Association of early neonatal-maternal outcomes with timing of elective caesarean section at term gestation

Background: The decision for optimal time for elective caesarean section (ECS) should be taken considering the minimum risk to the newborn as well as to the mother. This prospective observational study aimed to investigate the effect of gestation of ECS, on neonatal and maternal outcomes.Methods: All the pregnant term mothers admitted to our hospital for ECS and fulfilling the inclusion criteria were enrolled and divided into 2 groups, early term and full term. Patients having high-risk factors like intrauterine growth restriction, amniotic fluid disorders, multiple pregnancies, placenta previa, abruption placenta and medical co-morbidities were excluded. Early neonatal and maternal outcomes were compared between the 2 groups.Results: 244 mothers were eligible for ECS, 183 (75%) women underwent ECS in the early term and 61 (25%) at full term as per the decision of obstetricians of various units. The incidence of neonatal respiratory morbidity (NRM) was 2 percent in our study. Out of 244 newborns, 4 developed NRM in the form of delayed adaption in 3 and respiratory distress in 1. The incidence of respiratory distress was comparable in both groups. The incidence of NNJ, MSL and sepsis was higher in the early term but it was not significant statistically. Maternal outcomes like postpartum haemorrhage, the need for blood transfusion, bladder injury, thin scar, adhesions poorly formed LUS were observed in the early term but the difference was not significant.Conclusions: More research needs to be done for optimization of timing of ECS

Maternal and neonatal outcome in COVID-19 pregnancy: an ongoing review of first wave in a tertiary care center in North India

Background: This study analyzed the clinical outcomes in the obstetric patients with COVID-19 and their neonates in first wave of COVID-19 pandemic in North India, 2020.Methods: This prospective study was conducted between 10 May 2020 to 31 December 2020 on 83 obstetric patients with COVID-19 and their 52 neonates.Results: 36.14% obstetric patients presented with COVID-19 like symptoms with most common symptom as fever in 60% and cough in 53.33%. 4.81% patients were admitted in HDU and 1/83 (1.20%) patient who required ICU had mortality due post-operative complications. 20.48% had pre-existing medical diseases. Amongst (78) antenatal patients, 21.79% had pregnancy related hypertensive disorders, 12.82% had deranged liver function tests without hypertension and 8.97% had gestational diabetes mellitus. More probability of pre-term labour pains 2.4 (95% CI, 1.37-4.18) and IUFD 2.18 (1.13-4.20) were observed in symptomatic patients as compared to asymptomatic patients. Neonates born to COVID-19 symptomatic mothers had 1.81 (95% CI, 0.73-4.49) times the risk of being symptomatic, 1.37 (95% CI, 0.54-3.41) times the risk of getting admitted to NICU and 1.57 (95% CI, 0.48-5.09) times the risk of getting infected by SARS-CoV-2 and increased morbidity in neonates. 8% neonates had perinatal and 1.5% had horizontal transmission of SARS-CoV-2.Conclusions: First wave of COVID-19 pandemic did not cause significant adverse outcome in pregnant patients and mother-newborn dyads in our tertiary care centre when active and intensive management of mothers and newborns were done but still there is possibility of severe morbidity and mortality due to COVID-19.

Neonatal dengue with enterococcus sepsis

Dengue infection is possible in all the three trimesters of pregnancy and is associated with various maternal and neonatal complications. The occurrence of subclinical infections may lend further confusion to the situation. Here, we report a case of neonatal dengue diagnosed with dengue NS1 antigen positive and IgM positive followed by secondary sepsis with Enterococcus faecium. Case studies like these may contribute to increased awareness of the suspicion of the associated life-threatening infections that can occur with neonatal dengue, their manifestations, and the management, thus improving their outcome

An Asian multicenter retrospective study on persistent pulmonary hypertension of the newborn: Incidence, etiology, diagnosis, treatment and outcome

Objectives: To explore the incidence, etiologies, diagnostic methods, treatment options and outcomes in neonates with persistent pulmonary hypertension of the newborn (PPHN) and to identify mortality risk factors in a study from six Asian countries.Methods: A retrospective chart review of patients with documented PPHN from seven centers in six Asian countries (Japan, Kuwait, India, Pakistan, Singapore, and Thailand) between 1 January, 2014 and 31 December, 2016, was performed.Results: A total of 369 PPHN infants were identified. The incidence of PPHN ranged from 1.2–4.6 per 1000 live births. The all-cause mortality rate was 20.6% (76 of 369). Meconium aspiration syndrome was the primary cause of PPHN (24.1%). In most cases (84.8%) echocardiography was used to establish the diagnosis of PPHN. Sildenafil was the most commonly used pulmonary vasodilator (51.2%). Multivariate multiple regression analysis indicated gestational age \u3c 34 weeks (adjusted odds ratio (OR) = 3.27; 95% CI 1.56–6.74), congenital diaphragmatic hernia (CDH)/lung hypoplasia (LH) (adjusted OR = 6.13 (95% CI 2.28–16.42)), treatment with high frequency oscillation ventilation (HFOV) with or without inhaled nitric oxide (iNO) (adjusted OR = 3.10 (95% CI 1.52–6.34)), and inotropic agents (adjusted OR = 9.43 (95% CI 2.71–32.83)) were independently associated with increased risk of death.Conclusions: The incidence of PPHN in the current study was higher than in western settings. Birth weight, gestational age, CDH/LH, HFOV/iNO, and inotropic agents were significant mortality risk factors