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BMC Pregnancy and Childbirth Dec 2023Prior studies have shown that, when administered as an intravenous bolus to prevent uterine atony, prophylactic phenylephrine infusion increased the dose requirement of... (Randomized Controlled Trial)
Randomized Controlled Trial
Oxytocin infusion for maintenance of uterine tone under prophylactic phenylephrine infusion for prevention of post-spinal hypotension in cesarean delivery: a prospective randomised double-blinded dose-finding study.
BACKGROUND
Prior studies have shown that, when administered as an intravenous bolus to prevent uterine atony, prophylactic phenylephrine infusion increased the dose requirement of oxytocin and second-line uterotonics. For the prevention of uterine atony, oxytocin should be delivered by continuous infusion. Here, we aimed to determine the ED50 and ED90 parameters (the effective doses for 50 and 90% patients without uterine atony) of oxytocin for co-infusion with prophylactic phenylephrine during cesarean delivery.
METHODS
In this prospective randomized double-blinded dose-finding study, one hundred patients were divided into four groups to receive 2.5, 5.0, 7.5, or 10 IU/h oxytocin infusion, after the umbilical cord was clamped during the study period. The uterine tone was evaluated and defined as either adequate or inadequate. Probit regression analysis was applied to calculate the ED50 and ED90 of oxytocin infusion. Uterine tone, the percentage of patients who needed additional oxytocin bolus, second-line uterotonics, side effects, estimated blood loss, and neonatal outcomes were monitored.
RESULTS
The estimated ED50 and ED90 values of the oxytocin infusion doses for the prevention of uterine atony were 1.9 IU/h (95% CI -4.6-3.8) IU/h and 9.3 IU/h (95% CI 7.3-16.2) IU/h, respectively. Across groups, there was a significant linear trend between the infusion dose and the percentage of patients who required additional oxytocin (p-value = 0.002). No differences were observed in the incidence of side effects and neonatal outcomes.
CONCLUSION
Under the conditions of this study, the ED90 of oxytocin infusion for the prevention of uterine atony was 9.3 IU/h, which is higher than the current recommendation. This finding is helpful for clinical practice, because of the routine use of phenylephrine in cesarean delivery. Further studies are needed to determine the appropriate initial bolus of oxytocin after neonatal delivery.
TRIAL REGISTRATION
The study was registered on the Chinese Clinical Trial Register (register no. ChiCTR2200059556 ).
Topics: Pregnancy; Female; Infant, Newborn; Humans; Oxytocin; Phenylephrine; Uterine Inertia; Prospective Studies; Hypotension; Double-Blind Method; Infusions, Intravenous; Oxytocics
PubMed: 38057742
DOI: 10.1186/s12884-023-06165-5 -
Theriogenology Feb 2024Embryo transfer (ET) and intracytoplasmic sperm injection (ICSI) are widely used in equine species, but their effects on fetal adnexa and neonates have not been...
Embryo transfer (ET) and intracytoplasmic sperm injection (ICSI) are widely used in equine species, but their effects on fetal adnexa and neonates have not been investigated yet. The aim of this study was to retrospectively evaluate whether pregnancies obtained by ET or ICSI could be associated with the presence of macroscopic alterations of fetal membranes (FM) and umbilical cord (UC) and if the use of these techniques could influence neonatal outcome. Sixty-six light breed mares hospitalized at the Veterinary Teaching Hospital, University of Bologna, for attending delivery were included in the study. Mares were divided into Artificial Insemination (AI; 32/66 mares, 48 %), Embryo Transfer (ET; 12/66 mares, 18.2 %) and Intracytoplasmic Sperm Injection (ICSI; 22/66 mares, 33 %) groups. All the medical reports of mares and their foals were reviewed and data about mare, pregnancy, foaling, fetal membranes, umbilical cord and foal were recorded. The occurrence of dystocia resulted statistically different between AI group and ICSI group (p = 0.0066), and between AI group and ET group (p = 0.044). Macroscopic examination of FM revealed alterations in 30/66 mares (46 %): 8/32 in AI (25 %), 7/12 in ET (58 %) and 15/22 in ICSI (68 %) with significant lower incidence in AI compared to ET (p = 0.04) and ICSI (p = 0.002) groups. Alterations reported were chorionic villi hypoplasia, chorioallantois edema, allantois cysts, necrotic areas and greenish-grey concretions. Total length of UC resulted significantly shorter in ICSI group (49 ± 9 cm; p < 0.03) compared to AI (60 ± 17 cm) and ET (59 ± 15 cm). However, there were no differences in the incidence of foals' diseases at birth and in foals' survival among groups (p > 0.05). The results demonstrate that transfer of in vivo or in vitro produced embryos may lead to alterations of placental development, as observed in other species, without being associated with a higher incidence of neonatal morbidity and mortality. Further studies about trophoblast development, FM histological evaluation, and placental gene expression should be carried out to clarify the mechanisms underlying the placental alterations.
Topics: Animals; Pregnancy; Horses; Female; Male; Placenta; Retrospective Studies; Hospitals, Animal; Hospitals, Teaching; Semen; Reproductive Techniques, Assisted; Extraembryonic Membranes
PubMed: 38052132
DOI: 10.1016/j.theriogenology.2023.11.032 -
The Journal of Maternal-fetal &... Dec 2023The primary aim of this study is to utilize a neural network model to predict adverse neonatal outcomes in pregnancies complicated by gestational diabetes (GDM).
OBJECTIVE
The primary aim of this study is to utilize a neural network model to predict adverse neonatal outcomes in pregnancies complicated by gestational diabetes (GDM).
DESIGN
Our model, based on XGBoost, was implemented using Python 3.6 with the Keras framework built on TensorFlow by Google. We sourced data from medical records of GDM-diagnosed individuals who delivered at our tertiary medical center between 2012 and 2016. The model included simple pregnancy parameters, maternal age, body mass index (BMI), parity, gravity, results of oral glucose tests, treatment modality, and glycemic control. The composite neonatal adverse outcomes defined as one of the following: large or small for gestational age, shoulder dystocia, fetal umbilical pH less than 7.2, neonatal intensive care unit (NICU) admission, respiratory distress syndrome (RDS), hyperbilirubinemia, or polycythemia. For the machine training phase, 70% of the cohort was randomly chosen. Each sample in this set consisted of baseline parameters and the composite outcome. The remaining samples were then employed to assess the accuracy of our model.
RESULTS
The study encompassed a total of 452 participants. The composite adverse outcome occurred in 29% of cases. Our model exhibited prediction accuracies of 82% at the time of GDM diagnosis and 91% at delivery. The factors most contributing to the prediction model were maternal age, pre-pregnancy BMI, and the results of the single 3-h 100 g oral glucose tolerance test.
CONCLUSION
Our advanced neural network algorithm has significant potential in predicting adverse neonatal outcomes in GDM-diagnosed individuals.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Diabetes, Gestational; Pregnancy Outcome; Maternal Age; Algorithms; Neural Networks, Computer; Retrospective Studies
PubMed: 38044265
DOI: 10.1080/14767058.2023.2286928 -
Annals of Epidemiology Jan 2024To build an evidence-based model to estimate case-specific risk of perinatal hypoxic ischemic encephalopathy.
PURPOSE
To build an evidence-based model to estimate case-specific risk of perinatal hypoxic ischemic encephalopathy.
METHODS
A retrospective, cross-sectional study of all births in Hawaii, Michigan, and New Jersey between 2010 and 2015, using linked maternal labor/delivery and neonatal birth records. Stepwise logistic regression and competitive Akaike information criterion were used to identify the most parsimonious model. Predictive ability of the model was measured with bootstrapped optimism-adjusted area under the ROC curve.
RESULTS
Among 836,216 births there were 376 (0.45 per 1000) cases of hypoxic ischemic encephalopathy. The final model included 28 variables, 24 associated with increased risk, and 4 that were protective. The optimism-adjusted area under the ROC curve was 0.84. Estimated risk in the study population ranged from 1 in ∼323,000 to 1 in 2.5. The final model confirmed known risk factors (e.g., sentinel events and shoulder dystocia) and identified novel risk factors, such as maternal race and insurance status.
CONCLUSION
Our study shows that risk of perinatal hypoxic ischemic encephalopathy injury can be estimated with high confidence. Our model fills a notable gap in the study of hypoxic ischemic encephalopathy prevention: the estimation of risk, particularly in the United States population which is unique with respect to racial and socioeconomic disparities.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Hypoxia-Ischemia, Brain; Retrospective Studies; Cross-Sectional Studies; Risk Factors; Parturition
PubMed: 38042440
DOI: 10.1016/j.annepidem.2023.11.011 -
The Journal of Veterinary Medical... Jan 2024Cats normally play a role of the definitive host in which the plerocercoid (sparganum), the second larval form of Spirometra spp., develops into an adult in the...
Cats normally play a role of the definitive host in which the plerocercoid (sparganum), the second larval form of Spirometra spp., develops into an adult in the intestines. However, some cases of cats with visceral or subcutaneous sparganosis were sporadically reported worldwide. We herein documented the discovery of a sparganum in abdominal cavity of a domestic cat during a surgery of dystocia. The larva was molecularly identified as Spirometra mansoni, belonging to Type I, that was recently misidentified to be S. erinaceieuropaei in several Asian countries. This is the first report for sparganum of S. mansoni in the cat. The future study is necessary to provide further insights into the species of Spirometra causing sparganosis and spirometrosis in humans and other animals.
Topics: Humans; Animals; Cats; Spirometra; Sparganum; Sparganosis; Vietnam; Larva; Abdominal Cavity; Cat Diseases
PubMed: 38030282
DOI: 10.1292/jvms.23-0236 -
Archives of Razi Institute Jun 2023Pregnancy toxemia (PT), also known as ketosis or twin lamb disease, is a group of in-sequence metabolic disorders usually observed in the last pregnancy period of ewes....
Pregnancy toxemia (PT), also known as ketosis or twin lamb disease, is a group of in-sequence metabolic disorders usually observed in the last pregnancy period of ewes. Blood samples from 60 Awassi ewes were collected, including 50 ewes suffering from PT and 10 healthy ewes (2-8 years old) as a control group. All of them were in their final month of pregnancy from different regions of Salah Aldin Governorate, Iraq. The samples were collected between October 2021 and February 2022. Biochemical analysis of serum concentrations of all parameters was performed using the atomic absorption spectrophotometer, except for the beta-hydroxybutyrate and non-esterified fatty acids that were analyzed by enzyme-linked immunosorbent assay method. The results of the clinical criteria tests for temperature, respiration, and pulse showed nonsignificant differences (<0.05) in the infected animals, compared to the healthy group. Clinical signs included depression, loss of appetite, weight loss, lying down, odor of ketogenic bodies through breathing, inability to walk, neurological signs, dental grinding, jaundice, blindness, bloat, dystocia, animal death, and fetal death. Based on the results of the biochemical parameters tests of the blood, a significant increase (<0. 05) was observed in the parameters of the results of beta-hydroxybutyrate, non-esterified fatty acids, triglycerides, total bilirubin, and liver enzymes (ALT, AST, ALP, and GGT) in the animals affected by PT, compared to the control group. However, a significant decrease (<0.05) was observed in the parameters of glucose, cholesterol, total protein, albumin, and globulin in the affected animals, compared to the healthy group. Concerning the association between disease and oxidative stress criteria, the infected animals showed a substantial (<0.05) increase in malondialdehyde concentration and a significant (<0.05) drop in glutathione and superoxide dismutase levels.
Topics: Animals; Pregnancy; Sheep; Female; Pre-Eclampsia; Blood Glucose; Iraq; 3-Hydroxybutyric Acid; Fatty Acids, Nonesterified; Sheep Diseases
PubMed: 38028820
DOI: 10.22092/ARI.2022.359922.2515 -
Cureus Oct 2023This review article conducts a comprehensive analysis of gestational diabetes mellitus (GDM) and its ramifications for both maternal health and the well-being of their... (Review)
Review
This review article conducts a comprehensive analysis of gestational diabetes mellitus (GDM) and its ramifications for both maternal health and the well-being of their offspring. GDM is a significant pregnancy complication in which women who have never had diabetes acquire chronic hyperglycemia during their gestational period. In most cases, hyperglycemia is caused by impaired glucose tolerance caused by pancreatic beta cell dysfunction in the background of chronic insulin resistance. Being overweight or obese, having an older mother age, and having a family history of any type of diabetes are all risk factors for developing GDM. GDM consequences include a higher risk of maternal cardiovascular disease (CVD) and type 2 diabetes, as well as macrosomia and delivery difficulties in the newborn. There is also a longer-term risk of obesity, type 2 diabetes, and cardiovascular disease in the infant. Premature birth, hypoglycemia at birth, and shoulder dystocia are also a few of the fetal problems that can result from GDM. Unfortunately, there is no widely acknowledged treatment or preventative strategy for GDM at the moment, except lifestyle modification (diet and exercise) and, on occasion, insulin therapy, which is only of limited value due to the insulin resistance that is commonly present. Although new oral medications for diabetes management, such as glyburide and metformin, show potential, there are ongoing worries regarding their safety over an extended period for both the mother and the child. By identifying gaps in the research, it calls for further investigations and a multidisciplinary approach, ultimately aiming to enhance the management and care for women with GDM, which would impact these affected individuals indubitably.
PubMed: 38021940
DOI: 10.7759/cureus.47500 -
Cureus Oct 2023Brachial plexus birth injury (BPBI) is a rare dystocia complication. Although it has a good prognosis, a significant number retain functional impairment to varying...
OBJECTIVES
Brachial plexus birth injury (BPBI) is a rare dystocia complication. Although it has a good prognosis, a significant number retain functional impairment to varying degrees. The data concerning shoulder function improvement and complication rates are conflicting due to variations in outcome measures between the studies. Therefore, we report our experience with this approach.
METHODS
It was a retrospective study conducted at King Faisal Specialist Hospital and Research Center in Riyadh (FSH&RC), Saudi Arabia. Data such as patient demographics, Mallet scores, and passive external rotation (PER) in adduction and abduction were retrieved from the medical records.
RESULTS
In active shoulder function, Mallet score significantly improved (P=0.00). The improvement was most remarkable in active external rotation movement (P=0.00) followed by hand to the neck. However, no significant gain was observed in active abduction and hand-to-back. At the final follow-up, with a mean of 2.9 years, the improvement in PER in adduction and abduction was maintained. Compared to six months postoperative, no significant difference was found in hand-to-neck, hand-to-back, and total Mallet score.
CONCLUSION
Subscapularis z-lengthening with coracoidectomy was consistently effective in correcting internal rotation contraction in a patient with BPBI. Significant improvements were observed in the Mallet score and PER in adduction and abduction.
PubMed: 38021901
DOI: 10.7759/cureus.47740 -
Nature Communications Nov 2023The timely onset of female parturition is a critical determinant for pregnancy success. The highly heterogenous maternal decidua has been increasingly recognized as a...
The timely onset of female parturition is a critical determinant for pregnancy success. The highly heterogenous maternal decidua has been increasingly recognized as a vital factor in setting the timing of labor. Despite the cell type specific roles in parturition, the role of the uterine epithelium in the decidua remains poorly understood. This study uncovers the critical role of epithelial SHP2 in parturition initiation via COX1 and COX2 derived PGF2α leveraging epithelial specific Shp2 knockout mice, whose disruption contributes to delayed parturition initiation, dystocia and fetal deaths. Additionally, we also show that there are distinct types of epithelium in the decidua approaching parturition at single cell resolution accompanied with profound epithelium reformation via proliferation. Meanwhile, the epithelium maintains the microenvironment by communicating with stromal cells and macrophages. The epithelial microenvironment is maintained by a close interaction among epithelial, stromal and macrophage cells of uterine stromal cells. In brief, this study provides a previously unappreciated role of the epithelium in parturition preparation and sheds lights on the prevention of preterm birth.
Topics: Animals; Female; Humans; Infant, Newborn; Mice; Pregnancy; Biochemical Phenomena; Labor, Obstetric; Parturition; Premature Birth; Uterus
PubMed: 37963860
DOI: 10.1038/s41467-023-43102-8 -
Acta Obstetricia Et Gynecologica... Feb 2024Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to...
INTRODUCTION
Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide. There are several known risk factors for postpartum hemorrhage related to pregnancy and delivery, but less evidence of predisposing factors. Recent research has shown that vitamin D deficiency may increase the risk of cesarean section due to dystocia, based on its effect on striated muscle as well as possible effect on the myometrium. Whether vitamin D deficiency increases the risk for postpartum hemorrhage and especially atonic hemorrhage is unknown.
MATERIAL AND METHODS
This was a retrospective translational study. The study population included 1367 women in Sweden and the main exposure was the serum concentration of 25-hydroxylated vitamin D at time of delivery. The LIASON® 25 OH vitamin D total assay method was used for analyzing 25-hydroxylated vitamin D. Vitamin D insufficiency was defined as serum concentration <50 nmol/L and vitamin D deficiency as serum concentrations <25 nmol/L. Primary outcomes were postpartum hemorrhage and severe postpartum hemorrhage defined as bleeding ≥500 mL and ≥ 1000 mL, respectively 2 h after delivery. Secondary outcome was atonic postpartum hemorrhage. Crude and adjusted odds ratios were calculated with 95% confidence intervals using univariable and multivariable logistic regression. Three different adjustment methods were used, adjusting for maternal, obstetrical and neonatal confounders.
RESULTS
Postpartum hemorrhage and severe postpartum hemorrhage afflicted 31.3% and 6.4% of the women, respectively. Rate of atonic postpartum hemorrhage was 21% in the whole population. Rate of vitamin D insufficiency and deficiency was 57%. Vitamin D insufficiency or deficiency was neither found to be associated with postpartum hemorrhage, nor with atonic postpartum hemorrhage.
CONCLUSIONS
In this study, the vitamin D status of women at the time of delivery was not a predictor of postpartum hemorrhage overall or atonic postpartum hemorrhage.
Topics: Infant, Newborn; Humans; Pregnancy; Female; Postpartum Hemorrhage; Uterine Inertia; Cesarean Section; Retrospective Studies; Vitamin D Deficiency; Vitamin D
PubMed: 37960966
DOI: 10.1111/aogs.14719