Effect of Membrane Sweeping on the Initiation of Spontaneous Labour

Background: Membrane sweeping causes induction of labour by release of prostaglandins, and other hormones. Aim: To determine efficacy of membrane sweeping on induction of spontaneous labour in post-date women. Study design: Randomized controlled trial. Place and duration of study: Department of Obstetrics & Gynaecology, Health Bridge Hospital, Ghazi Road, Lahore from 1st January 2020 to 31st December 2020. Methodology: One hundred and fifty pregnantwomen with ≥40 weeks of gestationwere randomly divided into two groups of 75 pregnant women each. Group A were those who consented for undergoing membrane sweeping whereas group B did not undergo this process. Results: The mean age of the enrolled pregnant women was25.7±3.05 years. The mean duration of pregnancy in group A was 40.1±0.2 weeks and in group B was 40.2±0.1 weeks. Regarding spontaneous onset of labour, in group A, 38(50.6%) patients went into labour with sweeping of membranes and in group B, 10(13.4%) patients had spontaneous onset of labour. There were only two cases of infection reported in Group A and one in group B. Conclusion: Membrane sweeping for natural induction of spontaneous labour. Key words: Membrane sweeping, Labour induction, Efficacy

MATERNAL AND PERINATAL OUTCOMES OF CORONAVIRUS DISEASE COVID 19 INFECTION IN PREGNANCY – A RETROSPECTIVE STUDY.

Purpose: To study maternal and perinatal outcomes of COVID –positive pregnant women in a tertiary healthcare centre. Materials And Methods: This was a retrospective statistical analysis of records of COVID positive women who delivered at our institution between May 2020 to December 2020. Results: There were 44 COVID positive pregnant women during the study period of which 40 (90.9%) were term pregnancies and 4 (9.09%) preterm pregnancies. There were 17 (38.63%) women who had spontaneous onset of labour, 14 (31.8%) were induced and 13(29.5%) had elective LSCS. 14(31.8%) women had normal vaginal delivery,26(59.09%) had LSCS and 4(9.09%) had instrumental delivery. Most women 39(88.6%) were asymptomatic and 5(11.3%) presented with mild symptoms. 30 patients (68.18%) had underlying medical disorders. There were 5 (11.3%) babies with low birth weight (<2.5kg) , APGAR scores at 5 min was >7 for all babies. Six (15.7%) babies required NICU admission and 2 (4.5%) were COVID positive. Conclusion: Majority of the COVID positive women were asymptomatic . Majority of the patients had an underlying comorbidity.None underwent ICU admission. Risk of preterm delivery and NICU admission was similar to COVID negative patients. Risk of vertical transmission exists. Fetal outcomes in terms of APGAR scores at 5 min, birth weight was found to be good.

Prevelance of symptoms during menstruation and its management among adolescent girls

Background: Menstruation is a natural phenomena of the female reproductive cycle in which discharge of blood from the uterus exits through the vagina every month, it is the spontaneous onset of puberty. 75% of girls confront some problems associated with menstruation including delayed, irregular, painful and heavy menstrual bleeding. Menstruation can be accompanied with premenstrual and postmenstrual symptoms which include both physiological symptoms and psychological symptoms. It is important to treat both physiological and psychological symptoms with pharmacological and nonpharmacological treatment approaches.Methods: The study was a prospective observational study done with a sample size of 650 subjects of 9 to 18 age group in whom menstruation already occurred were recruited from five different schools in regions of Pathanamthitta and Alappuzha. The study was conducted in 3 phases, where initially a predesigned well-structured questionnaire was provided to assess the attitude, awareness and practices.Results: Subjects experienced some or other type of symptoms and had better knowledge regarding menstrual symptoms and its importance of management when compared to subjects from other regions of India which was imparted from a developed and supporting society but still, they lacked some adequate and updated information on symptoms and management of symptoms during menstruation.Conclusions: So, this study laid the groundwork for discussion on menstrual symptoms, various approaches of treatment to the adolescent girls, providing them the information they lacked and better guidance.

Spontaneous epidural pneumorrhachis in 14 years old

Background: Pneumorrhachis is an exceedingly rare complication of pneumomediastinum as air tracks through tissue planes into the epidural (or subdural space). The majority of these patients present with a clear history of trauma, iatrogenic injury, pneumothorax, vomiting, or retching. Case Description: A 14-year-old male presented with the asymptomatic spontaneous onset of pneumorrhachis associated with significant pneumomediastinum of unclear etiology. Conclusion: Most patients with pneumorrhachis present with nonfocal neurological examinations. For these patients, it is critical to rule out infection as the cause of epidural gas. If other systemic signs are present, then urgent contrast-enhanced magnetic resonance imaging should be obtained. The majority of patients will demonstrate spontaneous radiographic resolution of pneumorrhachis within several days.

Outcomes of Induction Versus Spontaneous Onset of Labour at 40 and 41 Gw: Findings From A Prospective Database, Sri Lanka

Objectives The World Health Organization recommends induction of labour (IOL) for low risk pregnancy from 41 + 0 gestational weeks (GW). Nevertheless, in Sri Lanka IOL at 40 GW is common practice. This study compares maternal/newborn outcomes after IOL versus spontaneous onset of labour (SOL) at 40 GW (IOL40) and 41 GW (IOL41). Methods Data were extracted from the routine prospective individual patient database of the Soysa Teaching Hospital for Women, Colombo. IOL and SOL groups were compared using logistic regression. Results Of 13670 deliveries, 2359 (17.4%) were singleton and low risk at 40 or 41 GW. Of these, 456 (19.3%) women underwent IOL40, 318 (13.5%) IOL41, and 1585 (67.2%) SOL. Both IOL40 and IOL41 were associated with an increased risk of any maternal/newborn negative outcomes (OR = 2.21, 95%CI = 1.75–2.77, p < 0.001 and OR = 1.91, 95%CI = 1.47–2.48, p < 0.001 respectively), maternal complications (OR = 2.18, 95%CI = 1.71–2.77, p < 0.001 and OR = 2.34, 95%CI = 1.78–3.07, p < 0.001 respectively) and CS (OR = 2.75, 95%CI = 2.07–3.65, p < 0.001 and OR = 3.01, 95%CI = 2.21–4.12, p < 0.001 respectively). Results did not change in secondary and sensitivity analyses. Conclusions Both IOL groups were associated with higher risk of negative outcomes compared to SOL. Findings, potentially explained by selection bias, local IOL protocols and CS practices, are valuable for Sri Lanka, particularly given contradictory findings from other settings.

Effect of Induction of Labor on Maternal and Perinatal Outcomes in Low-Risk Singleton Pregnancies: A Retrospective Case-Control Study

Background: To investigate the effect of induction of labor on maternal and fetal outcomes. Methods: This retrospective case-control study included 4386 pregnant women with low-risk singleton pregnancies who underwent regular prenatal examination and successful vaginal delivery at ≥41 weeks and 0 days of gestation in Fujian Maternal and Child Health Hospital between January 2014 and December 2018. Clinical data were reviewed according to the mode of labor initiation; the women were divided into an induction of labor group (2007 cases) and a spontaneous onset of labor group (2361 cases). Two-sample independent t-test and χ 2 tests were used to analyze the differences in clinical characteristics such as maternal age and parity between the two groups. Results: The induction of labor group had a significantly longer total duration of labor (9.37±5.37 vs. 8.82±5.13 h; P<0.001), was associated with more postpartum blood loss (219.18±188.32 vs. 199.95±124.69 mL; P=0.01), and had a significantly higher incidence of severe postpartum hemorrhage (PPH) (0.8% [16/2007] vs. 0.33% [8/2361]; P=0.041) than the spontaneous onset of labor group. However, no significant difference was found in the neonatal outcomes. After adjusting for age, induction of labor in nulliparous women was more likely to lead to PPH than spontaneous onset of labor (2.74% [55/2007] vs. 1.65% [39/2361]; odds ratio=1.557; 95% confidence interval: 1.039–2.332; P<0.05]. Conclusion: Induction of labor increases postpartum blood loss, especially in primary parturients, leading to an increased risk of PPH, which may be related to the prolongation of the total duration of labor. Therefore, low-risk nulliparous women should try to avoid induction of labor without medical indications.

Serum Melatonin as a Biomarker for Assessment of Late-term and Postterm Pregnancies in Women without Spontaneous Onset of Labor

We conducted a prospective study to assess serum melatonin as a biomarker to predict the development of late-term and postterm pregnancies and spontaneous beginning of labor in women with term pregnancies. Population of this prospective study included pregnant women with late-term and postterm pregnancies and term pregnancies as controls. In these study groups, serum melatonin concentrations were measured in women with or without labor and their perinatal data were collected. In the postterm pregnancies without labor, the lowest median melatonin concentrations were measured (p<0.05). In the late-term and postterm pregnancies with and without labor, the median serum melatonin concentrations were significantly lower than term ones (p<0.05). In the term pregnancies with labor, the highest median melatonin concentration was measured (p<0.05). A serum melatonin concentration≤34 pg/mL as a cut-off value determines late-term and postterm pregnancy with a sensitivity of 80.4% and a specificity of 81.4%. A serum melatonin concentration>29.35 pg/mL as a cut-off value determines presence of labor with a sensitivity of 82.1% and a specificity of 55.0%. In women with term pregnancies, with the measurement of serum melatonin, it is possible to predict the development of late-term and postterm pregnancies and whether these pregnancies undergo spontaneous labor. With further studies, these findings need to be supported before their routine clinical use.