Effect of gestational weight gain on pregnancy outcomes in underweight pregnant women

Objective:To determine a relationship between inadequate gestational weight gain and adverse pregnancy outcomes among Thai gravidas with underweight. Methods: A retrospective cohort study was conducted in 306 underweight pregnant women who attended our antenatal clinic between December 2009 and August 2012. The study subjects (women who gained less than 12 kg throughout pregnancy) were matched 1:1 with the control subjects (women who gained ≥12 kg) by age group and parity. Adverse pregnancy outcomes including low birth weight (LBW), small-for-gestational age (SGA), birth asphyxia, and neonatal intensive care unit (NICU) admission were compared between the two groups.Results: Complete data of 145 study subjects and 145 controls were analyzed. The study group had significantly lower mean neonatal birth weight than the control group: 2,939.0±338.1 grams vs. 3,037.2±336.9 grams; p=0.014. By univariable and multivariable analyses, women in the study group were not at increased risk of LBW, SGA, birth asphyxia, and NICU admission compared to control subject. However, when different thresholds for inadequate weight gain were applied, we found that gestational weight gain less than 8 kg was significantly associated with LBW, but not SGA, birth asphyxia, and NICU admission, in underweight women. The adjusted OR was 4.5 (95% confidence interval, 1.4-14.6; p=0.012). Conclusion: There was no significant relationship between inadequate gestational weight gain (<12 kg) and adverse pregnancy outcomes among Thai gravidas with underweight. However, women who gained less than 8 kg were at significantly increased risk of delivering a LBW infant

Diagnosis and repair of perineal injuries: knowledge before and after expert training-a multicentre observational study among Palestinian physicians and midwives.

OBJECTIVE: To assess whether a 2 days training with experts teaching on diagnosis and repair of perineal injuries among Palestinian midwives and physicians could change their level of knowledge towards the correct diagnosis and treatment. STUDY DESIGN: Multicentre observational study. SETTING: Obstetric departments in 6 government Palestinian hospitals. PARTICIPANTS: All physicians and midwives who attended the training. METHODS: A questionnaire comprising of 14 questions on the diagnosis and repair of perineal tears was distributed to all participants before the training (n=150; 64 physicians and 86 midwives) and 3 months after the training (n=124, 53 and 71, respectively). Characteristics, differences of the study population and level of knowledge before and after the training were presented as frequencies and percentages. Consistency in responses was tested by estimating the p value of McNemar test. RESULTS: Among physicians only 11.4% had accurate knowledge on perineal anatomy before the training compared with 78.85% after the training (p<0.001). For midwives, the corresponding numbers were 9.8% and 54.2%, respectively (p<0.001). Before the training, 5.8% of the physicians were aware that rectal examination is mandatory before and after suturing of episiotomies compared with 45.8% after the training (p<0.001). The corresponding numbers for midwives were 0% and 18% (p<0.001), respectively. Physicians knowledge of best practice of skin repair following episiotomy improved from 36.5% to 64.5% (p=0.008) and among midwives from 26.1% to 50.7% (p<0.001). Physicians knowledge of the overlap technique in the repair of full thickness external anal sphincter tears improved from 28.5% to 42.8% (p=0.05), whereas knowledge of repairing torn internal anal sphincter separately improved from 12.8% to 86.8% (p<0.001). CONCLUSIONS: Improvement in the level of knowledge on diagnosis and repair of perineal tears was observed for all physicians and midwives who attended the 2 days' expert training. Regular ongoing training will serve to maintain the newly acquired knowledge

The outcomes of midline versus medio-lateral episiotomy

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Comparison of Triglyceride Level between 24-28 week’s Gestation of Nondiabetic Women with and without Positive Diabetic Screening

Objectives: To determine the difference in triglyceride levels (TG) between normal and abnormal glucose screening test but not diagnosed GDM in pregnant women.Materials and Methods: A prospective cohort study was conducted in 108 singleton pregnant women undergoing 50g glucose challenge test (50g GCT) at 24 to 28 weeks of gestation during June to November 2015. Eighty four in control group had normal 50g GCT and twenty four subjects with abnormal 50g GCT but negative on diagnostic test [100g oral glucose tolerance test (OGTT)] in study group. The TG and fasting blood sugar (FBS) were collected in both groups after 50g GCT for one week. Hypertriglyceridemia was defined as triglyceride level of 75th percentile or greater. The Receiver Operator Characteristic (ROC) curve was constructed to look for the cut-off level of TG which provide the best sensitivity and specificity of large for gestational age (LGA).Results: There was no significant difference in TG which was 188 and 189 mg/dl in control and study group respectively (p = 0.402). Hypertriglyceridemia was 237 mg/dl or greater. Incidence of hypertriglyceridemia was not different between groups (p = 0.508). The percentage of LGA in the study group was 29.2% while in the control group was 9.5% (p = 0.039). Using the cut-off TG > 183.5 mg/dl has a sensitivity of 60% and specificity of 44% for LGA detection. Conclusion: TG was not different between pregnant women with normal 50g GCT and those who had abnormal 50g GCT but negative on diagnostic test. The TG was not good indicator for LGA detection