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Article
Homocysteine Changes in Preeclampsia
التغيرات في تركيز مادة الهوموسستائين في الدم في حالة مقدمة الارتعاج

Authors: Maha Al-Bayati مها البياتي --- Ali Taki Al-baldawi علي تقي
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2007 Volume: 20 Issue: 3 Pages: 426-431
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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AbstractObjective: To determine whether homocysteine, a relatively new risk factor for possible endothelial cell dysfunction and premature vascular disease, is elevated in pregnant women with preeclampsia.Methods: A case-control study design conducted at Al-kadimiya teaching hospital for the period from September 2000 through April 2001. The study sample consisted of 100 pregnant women in labour subdivided into three groups (40 pregnant women with severe preeclampsia, 30 pregnant women with mild preeclampsia and 30 normotensive pregnant women as a control). Plasma homocysteine concentration measurement and observation of the maternal and fetal outcome was done for all groups.Results: The incidence of hyperhomocysteinemia was significantly higher among patients with severe preeclampsia (80%) compared to those with mild preeclampsia (67%) and the normotensive group (7%) and the incidence of adverse maternal and neonatal outcome is significantly higher among patients with severe preeclampsia compared to the others.Conclusion: Plasma total homocysteine concentration is elevated in pregnant women with preeclampsia during labour being significantly higher in cases with severe preeclampsia so hyperhomocysteinemia is considered a risk factor for adverse maternal and neonatal outcome.

هدف الدراسة : بيان ومعرفة هل ان تركيز مادة الهوموسستائين في الدم والذي يعتبر نسبيا كعامل خطر جديد لاحتمال الاختلال الوظيفي في الخلايا البطانية والإصابة المبكرة بأمراض الأوعية الدموية يزداد لدى الحوامل في حالة مقدمة الارتعاج. أجريت هذه الدراسة في مستشفى الكاظمية التعليمي/ قسم النسائية والتوليد على مائة سيدة في حالة ولادة وقد قسمت السيدات الى ثلاثة مجاميع :1- المجموعة ا: تتالف من 40 سيدة تعاني من مقدمة الارتعاج الشديدة .2- المجموعة ب: تتالف من 30 سيدة تعاني من مقدمة الارتعاج البسيطة. 3- المجموعة ج: تتالف من 30 سيدة حامل تتمتع بصحة جيدة (كمجموعة ضبط ).شملت الدراسة قياس تركيز مادة الهوموسستائين في الدم ومتابعة صحة الأم والطفل بعد الولادة لكل المجاميع.تمخض تحليل النتائج إحصائيا عن مايلي : 1- وجدت علاقة وثيقة بين تركيز مادة الهومو سستائين في الدم وشدة مقدمة الارتعاج حيث ان تركيزه أعلى لدى السيدات الحوامل في المجموعة ا (80%) عنه في المجموعة ب (67%) و المجموعة ج (7%). 2- الزيادة في تركيز مادة الهوموسستائين في الدم مصحوبة بارتفاع نسبة المضاعفات لدى الام والطفل .الاستنتاج:تركيز مادة الهوموسستائين في الدم أعلى لدى السيدات الحوامل المصابات بمقدمة الارتعاج الشديد أثناء الولادة عنه لدى المصابات بمقدمة الارتعاج البسيط ومجموعة الضبط وزيادة تركيز مادة الهوموسستائين في الدم قد تسبب ارتفاع في نسبة المضاعفات لدى الأم والطفل.


Article
Presentation and Management Outcome of Eclampsia at AlElwiya Teaching Hospital

Authors: Samar Sarsam, Thikra madlol --- Yousif Abdul Raheem, Inteasar Twaigery
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2013 Volume: 12 Issue: 2 Pages: 277-281
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT: BACKGROUND: Eclampsia is a life-threatening complication of pregnancy for both the baby and the mother. Research isunderway to understand this complex condition and to improve the treatments that are currently used tocontrol it as it is a preventable complication of pre-eclampsia.OBJECTIVE: The study reviews the cases of eclampsia managed at Elwiya teaching Hospital with respect toincidence, management, maternal and perinatal outcome. METHODS: This prospective observational study was carried out in the department of Obstetrics and Gynaecologyat Elwiya Teaching Hospital – Baghdad-Iraq. Fifty two cases of eclamptic fits were dealt with from the1st of January till the 31st of December 2008. Pregnant patients with other convulsive disorders andmore than 7 days postpartum were excluded from the study. All the patients included were evaluated bydetailed history (taken from the attendants). Management was according to basic protocol foreclampsia; stabilization of patients, anticonvulsive therapy Magnesium sulfate, phenytoin and/ordiazepam and early delivery. A team of specialists and trained nurses were needed in the intensive careunit to deal with eclamptic mothers.RESULTS: During the year 2008, total number of deliveries from the 1INTRODUCTION: Eclampsia is one of the fatal complications of preeclampsiawhich is a multisystem disorder; itpresents a challenge to obstetricians and otherphysicians. Eclampsia is defined as seizure activityunrelated to other cerebral conditions in a pregnantwoman with pre-eclampsia. The condition wasknown to the ancient Greeks, who named it eclampsia. It has been prevalent since the time ofHippocrates; it remains an important cause ofmaternal mortality throughout the world,accounting for about 50000 deaths worldwide.Department of Obstetrics and Gynecology atElwiya Teaching Hospital – Baghdad . (1)st of January till the 31An eclamptic seizure occurs in 0.5% of mildly preeclampticpregnancies and 2% of severe preeclamptics.(2) st of December was12154, of these patients 52 presented with eclamptic fit with incidence rate of 4.28 per 1000 deliveries.The distribution of cases regarding the seasons was more in winter. 35 patients (67.31%) had poorantenatal care, 17 (32.69%) had good antenatal care. Four patients had history of eclampsia in theirprevious pregnancies. All the patients gave history of imminent eclampsia; two of them had blindnessalso; albumin in urine was negative in two cases only. Serious maternal complications occurred in28(53.84%) cases. Eight of the neonates died due to severe RDS.CONCLUSION: Eclampsia is still present and common in our locality; we need better antenatal care to predict pregnantladies liable to develop eclamptic fit in order to decrease the incidence of eclampsia complicatingpregnanc


Article
Fetal and Maternal Outcomes in Oligohydramnios Pregnancy (37–40 Weeks of Gestation) at Labor

Author: Hividar Abdulqahar Majeed, Maida Yousif Shamdeen
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2019 Volume: 16 Issue: 3 Pages: 248-251
Publisher: Babylon University جامعة بابل

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Abstract

Background: The role of amniotic fluid is to provide a protective environment for fetus growth. The low volume of amnioticfluid (oligohydramnios) has been reported to associate with perinatal and neonatal outcomes. Objectives: The aim of this study was to explorethe effect of oligohydramnios on fetal outcomes at intrapartum and early neonate, including fetal distress. Materials and Methods: In the presentinvestigation, the pregnant women who attended the labor ward of Duhok Maternity Hospital were consecutively screened for eligibility criteria.The patients presented with oligohydramnios from 37 to 40 weeks of gestation to labor room were included in this study and were followedup for neonatal outcomes. The diagnosis of oligohydramnios was established as an amniotic fluid index of 5 cm or less by the ultrasoundexamination. Results: The mean age of the women with oligohydramnios was 26.10 ± 5.20 years ranged between 16 and 40. The mean ageof the gestational age was 38.54 ± 1.13 weeks ranging from 37 to 40. The previous history of a dead newborn was so low (mean: 0.02 ± 0.14).Half of the patients delivered their pregnancies by cesarean section (C/S) (50.5%), and most of them had a good Apgar score value (98.8%).The study showed that women who had a past medical history or delivered by C/S, their newborns were more likely to admit to neonatalintensive care unit (NICU), 36.8% versus 12.1% (P = 0.017) and 78.9% versus 21.1% (P = 0.010), respectively. Conclusions: The presentstudy recommends that pregnant patients diagnosed with oligohydramnios are at a higher risk of C/S and NICU admission.


Article
Effect of Maternal Hypertension on Neonatal Outcome in Diyala Province, Iraq

Authors: Kareem Assi Obaid كريم عاصي عبيد --- Maan Baker Kadoori معن بكر قدوري --- Ghasaq Maan Baker غسق معن بكر
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2013 Volume: 5 Issue: 2 Pages: 69-74
Publisher: Diyala University جامعة ديالى

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Background: Maternal hypertension and preeclampsia are a multisystem, highly variable disorder unique to pregnancy and a leading cause of maternal and fetal/neonatal morbidity and mortality. Given the progressive nature of the disorder, delivery is often necessary to minimize maternal morbidity and mortality; obstetricians must balance the need for achieving in utero fetal maturation with the maternal and fetal risks of continuing pregnancy.Objectives: To evaluate the maternal burden and neonatal outcomes of infants delivered to mothers with preeclampsia, to review the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.Materials and Methods: A cohort prospective study done in Albatool Maternity Teaching Hospital from October 2011 to April 2012 for 55 mothers coming for antenatal follow up how hypertension and preeclampsia had been followed till delivery with their delivered neonates looking for the maternal hypertension, medication, liver function, complete blood picture, complications of preeclampsia and neonatal condition at birth, weight, respiratory function, feeding, complete blood picture and liver function, small for gestational age (SGA), respiratory distress syndrome (RDS), and neonatal death (NND) . Results: Infants of women with preeclampsia were more likely to be SGA 27(49% ) and have RDS 6 (10.1%); Frequency of preterm delivery at <37 weeks' gestation rose greatly with increasing severity of maternal hypertension 16 (29%). Fetal distress was seen in 12 cases (21.8%) with meconium staining of liquor in 8 cases 14.5% ,33 neonates (60%) required admission for many reasons. Mothers with hypertension have high risk of ante partum hemorrhage 40(72%), 17 delivered normally (30%) while 38 delivered by caesarean section (70%).Conclusion: Compared with neonates delivered prematurely because of other etiologies, neonates born to preeclamptic mothers were more likely to be SGA and have less RDS, but had a decrease in mortality. This may be a reflection of the differences in the underlying pathophysiology behind indicated preterm birth due to preeclampsia.


Article
Relationship between Fetal Gender, Pregnancy and Neonatal outcome among Pregnant Women attending labour ward at Al- Batool Teaching Hospital for Maternity and Children in Diyala Governorate Iraq

Author: Sawsan Talib Salman
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2014 Volume: 7 Issue: 1 Pages: 41-49
Publisher: Diyala University جامعة ديالى

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Background: In many societies, adverse outcomes in pregnancy and labour have often be ascribed to male fetal gender, so, In recent years, many investigators try to find any relationship between fetal gender and pregnancy outcome.Objective: To evaluate the role of fetal gender on pregnancy and neonatal outcome.Subjects and methods: A cross sectional study was done at a labour ward in Al-Batool Teaching hospital for maternity and children in Diyala Governorate, Iraq during the period from 1st of August till 31st of October 2013. One hundred one pregnant women were eligible for enrollment in the study according to inclusion criteria. The effect of fetal gender on both maternal and fetal parameters were all recorded.Results: A total of 101 neonate were born, of whom 53 were males and 48 were females, there was no significant differences noticed between male and female regarding to the maternal age and parity. Also the result showed that preterm and post term pregnancies more frequently in male bearing pregnancies than in female bearing pregnancies (4.95%, 0.99% respectively), despite these findings were significant statistically, while fetal gender has no positive correlation to the weeks of gestation. Pregnant women with a male fetus had a higher rate of cesarean section (8.91%) than with female fetuses (4.95%) which is statistically significant but there is no positive correlation between fetal gender and cesarean section, the results of this study find that there is no correlation between neonate gender and birth weight. By studying the correlation between neonate gender and other neonatal parameters like Apgar score <7 at 5 mint, admission to NICU, clear liquor, and Meconium liquor it was proved that there is no correlation between fetal gender and these parameters except there is a positive correlation between male gender and Apgar score <7 at 1 mint.Conclusions: There is a positive correlation between male gender and Apgar score <7 at 1 minute but no correlation found between fetal gender and other maternal or neonatal parameters.


Article
Effectiveness and safety of the oxytocin antagonist( atosiban) versus beta-adrenergic agonists (salbutamol) in the treatment of preterm labor.

Authors: Yasamin H. Sharif Al-Shibany ياسمين حمزة شريف --- Saba M. Swadi Al- Thuwainy صبا مطشر الثويني
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2015 Volume: 11 Issue: 20 Pages: 176-183
Publisher: Al-Qadisiyah University جامعة القادسية

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Background and Objectives: preterm labor complicates 5-10% of pregnancies and is a leading cause of neonatal morbidity and mortality worldwide and 70-80% of perinatal deaths occur in preterm infants. The aim of this study is to compare the effectiveness, safety and adverse effects of the oxytocin antagonist medication(atosiban) with those of beta-adrenergic agonist (salbutamol) in the treatment of patients with preterm labor.Patients and Methods: one hundred pregnant women with preterm labor were enrolled in this study from the period of( January 2014 – January 2015) at Al-Diwaniya Maternity and Pediatrics Teaching Hospital-Iraq with a gestational age of 24-34 weeks, they were randomly assigned to receive tocolytics either salbutamol (n=50) or atosiban (n=50).Salbutamol was given by(intravenous infusion 10-50 microgram)for up to 48 hour. Atosiban was given by (intravenous bolus dose of 6.75 mg then 300microgram/minute for 3 hour and 100microgram/minute for up to 48hour). Retreatment with the study drugs or alternative tocolytic agents was allowed. Main outcome measures included were tocolytic effectiveness, which was assessed in terms of number of women undelivered after 48hour and 7 days. Tocolytic safety was assessed in terms of maternal and fetal side effects and neonatal morbidity.Results: there were no significant differences between the salbutamol and the atosiban group in prolongation of pregnancy for 48 hour (44% versus67746%;p=0841)and 7 days(20% versus 32%;p=0.171) ,respectively. Maternal adverse events , including tachycardia occurred more frequently in the salbutamol group(22% versus 8%;p=0.050).Neonatal outcomes and complications were comparable between the two study groups(42% versus 32%;p=0.30).Conclusions: the oxytocin antagonist (atosiban) was as effective as beta-agonist(salbutamol) in delaying threatened preterm birth , and found to be better tolerated by both the mother and fetus than salbutamol , with a comparable neonatal safety profil.This study supports the clinical use of atosiban as a first line tocolytic in the treatment of preterm labor

التأثيرات و الاعراض الجانبية لاستتداا عاتاا الاسيستيبا و عتي عاضتد ضلاتاس لووينيتيستيي الب ترعنتا ضنتتابوت الدةيتة قالنااانتة ضتا عاتاا النتالبييساضي وعتي عاضتد ضالتي لننتتابوت البيتتا ت الدةيتة الب تر ةلعوج حالات اليلاسة النبكرة.الطر اة: أجر ت الاااسة ضنت لى اليلاسة و الأطلا التعةين الا يانية العراق , لةلترة ضتي هت ر يتاني -الثان / 4102 و لغا ة ه ر ياني الثان / 4102 ( عةى 011 اضرأة حاضد قعنر 52 01 ستنة( و اسلةتي التى نت -الطتياا ضتا اعتراض لةتيلاسة النبكترة و يانتت تترة الانتد ضتي 52 42 أستبي ( ضتا وجتيس انابالتات لةترح -سنتغرق 51 ثانية قنعا ≤ أاقعة انابالات لو 01 س ياة و يا اسنا عنق الرح ضي 0الى 5 س (و 1التى 5س (لةنياات عا نة اليلاسة وسرعة نبض الجنيي طبيعية , س ساني النر لاات الى ضجنيعتيي: النجنيعة الأولتىو عاسعا 21 ضر لاتة عيلجتت قعاتاا النتالبييساضي عتي طر تق ضاةتي الااتي اليا تا و النجنيعتة الثانيتة 21ضر لاة عيلجت قعاااالاسيسيبا اليا ا ضا ضرا بة هاة الانابالات و الاعراض الجانبية لكد عااا عةى الا والجنيي لغرض سألير اليلاسة النبكرة و ساةيد النلااعلات النر ر ة و الي يات لاى النياليا الداج حا ث اليلاسة.النتتتا: : لتت كتتي عنتتاف التتتو تت ستتألير حتتالات التتيلاسة النبكتترة لنتتاة 21 ستتاعة 22 % ضااقتتد 20 %( و 7أ تا 41 % ضااقتتد 54 %( قتيي النجنيعتتة الأولتى و الثانيتتة عةتى التتتيال و لكتي الاعتتراض الجانبيتة ضثتتد سنتتاانبلاات ةب الا يانت ايثر عنا النجنيعة الأولى الت عيلجت قعاتاا النتالبييساضي 44 % ضااقتد 1%(.لت سكتيعناف التو ات النتا: الإحصا:ية لةنلااعلات النر ر ة لاى النياليا الداج حا ث اليلاسة قيي النجنيعتيي.الاستتنتاج: استتداا عاتاا الاسيستيبا لتا نتتا: ضاااقتة لاستتداا عاتاا النتالبييساضي ت ستألير حتاو التيلاسةالنبكرة و لكي لا أعنية سر ر ة ا لاد ضي النالبييساضي قنب ةة الاعراض الجانبية لاى الا و الجنيي و ننصتقاستتدااضا يتأو لت عوجت لاتالات التيلاسة النبكترة لتاةيتد النلاتاعلات و ننتب الي يتات لتاى الدتاج حتا ثاليلاسة.


Article
Significance of Umbilical Cord Nucleated Red Blood Cells Count in Overdue Pregnancy

Authors: Yosve Salih --- Abdulrazak H Alnakash
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2009 Volume: 8 Issue: 3 Pages: 249-252
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Elevated count of nucleated red blood cells (n-RBCs) in the cord blood of fetuses at birth as well as prolongation of pregnancy, have been suggested as predictor of adverse perinatal outcome.OBJECTIVE:A prospective cohort study to evaluate the association between umbilical cord nucleated RBCs (uc-nRBC) count in uncomplicated overdue pregnancies with their neonatal outcome.PATIENTS & METHODS:One hundred and eighty five ladies with overdue pregnancy (41-42 weeks+3days) were included in the study. Dating was confirmed by their precisely recalled last menstrual periods and early pregnancy sonographies. At their deliveries, umbilical cord nucleated red blood cells were counted and expressed per 100 white blood cells. Mode of delivery, the newborn outcome and the risk factors were all analyzed with the obtained counts of the n-RBCs using descriptive and inferential statistics.RESULT:The number of n-RBCs counted, ranged from 3-43/ 100 WBC and accordingly the cases were categorized into 3 groups. Those with more than 20 n-RBC/100 WBC (high risk group) showed higher incidence of neonatal risk outcomes (49.3% of the calculated total risks) than the group with 3-10 n-RBC (low risk group) which included about half of the participants, it exhibited only 20.5% of the total risks. The risk outcomes include; meconium staining, admission to neonatal intensive care unit, neonatal death and Apgar score at 7 minutes less than 5. Moreover, cesarean section rate in high risk group was almost double its rate in the low risk group (44.7% Vs 22.5%).The association between risk outcome and n-RBC counts is statistically highly significant P value < 0.001.CONCLUSION:In overdue pregnancy, umbilical cord n-RBC count of the new born is significantly associated with risk outcome.


Article
Neonatal outcomes in elective repeated caesarean section at term pregnancy
النتائج الوليدية في الولادات القيصرية الاختيارية المتكررة في الحمل الكامل

Authors: Vian Rbhass Sherwani فيان رهباس الشيرواني --- Ishraq Mahmood Shakir د.اشراق محمود شاكر
Journal: Diyala Journal of Medicine مجلة ديالى الطبية ISSN: 97642219 Year: 2017 Volume: 12 Issue: 1 Pages: 9-14
Publisher: Diyala University جامعة ديالى

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Background: Caesarean delivery is associated with adverse health outcomes on both women and newborn infant. Timing of elective caesarean delivery also had an effect on the neonatal outcomes.Objective: To find out the association between neonatal outcomes and gestational age and determining the favorable time for elective caesarean delivery.Patients and Methods: A hospital-based cross-sectional study was done from 1st July, 2014 to 31st January, 2015 at the maternity teaching hospital in Erbil. A convenience sample of 200 full term pregnant women was selected from those admitted to the hospital for elective repeated caesarean delivery. Gestational age was determined by 1st trimester ultrasound and last menstrual period. Data on fetal variables probably associated with neonatal outcomes were collected in especially designed questionnaire. Results: The rate of elective repeated caesarean section before 39th week of gestation was 81.5%. Mean weight of infants and mean Apgar scores of infants at delivery were increasing with gestational age P < 0.001. The rate of admission to neonatal intensive care unit was higher among those delivered at 37th than 38th week of gestation. No admission was reported among those delivered at 39th week of gestation (P=0.006). No significant variations in the duration of admission, status of infant on discharge, and rates of respiratory symptoms were demonstrated between those delivered at 37th and 38th week of gestation.Conclusion: The vast majority of elective caesarean delivery are performed early before 39th week of gestation, which is associated with high incidence of neonatal morbidity and mortality.

خلفية الدراسة: ترتبط الولادة القيصرية مع تأثيرات صحية سلبية على كل من النساء و الأطفال حديثي الولادة. كما أن توقيت الولادة القيصرية الاختيارية يؤثر أيضاً على النتائج الصحية للوليد.اهداف الدراسة : أيجاد العلاقة بين الحالة الصحية للوليد مع عمر الحمل, و معرفة التوقيت المناسب لأجراء الولادة القيصرية الاختيارية.المرضى والطرائق: تعد هذه الدراسة دراسة وصفية منفذة في المستشفى التعليمي للولادة في اربيل. تم اختيار عينة ملائمة متكونة من 200 امرأة حامل في الاسبوع الحملي 37 -42 من النساء الحوامل اللاتي ادخلن الى المستشفى لغرض اجراء الولادة القيصرية الاختياريةالمتكررة. تم تحديد العمر الحملي لهولاء النسوة الحوامل من خلال اجراء الفحص بالامواج فوق الصوتية في الثلث الاول من الحمل و بالاعتماد على تأريخ آخر دورة شهرية. تم جمع المعلومات حول المتغيرات الجنينية التي من المحتمل ان تؤثر على النتائج الوليدية (Neonatal outcomes) بواسطة استمارات استبيان اعدت خصيصاً لهذا الغرض. النتائج: كان معدل الولادات القيصرية الاختيارية المتكررة قبل الاسبوع الحملي 39 مساوياً لـ 81,5%. زيادة متوسط وزن و متوسط نتائج أبغار (Apgar score) للأطفال عند الولادة مع زيادة عمر الحمل(P < 0.001). كان معدل الرقود في وحدات العناية المركزة للأطفال حديثي الولادة عالياً بشكل ملحوظ للولادات في الاسبوع الحملي 37 مقارنة بالاسبوع الحملي 38. لم يسجل رقود لوحدات العناية المركزة للأطفال حديثي الولادة بين الولادات بالعمر الحملي 39 (P = 0.006). لم يسجل اي اختلاف واضح في فترات الرقود, الحالة الصحية عند الخروج من وحدات الرعاية المركزة, و معدلات العلامات التنفسية بين الولادات في الاسبوع الحملي 37 مقارنة بالاسبوع الحملي 38.الاستنتاجات: غالبية الولادات القيصرية الاختيارية تتم مبكراً قبل الاسبوع الحملي 39, و التي ترتبط مع ارتفاع معدل حدوث المراضة و الوفيات بين حديثي الولادة.

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