Análise dos efeitos em fetos expostos à hiperêmese gravídica durante a gravidez / Analysis of the effects on fetuses exposed to hyperemesis gravidarum during pregnancy

INTRODUÇÃO: De etiologia desconhecida, a hiperêmese gravídica é um quadro caracterizado por vômitos persistentes, perda de 5% ou mais do peso, cetonúria, hipocalemia e desidratação. Acredita-se que a gonadotrofina coriônica humana (hCG) provoque aumento das náuseas e vômitos por meio de seu estímulo à produção de estrogênio pelo ovário, provocando a exacerbação dos sintomas do "enjoo matinal". OBJETIVO: Logo, essa revisão narrativa tem como objetivo analisar as repercussões fetais do quadro de hiperêmese gravídica. MÉTODOS: Foram realizadas buscas em Sistema Online de Busca e Análise de Literatura Médica - MEDLINE®. Sendo utilizadas os Medical Subject Headings (MeSh terms) e seus sinônimos: "hyperemesis gravidarum", "fetal risks", sendo selecionados ao todo 13 artigos. RESULTADOS: Os estudos demonstraram que a hiperêmese gravídica pode trazer malefícios para mãe e feto. A gestante pode apresentar distúrbios eletrolíticos, encefalopatia de Wernicke, fraqueza muscular, disfunções emocionais como depressão, ansiedade e estresse pós-traumático. DISCUSSÃO: Os estudos revelaram que a patologia pode estar relacionada ao risco aumentado para desfechos adversos no nascimento, como baixo peso ao nascer, nascimento prematuro e pequena estatura para idade gestacional. Ademais, alguns estudos relataram os riscos prejudiciais no neurodesenvolvimento do recém-nascido, como problemas psicológicos e comportamentais na idade adulta, redução à sensibilidade à insulina, e comorbidades (obesidade e doenças cardiovasculares) além de distúrbios de desenvolvimento neuropsicomotor. CONCLUSÃO: Gestantes que apresentam o quadro de hiperêmese gravídica devem ser regularmente acompanhadas com consultas entre 1 a 2 semanas, conforme a gravidade do caso e o mais precocemente possível tratadas, a fim de evitar maiores complicações tanto maternas quanto fetais.

INTRODUCTION: Of unknown etiology, hyperemesis gravidarum is a condition characterized by persistent vomiting, 5% or more weight loss, ketonuria, hypokalemia and dehydration. Human chorionic gonadotropin (hCG) is believed to cause increased nausea and vomiting through its stimulation of estrogen production by the ovary, causing exacerbation of "morning sickness" symptoms. OBJECTIVE: Thus, this narrative review aims to analyze the fetal repercussions of hyperemesis gravidarum. METHODS: Searches were performed in the Online Medical Literature Analysis and Search System - MEDLINE®. The Medical Subject Headings (MeSh terms) and their synonyms were used: "hyperemesis gravidarum", "fetal risks", being selected a total of 13 articles. RESULTS: The studies showed that hyperemesis gravidarum can bring harm to mother and fetus. The pregnant woman may present electrolyte disturbances, Wernicke's encephalopathy, muscle weakness, emotional dysfunctions such as depression, anxiety, and post-traumatic stress. DISCUSSION: The studies revealed that hyperemesis gravidarum may be associated with increased risk of adverse outcomes. Furthermore, some studies reported harmful risks in neurodevelopment of the newborn, such as psychological and behavioral problems in adulthood, reduced sensitivity to insulin, and comorbidities (obesity and cardiovascular diseases) and neurodevelopmental disorders. CONCLUSION: Pregnant women who present with hyperemesis gravidarum should be followed up with consultations between 1 to 2 weeks, according to the severity of the case and treated as early as possible in order to avoid further complications both maternal and fetal.

Lactate and pH values in newborns with a history of acute fetal distress / Valores de lactato y pH en recién nacidos con antecedente de sufrimiento fetal agudo

Abstract Background: Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD. Methods: We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2. Results: Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity. Conclusions: Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.

Resumen Introducción: El sufrimiento fetal agudo (SFA) es una condición que amerita un diagnóstico oportuno debido a que genera hipoxia, acidosis e incluso la muerte intrauterina. El objetivo de este estudio fue determinar los valores de lactato y pH en cordón umbilical en recién nacidos de término con antecedente SFA. Métodos: Se llevó a cabo un estudio transversal, en recién nacidos a término, de madres que tuvieron al menos un antecedente para SFA de tipo perinatal, neonatal o gasométrico. Se consideró morbilidad neonatal cuando presentaron Apgar al minuto ≤ 6, o requirieron maniobras avanzadas de reanimación neonatal, o ingreso a Unidad de Cuidados Intensivos Neonatales (UCIN). El punto de corte fue > 4 mmol/L para los valores de lactato y pH < 7.2. Resultados: De un total de 66 recién nacidos, el 33.3% de las madres presentaron al menos un antecedente para desarrollar SFA; el 22.7% presentó enfermedad hipertensiva del embarazo, el 13.6%, oligohidramnios, y el 63.6%, otros factores. El 28.7% requirieron maniobras avanzadas de la reanimación neonatal y el 7.5%, el ingreso a la UCIN. En la gasometría, el valor de lactato y pH para el grupo de recién nacidos con morbilidad neonatal fue de 4.726 ± 1.401 y 7.293 ± 0.056 respectivamente, versus 2.240 ± 0.318 y 7.359 ± 0.022 (p < 0.05) para el grupo sin morbilidad neonatal asociada. Conclusiones: Se observó un incremento del 25% de los valores de lactato en cordón umbilical y una disminución del 1% del pH en los recién nacidos con antecedente de SFA y morbilidad asociada.

Correlation between meconium-stained amniotic fluid and intrauterine infection / 中华实用儿科临床杂志

Fetal hypoxia has long been described as the main cause of meconium-stained amniotic fluid (MSAF). However, recent studies have reported the presence of a variety of pathogenic microorganisms in meconium and amniotic fluid, and even more bacterial species in MSAF.Clinical observations also revealed that MSAF was closely related to fetal-neonatal infection and perinatal infection of pregnant women.Shortly after birth, the fetuses with MSAF developed infectious symptoms or showed abnormalities in infection-related laboratory indicators.Therefore, intrauterine infection may be one major cause of MSAF.To further our understanding of the factors leading to MSAF will improve the clinical management and prognosis of infants.

Prenatal repair of gastroschisis using partial carbon dioxide insufflation fetoscopy: lessons learned

ABSTRACT We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair.

The effect of COVID-19 fear on prenatal distress and childbirth preference in primipara

SUMMARY OBJECTIVE: The purpose of this study was to examine the effect of COVID-19 fear on prenatal distress and childbirth preference in primipara. METHODS: This descriptive and cross-sectional study was conducted with 206 primipara women in Istanbul between June and December 2021. The data were collected with an information form, "The Fear of COVID-19 Scale" and "The Prenatal Distress Questionnaire." RESULTS: The median of the Fear of COVID-19 Scale was 14.00 (7-31) and the median of the Prenatal Distress Questionnaire was 10.00 (0-21). A statistically significant positive and weak correlation was found between "The Fear of COVID-19 Scale" and "The Prenatal Distress Questionnaire" (r=0.21; p=0.00). Overall, 75.2% of pregnant women preferred normal (vaginal) delivery. There was no statistically significant relationship between "The Fear of COVID-19 Scale" and childbirth preference (p>0.05). CONCLUSION: It was determined that fear of coronavirus increases prenatal distress. Women should be supported to cope with fear of COVID-19 and prenatal distress, both during the preconceptional and antenatal periods.

Study of magnitude of grand multiparty and its perinatal outcome in a tertiary hospital of rural area in Maharashtra

Background: Grand multiparous pregnancies have been considered to be at higher risk of developing antenatal and perinatal complica?ons like pre-eclampsia, gesta?onal diabetes mellitus, anemia, antepartum hemorrhages, preterm labor, mal-presenta?on, mal-posi?on and feto-pelvic dispropor?on This study was done to know the magnitude of grand mul?para a?ending the ter?ary care center with possible complica?ons related to high parity. Objec?ves:To study the prevalence possible fetomaternal complica?ons associated with grand mul?para at rural setup. Methodology:Descrip?ve cross-sec?onal study conducted in medical college of rural area for 12 months. Grand mul?para with 5 or more deliveries before current pregnancy coming for antenatal checkup and delivery were enrolled. Antenatal history was recorded ?ll delivery and feto-maternal outcomes were noted. Results:Out of 1500 deliveries conducted during study period, 110 (7.5%) cases were grand mul?para. Majority of them (79.5%) were Muslim and 80% were anaemic. 60% delivered with FTND, and 25.4% had emergency LSCS with one intrauterine death and a single breach delivery. Predominantly preeclampsia (23.6%) and malpresenta?on (14.5%) were diagnosed as antepartum complica?ons. Almost one fi?h of them had postpartum hemorrhage which was controlled with no mortality. 13 (11.8%) grand mul?para women had s?ll birth or early neonatal death, though fetal distress was observed in 37 cases. Conclusion: Grand mul?party is s?ll a high-risk pregnancy associated with adverse maternal and fetal outcomes in our facility with mul?ple interrelated but mostly preventable causes.

A STUDY ON FETO-MATERNAL OUTCOME IN A POSTDATED PREGNANCY

BACKGROUND: The objective of the study is to find out the fetal and maternal complications in post dated pregnancy. This is a prospective observational study. METHODS: Patients who have completed 40weeks of gestational age, meeting the inclusion criteria. RESULTS: Of 100 cases 74(74%) cases were under 20 to 25 years, majority cases were primigravida (66%), overall caesarean rate was 36%, Meconium-stained liquor with fetal distress was the most common indication for LSCS 9(25 %). Fetal distress was the most common fetal complications, number of induced labor is 71.4% at 41 weeks 1 day to 42 weeks CONCLUSION: In our study we concluded that prolonged pregnancy was associated with significant risk of perinatal complications like fetal distress, meconium aspiration syndrome and IUGR. There was significantly increased risk of obstetric complications like oligohydramnios, perineal tear, atonic PPH and shoulder dystocia.

Subcutaneous terbutaline and oral nifedipine for intrapartum fetal resuscitation: a prospective randomized controlled study / 中华围产医学杂志

Objective:To compare the safety and efficacy of terbutaline and nifedipine for acute intrapartum fetal resuscitation (IUFR).Methods:This was a prospective randomized controlled study involving 110 pregnant women with non-reassuring fetal heart rate tracings (NRFHT) during delivery at Guangzhou Women and Children's Medical Center between January and April 2021. These women were randomly allocated to receive subcutaneous terbutaline sulphate (0.25 mg, terbutaline group) or oral nifedipine (10 mg, nifedipine group), with 55 subjects in each group. Hemodynamic parameters including blood pressure, heart rate, and oxygen saturation before and 5, 15 and 30 min after treatment as well as the success rate of intrapartum resuscitation, the onset time of medication, and the incidence of postpartum hemorrhage were analyzed using t test, Chi-square test or Fisher's exact test. Results:Two groups both showed no significant difference in the mean arterial pressure or oxygen saturation before or after treatment (all P>0.05). The heart rate was not affected in nifedipine group at any time points ( P>0.05). While the patients treated with terbutaline showed accelerated maternal heart rate 5, 15 and 30 min after administration as compared with the baseline[(97.0±20.2), (99.2±13.8), (91.8±12.6) vs (81.7±11.3) bpm, all P<0.001], but it began to decrease at 30 min, with a drop of 6.4 bpm compared with that at 15 min (95% CI: 1.5-11.2, P<0.05). None of the pregnant women had adverse reactions requiring medical intervention. The rates of successful acute resuscitation were similar in the two groups [terbutaline: 78.2% (43/55) vs nifedipine: 70.9% (39/55), χ 2= 0.77, P=0.381]. Terbutaline had a shorter onset time than nifedipine in slowing the frequency of contractions and returning fetal heart rate to class Ⅰ category [2(1-6) vs 6(1-10) min, U=2 348.50, P<0.001]. No significant difference was found between the two groups in terms of NRFHT-indicated cesarean section, assisted vaginal delivery, or second dose of tocolysis within 1 h (all P>0.05) nor in blood loss volume, postpartum hemorrhage rate, low Apgar score, low umbilical artery pH value (pH<7.2), neonatal asphyxia rate, or neonatal intensive care admission rate (all P>0.05). Conclusion:Terbutaline spends less time than nifedipine to take effect and may be an alternative for acute IUFR without significant adverse outcomes.

Effect of excessive umbilical cord torsion on fetal and neonatal outcomes / 中国新生儿科杂志

Objective:To study the effect of excessive torsion of the umbilical cord on fetal or neonatal outcomes.Methods:The observation group was selected from the puerperae who delivered in Beijing Obstetrics and Gynecology Hospital from July 2016 to June 2020 with excessive torsion of the umbilical cord. In the same period, the puerperae without excessive torsion of the umbilical cord were selected as the control group with a ratio of 1∶1. The general condition, mode of delivery, perinatal outcomes, and the effect of different umbilical coiling index (UCI) [twisted umbilical cord weeks/umbilical cord length (cm)] on fetal and neonatal outcomes were retrospectively analyzed between two groups.Results:Compared with the control group, the observation group (1 780 cases) had smaller neonatal gestational age [(37.9±3.2) weeks vs. (38.4±2.9) weeks], birth weight [(3 007±726) g vs. (3 354±616) g] and length [(48.5±4.3) cm vs. (49.6±4.1) cm], but higher incidence of fetal distress [34.9% (622/1 780) vs. 12.9% (230/1 780)], neonatal asphyxia [1.5% (26/1 780) vs. 0.7% (13/1 780)], and cord blood pH<7.20 [4.2% (75/1 780) vs. 2.8% (49/1 780)], the difference was statistically significant ( P<0.05). The UCI≥0.73 group had lower neonatal gestational age, birth weight and length, but higher incidence of cord blood pH<7.20 and neonatal asphyxia than the UCI<0.73 group, with statistically significant differences ( P<0.05). Conclusions:Excessive torsion of the umbilical cord increases the incidence of fetal hypoxia and neonatal asphyxia and has a significant effect on neonatal gestational age, birth weight and length. The higher the UCI, the greater the impact on fetus and neonate.

Reporte de caso: ruptura uterina durante trabajo de parto, en útero sin cicatriz previa / Case review: uterine rupture during labor, in uterus without previous scar

Resumen La ruptura uterina es una complicación obstétrica poco frecuente con una alta morbilidad y mortalidad materna e infantil. El diagnóstico precoz y el tratamiento inmediato son factores pronósticos importantes tanto para la madre como para el feto. Se presenta el caso de una paciente multigestante, con alto riesgo por diabetes gestacional compensada y déficit de proteína S sin manejo, con embarazo a término y adecuado control prenatal, que ingresa hemodinámicamente estable, con cambios cervicales iniciales, feto en presentación longitudinal, cefálico con monitoreo fetal categoría ACOG 1 para conducción del trabajo de parto, y presenta ruptura uterina espontánea, dando lugar a un hemoperitoneo materno y sufrimiento fetal agudo con posterior tratamiento quirúrgico de urgencia mediante una cesárea e histerectomía, por atonía uterina sin control del sangrado con maniobras farmacológicas. Este caso es muy significativo por la falta de factores de riesgo y su presentación clínica atípica, tanto en síntomas y signos como en la ubicación de la ruptura. MÉD. UIS.2021;34(1): 107-12.

Abstract Uterine rupture is a rare obstetric complication with high maternal and infant morbidity and mortality. Early diagnosis and immediate treatment are important prognostic factors for both mother and fetus. The study presents the case of a multigravida patient, with high risk for compensated gestational diabetes, and uncontrolled protein S deficiency. The patient, who was full-term and had adequate prenatal control, was admitted hemodynamically stable, with initial cervical changes, fetus in longitudinal presentation, andcephalic with monitoring category ACOG 1. The patient spontaneous uterine rupture, which leads to maternal hemoperitoneum and acute fetal distress. Cesarean section and hysterectomy were performed as emergency surgical treatments due to uterine atony without bleeding control with pharmacological maneuvers. This case is great significance due to the lack of risk factors and the atypical clinical presentation, evidenced in the signs and symptoms and the rupture's location. MÉD.UIS.2021;34(1): 107-12.

Study on the correlation between methylation level of PGC-1α gene and fetal distress in pregnant women with gestational diabetes mellitus / 中华内分泌外科杂志

Objective:To detect the methylation level and mRNA expression level of peroxisome proliferator activated receptory-coactivator-1α (PGC-1α) gene in placental tissue of pregnant women with gestational diabetes (GDM) and to explore the relationship between them and fetal distress.Methods:A total of 174 pregnant women with GDM admitted to in our hospital from Jul. 2018 to Dec. 2019 were selected as the study objects, among which 78 pregnant women with fetal distress were selected as the fetal distress group; and 96 pregnant women with normal delivery and without fetal distress were the control group; during the same period, 82 normal pregnant women without GDM were selected as the healthy group. The methylation level of PGC-1α gene in placenta was detected by direct sequencing after DNA was treated with sodium bisulfite; the expression of PGC-1α mRNA in placenta was detected by real-time fluorescence quantitative PCR (qRT-PCR) ; the levels of triglyceride (TG) , total cholesterol (TC) , low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were measured by automatic biochemical analyzer; the relationship between methylation frequency of PGC-1α gene and the expression level of PGC-1α mRNA was analyzed; and the influencing factors of fetal distress were analyzed.Results:PGC-1α gene methylation frequency and TG level were higher in the fetal distress group [ (25.42±7.31) %, (4.72±0.68) mmol/L] than in the control group [ (9.26±2.67) %, (4.31±0.64) mmol/L] and the healthy group [ (3.24±1.07) %, (4.33±0.72) mmol/L]. PGC-1α gene methylation frequency was higher in the control group than in the healthy group, and the differences were statistically significant ( P<0.05) ; PGC-1α mRNA expression level in fetal distress group (0.67±0.16) is lower than that in the control group (0.74±0.14) and healthy group (1.00±0.27) . PGC-1α mRNA expression level in control group was lower than that in healthy group, and the difference was statistically significant ( P<0.05) ; the methylation frequency of PGC-1α gene was negatively correlated with the expression level of PGC-1α mRNA in pregnant women with fetal distress ( r=-0.515, P<0.05) ; the methylation of PGC-1α gene was an independent risk factor for fetal distress ( P<0.05) , and the high expression of PGC-1α mRNA was the protective factor of fetal distress ( P<0.05) . Conclusion:DNA methylation level of PGC-1α gene in pregnant women with GDM is related to fetal distress, which may be the target of gene modification for fetal distress.

Umbilical cord constriction as a cause of intrauterine fetal death / Constrição de cordão umbilical como causa de morte fetal intrauterina

ABSTRACT The umbilical cord constriction (UCC) is an uncommon condition and an important etiology for stillborn fetuses. The main goal of this study was to verify the UCC occurrence as the cause of intrauterine fetal death, the associated etiology and its pathological characteristics. Therefore, a descriptive retrospective cross-sectional study was developed using the database from a Pathology Institute, in Brazil, from 1995 to 2017. The results presented a total of 1,359 embryo/fetus deaths - 69 (5.07%) due to UCC, 60.9% males and 39.1% females. The average age of pregnant women was 27.5 years ± 7.2 years of standard deviation (SD). The majority of deaths occurred during the second trimester (76.5%), followed by the first (14.7%) and third (8.8%) trimesters, respectively. One constriction alone was found in 87% of cases, 11% had two constrictions and only 1% had three or more. The presence of congenital malformations was detected in 20.2% of necropsies, the identification of chronic fetal distress was described in 71% of the technical reports and 17% of the cases had obstructive vasculopathy characteristics in microscopy analysis. Regarding the anatomopathological characteristics between the male and female sexes, no significant difference was found (p > 0.05) correlating gestational age, weight or congenital malformations. UCC was a cause of fetal death found in 5% of the cases, and it was linked to congenital malformations, fetal distress and obliterative vasculopathy.

RESUMEN La constricción del cordón umbilical (CCU) es una condición infrecuente que no está bien descrita en la literatura, a pesar de ser una importante etiología observada en mortinatos. El objetivo de este estudio fue verificar la ocurrencia de CCU como causa de muerte fetal y las características patológicas asociadas. Para ello, se llevó a cabo un estudio retrospectivo transversal con informaciones de la base de datos de un Instituto de Patología, en Brasil, de 1995 hasta 2017. Los resultados fueron: 1.359 muertes de embriones/fetos, de las cuales 69 (5,07%) se debieron a CCU; 60,9% eran del sexo masculino y 39,1%, del femenino. El promedio de edad de las mujeres embarazadas fue de 27,5 anos; desviación estándar de ± 7,2 anos. La mayoría de las muertes ocurrió en el segundo trimestre (76,5%), seguido del primero (14,7%) y del tercero (8,8%). Entre el total de casos de CCU observados, 87% tuvieron sólo una constricción; 11%, dos; y 1%, tres o más. La presencia de malformaciones congénitas fue encontrada en 20,2% de las necropsias; la identificación de sufrimiento fetal crónico fue reportada en 71% de los informes; y características de vasculopatía obstructiva en el análisis de microscopía, en 17% de los casos. Con respecto a las características anatomopatológicas entre los sexos masculino y femenino, no se encontró ninguna diferencia significativa (p > 0,05) correlacionando edad gestacional de los fetos/embriones, peso o malformaciones congénitas. La CCU es una condición rara de muerte fetal asociada a bajo peso fetal y restricción de crecimiento. Nuestra investigación sugiere una posible relación entre la CCU y la vasculopatía obliterativa.

RESUMO A constrição de cordão umbilical (CCU) é uma condição infrequente, não bem descrita na literatura, apesar de ser uma importante etiologia observada em fetos natimortos. O objetivo deste estudo foi verificar a ocorrência de CCU como causa de morte fetal e as características etiopatológicas associadas. Para tanto, um estudo retrospectivo transversal foi realizado a partir das informações do banco de dados do Instituto de Patologia de Passo Fundo, durante os anos de 1995 a 2017. Os resultados foram: 1.359 mortes de embriões/fetos, das quais 69 (5,07%) foram devidas a CCU; 60,9% eram do sexo masculino e 39,1%, do feminino. A média de idade das gestantes foi de 27,5 anos; desvio padrão (DP) de ± 7,2 anos. A maioria das mortes ocorreu no segundo trimestre (76,5%), seguido pelo primeiro (14,7%) e terceiro (8,8%). Entre o total de CCU observadas, 87% tiveram ocorrência de apenas uma constrição; 11%, de duas; e 1%, de três ou mais. A presença de malformações congênitas foi encontrada em 20,2% das necropsias; a identificação de sofrimento fetal crônico foi relatada em 71% dos laudos; e características de vasculopatia obstrutiva na análise da microscopia, em 17% dos casos. Em relação às características anatomopatológicas entre os sexos masculino e feminino, nenhuma diferença significativa (p > 0,05) foi encontrada correlacionando idade gestacional dos fetos/embriões, peso ou malformações congênitas. A CCU é uma condição incomum de morte fetal associada a baixo peso fetal e restrição de crescimento. Nossa pesquisa sugere uma possível relação entre a CCU e a vasculopatia obliterativa.

Cholestasis of pregnancy: effects on maternal and fetal outcome

Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs in late pregnancy affecting 1.5-2% pregnancies. Limited data is available regarding its fetal and maternal implications. This study aims to assess the impact of ICP on maternal and fetal outcome.Methods: A total 200 patients with pruritus in later half of pregnancy were studied over a period of 18 months out of which 135 were diagnosed as ICP. Clinical and biochemical parameters like serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, and gamma glutamyl transferase was recorded. Maternal and fetal outcome was noted in the form of LSCS rate, preterm births, fetal distress and neonatal ICU admissions.Results: In this study, most common symptom was pruritus. Most of cases had onset of symptoms between 32-36 weeks. High LSCS rates were seen among cases. Intrapartum complications viz. meconium staining of amniotic fluid (57.8%), preterm delivery (11.9%), fetal distress (42.2%) were significantly higher in study population and there was high incidence of NICU admissions (49. 6% neonates) among cases mostly due to meconium aspiration and prematurity.Conclusions: ICP increases maternal morbidity and is associated with adverse perinatal outcome viz. increased risk of fetal distress, preterm births and sudden IUD at term as evidenced in this study. A timely intervention at 37-38 weeks will reduce the adverse outcomes.

Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.

A study to correlate admission non stress test and immediate post-partum umbilical cord arterial pH with neonatal outcome

Background: Continuous electronic fetal monitoring in labour has become a standard practice in developed countries; this may not be possible in low middle-income countries. So, this study was conducted to correlate admission non stress test (NST) and immediate post-partum umbilical cord arterial (UCA) pH with neonatal outcome.Methods: This prospective observational study was conducted at tertiary care centre in North India. After informed and written consent, 100 pregnant women with singleton live pregnancy of gestational age ≥32 weeks admitted in labour, were subjected to admission NST and immediately after delivery sample for UCA pH was taken. Clinically relevant neonatal outcome was correlated with admission NST and UCA pH. Appropriate statistical tests were used and p-value <0.05 taken as significant.Results: Admission NST was normal, suspicious, pathological in 67%, 27%, 6% subjects, respectively. Study found statistically significant correlation between admission NST and UCA pH with neonatal outcomes (i.e. fetal distress, need of advanced resuscitation, delayed oral feeding). Fetal distress was seen in 9 newborns, in these 8 delivered by CS and 1 required ventous application. Admission NST had high sensitivity (88.89%) and NPV (98.5%) for detection of fetal distress. The optimal cut off for pH and lactate was 7.25 and 2.55 mmol/L, respectively to predict fetal distress.Conclusions: Admission NST can be considered as a screening modality to detect fetus in distress and it showed good correlation with umbilical cord arterial pH for predicting short term neonatal outcome.

A study of caesarean section at full cervical dilatation

Background: Caesarean sections performed in the second stage of labour are difficult and have many implications on both mother and baby. This study was conducted to analyse fetal and maternal outcome in case of caesarean section at full cervical dilatation.Methods: This prospective study was conducted at one of tertiary care teaching institute for period of 1st August 2019 to 31st January 2020. It includes all women delivered by caesarean section at full cervical dilatation at study institute during study period. Cases were looked for parity, maternal age, gestational age, baby birth weight, indication of cesarean section and associated factors.Results: Out of total 3657 deliveries 1690 were delivered by caesarean section, out of which 65 (3.8%) caesarean sections were conducted at full cervical dilation. The most common indication of caesarean section was deep transverse arrest in 66.15% of cases. The maximum number of cases (69.23%) were seen between the age group of 20 to 25 years. Majority of second stage cesarean section (70.77%) were performed in primi gravida. 80% of caesarean sections at full cervical dilatation were performed after 37 weeks of gestation. 15.38% of patients had anemia, 20% had hypertension, 4.61% had history of previous caesarean section. Baby weight at time of birth was 2.5 to 3.5 kg in 67.70% of cases. 15.38% of patients required blood transfusion.Conclusions: A skilled obstetrician is required to take timely and proper decision in such cases and also to conduct cesarean section at second stage of labour.

Study of intrapartum fetal distress with the help of cardiotocography and its correlation with umbilical cord blood sampling

Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.

Study of perinatal outcomes in normal and borderline oligamnios

Background: Oligamnios is a common cause of perinatal mortality and morbidity, but the outcome of borderline oligamnios, defined as Amniotic Fluid Index (AFI) between 5 and 8, is less clear. This study aims to find out the effect of borderline oligamnios on perinatal outcomes in pregnancies beyond 37 weeks.Methods: An observational prospective study of 131 antenatal mothers with AFI between 5 and 8, after 37 weeks of gestation was conducted in Sree Gokulam Medical College and Research Foundation from October 2017 to September 2019. These observations were compared with that of 131 antenatal mothers with normal AFI beyond 37 weeks of gestation. The observations according to fetal heart rate abnormalities, meconium staining of amniotic fluid, mode of delivery, low birth weight babies, APGAR score, the need of neonatal intensive care unit (NICU) admissions due to neonatal complications were statistically analysed.Results: Both groups were comparable with respect to age, parity and gestational age. In those with borderline oligamnios, fetal heart rate abnormality was seen in 21% (28), meconium stained amniotic fluid in 18% (23), 70% (91) delivered vaginally and 30% (40) underwent caesarean section, 31% (41) babies weighed below 2.5 kg and 21% (27) neonates needed NICU admissions. In those with normal AFI, none showed fetal heart rate abnormality, 2% (3) showed meconium staining, 93% (122) delivered vaginally and 7% (9) underwent caesarean section, 11% (14) babies weighed below 2.5 kg and 3% (4) neonates needed NICU admissions.Conclusions: Borderline oligamnios is associated with poor perinatal outcome. AFI can be used as an adjunct to other fetal surveillance methods. It helps to identify those infants at risk of poor perinatal outcome.

Study of fetomaternal outcome in cases of premature rupture of membrane at tertiary care rural institute of Western Uttar Pradesh, India

Background: Premature rupture of membranes (PROM) is the rupture of the fetal membranes before the onset of labor. Preterm PROM complicates approximately 3 percent of pregnancies and leads to one third of preterm births. It increases the risk of prematurity and leads to a number of other perinatal and neonatal complications.Methods: This was a prospective study carried out at the department of obstetrics and gynaecology, UPUMS, Saifai from April 2018 to September 2018 (6 months study). Patients with Spontaneous rupture of membranes any time beyond 28th week of pregnancy, but before the onset of labour. Patients with following conditions were excluded from the study- meconium stain liquor, cord prolapse, antepartum haemorrhage, active infection at other sites, active liver disease.Results: A total of 103 cases of premature rupture of membrane (PROM) were recorded from April 2018 to September 2019 among 1523 admitted pregnant patients. Most of the patients 56 (54.36%) were delivered by caesarean section (C/S). Previous C/S, oligohydramnios, fetal distress, chorioamnionitis were the common indications for doing C/S. Forty-seven (45.63%) patients were delivered vaginally.Conclusions: Most of the affected women belongs to 20-24 years of age (53.39%). Term PROM was more in comparison to PPROM and most of them were multigravidae. Cesarean section rate was high. Most common complication was of subclinical urogenital infection (51.02%).

Caesarean-Section Frequency and Indications among Doctors and Non-Doctors

Objective: To find and compare the frequency of caesareansection and its indications among doctors and non-doctorspresented to tertiary-care hospitals of Peshawar city, Pakistan.Methodology: A descriptive cross sectional study wasconducted in four tertiary-care hospital of Peshawar city ofPakistan. Data on Caesarean section frequency and itsindications were collected from the clinical records of 400participants from March to May, 2016.Results: Among the total 400 participants, the frequency ofcaesarean-section was 52.5% (80% in doctors and 25% innon-doctors). A statistically significant difference wereidentified when chi-square test were used to compare thedifference between the two groups (P <0.05). Emergencycaesarean was performed in 120 (57.2%) patients whileElective caesarean was performed in 90 (42.8%). The mostcommon indication for caesarean-section was failedinduction/failed progress of labor (23%).Conclusion: The increased caesarean-section rate observedin doctors community is highly alarming. Our results should betaken into consideration when formulating policies to managethe national trend of increasing caesarean-section rates.