Maternal Fetal Medicine
Zahra Panahi; Sedigheh Hantoushzadeh; Soudabeh Kazemi Aski,; Saeede Eslami Khotbesara; Mamak Shariat; Fahimeh Ghotbizadeh; Razieh Akbari
Articles in Press, Accepted Manuscript, Available Online from 17 May 2023
Abstract
Introduction: Despite the high efficacy of the Apgar score to find respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one the best indicator of fetal hypoxia. Therefore it’s so beneficial to consider these criteria and ...
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Introduction: Despite the high efficacy of the Apgar score to find respiratory distress, a low Apgar score doesn’t necessarily indicate fetal hypoxia-asphyxia. Umbilical Artery pH (UApH) is one the best indicator of fetal hypoxia. Therefore it’s so beneficial to consider these criteria and its relationship with Apgar score for accurate diagnosis of prenatal respiratory distress retrospectively and by which reduces the unnecessary cesarean section(CS) rate.
Methods: 162 full-term (≥259 days) neonates delivered by CS with a diagnosis of decreased fetal heart rate (FHR) were evaluated. 1-min and 5-min Apgar scores and UApH were measured. The correlation between Apgar scores with UApH and the association between UapH and Apgar with the NICU admission were evaluated. The effect of other variables including mother’s age, gravidity, gestational age, birth weight, newborn gender, and causes of decreased FHR on Apgar scores and UApH were studied as well.
Results: The most common cause of decreased FHR was fetal distress, boys had higher weight (p=0.033) and lower UApH (p=0.049) than girls. Other parameters were not different significantly between males and females. There was a positive correlation between UApH and 1-min and 5-min Apgar scores (r=0.464 and r=0.370 respectively) when controlled for birth weight (p<0.0001). The RR for NICU admission in male acidemic neonates with abnormal 1-min Apgar was 14.05(CI95%: 5.7-34.6) in comparison to females (RR=1.06, CI95%:1-1.26).
Conclusion: Mild acidemia (UApH<7.2) at least in male fetuses would be a good predictor for postnatal complications and the need for NICU admission. Future studies with more samples are suggested.
Afsaneh Amirabi; Nashmil Amjadipour; Leyla Dinparast
Volume 3, Issue 1 , March and April 2018, , Pages 23-28
Abstract
Aims: Morbidly adherent placenta/Placenta accreta syndrome refers to morbid implantation, invasion, and/or adhesion of a placenta, whose incidence rate has increased due to the growing trend of cesarean section. Diagnosing placenta accreta before delivery plays a crucial role in reducing morbidity and ...
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Aims: Morbidly adherent placenta/Placenta accreta syndrome refers to morbid implantation, invasion, and/or adhesion of a placenta, whose incidence rate has increased due to the growing trend of cesarean section. Diagnosing placenta accreta before delivery plays a crucial role in reducing morbidity and mortality of the mother and fetus. This study aimed at evaluating the diagnostic value of the Doppler ultrasonography in diagnosis of morbidly adherent placenta.
Instruments and Methods: In this descriptive-analytical study, 150 singleton pregnant women with gestational age of ≥24 weeks with a history of uterine incision (C/S, myomectomy, or metroplasty), underwent a Doppler ultrasonography to detect the position of placenta and evidence for adherent placenta. The data were analyzed by SPPS 21 software.
Findings: Twelve patients underwent the cesarean-hysterectomy during their cesarean sections due to severe bleeding and morbidly adherent placenta. In terms of pathologic findings, placenta accreta, placenta increta, and placenta percreta were reported in 7 cases, 3 cases, and 1 case, respectively. The Doppler ultrasonography had a sensitivity of 91.67%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 99.28% in the diagnosis of morbidly adherent placenta.
Conclusion: The thinning or absence of the retroplacental myometrial thickness and the large retroplacental lacunae are the most powerful ultrasonographic markers in the diagnosis of the placenta accreta such that the negativity of these markers can be interpreted as the absence of placenta accreta and the positivity of them can be interpreted as the presence of the placenta accreta.
