COL1A1 GENE POLYMORPHISM IN MATERNITY PATIENTS WITH SOFT TISSUE INJURIES

The aim of the paper is to determine the impact of COL1A1 gene polymorphism on soft tissue injuries in maternity patients. Materials and Methods. The study involved 62 maternity patients who were divided into 2 groups. The first group included 45 patients (72.5 %) without type 1 collagen mutation, alpha 1 Sp1-polymorphism (G2046T) G/G. The second group consisted of 16 patients (27.5 %) with mutation in COL1A1 gene, Sp1-polymorphism (G2046T) G/T. During the study, a homozygous mutation, Sp1-polymorphism (G2046T) T/T was observed in one patient. Age, parity and mean fetal weight of women were comparable. Results. In patients with the COL1A1 mutation, Sp1-polymorphism (G2046T), the incidence of soft tissue birth injuries was 2.3 times higher than in those without such a mutation. Thus, it was confirmed that COL1A1 gene mutation contributes to the soft tissue trauma of the birth canal. It can be regarded as a prognostic criterion and as a basis for preventive measures during pregnancy. Conclusion. Birth trauma risks remain a controversial issue. One of the factors may be COL1A1 gene mutation. Key words: birth trauma, pelvic floor muscle insufficiency, collagen 1 gene polymorphism (COL1A1). Цель работы – определить роль полиморфизма гена COL1A1 у женщин с родовыми травмами мягких тканей родовых путей. Материалы и методы. В исследовании приняло участие 62 родильницы, которые были разделены на 2 группы. В первую группу включены 45 (72,5 %) родильниц, у которых мутация коллагена типа 1, альфа 1 Sp1-polymorphism (G2046T) G/G не обнаружена. Во второй группе, состоящей из 16 (27,5 %) родильниц, обнаружена мутация гена COL1A1 Sp1-polymorphism (G2046T) G/T. В процессе проведения исследования у одной пациентки обнаружена гомозиготная мутация Sp1-polymorphism (G2046T) T/T. Пациентки были сопоставимы по возрасту, паритету и средней массе плода. Результаты. У пациенток с мутацией COL1A1 Sp1-polymorphism (G2046T) частота родовых травм мягких тканей оказалась в 2,3 раза выше, чем у пациенток без мутации. Таким образом, подтверждено, что мутация данного гена имеет определенное значение в реализации риска травм мягких тканей родовых путей, что может послужить прогностическим критерием и основанием для проведения профилактических мероприятий в период беременности. Выводы. Вопрос о рисках родового травматизма остается спорным. Одним их факторов может явиться мутация гена COL1A1. Ключевые слова: родовой травматизм, недостаточность мышц тазового дна, полиморфизм гена коллагена 1 (COL1A1).

Neonatal Morbidity Pattern among Infants Born to Diabetic Mothers at Jamhouria Hospital, Benghazi- Libya

Introduction: Diabetes has long been associated with maternal and perinatal morbidity and mortality. The infant of a diabetic mother have higher risks for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risks of abortions and stillbirths. Abnormal fetal metabolism during pregnancy complicated by maternal diabetes mellitus results in multiple neonatal sequallae, including abnormalities of growth, glucose and calcium metabolism, hematologic status, cardio- respiratory function, bilirubin metabolism, and congenital anomalies. The causes of the fetal and neonatal sequallae of maternal diabetes are Multifactorial. However, many of the perinatal complications can be traced to the effect of maternal glycemic control on the fetus & can be prevented by appropriate periconceptional & prenatal care. Objective: to describe the morbidity pattern among infants of diabetic mothers (IDMs) either gestational or preconception diabetes mellitus. Methods: A cross sectional study was conducted in Jamhouria hospital/ neonatal ward & enrolled 120 consecutive infants born to diabetics mother either gestational or preconception diabetes mellitus over one year period. Results: 120 babies were diagnosed as IDMs and were admitted to Neonatal intensive care unit, male, female, 74(60.8%) were gestational diabetes, and 46 (38.3%) with preconception diabetes, full term comprise 98 cases (81.6%) while premature were 22 cases (18.3%). For birth weight 20 case [16.7%} were low birth weight, macrosomia represent 16 case (13.3%). Most common congenital anomalies was cardiac lesion 36 cases, for GDM 18 case =24.3% were PCDM 18 case around 40.0%. Central nervous system 11 case (9.1%) all of them dilated ventricular system& only 2 of them need surgical intervention with shunt. Gastrointestinal anomalies 4 cases {3.4%} 2 of them ectopic anus & 2 short bowel syndrome. Most common metabolic disturbance was Hypocalcemia 17 case (14.1%), followed by hypoglycemia 11 case (9.1%), followed with hyper bilirubinemia 3 cases (2.5%) Followed by Respiratory distress syndrome 26 case (21.6%), 17 case hyaline membrane disease (14.1%) ,transient tachypnea of neo born 9 cases (7.5%) , Birth trauma 3 cases Erb,s palsy one of them birth asphyxia. Conclusion: Most common type of diabetes in pregnancy is gestational diabetes, and most common congenital anomalies is the cardiac lesion & the most common metabolic disturbance is the hypocalcemia. Macrosomia associated with large birth weight as well as birth trauma. Large for gestational age and hypoglycemia associated mainly with poor maternal glycemic control.

Importance of Imaging in Congenital Unilateral Vocal Fold Paralysis: A Case of Neck Neuroblastoma Presenting with Unilateral Vocal Fold Paralysis

Congenital vocal fold paralysis (VFP) is an important cause of respiratory compromise in infants. It can either be unilateral or bilateral, while imaging is routinely performed for bilateral VFP to evaluate for potential neurological causes, and such a practice may not be routine for unilateral VFP. While many of the unilateral VFP cases are idiopathic, the cause may occasionally be more sinister in nature, such as tumors. Therefore, unless an obvious cause of unilateral VFP is present (such as cardiac surgery or birth trauma), routine imaging of the brain, neck, and mediastinum should be performed for congenital unilateral VFP. We describe a rare case of a cervical neuroblastoma presenting with unilateral VFP that was detected only on imaging, thus highlighting its value and importance.

Predictive Risk Factors for Mild and Severe Germinal Matrix Hemorrhage and Associated Neurodevelopmental Prognosis: A Retrospective Study

Aims: To compare commonly mentioned risk factors between mild germinal matrix hemorrhage-Intraventricular hemorrhage (GMH-IVH) (grade I & II) and severe GMH-IVH (grade III & IV) and to study the long-term neurodevelopmental outcomes in relation to severe GMH-IVH. Study Design: Retrospective cohort study. Place and Duration of Study: Neonatal intensive care unit, King Fahad University Hospital, between 2000 and 2020. Methodology: We included 54 premature infants at ≤36 weeks of gestation and with birth weight <2500g admitted to our neonatal intensive care unit. Premature neonates were divided into two subgroups: mild GMH-IVH (grade I and II) and severe (grade III and IV). We investigated the risk factors and neurodevelopmental outcomes in association with GMH-IVH. Results: Amnionitis (OR: 1.190, 95% CI 0.515-2.749), lower genital tract infection (OR: 1.190, 95% CI 0.515-2.749), antenatal infection (OR: 1.406, 95% CI 0.866-2.283), gestational diabetes mellitus (OR: 1.815, 95% CI 1.410-2.337), usage of inotropes (OR: 1.731, 95% CI 1.348-2.222), APGAR score <7 (OR: 0.806, 95% CI 0.493-1.316), birth trauma (OR: 1.767, 95% CI 1.396-2.236), catecholamines (OR: 1.470, 95% CI 0.903-2.393), intubation (OR: 1.300, 95% CI 0.686-2.464), asphyxia (OR: 1.135, 95% CI 0.718-1.794), Abnormal coagulation (OR: 1.197, 95% CI 0.756-1.896), congenital heart disease (OR: 1.727, 95% CI 1.124-2.653), low hematocrit (OR: 1.140, 95% CI 0.688-1.889), resuscitation (OR: 1,193, 95% CI 0.748- 1.904) and ventriculoperitoneal (VP) shunt as a prognosis of hydrocephalus (P-value: 0.005) all showed a higher incidence with severe GMH-IVH Conclusion: Amnionitis, lower genital tract infection, antenatal infections, GDM, usage of inotropes, APGAR score <7, birth trauma, catecholamines, intubation, asphyxia, resuscitation, abnormal coagulation parameters, congenital heart disease, low hematocrit and hydrocephalus with VP shunt were higher in severe GMH-IVH.

Ergonomi Duduk yang Benar untuk Mencengah Terjadinya Low Back Pain (LBP) di Kelurahan Mayang Mangurai Kota Jambi

One of the musculoskeletal disorders that often occurs due to incorrect ergonomics is low back pain. Low back pain (LBP) is a pain syndrome that occurs in the lower back region which is the result of various causes including abnormalities of the spine or spine from birth, trauma, tissue changes, and the influence of gravity. Community service activities will be held in April-June 2021 with discussion methods and delivering materials and leaflets related to the introduction of ergonomics in the correct sitting position in order to reduce the impact of low back pain. This Community Service (PKM) aims to be used as a source of knowledge for recitation mothers at the Nurul Al-Ikhlas mosque. The results of the evaluation through the question and answer were that the study mothers had understood the introduction of ergonomic sitting to prevent LBP

Assessment of Childbirth-Related PTSD: Psychometric Properties of the German Version of the City Birth Trauma Scale

Background: About 3–4% of women in community samples suffer from childbirth-related posttraumatic stress disorder (PTSD). Surprisingly, the recently developed City Birth Trauma Scale (City BiTS) was the first diagnostic tool for childbirth-related PTSD covering DSM-5 criteria for PTSD. Since no questionnaire on childbirth-related PTSD is available in German, we aimed to validate a German translation of the City BiTS and to provide information on its psychometric properties.Methods: A community sample of 1,072 mothers completed an online survey, which included questions on sociodemographic and obstetric characteristics, the German version of the City BiTS, the Impact of Event Scale-Revised (IES-R), the PTSD Checklist for DSM-5 (PCL-5), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale of the Depression, Anxiety, and Stress Scale (DASS-Anxiety).Results: Exploratory factor analysis (EFA) on a random split-half sample confirmed the previously reported two-factorial structure of the City BiTS. The factors “Childbirth-related symptoms” and “General symptoms” explained about 53%, 52% of variance. Internal consistency was good to excellent for the subscales and the total scale (Cronbach's Alpha = 0.89−0.92). In a confirmatory factor analysis (CFA) in the holdout sample the two-factorial solution reached the best model fit out of three models. Correlation analyses showed convergent validity of the City BiTS (total scale and subscales) with the IES-R and PCL-5 and divergent validity with the EPDS and the DASS-Anxiety.Limitations: Data were acquired in a community sample and prevalence rates might not be representative for mothers of high-risk groups, e.g., after preterm birth.Conclusions: The German version of the City BiTS is the first German questionnaire which allows to assess symptoms of childbirth-related PTSD according to DSM-5 criteria. Besides an improvement in clinical routine it will help to make data on prevalence of childbirth-related PTSD internationally comparable. In addition, this work provides a basis to assess childbirth-related PTSD in studies conducted with a longitudinal study design or in high-risk samples.

Head injuries related to birth trauma among low birthweight neonates during vacuum extraction: a retrospective cohort study

Objective: Prematurity [gestational age (GA)<34w] is a relative contraindication to vacuum extraction (VE). Current data do not discriminate clearly between prematurity and low-birthweight (LBW). We aimed to evaluate the impact of non-metal vacuum cup extraction on neonatal head injuries related to birth-trauma (HI), among newborns with LBW (<2,500g). Design: A retrospective cohort. Population: 3,335 singleton pregnancies, delivered by VE from 2014 to 2019. All were >34w GA. Methods: We compared 207 (6.2%) neonates with LBW <2,500g to 3,128 (93.8%) neonates with higher BW, divided into 3 subgroups (2,500-2,999g, 3,000-3,499g, and >3,500g). Main outcome measures: HI and other neonatal complications. Results: The lowest rates of subgaleal hematoma occurred in neonates <2,500g (0.5%) and increased with every additional 500g of neonatal birthweight (3.2%, 4.4% and 7.6% in 2,500-2,999g, 3,000-3,499g, and >3,500g groups, respectively; p=0.001). Fewer cephalohematomas occurred among LBW neonates (0.5% in <2,500g) and increased with every additional 500g of birthweight (2.6%, 3.3% and 3.8% in 2,500-2,999g, 3,000-3,499g, and >3,500g groups, respectively, p=0.026). Logistic regression found increasing birthweight as a significant risk-factor for head injuries during VE, with adjusted odds ratios of 8.874, 10.624, 13.980 for 2,500-2,999g, 3,000-3,499g, and >3,500g, respectively (p=0.015). NICU hospitalization rates were highest among neonates weighing <2,500g (10.1%) compared to the other groups (2.7%, 1.7% and 3.3% in 2,500-2,999g, 3,000-3,499g, >3,500g respectively, p=0.000). Conclusions: VE of neonates weighing <2500g at 34w and beyond seems as a safe mode of delivery when indicated, with lower rates of HI, compared to neonates with higher BW. Funding: none.