Early Infant Morbidity in the City of São Paulo, Brazil

BACKGROUND: Early infant morbidities may produce adverse outcomes in subsequent life. A low Apgar score is a convenient measure of early infant morbidity. We study determinants of early infant morbidity (sex, plurality, mode of delivery, prior losses, gestational age, prenatal care and birth weight, parity and maternal age, race, maternal education and community development) for the 1998-birth cohort, City of São Paulo, Brazil. METHODS: This study identified all deliveries that took place in the City of São Paulo during 1998. Information was extracted from 209,628 birth records. We used multivariate logistic regression to assess the effect of each independent variable on Apgar score less than seven at one minute and Apgar score less than seven at five minutes. RESULTS: Low birth weight, prematurity and community development were found to be strong predictors of morbidity. Maternal education showed strong negative correlation with both Apgar scores. The negative correlations between maternal schooling and Apgar scores were observed after prenatal care, parity and maternal age were included in the model. Unmeasured proximate factors may thus be the true source of disparity between educational groups. Children of very young adolescent mothers had lower Apgar scores at one minute (but not at five minutes) than those born to mothers 15 to 19. Parity one or higher was associated with decreased odds of low Apgar scores. Cesarean section and operative delivery were associated with higher odds of early infant morbidity. CONCLUSION: Education may allow mothers to have better care in the peripartum period. More educated mothers may be more likely to recognize certain morbidities through the pregnancy period and the monitoring of such morbidities yields better infant outcomes. Also, having less than seven prenatal care visits was found to predict early infant morbidity and one way to increase the use of such services is to focus on aspects of care that may lead to easier accessibility and continuity of prenatal care. Physicians should inform mothers about the risks associated with high number of children for a next infant and also about the risks for the infant associated with unnecessary cesarean sections. Special attention should be paid to adolescent mothers, since much of their increased risk is likely to be minimized by counseling

Transatlantic Air Travel in the Third Trimester of Pregnancy: Does It Affect the Fetus?

AbstractMost commercial airlines allow pregnant women to fly up to 36 weeks of gestation. Available information suggests that noise, vibration, and cosmic radiation present a small risk for the pregnant air traveler. The goal of the study was to assess the possible effect of transatlantic flights on the condition of the third-trimester fetus. In total, 112 patients were recruited into the study between January 2005 and June 2016. All underwent a transatlantic flight in the third trimester of pregnancy. All underwent nonstress test before and within 12 hours after the transatlantic flight, and 24 hours later. Patients were asked to report changes in fetal movements (FMs), if any, during takeoff, flight itself, and landing. The time of flight varied from 8 to 15 hours; average flight time was 9 ± 3.8 hours. Ninety-eight patients were the passengers of first or business class, and the rest were of economy class. Increased FM during takeoff was reported by 17 patients (15%), no change in FM by 62 (35%), decreased FM by 4 (3.6%). During flight itself, increased FM was reported by 6 pregnant passengers (5.4%), no change in FM by 70 (63%), decreased FM by 8 (7%).</jats:p

Endoscopical determination of umbilical cord complications in labor

Peer Reviewe

Can Cervical Cerclage Prevent Umbilical Cord Prolapse in Patients with Funic Presentation?

Objective: Umbilical cord prolapse is a rare event complicating 0.17%–0.62% of all pregnancies. Funic presentation is a known risk factor for umbilical cord prolapse. Currently, there is no strategy to prevent umbilical cord prolapse in patients with funic presentation. The novel technique used is placement of late cervical cerclage to create a mechanical barrier and prevent an umbilical cord prolapse. Methods: Six patients with a sonographically detected funic presentation were included in the study. Funic presentation was defined as the sonographic presence of the umbilical cord below the presenting part using both transabdominal and transvaginal sonography. Cord prolapse was defined as an umbilical cord seen or palpated below the presenting part. Cervical cerclage was placed in patients with persistent funic presentations, which is the detection of the umbilical cord below the presenting part, on two or more sonograms at least a week apart. Results: Cervical cerclages were placed in six patients with funic presentation between 28 and 34 weeks of gestation without immediate complications. All patients were delivered by a cesarean section between 35 and 38 weeks of pregnancy. None experienced umbilical cord prolapse. Funic presentation was confirmed at birth in all cases. Apgar scores varied between 7 and 10. Conclusion: It appears that cervical cerclage may be an effective measure to prevent umbilical cord prolapse in cases of known persistent funic presentation. </jats:sec