Serum magnesium level at 24 to less than 37 weeks: a prospective COHORT study predicting spontaneous preterm delivery

Background: Preterm labour is a leading cause of perinatal morbidity and mortality. Out of various causes, many macronutrients and micronutrients are said to have a role in pathogenesis of preterm labour, one of them is magnesium. Magnesium inhibits myometrial contractions by antagonizing calcium mediated uterine contractions. With advancement of pregnancy serum magnesium levels falls causing hyper excitability of neuromuscular junction bringing in uterine hyperactivity. The study was aimed to measure and compare the level of serum magnesium in preterm labour and normal pregnancy and to find the association of serum magnesium level with preterm labour.Methods: This cohort observational study was done in Department of Obstetrics and Gynaecology, King George's Medical University, Lucknow and eligible participants i.e., pregnant women with singleton gestation between 24 and <37 weeks of gestation were enrolled.112 women with preterm labour and 120 with no preterm labour were taken as study and control group respectively, serum magnesium level measured and followed till delivery.Results: The study showed mean serum magnesium level was 1.79�22 mg/dl in study group as compare to 1.98�25 mg/dl in control group and the difference was statistically significant (p<0.001). The value of Serum Magnesium below 1.885 mg/dl had a sensitivity of 64.8% and specificity of 66.1%.Conclusions: We can conclude that low serum magnesium is associated with preterm labour and serum magnesium estimation in pregnancy may be a valuable marker of predicting preterm labour.

Decision-to-delivery interval and obstetric outcomes of emergency caesarean sections in a Nigerian teaching hospital

Prolonged Decision-to-Delivery interval (DDI) is associated with adverse maternal-foetal outcomes following emergency Caesarean section (EmCS). Objectives: To determine the DDI, predictive factors, and the foeto-maternal outcomes of patients that had EmCS in a Nigerian Teaching Hospital. Methods: A descriptive study of all EmCS performed at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria, from 1st June 2020 to 31st May 2021, was conducted. Relevant data were extracted from the documentations of doctors, nurses and anaesthetists using a designed proforma. The data obtained were analysed using the IBM SPSS Statistics for Windows, version 25. Results: The median (IQR) DDI was 297 (175-434) minutes. Only one patient was delivered within the recommended DDI of 30 minutes. The most common cause of prolonged DDI was delay in procuring materials for CS by patients' relatives(s)/caregiver(s) (264, 85.2%). Repeat CS (AOR = 4.923, 95% CI 1.09-22.36; p = 0.039), prolonged decision-to-operating room time (AOR = 8.22, 95% CI 1.87-8.66; p<0.001), and junior cadre of surgeon (AOR = 25.183, 95% CI 2.698-35.053; p = 0.005) were significant predictors of prolonged DDI. Prolonged DDI > 150 minutes was significantly associated with maternal morbidity (p = 0.001), stillbirth (p = 0.008) and early neonatal death (p = 0.049). Conclusion: The recommended DDI of 30 minutes for CS is challenging in the setting studied. To improve foetomaternal outcomes, efforts to reduce the DDI should be pursued vigorously, using the recommended 30 minutesas a benchmark.

Shortened versus standard post-partum maintenance therapy of magnesium sulphate in severe pre-eclampsia: a randomised control trial

Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.

La preeclampsia: un problema intrincado / Preeclampsia: an intricate problem

Sin conocer aún el origen preciso de la preeclampsia, sabemos hoy que es un trastorno con fondo genético e inmunológico-inflamatorio que compromete el endotelio y, con alteraciones metabólicas y de estrés oxidativo, es definida como la presencia de hipertensión arterial con compromiso multiorgánico en una gestante. Produce serio compromiso materno y feto-neonatal y la posibilidad de secuelas metabólicas y cardiovasculares en el futuro para ambos. Sin medidas de prevención o terapéuticas efectivas, la preeclampsia debe ser sospechada por su historia obstétrica o familiar y por la sintomatología de compromiso orgánico, como cefalea, dolor en hipocondrio derecho, falta de crecimiento uterino, compromiso del bienestar fetal, entre otros. La terminación del embarazo será a las 37 semanas de preferencia y de acuerdo al estado materno y fetal. La atención del puerperio será preferente.

The origin of preeclampsia is not known but is considered a genetic-immuno-inflammatory disorder that compromises the endothelium along with metabolic alterations and oxidative stress. It is currently defined as presence of arterial hypertension and multiorganic involvement in a pregnant woman. Mother and the fetus-neonate are dangerously ill and are prone to metabolic and cardiovascular sequelae in the future. Preventive and therapeutic measures are not effective, but preeclampsia should be suspected considering obstetrical and familiar background and by organic symptomatology including headache, right upper abdominal pain, lack of uterine growth, fetal compromise and others. Pregnancy termination is recommended at 37 weeks of gestation and according to maternal and fetal wellbeing. Care in the puerperium should be preferential.

Perfil epidemiológico y perinatal de pacientes con preeclampsia / Epidemiological and perinatal profile of preeclampsia patients

Introducción: la preeclampsia es un problema obstétrico mayor que acarrea importante morbilidad y mortalidad materna y perinatal por los trastornos sistémicos asociados. Objetivo: comparar los resultados maternos y perinatales en gestantes que cursaron con preeclampsia en sus diferentes presentaciones clínicas. Métodos: estudio prospectivo, descriptivo, transversal, realizado en el hospital "Enrique Cabrera", desde el 1ro. de enero de 2010 al 31 diciembre de 2011. De las gestantes con trastornos hipertensivos (n = 293), se eligieron aquellas con preeclampsia (n = 89) y se dividieron en tres grupos: preeclampsia leve (n = 30), preeclampsia grave (n = 48) y preeclampsia sobreañadida (n = 11). Variables epidemiológicas, obstétricas y perinatales se procesaron por el sistema estadístico SPSS-11,5, utilizando estadística descriptiva, comparación de proporciones mediante la prueba de Chicuadrado y estimado de medias de variables cuantitativas con ANOVA-Eta, considerando la diferencia estadísticamente significativa p £ 0,05. Resultados: predominaron las adolescentes en la preeclampsia grave (25 %) y las ³ 35 años en la preeclampsia sobreañadida (p = 0,002), la obesidad también prevaleció en la preeclampsia sobreañadida (54,5 %, p = 0,01). La mayoría del grupo con preeclampsia leve (60 %) y preeclampsia grave (64,6 %) eran nulíparas, p = 0,009. Fue significativo el índice de prematuridad de la preeclampsia grave (43,8 %, p = 0,005) y el parto por cesárea señoreó en todos los grupos, fundamentalmente en la preeclampsia grave (93,8 %, p = 0,000). La media del peso al nacer fue significativamente inferior en la preeclampsia grave (2 451 g, p = 0,01). Conclusiones: no hubo grandes diferencias en cuanto a los resultados perinatales entre las pacientes que cursaron con los distintos grados de severidad de la preeclampsia.

Introduction: preeclampsia is a major obstetric problem that carries significant morbidity and maternal and perinatal mortality due to associated systemic disorders. Objective: to compare maternal and perinatal outcomes in pregnant women who had preeclampsia in their different clinical presentations. Methods: a prospective, descriptive, cross-sectional study was conducted at Enrique Cabrera hospital from January 1st, 2010 to December 31st 2011. Out of the pregnant women with hypertensive disorders (n = 293), those with preeclampsia (n = 89) were chosen; and they were divided into three groups, mild preeclampsia (n = 30), severe preeclampsia (n = 48) and superimposed preeclampsia (n = 11). Epidemiological, obstetric, and perinatal variables were processed by the SPSS-11, 5 statistical systems, using descriptive statistics, comparison of proportions by Chi-square test and the estimated mean of quantitative variables with ANOVA-Eta, considering the statistically significant difference p ? 0.05. Results: the adolescents had more severe preeclampsia (25 %) and ³ 35 year old patients in the superimposed preeclampsia (p = 0.002), obesity also prevailed in the superimposed preeclampsia (54.5 %, p = 0.01). Most of the patients in the mild PE group (60 %) and severe preeclampsia (64.6 %) were nulliparous, p = 0.009. Prematurity index of severe preeclampsia (43.8 %, p = 0.005) was significant; cesarean delivery was high in all groups, mainly in severe preeclampsia (93.8 %, p = 0.000). The mean birth weight was significantly lower in severe preeclampsia (2 451 g, p = 0.01). Conclusions: there were no major differences in perinatal outcomes among patients who were enrolled with various degrees of preeclampsia severity.

Perinatal outcome in anaemic pregnant women in South-Western Nigeria.

Background: Anaemia in pregnancy is a global public health problem in most developing and developed countries with major consequences for human health as well as social and economic development. Fetuses of anaemic mothers are at risk of preterm deliveries, low birth weights, morbidity and perinatal mortality due to the impairment of oxygen delivery to placenta and foetus. Methods: This study was conducted at the antenatal clinic and labour ward complex of a teaching hospital in south-western Nigeria to determine the effect of anaemia in pregnancy on perinatal outcome. Eligible participants were enrolled for the study by consecutive sampling method. Relevant data were extracted from the case records of these eligible women and a structured interviewer administered questionnaire was used for the data collection. Results: There were statistically significant differences between anaemia and reduced gestational age at birth (P = 0.000), low one-minute (P = 0.000) and five-minute (P = 0.003) Apgar scores, reduced birth weight (P=0.005) and foetal death (P = 0.013). No significant difference was noted in the rate of neonatal admission in the two groups (P = 0.085). Conclusion: This study has thus highlighted the importance of considering maternal anaemia as an indicator of adverse perinatal outcomes. There is therefore, a need to counsel intending mothers and their partners about early antenatal booking, compliance with routine antenatal medications and prompt identification and treatment of anaemia in pregnancy, all as means of curtailing the overwhelming perinatal morbidity and mortality associated with the condition.

Eclampsia: repercusión materna y perinatal / Eclampsia: maternal and perinatal repercussion

Determinar la incidencia de eclampsia y su repercusión materna y perinatal en el Departamento de Obstetricia y Ginecología. Departamento Clínico Integral de la Costa. Universidad de Carabobo. Hospital “Dr. Adolfo Prince Lara” Puerto Cabello. Estudio descriptivo, retrospectivo, longitudinal y analítico de 40 casos con diagnóstico de eclampsia en 31 532 nacimientos en un período de 10 años: 1998 - 2007. La incidencia fue de 0,13 por ciento, 1 caso por cada 788 nacimientos. Predominó el grupo etario de 10 - 19 años (52,5 por ciento), concubinas 60 por ciento, grado de instrucción primaria (60 por ciento). Prevaleció el antecedente familiar de hipertensión en la madre (25 por ciento), el antecedente personal de preeclampsia en embarazo anterior (12,5 por ciento). Los principales signos y síntomas fueron: hiperreflexia (65 por ciento), cefalea (50 por ciento), escotomas y amaurosis (20 por ciento). La primera convulsión se presentó ante-parto (75 por ciento). Sin control de embarazo (55 por ciento). Destacaron las I gestas (72,5 por ciento), edad de embarazo 37-41 semanas (50 por ciento), tipo de parto: cesárea (85 por ciento). En los resultados perinatales prevaleció: neonatos deprimidos (52,5 por ciento), peso neonatal entre 2.500-3.499 g (50 por ciento), con morbilidad de 30,55 por ciento, la mayoría debido a síndrome de dificultad respiratoria. La mortalidad fetal fue de 9,09 por ciento y la mortalidad neonatal 9,09 por ciento. Morbilidad materna fue de 53,84 por ciento, asociada: síndrome Hellp (23,07 por ciento), insuficiencia renal aguda (7,69 por ciento), desprendimiento prematuro de placenta (7,69 por ciento); hubo una muerte materna (2,5 por ciento). Es importante que todas las mujeres embarazadas reciban atención médica continua y oportuna, lo cual permite el diagnóstico y tratamiento temprano de afecciones como la pre-eclampsia y eclampsia, esta última es una de...

To determine the incidence of eclampsia and maternal and perinatal impact en el Departamento de Obstetricia y Ginecologia, Hospital “Dr. Adolfo Prince Lara”, Departamento Clínico Integral de la Costa, Universidad de Carabobo. Puerto Cabello. A descriptive, retrospective, longitudinal and analytical diagnosis of 40 cases in 31 532 births eclampsia over a period of 10 years from 1998 to 2007. The incidence was 0.13 percent, 1 case per 788 births. The predominant age group of 10 - 19 years (52.5 percent), concubines 60 percent, primary education level (60 percent). The prevailing family history of hypertension in the mother (25 percent), personal history of preeclampsia in previous pregnancy (12.5 percent). The main signs and symptoms were hyperreflexia (65 percent), headache (50 percent), scotoma and amaurosis (20 percent). The first seizure came before delivery (75 percent). Without birth control (55 percent). First gravity (72.5 percent), gestational age 37-41 weeks (50 percent), type of delivery: cesarean section (85 percent). Prevailed in perinatal outcomes: depressed neonates (52.5 percent), birth weight between 2 500-3 499 g (50 percent), with morbidity of 30.55 percent, mostly due to respiratory distress syndrome. Fetal mortality was 9.09 percent and 9.09 percent neonatal mortality. Maternal morbidity was 53.84 percent, associated: HELLP syndrome (23.07 percent), acute renal failure (7.69 percent), abruption (7.69 percent) there was one maternal death (2.5 percent ). It is important that all pregnant women receive ongoing and timely medical care, allowing early diagnosis and treatment of conditions such as pre-eclampsia and eclampsia, the latter is a major obstetric emergencies, this review reveals once again that contributes decisively to the morbidity and maternal and perinatal mortality. It involves an early and intensive support to reduce their impact.

Flujometría Doppler patológica y su correlación con el pronóstico perinatal a corto plazo

Objetivos: Determinar la morbilidad y mortalidad de fetos con flujometría Doppler patológico y evaluar discapacidades en el corto plazo. Diseño: Estudio tipo retrospectivo, observacional, analítico, correlacional. Lugar: Unidad de vigilancia fetal, Hospital Nacional Edgardo Rebagliati Martins, Red Asistencial Rebagliati, EsSalud, Lima, Perú. Participantes: Gestantes con flujometría Doppler patológicos y sus perinatos. Intervenciones: Se estudió todos los casos de gestantes con flujometría Doppler alterado, entre febrero de 2008 y febrero de 2010. Se agrupó por tipos de flujometría Doppler y se describió la frecuencia de patología y morbimortalidad perinatal, correlacionándolas con la edad gestacional. El análisis se realizó con el paquete estadístico SPSS 11,0, la prueba chi cuadrado para las variables discretas y la de Kruskal-Wallis, para las variables continuas. Se asumió un valor de significancia de p < ,005. Principales medidas de resultados: Morbilidad y mortalidad perinatal, discapacidades motoras, auditivas y psicomotoras a las 6 meses de edad. Resultados: Sesentaitrés gestantes cumplieron con el criterio de inclusión. El peso medio al nacer de sus fetos fue 1 593 g; 24 casos (40%) presentaron peso al nacer menor al percentil 10 para la edad gestacional. La mayor parte mostró flujometría Doppler tipo III, 46 casos con signos de redistribución hemodinámica. La mortalidad global fue 8%. Cuatro fetos murieron intraútero; 59 fetos (94%) llegaron a nacer vivos; de ellos solo un caso falleció durante el periodo de estudio. La tasa global de mortalidad fue significativamente mayor y el peso al nacer más bajo en el grupo de fetos con flujometría Doppler tipo IV, con una media de 937 g. La mortalidad fue significativamente más alta en el grupo de 24 a 27,6 semanas. La estancia en UCI, la necesidad de ventilación asistida (VM) y presión positiva continua, el riesgo de desarrollar retinopatía y hemorragia interventricular y las discapacidades auditivas y trastorno del desarrollo psicomotor estuvieron correlacionados con la prematuridad. Conclusiones: Los casos de flujometría Doppler con compromiso hemodinámico severo presentaron acidemia y tasa alta de mortalidad, independiente del percentil de crecimiento al nacer. La mortalidad intraútero se asoció significativamente a la severidad mostrada por el estudio Doppler, por lo que no se recomienda continuar el embarazo en los tipos III y IV, si hay madurez pulmonar fetal.

Objectives: To determine both morbidity and mortality in fetuses with pathological Doppler velocimetry and short term handicap. Design: Retrospective, observational, analytical, correlation study. Setting: Fetal surveillance unit, Hospital Nacional Edgardo Rebagliati Martins, Red Asistencial Rebagliati, EsSalud, Lima, Peru. Participants: Pregnant women with pathological Doppler velocimetry and their perinates. Interventions: All pregnant women with altered Doppler velocimetry between February 2008 and February 2010 were studied. They were grouped by Doppler velocimetry types, and frequency of pathology; perinatal morbidity and mortality were determined and correlated with gestational age. SPSS 11,0 was used for statistical analysis, chi square test for discrete variables and Kruskal-Wallis test for continued variables. Significant value was p < ,005. Main outcome measures: Perinatal morbidity and mortality, motor, hearing and psychomotor discapacities at 6 months after birth. Results: Sixty-three pregnant women fulfilled inclusion criteria. Their mean newborns weight was 1 593 g; 24 cases (40%) presented weight at birth less than 10th percentile for gestational age. Most of them showed type III Doppler velocimetry, 46 with signs of hemodynamic redistribution. Global mortality was 8%. Four fetuses died in utero; 59 fetuses (94%) were born alive and only one case died during the study period. Mortality rate was significantly higher and birth weight less in type IV Doppler velocimetry fetuses, mean weight 937 g. Mortality was significatively higher at 24-27,6 weeks. ICU stay, need of assisted ventilation and continuous positive pressure, risk to develop retinopathy and interventricular hemorrhage, and hearing and psychomotor discapacities correlated with prematurity. Conclusions: Doppler velocimetry fetuses with severe hemodynamic compromise presented acidemia and high mortality rate, independent of growth percentile. Intrauterine mortality was significantly associated with Doppler velocimetry severity changes. To continue pregnancy with type III or IV Doppler velocimetry is not recommended in fetuses with lung maturity.

The Clinical Characteristics of Pregnancy Induced Hypertension / 대한주산의학회잡지

OBJECTIVE: To study the clinical characteristics of pregnancy induced hypertension(PIH). METHODS: Five hundred seventy-five cases of PIH and 7,702 cases of normotensive pregnancies who were delivered their infants at Wonkwang University Hospital from January, 1994 to December, 1998 were selected for the study. The data were collected by review of the hospital record and the statistical analysis was performed using Chi-square tests, and statistical significance was defined as p<0.05. RESULTS: The incidence of PIH was 7.1% of total deliveries. Among the PIH, the incidence of mild preedampsia was found in 59%, severe preeclampsia in 36%, and edampsia in 5%. The most prevalent gestational period was 38-42wks gestation in mild PIH and 33-37wks gestation in severe PIH & eclampsia. The incidence of cesarean section was significantly higher in severe PIH & eclampsia(72.2%) than in mild PIH(48.7%) and normotensive pregnancies(39.7%). The incidence of hypoalbuminemia, preterm labor, placental abruption, disseminated intravascular coagulation, and pulmonary edema were significantly higher in severe PIH & edampsia than in mild PIH and normotensive pregnancies. Compared with normotensive pregnancies or mild PIH, severe PIH & eclampsia had significantly elevated risks for low birth weight, intrauterine growth retardation, fetal distress, low apgar score, meconium stained, and neonatal deaths. CONCLUSION: The incidence of PIH is not decreasing and it still an important role in the cause of maternal and perinatal mortality and morbidity in Korea. So, further studies are necessary to prepare a guide for the treatment of PIH.

Diabetes mellitus durante la gestación y morbimortalidad perinatal / Gestacional diabetes and perinatal morbimortality in Medellín, Colombia

El análisis retrospectivo de 166 pacientes embarazadas y con diagnóstico de diabetes mellitus, atendidas en el Hospital Universitario San Vicente de Paúl, de Medellín, Colombia, permite apreciar un registro inadecuado de la información, lo que le resta confiabilidad, y la carencia de protocolos apropiados de manejo. La diabetes gestacional (DMG) se presentó en 81 pacientes (48.8 por ciento), seguida por la diabetes mellitus no insulino dependiente (DMNID) (69 pacientes; 41.5 por ciento) y por último la diabetes insulina dependiente (DMID) en 16 pacientes (9.6 por ciento). Se halló una tasa de morbilidad perinatal del 52.2 por ciento (72 casos de los 138 en que se dispuso de información), inaceptable para esta población, distribuida así por entidades: macrosomía (16 casos; 22.2 por ciento), sufrimiento fetal agudo (15 casos; 20.8 por ciento), sufrimiento fetal crónico (10 casos; 13.9 por ciento), polihidramnios (9 casos; 12.5 por ciento), hipoglicemia (8 casos; 11.1 por ciento), trauma fetal (6 casos; 8.3 por ciento), síndrome de dificultad respiratoria (5 casos; 6.9 por ciento) hiperbilirrubinemia (5 casos; 6.9 por ciento) e hipocalcemia (1 caso). Cabe resaltar que las entidades potencialmente prevenibles (macrosomía, sufrimiento fetal agudo y crónico, polihidramnios, trauma fetal y síndrome de dificultad respiratoria ) fueron más frecuentes en la población de DMNID y DMG, lo que refleja un manejo clínico inadecuado. La mortalidad fetal fue del 3.6 por ciento (5 casos) y en tres de ellos se asoció a hipertensión materna. Se puso en evidencia la urgente necesidad de un protocolo interdisciplinarlo de manejo clínico, con el cual se puedan establecer un registro adecuado y pautas de manejo conforme a las necesidades de la población de riesgo que atiende esta Institución de referencia

Retrospective analysis of 166 pregnant women with gestational diabetes mellitus, at San Vicente de Paúl Hospital, Medellín, Colombia, evidenced inadequate registration of information and lack of clinical management protocols, despite the fact that this is a reference institution. Gestational diabetes mellitus (GDM) was found in 81 patients (48.8%), non-insulin-dependent diabetes mellitus (NIDDM) in 69 (41.5%) and insulin-dependent diabetes mellitus (IDDM) in 16 (9.6%). Perinatal morbidity rate was 52.2% (72 cases among the 138 in which information was available), distributed as follows: macrosomy (16 cases; 22.2%), acute fetal distress (15 cases; 20.8%), chronic fetal distress (10 cases; 13.9%), polyhydramnios (9 cases; 12.5%), hypoglycemia (8 cases; 11.1 %) and delivery fetal trauma (6 cases; 8.3%). It was remarkable that the potentially preventable entities (macrosomy, acute and chronic fetal distress, polyhydramnios, fetal trauma and respiratory failure syndrome) were more frequent in NIDDM and GDM groups, indicating an inadequate clinical management; fetal mortality was 3.6% (5 patients) mostly associated to maternal hypertension. These results point out to the urgent need of establishing in this third level hospital an interdisciplinary management protocol of gestational diabetes, with apropriate registration of information and clear clinical guides