found to be significant indicators for preterm birth/PPROM and low birthweight. Conclusion Syrian refugees had increased risks of certain adverse obstetric outcomes, including preterm delivery, PPROM, lower birth weight, and anemia. Several factors may influence these findings; thus, refugee women would benefit from more targeted care during pregnancy and childbirth.

Pregnancy Outcomes In Women With Preexisting And Gestational Diabetes Mellitus

Context: Diabetes in pregnancy is increasing and associated with increased risk of complications. There is little data on whether the pregnancy outcomes have changed over time. Aim:The aim is to compare rates of pregnancy outcomes between women with preexisting diabetes and gestational diabetes (GDM). Settings and Design:This was a prospective observational study done in women with preexisting diabetes and GDM. Methods and Material: Baseline characteristics and medical comorbidities were recorded. Women were counseled regarding life style modification (LSM) and glycemic goals. Metformin and/or insulin were used accordingly. Maternal outcomes and neonatal outcomes were assessed. Results: Out of 183 subjects who were enrolled, 74 (40 %) were women with preexisting diabetes and 109 (60%) were GDM. More than 50% of patients required combination of LSM, metformin and insulin in both groups. Pregnancy weight gain was higher in GDM (11.15±3.48) compared to preexisting diabetes (10.07±3.25; p<0.05). Preterm delivery was more in preexisting diabetes (43.28%) than GDM (25.24%; p=0.01). There were higher miscarriages in preexisting diabetes compared to GDM (p=0.02) whereas intra uterine deaths were similar in both groups. Prevalence of PIH was 26.86% in preexisting diabetes and 15.53% in GDM (p=0.08). Caesarean section rate was 89.55% in preexisting diabetes and 87.37% in GDM. Birth weight was higher in neonates of GDM compared to preexisting diabetes (3.05±0.42 versus 2.88±0.52, p=0.02). There were four neonates with congenital malformations in preexisting diabetes and none in GDM. Conclusions: The present study in women with Preexisting Diabetes and GDM showed higher miscarriages and higher preterm deliveries in preexisting diabetes. There were high rates of caesarean section, reduced macrosomia and lesser congenital malformations in the present study.