The impact of intrapartum pethidine on the neonatal outcome: a perspective review

Objective: To study the effect of intrapartum pethidine administration on the fetal heart rate pattern and neonatal outcome. Method: This is a prospective observational study done on forty low risk uncomplicated pregnancy at term in the first stage of labour. The study was done in the labour suite in Hospital Tengku Ampuan Afzan Kuantan, Malaysia. Intramuscular Pethidine 1mg/kg was given as intrapartum analgesia to all consented patient with normal baseline fetal heart rate and clear liquor. Intrapartum fetal heart rate pattern and neonatal outcome were reviewed and analysed by SSPS 17.0. Results: Total of 40 patients recruited in this study with mean age of 27.9 ± 6.03 years and mean gestational age of 39.0 ± 0.81 weeks. The mean duration from pethidine administration to delivery is 285.5 ± 178.9 minutes (4 hours and 45 minutes). Out of 40 patients, 2 (5%) cases had suspicious CTG 1 hour post pethidine administration, first one with absence of acceleration and the second with early deceleration which lasted for 45 minutes and one hour respectively. All neonates delivered with good Apgar Score, 8 at 1 minute and 9 at 5 minute. A total of 9 (22.5%) cases were admitted to the Neonatal Intensive Care Unit (NICU). Seven (17.5%) cases were admitted for observation because of delivery less than 4 hours after pethidine administration, following the neonatal protocol at our centre. Two (5%) cases were admitted for G6PD. Neither required ventilation nor antidotes. All of them were discharged to mother after 24 hours apart from those admitted because of G6PD. Conclusion: Intrapartum pethidine is still an analgesic option which is simple, cheap and easily available without major effect to the fetal heart rate pattern and the neonatal outcome

Background knowledge, attitude and practice of contraception among Pahang women

Objectives: 1. To study the knowledge awareness regarding contraception among women from Pahang.. 2. To identify the most popular method of contraception in use. 3. To find out the common reasons for the less frequent use of contraception. 4. To asses factors impacting knowledge in the use of contraception. METHOD This cross sectional study included 200 women from Pahang state from the first of September to 31st of December 2012. Any women with history of sexual exposure and consented were included to this study. Questioner was given in malay language to each female who asked to answer it on the spot and without assistant unless for the indication of reading for those who cannot read and write(just three illiterate women required the assistant). RESULT Out of 200 participants who were included in this study, the majority 87%(174) were in the reproductive age between 20- 40 year old, 11.5%(23) age more than 40 and 1.5%(2) less than 20. Ninety five percent are married(190) and 5% (10) are unmarried. A 53% (106) have tertiary education, 41.5(83) participants with secondary level. Four percent(8) and 1.5%(three) responder were from primary and no education background respectively. Majority of the responder were Malay 185(92.5%), Indian 2.5%(five),Chinese 1.5 %(3) and 3.5% (7) others. There is positive correlation between the educational status and the knowledge of contraception, being higher among ladies with tertiary education about 54.2% and lowest 1.1% in among women without education background. The practice of contraception followed the same pattern. Almost 50%(97/200) of respondents were aware of modern contraception,only the minority (4/200) only aware of tradisional contraception and the other 50%(99/200) were know both type of contraception. Among the respondents 76%( 152/200) were believed that contraception were effective. and 12.5%(25/200) were not effective and a nonnegligible proportion 11.5%(23/200) were not sure. A large number of women 70%(140/200) stated that no contraception side effects, 15.5%(31/200) talking about that and 14.5%( 29/200) were unsure. Educational level had broadly positive impact on the mentioned attitude. The method known to the greatest degree were contaceptives pills 27.7%(46),condom 15%(25) and combinations method. Among all the women 22.5%(38) choosed other method of contraception. A total of hundred respondents were not using any contraception method in this study, 52%(52) due to inconvenience side effects 12%(12) related to medical problems and 36%(36) because of other reasons. Among 190 married women, 88.9% of them had a discussion with husband regarding contraception and 87.1%(148) had gained support from husband. Out of these 70.5%(134) agreed to practise contraception in future. CONCLUSION Educational level had significant impact on the knowledge ,attitude and practice of contraception among Pahang Women with majority of them gained husband support

The success rate of vaginal birth after caesarean section and labour outcomes in women with intrapartum epidural analgesia vs parenteral opioid: preliminary result

Introduction: Neuraxial analgesia(epidural), is one of the most effective treatment for labour pain, however this benefit was offset by possible association with increased risk of caesarean section and prolonged labour. The American college of Obstetrician and Gynaecologist recommended delaying the administration of epidural analgesia when possible until cervical dilatation reach at least 4-5 cm, due to increase risk of CS up to 12 folds based on early studies Objective: To compare the effect of epidural with parenteral opioid analgesia on the outcome of labour, successes rates of vaginal birth in women undergoing trial of scar. Method: A prospective study conducted in Hospital Tengku Ampuan Afzan in 2014, all consented women for trial of scar were counselled for either intrapartum epidural or parenteral opioid while in labour with the cervical dilatation of 3-4 cm. Result: Total of 14 ladies with the mean age of 31.9(range 23-42) year, mean gestational age was 39.4 (SD=1.6) weeks, mean parity was 1.3 (11/14 cases were parity one), were recruited to this study from high risk labour room, divided into two equal groups, given intra partum epidural analgesia and parenteral pethidine. A seventy one per cent (5/ 7) cases in the epidural group were induction of labour (IOL), versus 57.1% (4/7) cases in the pethidine group. The mean duration of the first stage of labour was 7.4 (SD=1.6) hrs, 5(SD=3.5) hrs for the epidural and pethidine groups respectively. Only 28.6%(4/14) cases had spontaneous vaginal delivery, two cases from each group, another 28.6%(4/14) cases had assisted delivery, three from the pethidine group, all indicated for fetal distress (FD) apart from one was indicated for poor progress from the pethidine group. About 42.8(6/14) cases delivered abdominally, the majority 66.7 %(4/6) cases were from the epidural group, but statistically was not significant (P=0.435). Three out of four cases the indication was for poor progress and one for (FD), while the two cases from the pethidine group indicated for poor progress and FD. The duration of the second stage was 25.3(SD=11) minutes in the epidural group versus 18(SD=15) minutes in the pethidine group. None of the two groups have a maternal or neonatal complications. Conclusion: Epidural analgesia may be associated with prolonged labour, with lower rate of successful vaginal birth after CS, without increasing the complications rate. However large sample size is required to evaluate the statistical significance

The impact of intrapartum pethidine on the neonatal outcome. a prospective review

Objective: To study the effect of intrapartum pethidine administration on the fetal heart rate pattern and neonatal outcome. Methods: This is a prospective observational study done on forty low risk uncomplicated pregnancy at term in the first stage of labour. The study was done in the labour suite in Hospital Tengku Ampuan Afzan Kuantan, Malaysia. Intramuscular Pethidine 1 mg/kg was given as intrapartum analgesia to all consented patient with normal baseline fetal heart rate and clear liquor. Intrapartum fetal heart rate pattern and neonatal outcome were reviewed and analysed by SSPS 17.0. Results: Total of 40 patients recruited in this study with mean age of 27.9 ± 6.03 years and mean gestational age of 39.0 ± 0.81 weeks. The mean duration from pethidine administration to delivery is 285.5 ± 178.9 min (4 h and 45 min). Out of 40 patients, two (5%) cases had suspicious CTG 1 h post pethidine administration, first one with absence of acceleration and the second with early deceleration which lasted for 45 min and 1 h respectively. All neonates delivered with good Apgar Score, 8 at 1 min and 9 at 5 min. A total of nine (22.5%) cases were admitted to the Neonatal Intensive Care Unit (NICU). Seven (17.5%) cases were admitted for observation because of delivery <4 h after pethidine administration, following the neonatal protocol at our centre. Two (5%) cases were admitted for G6PD. Neither required ventilation nor antidotes. All of them were discharged to mother after 24 h apart from those admitted because of G6PD. Conclusion: Intrapartum pethidine is still an analgesic option which is simple, cheap and easily available without major effect to the fetal heart rate pattern and the neonatal outcome

The success rate of trial of labour after caesarean section: does intrapartum epidural analgesia affect the outcomes?

Introduction: Neuraxial analgesia, is an effective treatment for labour pain, however this benefit was offset by possible association with increased risk of caesarean section and prolonged labour. The American college of Obstetrician and Gynaecologist recommended delaying the administration of epidural analgesia until cervical dilatation reach 4–5 cm, due to increase risk of CS up to 12 folds based on early studies Objective: To study the effect of epidural analgesia on the successes rates of vaginal birth in women undergoing trial of scar and labour outcome. Method: A prospective study conducted in Hospital Tengku Ampuan Afzan started June 2014, all consented women for trial of scar were counselled for either intrapartum epidural (study group) or control group were the women offered parenteral opioid or antanox, with the cervical dilatation of 3–4 cm. Result: Total of 42 ladies with the mean age of 30.7, mean gestational age was 39.4 (SD = 1.6) weeks, mean parity was 1.5, were recruited to this study from the labour room, divided into two equal groups, study group and control group. A sixty one point nine per cent (13/21) cases in the epidural group were induction of labour, versus 28.5% (6/21) cases from group. The mean duration of the first stage of labour was longer for the epidural group 6.3 (SD = 2.01) hrs, versus 4.4(SD = 2.68) hrs for the control groups but no statistical significant difference (P value 0.24). About 40.4% (17/42) cases had spontaneous vaginal delivery, with only 35% (6/17) cases from epidural group. Another 16.7% (7/42) cases had assisted delivery, four cases from epidural group. All indicated for fetal distress (FD) and only two cases indicated for prolong second stage both from the epidural group. The duration of AOCOG 2015 Abstract, Electronic Poster Presentations, Maternal Fetal Medicine © 2015 Japan Society of Obstetrics and Gynecology 127 the second stage was 39.9 minutes in the epidural group versus 22 minutes in the control group which is statistically significant. About 42.8% (18/42) cases delivered abdominally, the majority 61.1% (11/18) cases were from the epidural group (6 were indicated for poor progress, one failed induction and 4 for fetal distress), but was statistically not significant from control (P value 0.21). in the control group 3/7 cases were indicated for poor progress. None have maternal or neonatal complications. Conclusion: Epidural analgesia may be associated with prolonged labour, significantly prolonged second stage of labour, with lower rate of successful vaginal birth after CS, without increasing the complications rate. However large sample size is required to evaluate the statistical significanc

Background knowledge, attitude and practice of contraception among Pahang women

Objectives: Women bear the highest stress and burden of reproductive health. It is the women’s right to choose and practice their own convenient contraceptive methods. Thus spreading of proper information regarding contraception is vital to reduce the reproductive related morbidity and mortality in our society. In our survey we aimed to study the awareness and the factors impacting knowledge regarding contraception among Pahang women. To find out regarding women attitude and perception of contraception METHOD : This cross sectional study included 200 women from Pahang state from the first of September to 31st of December 2012. Any women with history of sexual exposure and consented were included to this study. Questioner was given in malay language to each female who asked to answer it on the spot and without assistant unless for the indication of reading for those who cannot read and write(just three illiterate women required the assistant). RESULT: Out of 200 participants who were included in this study, the majority 87%(174) were in the reproductive age between 20- 40 year old, 11.5%(23) age more than 40 and 1.5%(2) less than 20. Ninety five percent are married(190) and 5% (10) are unmarried. A 53% (106) have tertiary education, 41.5(83) participants with secondary level. Four percent(8) and 1.5%(three) responder were from primary and no education background respectively. Majority of the responder were Malay 185(92.5%), Indian 2.5%(five),Chinese 1.5 %(3) and 3.5% (7) others. There is positive correlation between the educational status and the knowledge of contraception, being higher among ladies with tertiary education about 54.2% and lowest 1.1% in among women without education background. The practice of contraception followed the same pattern. Almost 50%(97/200) of respondents were aware of modern contraception,only the minority (4/200) only aware of tradisional contraception and the other 50%(99/200) were know both type of contraception. Among the respondents 76%( 152/200) were believed that contraception were effective. and 12.5%(25/200) were not effective and a nonnegligible proportion 11.5%(23/200) were not sure. A large number of women 70%(140/200) stated that no contraception side effects, 15.5%(31/200) talking about that and 14.5%( 29/200) were unsure. Educational level had broadly positive impact on the mentioned attitude. The method known to the greatest degree were contaceptives pills 27.7%(46),condom 15%(25) and combinations method. Among all the women 22.5%(38) choosed other method of contraception. A total of hundred respondents were not using any contraception method in this study, 52%(52) due to inconvenience side effects 12%(12) related to medical problems and 36%(36) because of other reasons. Among 190 married women, 88.9% of them had a discussion with husband regarding contraception and 87.1%(148) had gained support from husband. Out of these 70.5%(134) agreed to practise contraception in future. CONCLUSION Educational level had significant impact on the knowledge ,attitude and practice of contraception among Pahang Women with majority of them gained husband support

Expression of virulence genes in group B streptococcus isolated from symptomatic pregnant women with term and preterm delivery

Aims: Maternal vaginal Group B Streptococcus (GBS) colonization is considered a risk factor for preterm delivery and, consequently, neonatal infections. Previous studies have portrayed the important roles of these virulence factors, including hemolytic pigment, hyaluronidase (HylB), serine-rich protein (Srr) and bacterial surface adhesion of GBS (BsaB) in mediating GBS colonization and intrauterine ascending infection, causing preterm delivery. This study aimed to investigate the association between mRNA expression of virulence genes in GBS isolates obtained from symptomatic pregnant women and preterm delivery. Methodology and results: GBS isolates were obtained from high vaginal swabs of 40 symptomatic pregnant women of gestational age of less than 37 weeks. RNA was extracted from these GBS isolates and RT-qPCR was performed to determine the relative mRNA expression of GBS virulence genes, including CylE (encode enzyme required for the biosynthesis of the hemolytic pigment), HylB, Srr-1 and BsaB. Socio-demographic details and obstetric history were not found to be associated with the delivery outcomes of these women. The GBS isolates from symptomatic pregnant women who delivered prematurely showed a higher expression of CylE gene and a trend towards an elevated expression of HylB gene compared to women with term delivery. While the expression of both Srr-1 and BsaB genes was similar between symptomatic pregnant women who had term or preterm delivery. Conclusion, significance and impact of study: The results suggest that following vaginal colonization, both CylE and HylB genes are likely to contribute to intrauterine ascending infection and inflammation, leading to preterm delivery in humans. These virulence factors may be targeted for the pre-clinical stages of vaccine development or therapeutic intervention