-
AJOG Global Reports May 2024The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision...
The iPREFACE score is useful for predicting fetal acidemia: A retrospective cohort study of 113 patients who underwent emergency cesarean section for non-reassuring fetal status during labor.
BACKGROUND
The iPREFACE score may aid in predicting fetal acidemia and neonatal asphyxia in emergency cesarean and vaginal deliveries, which may improve labor management precision in the future.
OBJECTIVE
This study aimed to assess the score use of the iPREFACE as an objective indicator of the need for rapid delivery in cases of repeated abnormal waveforms without concurrent indications for immediate medical intervention during labor.
STUDY DESIGN
This retrospective cohort study was conducted among term (37+ 0 days to 41+6 days) singleton pregnant women who underwent emergency cesarean delivery owing to a nonreassuring fetal status. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery score, calculated from a 30-minute cardiotocography waveform before the decision to perform emergency cesarean delivery, and the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer score, calculated from a 30-minute cardiotocography waveform before cardiotocography transducer removal, were employed. The primary outcome was the assessment of the predictive ability of these scores for fetal acidemia, whereas the secondary outcomes were differences in umbilical artery blood gas findings and postnatal outcomes between the 2 groups, divided by the cutoff values of the integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography score.
RESULTS
The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer scores demonstrated the capability to predict an umbilical artery blood pH of <7.2. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-decision of emergency cesarean delivery and -removal of cardiotocography transducer score, with cutoff values of 37 and 46 points, respectively, exhibited an area under the receiver operating characteristic curve of 0.82 and 0.87, respectively. The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring-removal of cardiotocography transducer group with ≥46 points had higher incidence rates of an umbilical cord artery blood pH of <7.2, <7.1, and <7.0 and neonatal intensive care unit admissions for neonatal asphyxia.
CONCLUSION
The integrated score index to predict fetal acidemia by intrapartum fetal heart rate monitoring, derived from cardiotocography during an emergency cesarean delivery, may enable clinicians to predict fetal acidemia in cases of nonreassuring fetal status. Improved prediction of fetal acidemia and facilitation of timely intervention hold promise for enhancing the outcomes of mothers and newborns during childbirth. Prospective studies are warranted to establish precise cutoff values and to validate the clinical application of these scores.
PubMed: 38699222
DOI: 10.1016/j.xagr.2024.100343 -
BMC Pregnancy and Childbirth May 2024The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The aim of this study is to determine the effectiveness of antenatal corticosteroid in reducing respiratory morbidity in babies born in the late preterm period.
METHODS
Two hundred and eighty-six pregnant women at risk of having a late preterm delivery were studied. One hundred and forty-three (143) served as the cases and were given 2 doses of 12 mg intramuscular dexamethasone 12 h apart, while 143 served as the controls and were given a similar quantity of placebo. The women were followed up prospectively and data were collected on the pregnant women and their newborns on a standardized form. The neonates were assessed for acute respiratory distress syndrome and transient tachypnea of the newborn based on clinical signs, symptoms, and chest x-ray results (when indicated). The primary outcome was the occurrence of neonatal respiratory morbidity.
RESULTS
The primary outcome occurred in 5 out of 130 infants (3.8%) in the dexamethasone group and 31 out of 122 (25.4%) in the placebo group (P value = 0.000003). Birth asphyxia, neonatal intensive care admission and need for active resuscitation at birth also occurred significantly less frequently in the dexamethasone group (P value 0.004, 0.009, 0.014 respectively). There were no significant group differences in the incidence of neonatal sepsis, neonatal jaundice, hypoglycemia and feeding difficulties.
CONCLUSIONS
Administration of dexamethasone to women at risk for late preterm delivery significantly reduced the rate of neonatal respiratory complications, neonatal intensive care unit admission, and need for active resuscitation at birth.
TRIAL REGISTRATION
PACTR ( www.pactr.org ) Registration Number: PACTR202304579281358. The study was retrospectively registered on April 19, 2023.
Topics: Humans; Female; Dexamethasone; Pregnancy; Infant, Newborn; Respiratory Distress Syndrome, Newborn; Adult; Infant, Premature; Prospective Studies; Glucocorticoids; Premature Birth; Prenatal Care; Transient Tachypnea of the Newborn; Gestational Age
PubMed: 38698318
DOI: 10.1186/s12884-024-06304-6 -
JTCVS Open Apr 2024Functional assessment of hearts during ex-vivo heart perfusion is not well-established. Conventional intraventricular balloon methods for large animals sacrifice the...
OBJECTIVE
Functional assessment of hearts during ex-vivo heart perfusion is not well-established. Conventional intraventricular balloon methods for large animals sacrifice the mitral valve. This study assessed the effectiveness of the modified intraventricular balloon method in comparison with other modalities used during working mode in juvenile pigs.
METHODS
Following asphyxia circulatory arrest, hearts were ischemic for 15 minutes and then reperfused on an ex-vivo device for 2 hours before switching to working mode. Left ventricular pressure was continuously measured during reperfusion by a saline-filled balloon fixated in the left atrium. Spearman Correlation Coefficients with linear regression lines with confidence intervals were analyzed.
RESULTS
Maximum dp/dt at 90 minutes of reperfusion and minimum dp/dt at 60 minutes of reperfusion showed a moderate positive correlation to that in working mode, respectively (Rs = 0.61, = .04 and Rs = 0.60, = .04). At 60 minutes of reperfusion, minimum dp/dt showed moderate positive correlation to tau (Rs = 0.52, = .08). Myocardial oxygen consumption during reperfusion consistently decreased at least 30% compared to working mode (at 90 minutes as the highest during reperfusion, 3.3 ± 0.8; in working mode, 5.6 ± 1.4, mLO/min/100 g, < .001).
CONCLUSIONS
Functional parameters of contractility and relaxation measured during reperfusion by the modified balloon method showed significant correlations to respective parameters in working mode. This mitral valve sparing technique can be used to predict viability and ventricular function in the early phase of ex-vivo heart perfusion without loading the heart during working mode.
PubMed: 38690439
DOI: 10.1016/j.xjon.2024.01.009 -
Frontiers in Neurology 2024Birth asphyxia and its main sequel, hypoxic-ischemic encephalopathy, are one of the leading causes of children's deaths worldwide and can potentially worsen the quality... (Review)
Review
Birth asphyxia and its main sequel, hypoxic-ischemic encephalopathy, are one of the leading causes of children's deaths worldwide and can potentially worsen the quality of life in subsequent years. Despite extensive research efforts, efficient therapy against the consequences of hypoxia-ischemia occurring in the perinatal period of life is still lacking. The use of hyperbaric oxygen, improving such vital consequences of birth asphyxia as lowered partial oxygen pressure in tissue, apoptosis of neuronal cells, and impaired angiogenesis, is a promising approach. This review focused on the selected aspects of mainly experimental hyperbaric oxygen therapy. The therapeutic window for the treatment of perinatal asphyxia is very narrow, but administering hyperbaric oxygen within those days improves outcomes. Several miRNAs (e.g., mir-107) mediate the therapeutic effect of hyperbaric oxygen by modulating the Wnt pathway, inhibiting apoptosis, increasing angiogenesis, or inducing neural stem cells. Combining hyperbaric oxygen therapy with drugs, such as memantine or ephedrine, produced promising results. A separate aspect is the use of preconditioning with hyperbaric oxygen. Overall, preliminary clinical trials with hyperbaric oxygen therapy used in perinatal asphyxia give auspicious results.
PubMed: 38685945
DOI: 10.3389/fneur.2024.1386695 -
Cardiovascular Pathology : the Official... 2024We report an unexpected death of a 22-year-old primigravida who was admitted to the hospital with sudden abdominal pain two days before a scheduled delivery. During an...
We report an unexpected death of a 22-year-old primigravida who was admitted to the hospital with sudden abdominal pain two days before a scheduled delivery. During an emergency caesarean section due to intrauterine asphyxia, intraabdominal bleeding was observed with no apparent source of bleeding. Newly formed blood clots in the subdiaphragmatic space and arterial bleeding near the splenic hilum required a surgery on the next day. Hemorrhagic shock led to multiple organ failure on the fourth day of admission. The autopsy revealed ruptured splenic artery at the pancreatic tail and near the splenic hilum. Microscopically, different stages of segmental arterial mediolysis were observed in partially thinned and aneurysmatic artery.
Topics: Humans; Female; Pregnancy; Splenic Artery; Rupture, Spontaneous; Fatal Outcome; Young Adult; Shock, Hemorrhagic; Hemorrhage; Pregnancy Complications, Cardiovascular; Cesarean Section; Autopsy; Multiple Organ Failure
PubMed: 38677635
DOI: 10.1016/j.carpath.2024.107650 -
Brain, Behavior, and Immunity Jul 2024Newborns exposed to birth asphyxia transiently experience deficient blood flow and a lack of oxygen, potentially inducing hypoxic-ischaemic encephalopathy and subsequent...
Newborns exposed to birth asphyxia transiently experience deficient blood flow and a lack of oxygen, potentially inducing hypoxic-ischaemic encephalopathy and subsequent neurological damage. Immunomodulatory components in plasma may dampen these responses. Using caesarean-delivered pigs as a model, we hypothesized that dietary plasma supplementation improves brain outcomes in pigs exposed to birth asphyxia. Mild birth asphyxia was induced by temporary occlusion of the umbilical cord prior to caesarean delivery. Motor development was assessed in asphyxiated (ASP) and control (CON) piglets using neonatal arousal, physical activity and gait test parameters before euthanasia on Day 4. The ASP pigs exhibited increased plasma lactate at birth, deficient motor skills and increased glial fibrillary acidic protein levels in CSF and astrogliosis in the putamen. The expression of genes related to oxidative stress, inflammation and synaptic functions was transiently altered in the motor cortex and caudate nucleus. The number of apoptotic cells among CTIP2-positive neurons in the motor cortex and striatal medium spiny neurons was increased, and maturation of preoligodendrocytes in the internal capsule was delayed. Plasma supplementation improved gait performance in the beam test, attenuated neuronal apoptosis and affected gene expression related to neuroinflammation, neurotransmission and antioxidants (motor cortex, caudate). We present a new clinically relevant animal model of moderate birth asphyxia inducing structural and functional brain damage. The components in plasma that support brain repair remain to be identified but may represent a therapeutic potential for infants and animals after birth asphyxia.
Topics: Animals; Animals, Newborn; Swine; Asphyxia Neonatorum; Brain; Disease Models, Animal; Female; Oxidative Stress; Hypoxia-Ischemia, Brain; Neurons; Glial Fibrillary Acidic Protein; Asphyxia; Pregnancy; Motor Cortex
PubMed: 38677626
DOI: 10.1016/j.bbi.2024.04.032 -
Animals : An Open Access Journal From... Apr 2024The aim of this study was to evaluate the influence of different stunning methods on the meat quality of fillets from fish farming. A total of 48 specimens of in the...
The aim of this study was to evaluate the influence of different stunning methods on the meat quality of fillets from fish farming. A total of 48 specimens of in the weight class 11.1 to 14.0 kg were investigated; these fish were subjected to different stunning methods for slaughter: ice asphyxia (IA), air asphyxia (AA), electronarcosis (EE) and hypothermia followed by bleeding (HB). Then, data were obtained from the analysis of pH, rigor mortis index (RI), water activity (Aw), instrumental texture (compression strength, firmness and adhesiveness) and blood glucose and via instrumental colourimetry. During the study, for up to 15 days of refrigerated storage, the methods provided pH values below 6.0. submitted to EE and HB remained longer in the pre-rigor status. In addition, they expressed lower percentages of Aw. The EE method resulted in better texture assignments in the fillets. The blood glucose values indicated that the fish subjected to EE were less stressed. Concerning instrumental colourimetry, the fillets submitted to EE and HB showed greater luminosity; the fillets subjected to AA showed greater red-green colour intensity, while the fillets subjected to EE showed greater yellow-blue colour intensity. Therefore, the fish did not suffer stress with electronarcosis, and the fillets showed better preservation, juiciness, and tenderness.
PubMed: 38672303
DOI: 10.3390/ani14081155 -
Sports (Basel, Switzerland) Apr 2024Breath-hold diving is explained as an activity that requires enduring muscle asphyxia and acidosis, high anaerobic capacity, and the tactic of the dive. Therefore, this...
Breath-hold diving is explained as an activity that requires enduring muscle asphyxia and acidosis, high anaerobic capacity, and the tactic of the dive. Therefore, this study aimed to construct and validate tests that will mimic anaerobic processes in the specific media of freedivers. The sample of participants included 34 Croatian freedivers (average age: 26.85 ± 4.0 years, competitive age: 3.82 ± 1.92 years, their body height: 180.14 ± 8.93 cm, and their body mass: 76.82 ± 12.41 kg). The sample of variables consists of anthropometric indices, competitive efficiency (maximal length of a dive (DYN)), and specific anaerobic capacities (100 m and 2 min tests). Newly developed tests included the swimming anaerobic sprint test (SAST) and diving anaerobic sprint test (DAST). DAST and SAST variables included the total time of the test (DAST/SAST) and the fastest interval (DAST/SAST). The results showed good reliability of the tests with high Cronbach alpha coefficients (DAST: 0.98, DAST: 0.97, SAST: 0.99, SAST: 0.91). Furthermore, pragmatic validity shows a high correlation among all variables and DAST (DYN: -0.70, 100 m: 0.66, 2 min: -0.68). High relation is also found between 100 m (0.96), 2 min (-0.94), and a moderate result for DYN (-0.43) and the SAST test. A factor analysis extracted one significant factor. The factor analysis involved DAST, SAST, DYN, 100 m, and 2 min tests regarding factor 1. After the examination of all variables, the total time of the DAST test showed the best predictive values for the performance of divers. However, both tests could be used for diagnostics and the evaluation of specific condition abilities in freediving.
PubMed: 38668578
DOI: 10.3390/sports12040110 -
SAGE Open Nursing 2024Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from...
INTRODUCTION
Asphyxia at birth remains the leading cause of neonatal morbidity and mortality worldwide, accounting for ∼23% of all neonatal deaths. Although the causes vary from country to country, early identification and treatment of risk factors can improve the situation.
OBJECTIVES
To determine the risk factors of birth asphyxia in hospital-delivered neonates in Dodoma, Tanzania.
METHODS
A matched case-control study was conducted from May to July 2017 at Dodoma Region Referral Hospital. Data were collected using a semistructured questionnaire and a standard antenatal care index card. Cases were neonates diagnosed with asphyxia at birth ( = 100), while controls were neonates not diagnosed with asphyxia at birth ( = 300). A binary logistic regression model was used to assess the independent variables associated with birth asphyxia and reported as crude and adjusted odds ratios along with their 95% confidence intervals.
RESULTS
A total of 400 newborns and their birth mothers were involved in the study. The average age of the case mothers was 26.9 years ( = 7.85) and that of the control mothers was 27.24 years ( = 6.08). Place of residence, anemia, maternal age, prenatal visits attended, use of herbs during labor, previously complicated pregnancy, duration of labor, meconium-stained amniotic fluid, and mode of delivery were predictors of birth asphyxia.
CONCLUSION
The study showed that most predictors of birth asphyxia can be prevented. The results suggest appropriate health education before conception, effective follow-up through prenatal care, early identification and treatment of high-risk pregnant women, and proper monitoring of labor and delivery.
PubMed: 38665876
DOI: 10.1177/23779608241246874 -
Journal of Medical Case Reports Apr 2024We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a...
BACKGROUND
We present a severe neonatal consequence due to the unexpected and crucial inversion of the fetal position after sudden termination of tocolysis during early labor of a woman with congenital uterine anomaly. It has been reported that congenital uterine anomalies latently affect the fetal position. The clinical pitfalls in childbirth with uterine anomalies are discussed here on the basis of clinical evidence.
CASE PRESENTATION
At a perinatal medical center in Japan, a 29-year-old Japanese mother who had a history of bicornuate uterus, received tocolysis to prolong her pregnancy for 5 days during the late preterm period after preterm-premature rupture of the membrane. She gave birth to a 2304 g male neonate of the gestational age of 35 weeks and 5 days with severe asphyxia by means of crash cesarean section for fetal sustained bradycardia after sudden termination of tocolysis. We found the fetal position to reverse from cephalic to breech position during early labor. He ended up having severe cerebral palsy after brain cooling against hypoxic-ischemic encephalopathy for 3 days. The mechanism of inversion from cephalic to breech position without amnionic fluid remains unclear, although women with a known diagnosis of a uterine anomaly have higher risk of adverse outcomes such as malpresentation.
CONCLUSIONS
When considering the clinical course of this case on the basis of the medical reports, we suspected that uterine anomalies and changes in intrauterine pressure could cause fetal malpresentation and adverse neonatal outcomes.
Topics: Humans; Female; Pregnancy; Adult; Infant, Newborn; Male; Cesarean Section; Uterus; Tocolysis; Urogenital Abnormalities; Asphyxia Neonatorum; Labor Presentation; Asphyxia; Breech Presentation
PubMed: 38664817
DOI: 10.1186/s13256-024-04524-0