This study examined determinants of low APGAR scores in newborns of women with preeclampsia who delivered at Cipto Mangunkusumo Hospital in 2014. The study found that 19% of newborns had low APGAR scores at 1 minute and 5.4% had low scores at 5 minutes. Early onset preeclampsia, preterm birth (<37 weeks), thrombocytopenia, severity of preeclampsia, and HELLP syndrome were independent risk factors for low 1-minute APGAR scores. There were no significant risk factors found for low 5-minute APGAR scores after adjusting for confounding factors. The study aims to identify risks for low APGAR
A presentation on Medically Indicated Deliveries Before 39 weeks.
Includes updated information from ACOG.
Medically indicated late-preterm and early-term deliveries. Committee Opinion No. 560. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:908–10.
The Relationship between Maternal Anemia and Birth Weight in New Borniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Gap identification in birth asphyxia management among cmw's in dist rict hafi...Zubia Qureshi
Background: In Pakistan, Neonatal Mortality Rate (NMR) has remained static since 1994 (1). In early neonatal period approximately 82% deaths are attributed to Birth Asphyxia (2, 3). Methodology: A cross sectional study was conducted to assess the CMWs knowledge regarding birth asphyxia in district Hafiz Abad, Pakistan. All the CMWs were included in the study, except those who were on leave in the study duration. Pre-structured questionnaire was used for this purpose. SPSS version 21 was used for analysis. Results: Response rate of this study is about 90%. Results showed that most of the CMWs i.e. 40 (72.7%) were below the age of 30 years, while 24 (40%) were married. Most of them 58.2% (32) had less than 3 years of experince as a community midwife. Regarding the diagnosis of Birth Asphyxia, 35 (63.6%) consider depressed breathing as sign of birth asphyxia. About 55% of the Community midwives took 30 minutes to resuscitate the baby. About 49% of them indicated that they use fetoscope to monitor the fetal heart rate. Age group and marital status of midwives found significantly associated with the proper diagnosis of Birth Asphyxia (P-value = <0.05). Cross tabulation results show that CMW’s age and marital status not significantly associated with time taken to manage the birth asphyxia (P-Value 0.164 and 0.141 respectively), while professional experience is significantly associated with it with p-value <0.001. Recommendations: There is need for continuous training of CMW’s in proper resuscitation and management skills of Birth Asphyxia. In addition, there is also a need to ensure the availability of resuscitating equipment’s and proper resources, so that the quality of proper neonatal care is ensured. Key words: Birth Asphyxia, Neonates, Mortality, Community midwives, Knowledge, Management.
Serum concentrations of CA-125 in normal and Preeclamptic pregnanciesiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Journal Club presented at Dept. of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi. Aspirin versus Placebo in Pregnancies at high risk for preterm preeclampsia
A presentation on Medically Indicated Deliveries Before 39 weeks.
Includes updated information from ACOG.
Medically indicated late-preterm and early-term deliveries. Committee Opinion No. 560. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:908–10.
The Relationship between Maternal Anemia and Birth Weight in New Borniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Gap identification in birth asphyxia management among cmw's in dist rict hafi...Zubia Qureshi
Background: In Pakistan, Neonatal Mortality Rate (NMR) has remained static since 1994 (1). In early neonatal period approximately 82% deaths are attributed to Birth Asphyxia (2, 3). Methodology: A cross sectional study was conducted to assess the CMWs knowledge regarding birth asphyxia in district Hafiz Abad, Pakistan. All the CMWs were included in the study, except those who were on leave in the study duration. Pre-structured questionnaire was used for this purpose. SPSS version 21 was used for analysis. Results: Response rate of this study is about 90%. Results showed that most of the CMWs i.e. 40 (72.7%) were below the age of 30 years, while 24 (40%) were married. Most of them 58.2% (32) had less than 3 years of experince as a community midwife. Regarding the diagnosis of Birth Asphyxia, 35 (63.6%) consider depressed breathing as sign of birth asphyxia. About 55% of the Community midwives took 30 minutes to resuscitate the baby. About 49% of them indicated that they use fetoscope to monitor the fetal heart rate. Age group and marital status of midwives found significantly associated with the proper diagnosis of Birth Asphyxia (P-value = <0.05). Cross tabulation results show that CMW’s age and marital status not significantly associated with time taken to manage the birth asphyxia (P-Value 0.164 and 0.141 respectively), while professional experience is significantly associated with it with p-value <0.001. Recommendations: There is need for continuous training of CMW’s in proper resuscitation and management skills of Birth Asphyxia. In addition, there is also a need to ensure the availability of resuscitating equipment’s and proper resources, so that the quality of proper neonatal care is ensured. Key words: Birth Asphyxia, Neonates, Mortality, Community midwives, Knowledge, Management.
Serum concentrations of CA-125 in normal and Preeclamptic pregnanciesiosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
Journal Club presented at Dept. of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Delhi. Aspirin versus Placebo in Pregnancies at high risk for preterm preeclampsia
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
Introduction: Preeclampsia is a medical emergency implicated in maternal and foetal morbidity and mortality. Research directed at finding the aetiologies of pre-eclampsia is inconclusive because most studies are either cross-sectional or semi -longitudinal in design with very limited potentials to determine precisely the age of pregnancy to suspect the development of preeclampsia with an absolute biomarker.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
UOG Journal Club: October 2013
Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE)
C. Lees, N. Marlow, B. Arabin, C. M. Bilardo, C. Brezinka, J. B. Derks, J. Duvekot, T. Frusca, A. Diemert, E. Ferrazzi, W. Ganzevoort, K. Hecher, P. Martinelli, E. Ostermayer, A. T. Papageorghiou, D. Schlembach, K. T. M. Schneider, B. Thilaganathan, T. Todros, A. van Wassenaer-Leemhuis, A. Valcamonico, G. H. A. Visser and H. Wolf
Link to the free-access article:
http://onlinelibrary.wiley.com/doi/10.1002/uog.13190/abstract
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations
N. O'Gorman, D. Wright, L. C. Poon, D. L. Rolnik, A. Syngelaki, M. de Alvarado, I. F. Carbone, V. Dutemeyer, M. Fiolna, A. Frick, N. Karagiotis, S. Mastrodima, C. de Paco Matallana, G. Papaioannou, A. Pazos, W. Plasencia, K. H. Nicolaides
Volume 49, Issue 6, Pages 756–760
Slides prepared by Dr Fiona Brownfoot (UOG Editor-for-Trainees)
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17455/full
Background: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become an established method of antenatal monitoring, Cerebroplacental and Cerebrouterine ratios have been studied to predict neonatal outcomes.
Aim of the Work: To assess if Cerebrouterine Ratio would be complementary to cerebroplacental Ratio in predicting adverse
neonatal outcome in preeclamptic pregnant women.
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA Võ Tá Sơn
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA
The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses
Introduction: Though there are many studies on the effects of anesthesia methods used for cesarean section on the newborn,
research on this topic still continues. In our prospective observational study, we investigated the effects of different anesthesia techniques used in routine cesarean deliveries on early neonatal outcomes in our hospital. This prospective, observational, randomized study included a total of 222 ASA II risk group pregnant women undergoing elective cesarean section at term (38-41 weeks’ gestation) without fetal distress. The women were randomized into three groups. In the general anesthesia with propofol group (Group P, n = 74), anesthesia was induced with 2 mg∙kg-1 propofol and 0.6-0.9 mg∙kg-1
rocuronium. In the general anesthesia with thiopental sodium group (Group T, n = 74), anesthesia was induced with 5 mg∙kg-1 thiopental sodium and 0.6-0.9 mg∙kg-1 rocuronium. Women in the spinal anesthesia group (Group SA, n = 74) were administered 0.5% (10 mg) hypertonic bupivacaine and 10 mcg fentanyl.
Low dose aspirin is a wonderful drug in the management of cerebrovascular and cardiovascular disease.However ther is lot of controversies about its use in obstetrics largely due to conclusions drawn on trials with flawed methodology, a reader must always view the evidence critically especially when the not harmful interventions are likely to benefit the patient....
Introduction: Preeclampsia is a medical emergency implicated in maternal and foetal morbidity and mortality. Research directed at finding the aetiologies of pre-eclampsia is inconclusive because most studies are either cross-sectional or semi -longitudinal in design with very limited potentials to determine precisely the age of pregnancy to suspect the development of preeclampsia with an absolute biomarker.
Recurrent pregnancy loss is a significant redroductive medical problem, influencing 2%–5% of couples. ... Throughout the years, proof based medications, for example, surgical correction of uterine abnormalities or asprin and heparin for antiphospholipid syndrome have improved the results for couples with repetitive pregnancy loss.
UOG Journal Club: October 2013
Perinatal morbidity and mortality in early-onset fetal growth restriction: cohort outcomes of the trial of randomized umbilical and fetal flow in Europe (TRUFFLE)
C. Lees, N. Marlow, B. Arabin, C. M. Bilardo, C. Brezinka, J. B. Derks, J. Duvekot, T. Frusca, A. Diemert, E. Ferrazzi, W. Ganzevoort, K. Hecher, P. Martinelli, E. Ostermayer, A. T. Papageorghiou, D. Schlembach, K. T. M. Schneider, B. Thilaganathan, T. Todros, A. van Wassenaer-Leemhuis, A. Valcamonico, G. H. A. Visser and H. Wolf
Link to the free-access article:
http://onlinelibrary.wiley.com/doi/10.1002/uog.13190/abstract
Cervical length screening for prevention of preterm birth in singleton pregnancy with threatened preterm labor: systematic review and meta-analysis of randomized controlled trials using individual patient-level data
V. Berghella, M. Palacio, A. Ness, Z. Alfirevic, K. H. Nicolaides and G. Saccone
Volume 49, Issue 3, Date: March (pages 322–329)
Slides prepared by Dr Shireen Meher (UOG Editors-for-Trainees)
Link to free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17388/full
Multicenter screening for pre-eclampsia by maternal factors and biomarkers at 11–13 weeks' gestation: comparison with NICE guidelines and ACOG recommendations
N. O'Gorman, D. Wright, L. C. Poon, D. L. Rolnik, A. Syngelaki, M. de Alvarado, I. F. Carbone, V. Dutemeyer, M. Fiolna, A. Frick, N. Karagiotis, S. Mastrodima, C. de Paco Matallana, G. Papaioannou, A. Pazos, W. Plasencia, K. H. Nicolaides
Volume 49, Issue 6, Pages 756–760
Slides prepared by Dr Fiona Brownfoot (UOG Editor-for-Trainees)
Read the free-access article: http://onlinelibrary.wiley.com/doi/10.1002/uog.17455/full
Background: Doppler ultrasound velocimetry of uteroplacental umbilical and fetal vessels has become an established method of antenatal monitoring, Cerebroplacental and Cerebrouterine ratios have been studied to predict neonatal outcomes.
Aim of the Work: To assess if Cerebrouterine Ratio would be complementary to cerebroplacental Ratio in predicting adverse
neonatal outcome in preeclamptic pregnant women.
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA Võ Tá Sơn
Vai trò của chỉ số não rốn trong đánh giá sức khỏe thai nhi ở thai AGA và SGA
The importance of the cerebroplacental ratio in the evaluation of fetal well-being in SGA and AGA fetuses
The Journal club for May features 2 papers. The first is a study on Angiogenic Factors vs. Doppler Surveillance in the Prediction of ddverse outcomes in late pregnancy SGA fetuses. The second studies the uterine artery Doppler and sFlt-1/PlGF ratio, discussing its value in diagnosis of early-onset pre-eclampsia.
Angiogenic Factors vs. Doppler Surveillance in the Prediction of Adverse Outcome Among Late-Pregnancy Small-for-Gestational-Age Fetuses
S.M. Lobmaier, F. Figueras, I, Mercade, M. Perello, A. Peguero, F. Crovetto, J.U. Ortiz, F. Crispi and E. Gratacos
Volume 43, Issue 5, Date: May 2014, pages 533-540
Uterine Artery Doppler and sFlt-1/PlGF Ratio: Prognostic Value in Early-Onset Pre-Eclampsia
P.I. Gomez-Arriaga, I. Herraiz, E.A. Lopez-Jiminez, D. Escribano, B. Denk and A. Galindo
Volume 43, Issue 5, Date: May 2014, pages 525-532
Obstetric outcomes associated with second trimester unexplained abnormal mate...Apollo Hospitals
1) To compare the adverse obstetrical outcomes in the patient population with normal blood MoMs.
2) To determine the probability of occurrence of an adverse obstetric event in relation with abnormal maternal blood
analytes.
Placental Elastography in Intrauterine Growth Restriction: A Case–control Studyasclepiuspdfs
Background: Intrauterine growth restriction (IUGR) is related to poor fetal outcome. Though, various tools are available for evaluation of IUGR they are notreliable inearly diagnosis of IUGR. Shear wave elastography (SWE) can be used to study the change in mechanical properties of various disease which can be a potential technique for early diagnosis of IUGR. Objective: The objective of the study was to compare the differences in SWE values of placentas between IUGR and normal pregnancies. Methodology: Normal second- and third-trimester pregnancies and IUGR pregnancies between 24 and 42 weeks period of gestation (POG), meeting the inclusion criteria were matched for age group and POG. SWE of placenta was performed in supine position during quiet respiration. The SWE of placenta was measured by placing the region of interest in relatively homogeneous area. The placental elasticity values obtained in pregnancies complicated by IUGR were compared with that of normal controls. Umbilical artery (UA) and fetal middle cerebral artery (MCA) Doppler findings were correlated with placental elasticity value of IUGR pregnancies.
This study aims to assess the effectiveness of L-arginine for prevention of preeclampsia in high-risk pregnancy. Preeclampsia is a significant reason for maternal mortality and morbidity, preterm birth, perinatal demise, and intrauterine growth restriction. Preeclampsia is when women have hypertension and protein in urine during pregnancy or after delivery. And also having low coagulating factors (platelets) in blood or markers of kidney or liver problems. Proof demonstrates that endothelial dysfunction is key to the pathogenesis of preeclampsia. Arginine-nitric oxide pathway to assess endothelial dysfunction in normotensive pregnancies and pregnancies confounded with preeclampsia. Arginine assumes a critical part in proliferation, fetal development, support of tissue integrity, and immune function, and also the treatment of sicknesses in pregnancy. Maternal plasma arginine focuses were observed to be lower in pregnancies muddled by Intrauterine growth restriction (IUGR) and expands the fetal healthful enhancement.
Role of soluble urokinase plasminogen activator receptor (suPAR) as prognosis...IOSR Journals
Biological marker suPAR was used in many pathological conditions, including infection. suPAR
was correlated with the severity of sepsis. The purpose of this study to determine levels of suPAR infants with
risk of infection as a prognostic indicator for sepsis. Groups of infants with the risk of infection (n = 43) were
followed prospectively on days 0, 3rd and 7th and observed for the incidence of sepsis compared to the control
group (n = 10). suPAR was measured by ELISA and the course of infection measured by clinical criteria.
Results suPAR day 0, 3 and 7, displayed in the form of bloxpot and AUC as prognostic power. suPAR control
levels 9.32 ng / mL, sepsis cutoff 15, 41 ng / mL and AUC of 80.3% [95% CI 65.7%, 94.9%, p = 0.00]. Graph
shows ROC AUC sepsis suPAR day 0, the 3rd and 7th respectively 61.9%, 66.6% and 94.4%. Sepsis with
improved output 16.53 ng / mL and worsening 22.19 ng / mL and AUC of 80.8% [95% CI (0.62 to 0.99), p =
0.02]. suPAR levels was increased in neonatal sepsis patients. suPAR could be used as a prognostic factor for
neonatal sepsis.
— This study was conducted to find out if AFI ≤ 5 cms has any clinical significance in identifying the subsequent fetal distress & associated maternal & perinatal outcomes, in pregnancies beyond 37 weeks. Methodology: This is a prospective case control study done from July 2010 to July 2012 (24 months) at Dr Vasantrao Pawar Medical College, Hospital and Research Center. Adgaon, Nashik. It study the pregnancy outcome comparison of 58 Anenatal Cases(ANCs)as Study Group with diangosis of oligohydramnios (AFI ≤ 5 cms) by ultrasound after 37 completed weeks of gestation w e r e compared with 58 ANCs (Control Group) with no oligohydramnios (AFI > 5 cms). These two groups were matched for other variables like age, parity, gestational age and any pregnancy complication. Results: There was significant difference between two groups. Hypertension and Preeclampsia were found significantly more in ANCs with oligohydramnios. FHR deceleration was also significantly higher in women with oligohydramnios. Women require LSCS were also significantly more in women with oligohydramnios. Newborn borned by women with oligohydramnios had significantly more chances to admit in NICU than in newborn born by women without oligohydramnios. Conclusion: It can be concluded from this study that women with oligohydramnios poor pregancy outcomes. Determination of AFI can be used as an adjunct to other fetal surveillance methods. Determination of AFI can be used as valuable screening test for predicting fetal distress in labour, requiring caesarean section.
Background: We conducted this study to identify outcomes of pregnancies complicated by pre-eclampsia and eclampsia in
Cameroon.
Methods: This was a cohort study at the Regional Hospital, Maroua-Cameroon between June 2005 and May 2007. The outcome of pre-eclamptic and ecliptic patients were compared. The level of signifi cance was 0.05.
International Journal of Reproductive Medicine & Gynecology
Initial Typeset
1. Susilo, et al.
Determinants of low apgar score among preeclamptic women
109
Determinants of low apgar score among preeclamptic deliveries in
Cipto Mangunkusumo Hospital: a retrospective cohort study in 2014
Keywords: APGAR score, newborn, preeclampsia
Sulaeman A. Susilo
Copyright @ 2015 Authors. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-
ShareAlike 4.0 International License (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original author and source are properly cited.
Clinical Research
Medical Journal of Indonesia
ABSTRAK
Latar belakang: Preeklampsia berimplikasi besar pada
luaran neonatus. Skor appearance, pulse, grimace, activity,
respiration (APGAR) 1 atau 5 menit adalah salah satu indikator
bertujuan mencari hubungan skor APGAR pada persalinan
dengan preeklampsia.
Metode: Penelitian ini menggunakan design kohort
retrospektif. Data didapatkan pada bulan Januari sampai
Desember 2013 dari seluruh wanita preeklamsia yang
melahirkanbayitunggaldiRumahSakitCiptoMangunkusumo,
Jakarta. Hasil luaran salah satunya berupa skor APGAR.
Analisis multivariat dengan menggunakan binari logistik
digunakan untuk mencari korelasi antara skor APGAR dengan
faktor-faktor resiko pada preeclampsia, hasil penelitian diuji
dengan uji kai kuadrat.
Hasil: Sebanyak 446 memenuhi kriteria inklusi dari 450 wanita
dengan preeklampsia, 4 diantaranya tereksklusi karena data
yang tidak lengkap. Skor APGAR 1 menit dan 5 menit berhasil
dikumpulkan pada 19% (86/446) dan 5,4% (24/446) dari
APGAR rendah 1 menit pertama. Sementara itu, tidak terdapat
APGAR 5 menit pertama.
Kesimpulan:
preterm, trombositopenia, derajat preeklampsia, dan sindrom
dalam satu menit pada anak yang lahir dari ibu dengan
preeklampsia.
ABSTRACT
Background: Preeclampsia has great implication on adverse
neonatal outcome. Appearance, pulse, grimace, activity,
respiration (APGAR) score at 1 or 5 minutes is one of the
indicators of physiologic maturity of the infant. Therefore, the
aim of this study was to know the correlation of APGAR score
in preeclamptic deliveries with its risk factors.
Methods: This study was a retrospective cohort. Data were
collected from January to December 2013 including all
preeclamptic women with singleton live pregnancies who
delivered their babies in Cipto Mangunkusumo Hospital.
The primary outcome was APGAR score. There were some
determinants conducted in this study. Binary logistic was used
as multivariate analysis to analyze the correlation between
APGAR score and risk factors of preeclampsia, data were
analyzed using chi square test.
Results: Out of 450 preeclamptic women, 446 of them
met the inclusion criteria. Low APGAR scores at 1 and 5
minutes were found in 19% (86/446) and 5.4% (24/446) of
neonates respectively. Early onset of preeclampsia (Adj OR =
(Adj OR = 3.315; 95% CI = 1.738 – 6.324), HELLP syndrome
(Adj OR = 2.00; 95% CI = 1.38 – 2.91) were independent risk
factors for having infant with low APGAR score at 1 minute.
Meanwhile, there was no significant risk factors at 5 minutes
APGAR score after adjustment.
Conclusion:Leukocytosis,earlyonsetpreeclampsia,preterm
birth, and thrombocytopenia, severity of preeclampsia, and
HELLP syndrome are independent risks of having infant
born with low APGAR score at 1 minute in preeclamptic
deliveries.
2. 110 Med J Indones, Vol. 24, No. 3
September 2015
Preeclampsia is one of the common conditions
of unknown etiology which increase the risk of
maternal and perinatal morbidity and mortality.1
The exact etiology of preeclampsia remains
unknown. Factors that are currently more
accepted include abnormal trophoblast invasion
of uterine blood vessels, increased vasopressor
response and vasospasm, immunological
intolerancetothefetusandgeneticabnormalities.2
pregnancies, it is an important factor in fetal
growth restriction as it is commonly associated
3
Preeclampsia is
syndrome of reduced organ perfusion related
to vasospasm and activation of the coagulation
cascade affecting multiple systems. The major
risk to the fetus results from decreased placental
perfusion leading to decreased blood supply of
oxygen and nutrients necessary for fetal growth
and wellbeing.1,3
The various complication seen are low
appearance, pulse, grimace, activity, respiration
(APGAR) score, intra uterine growth restriction
(IUGR), low birth weight, and increased need
for admission to neonatal intensive care unit
(NICU).4,5
The APGAR score, devised in 1952 by Dr. Virginia
Apgar, is a quick method of assessing the clinical
status of the newborn infant.6,
The APGAR
andcolor,eachofwhichisgivenascoreofzero,one,
or two.6
It is important to recognize that elements
of the APGAR score are partially dependent on the
physiologic maturity of the infant. Low APGAR
scores may be indicative of a number of maternal
and infant factors.6
intrauterine causes of low APGAR score may be
important for the prevention of conditions that
have been linked to low APGAR score at birth.7,8
Some studies found that preeclamptic women
tend to have infant with low APGAR score than
healthy women.9,10
Proteinuria and increased
blood pressure in preeclampsia are associated
with a lower fetal birth weight and a lower
APGAR score and an increased risk of adverse
perinatal outcome.11-13
Gawde, et al found that in
severe cases of preeclampsia, the APGAR score
at one minute is two-fold worse than in mild
preeclampsia1
. Five minutes APGAR score also
associated with several obstetric risk factors and
used to predict the effectiveness of resuscitation.
Preeclampsia is frequently seen in Indonesia
population. The intended use of APGAR score has
always been the same: to evaluate a newborn’s
condition at birth. This study was conducted
to correlate preeclampsia with APGAR score to
asses the condition of newborn infant.
METHODS
This retrospective cohort study was performed
betweenJanuarytoDecember2013.Theinclusion
criteria were preeclamptic women with singleton
live pregnancy who delivered their babies in Cipto
Mangunkusumo Hospital, Jakarta. The exclusion
criteria were patients with incomplete data. The
study population consisted of 450 preeclamptic
women, four out of them were excluded for not
havingacompletedata.Primaryoutcomemeasure
was morbidity of the infant as in APGAR score at
by perinatology residents. We divided group
of low APGAR score (< 7) and normal APGAR
based on medical record, which included age of
gestation, maternal age, IUGR, eclampsia, anemia,
low birth weight, mean arterial pressure (MAP),
early or late preeclampsia, parity, white blood
cell, platelet, frequency of antenatal care (ANC),
and severity of preeclampsia which we used as
independent variables.
Gestational age was calculated as the best
obstetrical estimate according to the last
menstrual period, or if it is not available, we used
ultrasonography. IUGR was diagnosed based on
ultrasonography when the fetal weight is less
than the tenth percentile for the gestational age,
or at least two standard deviations below the
mean weight for the gestational age. Diagnosis for
mild preeclampsia was based on systolic blood
mg per 24 hours or positive (+) using dipstick
test but without evidence of end organ damage
in the patient; severe pre-eclampsia if the systolic
in several minutes, proteinuria > 5 gr per 24
3. Susilo, et al.
Determinants of low apgar score among preeclamptic women
111
random urine samples or symptoms, and or
biochemical and or hematological impairment,
and any organ involvement. HELLP (Hemolysis,
Elevated liver enzyme levels, Low Platelet
with platelet count persistently < 100,000/
mm3
, serum transaminases twice than normal.
Superimposed pre-eclampsia was women with
chronic hypertension and de novo proteinuria
after 20 weeks of pregnancy. Early or late
34 weight of gestational age.
Binary logistic was used as multivariate analysis
to analyze the correlation between age of
gestation, maternal age, IUGR, eclampsia, anemia,
low birth weight, MAP, early or late preeclampsia,
parity, leukocyte, platelet, frequency of ANC, and
severity of preeclampsia and APGAR score. P
value < 0.05 was taken as the limit of statistical
RESULTS
There were 2,143 deliveries registered in our
database over a year period. Out of 450 women
who were diagnosed as pre-eclampsia, 446
of them met the inclusion criteria and had a
complete data. The distribution of characteristics
and the risk factors of low APGAR score among
the subjects are shown in Table 1.
Table 2 shows the comparison of low APGAR
score and normal score in one minute with risk
factors of preeclampsia. We found that weeks of
gestational age (WGA), platelet, hematocrit, white
blood cell, onset of preeclampsia, IUGR, and MAP
age, anemia, frequent ANC were not associated
with preeclamptic women having infant with low
APGAR score. We determined the cut off value
of hematocrit count using receiver operating
characteristics (ROC) curve. The cut off levels for
hematocrit was 38.95 %.
Table 3 shows the comparison of low APGAR
confounding factors of preeclampsia. We
found that WGA, platelet, onset and severity of
Variables Values
Maternal age (yr), n (%)
Low Risk (<35) 288 (64.7%)
High Risk (=>35) 157 (35.3%)
Parity, n (%)
Nullipara 183 (41%)
Multipara 263 (59%)
WGA (weeks),
max)
37 (25 – 42)
Aterm, n (%) 268 (60.1%)
Preterm,n (%) 178 (39.9%)
Birth weight (grams), mean ± SD 2560 ± 781.04
Systolic BP (mmHg), median (min 160 (90-270)
Diastolic BP (mmHg), median 100 (100-170)
Mean Arterial Pressure (mmHg)
(mean + SD)
126.67 (106-160)
Platelet count (x103
median 248 (19.9-69.7)
Hemoglobin level (g/dL), median 13 (8-17)
Leukocyte level (× 103
13.55 (7.22-31.80)
Hematocrit (%), mean ± SD 37.40 ± 14.98
APGAR Score 1 minute, n (%)
Low APGAR Score 86 (19.3%)
Normal APGAR Score 360 (80.7%)
APGAR Score 5 minute, n (%)
Low APGAR Score 24 (5.4%)
Normal APGAR Score 422 (94.6%)
ANC > 3 times, n (%)
Yes 361 (80.9%)
No 85 (19.1%)
Severity, n (%)
Mild pre-eclampsia 48 (10.8%)
Severe pre-eclampsia 345 (77.4%)
Superimposed pre-eclampsia 15 (3.4%)
HELLP Syndrome 38 (8.5%)
Eclampsia 31 (7%)
Onset, n (%)
Early onset 99 (22.2%)
Late onset 347 (77.8%)
Anemia (Hb < 11 g/dl), n (%) 58 (13.6%)
IUGR, n (%) 29 (6.5%)
Table 1. Clinical Characteristics and Delivery Outcomes of
Preeclamptic Women in the Study
this study. Maternal age, anemia, white blood
cell, hematocrit, frequent ANC, and MAP were
4. 112 Med J Indones, Vol. 24, No. 3
September 2015
not associated with preeclamptic women having
infant with low APGAR score.
3
late onset preeclampsia, preterm birth, platelet
3
/ ,
3
OR = 3.63; 95% CI = 1.93 – 6.86), early or late
preeclampsia (adj OR = 0.20; 95% CI = 0.09 –
Variables Low APGAR Score N(%) Normal APGAR Score N(%) P OR (CI 95%)
Maternal Age
Productive 59 (68.6%) 229 (63.8%) 0.401 1.24 (0.75-2.05)
Non-productive 27 (31.4%) 131 (36.2%)
Week of Gestation
Aterm (>34 weeks) 17 (19.8%) 251 (69.7%) <0.001* 0.11 (0.06 – 0.19)
Preterm (28 – 34 weeks) 69 (80.2%) 109 (30.3%)
Platelet
3
65 (75.6%) 342 (95%) <0.001* 6.14 (3.10 – 12.15)
<151x103
21 (24.4%) 18 (5%)
Anemia
No 70 (81.4%) 282 (78.3%) 0.532 1.21 (0.67 – 2.20)
Yes 16 (18.6%) 78 (21.7%)
Hematocryte
40 (46.5%) 111 (30.8%) 0.006* 1.95 (1.20 – 3.15)
< 38.9 46 (53.5%) 249 (69.2%)
Leukocyte
3
49 (57%) 125 (34.7%) <0.001* 0.40 (0.25 – 0.65)
< 15 × 103
37 (43%) 235 (65.3%)
ANC
Yes 68 (79.1%) 293 (81.4%) 0.623 0.86 (0.48 – 1.55)
No 18 (20.9%) 67 (18.6%)
Onset
Early-onset 55 (64%) 44 (12.2%) <0.001* 12.7 (7.41 – 21.90)
Late-onset 31 (36%) 316 (87.8%)
IUGR
Yes 12 (14%) 17 (4.7%) 0.002* 3.27 (1.50 – 7.14)
No 74 (86%) 343 (95.3%)
MAP
<135 59 (68.6%) 300 (83.3%) 0.002* 0.44 (0.26 – 0.75)
27 (31.4%) 60 (16.7%)
Severity
Mild pre-eclampsiaa
<0.001* 2.00 (1.38 – 2.91)
Severe pre-eclampsia
Superimposed
HELLP Syndrome
Table 2. Comparison between Low APGAR score and Normal APGAR Score at 1 minute group based on obstetrical characteristics
*Chi-Square, a
p < 0.05 severity of preeclampsia are fused in analyses
0.42), preterm birth (adj OR = 0.32; 95% CI =
0.14 – 0.70), and platelet level (adj OR = 0.38;
95% CI = 0.17 – 0.86) as independent risk
factors for having infant with low APGAR score
at one minute. Using binary logistic, we found
OR = 0.75; 95% CI = 0.42 – 1.34) were not at
increased risk for having infant born with low
APGAR score.
5. Susilo, et al.
Determinants of low apgar score among preeclamptic women
113
We adjusted early onset preeclampsia, preterm
3
/
that early or late preeclampsia (adj OR = 0.205;
95% CI = 0.06 – 0.76), preterm birth (adj OR =
0478; 95% CI = 0.10 – 2.22), platelet (adj OR =
0.402; 95% CI = 0.15 – 1.11), and IUGR (adj OR =
risk factor for infant born with low APGAR score.
Variables Low APGAR Score N (%) Normal APGAR Score N (%) P OR (CI 95%)
Maternal Age
Low Risk 16 (66.7%) 273 (64.6%) 0.837 1.10 (0.46-2.62)
High Risk 8 (33.3%) 149 (35.4%)
Week of Gestation
Aterm 4 (16.7%) 264 (62.6%) <0.001* 0.12 (0.04 – 0.36)
Preterm 20 (83.3%) 158 (37.4%)
Platelet
3
16 (66.7%) 391 (92.7%) <0.001* 6.31 (2.50 – 15.89)
<15x103
8 (33.3%) 31 (7.3%)
Anemia
No 20 (87%) 347 (86.3%) 0.931 0.95 (0.27 – 3.29)
Yes 3 (13%) 55 (13.7%)
Hematocrit
10 (41.7%) 141 (33.4%) 0.406 1.42 (0.62 – 3.29)
< 38.95 14 (58.3%) 281 (66.6%)
Leukocyte
3
13 (54.2%) 161 (38.2%) 0.118 0.52 (0.23 – 1.19)
< 15 × 103
11 (45.8%) 261 (61.8%)
ANC
Yes 20 (83.3%) 341 (80.8%) 0.759 1.19 (0.40 – 3.57)
No 4 (16.7%) 81 (19.2%)
Onset
Early-onset 17 (70.8%) 82 (19.4%) <0.001* 0.10 (0.04 – 0.25)
Late-onset 7 (29.2%) 340 (80.6%)
IUGR
Yes 5 (20.8%) 24 (5.7%) 0.003* 4.36 (1.50 – 12.70)
No 19 (79.2%) 398 (94.3%)
MAP
<135 18 (75%) 341 (80.8%) 0.485 0.71 (0.27 – 1.85)
6 (25%) 81 (19.2%)
Severity
Mild pre-eclampsiaa
<0.001* 1.26 (1.06 – 1.51)
Severe pre-eclampsiab
Superimposedc
HELLP Syndrome
Table 3. Comparison between Low APGAR Score and Normal APGAR Score at 5 minutes group based on obstetrical characteristics
*Chi -Square, a
p<0.05, severity of preeclampsia are fused in analyses (a,b,c)
DISCUSSION
In women with preeclampsia, we often see that
The association between abnormal placentation
and preeclampsia is well known and is thought
to involve in trophoblast invasion of maternal
spiral arteries.14
Abnormal placentation results
6. 114 Med J Indones, Vol. 24, No. 3
September 2015
lead to unsuccessful pregnancy outcomes. It is
wellknownthatlowAPGARscoremostcommonly
which is a later clinical manifestation of poor
placentation and placental ischemia as may
caused by preeclampsia. This may lead to the
high risk of perinatal morbidity and mortality.14
In women with preeclampsia, we tend to see
laboratory examinations due to the changes of
blood circulation which is related to severity of
was to conclude which covariates increase the
risk of preeclampsia resulting a low APGAR
score in neonates. Surprisingly, mean arterial
preeclamptic women having infant born with
low APGAR score after adjusting with other
9
15×103
et al13
who stated that hypertensive disorders of
pregnancy increase the risk of low APGAR score
for infant compared to control. Frequent ANC
risk for preeclamptic mothers having baby with
low APGAR score which is contradictive to Saito
et al2
study which showed that expert obstetric
management can prevent these problems in most
off-springs of those women, provided they receive
antenatal care and give obstetricians time to act.
This was probably due to lack of management on
antenatal care that was given to mothers when
they were pregnant. Although there were several
and those of others, discrepancies might be
explained by factors that were neither evaluated
nor controlled in our study.
Variable
Low APGAR Score 1 minute Low APGAR Score 5 minutes
P Adj OR 95% CI P Adj OR 95% CI
Leukocyte 15× 03
<0.001 3.63 1.93 – 6.86 - - -
Early onset preeclampsia <0.001 0.20 0.09 – 0.42 0.17 0.205 0.06 – 0.76
Preterm birth 0.004 0.32 0.14 – 0.70 0.346 0.478 0.10 – 2.22
Platelet 15 x103
0.002 0.38 0.17 – 0.86 0.079 0.402 0.15 – 1.11
MAP 135 mmHg 0.98 1.00 0.51 – 2.00 - - -
Hematocrit 38.95% 0.33 0.75 0.42 – 1.34 - - -
IUGR 0.25 0.59 0.24 – 1.45 0.05 0.305 0.93 – 1.00
Table 4. Multivariate analysis of Low APGAR Score (1 min), Low APGAR Score (5 min) and its risk factors
Weeks of gestation is a strong risk factor of
adverse respiratory outcome that was part of
scoring in APGAR, it was obviously documented
in several studies10
which concluded prematurity
as an independent risk factor for perinatal
adverse outcomes (OR = 43.9; p = 0.001).10
In this
study, we found that preterm birth associated
with increased risk of low APGAR score at one
counts and low APGAR score could possibly
syndrome (FIRS) because maternal white blood
cell count is one of the indicators of intrauterine
infection and development of FIRS. Aabidha, et
al13
found that white blood cell level of 15,750/
mm3
with intra-amniotic infection. It was shown that
the risk was three fold higher for having infant
born with low APGAR score.13
Hematocrit level
risk of infant born with low APGAR score by
using multivariate analyses. Hematocrit was
factors (p > 0.05). In this study, low platelet count
worsening thrombocytopenia may represent
associated in neonatal outcomes, in this case,
low APGAR score in infant born. Surprisingly,
after using multivariate analyses, there were no
caused by good resuscitation performed by the
residents who helped survival of the infants.
Our study offers several strengths, the high
number of preeclamptic women allowed us
to study the association between obstetric
7. Susilo, et al.
Determinants of low apgar score among preeclamptic women
115
parameters with neonatal outcome. However, our
study has also weakness due to its retrospective
design because it has potential of missing data.
As we directly reported the data after delivery,
we attempted to minimize bias. It was managed
by well-trained obstetric residents on duty and
rechecked bythe consultants.
In conclusion, our study found that some of
preeclampsia and preterm birth lead to low
APGAR score in neonates. Early management of
preeclampsia is needed to improve the survival
of neonates born. There is need for patient’s
education in recognizing the warning symptoms
of preeclampsia before it develop and causes
complications.
study
Acknowledgment
We gratefully acknowledge the support of the
Department of Obstetric and Gyeneacology,
Ciptomangunkusumo Hospital, Jakarta, for
allowing us the chance to collect the data.
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