Background: Labour pain has been identified as an important reason for women to prefer caesarean section (CS). Fentanyl is one of the short acting opioids recommended by World Health Organization for pain relief during labour. This study aimed to identify and describe the available evidence on the use of fentanyl (monotherapy) for labour pain management by any routes of administration or regime.Methods: We included the records published until 31 December 2021 which reported administration of fentanyl to women with normal labour for labour pain relief. Data were extracted by one reviewer and checked by another reviewer using a standardised agreement form. We mapped and presented data descriptively in figure and tabular format.Results: We included 51 records from 49 studies in our scoping review. The studies were conducted in 12 countries, mostly high-income countries. The study designs of the 51 included records were varied as follows: 38 (74.5%) experimental studies (35 randomised controlled trials and three quasi-experimental studies), and 12 (23.5%) observational studies (five retrospective cohort studies, four prospective cohort studies, two retrospective descriptive studies, and one descriptive study) and one qualitative study. Of the included records, six used intranasal fentanyl, five used subcutaneous fentanyl, 18 (35.3%) used intravenous fentanyl, 18 (35.3%) used intrathecal fentanyl, and nine used epidural fentanyl. Many records compared fentanyl with another analgesic agent while five records (9.8%) had no comparison group and seven records (13.7%) compared with no analgesia group. The doses of fentanyl varied by routes, study and the requirement depended on the women. Pain assessment was the most frequent outcome measure presented in the records (78.4%). Only nine records (17.6%) investigated women’s satisfaction about labour pain relief using fentanyl and seven records (13.7%) reported the effect of fentanyl on breastfeeding. The most common reported neonatal outcomes were foetal heart rate (33 records, 64.7%) and Apgar score (32 records, 62.7%).Conclusion: There is limited primary evidence especially randomised controlled trials to evaluate the effectiveness and harms of different routes of fentanyl in low- or middle-income countries. There is a need for high-quality research to establish the most effective route of fentanyl and associated effects for evidence-based international guidelines.

Objective: To compare fetal and neonatal cardiac functions in terms of global, systolic, and diastolic function between the preeclampsia and normotensive blood pressure of pregnancies. Methods: A prospective cohort study was conducted at a university hospital in Northeast Thailand. Twenty-nine pregnancies diagnosed as preeclampsia with or without severe features were compared with 29 normotensive pregnancies. Global cardiac, systolic, and diastolic function were assessed at prenatal and postnatal periods, by a professionally trained obstetrician and pediatric cardiologist, respectively. Results: The fetal left modified myocardium performance index (Mod-MPI) in preeclampsia and normotensive blood pressure were 0.60± 0.08 and 0.59± 0.08 (p-value=0.341), respectively, while fetal right Mod-MPI were 0.57± 0.16 and 0.54± 0.21 (p-value=0.861), respectively. There were no statistically significant differences in terms of fetal isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ejection time (ET), aortic peak systolic velocity (Ao PSV), pulmonary artery peak systolic velocity (PA PSV), mitral valve (MV) E:A ratio, or tricuspid valve (TV) E:A ratios between the two groups. Neonatal mitral valve E peak systolic velocity (MV-E PV) in preeclamptic and normotensive blood pressure groups were significantly different at 51.1± 8.02 cm/s and 43.56± 5.21cm/s (p-value=0.036), respectively, whereas neonatal left Mod-MPI, mitral valve A peak systolic velocity (MV-A PV), MV E:A ratio, and Ao PSV were not significantly different (p-value=0.436, 0.119, 0.379, and 0.709), respectively. Conclusion: Neonatal MV-E PV of the preeclampsia group was significantly higher than the normotensive blood pressure group, while there were no statistically significant differences in terms of global cardiac and diastolic functions during the fetal period between two groups.

Labor pain is the most intense pain a woman will experience during her lifetime. Epidural anesthesia is recommended as the most effective method for pain relief, but it has several limitations. Fentanyl has high analgesic potency with short-acting duration, but the large-scale trials that assessed the effectiveness and safety of it for labor pain management are still limited. This study aimed to compare the effectiveness and harm and maternal satisfaction of subcutaneous vs intravenous fentanyl for labor pain management. We conducted a multicenter, open-label randomized controlled trial. A total of 226 women were randomized to receive intravenous or subcutaneous fentanyl for labor pain management. Pain scores were evaluated before and after fentanyl administration at 5, 30, and 60 minutes and then every 60 minutes until delivery. The data were analyzed based on the intention-to-treat principle. Both intravenous and subcutaneous fentanyl significantly decreased labor pain from baseline to delivery (overall mean change, -1.39; 95% confidence interval, -1.62 to -1.17; and -0.89; 95% confidence interval, -1.24 to -0.05, respectively). The reduction in the pain score between the 2 groups was not different (overall mean difference, -0.35; 95% confidence interval, -0.76 to 0.05). Maternal satisfaction was high for both intravenous and subcutaneous fentanyl (89.4% and 93.8%, respectively). There was no difference in the maternal satisfaction rate between the 2 groups (relative risk, 0.95; 95% confidence interval, 0.88-1.03). No serious maternal and neonatal adverse effects were observed. Both intravenously and subcutaneously administered fentanyl were safe and significantly reduced pain from baseline to delivery among low-risk pregnancies. Maternal satisfaction with the childbirth experience was high regardless of the route of administration of fentanyl. No serious adverse effects of fentanyl were observed in either the mothers or the neonates.

Background: Uteroplacental insufficiency in fetuses with growth restriction (FGR) leads to chronic hypoxia and stress, predominantly affecting the adrenal glands. However, the mechanisms of impact remain unclear.Objectives: This study is aimed at comparing the Doppler indices of the adrenal artery and the adrenal gland sizes between FGR and those with normal growth.Materials and Methods: A multicenter, cross‐sectional study was conducted from February to December 2023. We compared 34 FGR to 34 with normal growth in terms of inferior adrenal artery (IAA) Doppler indices and adrenal gland volumes.Results: The IAA peak systolic velocity (PSV) in the FGR group was 14.9 ± 2.9 cm/s compared to 13.5 ± 2.0 cm/s in the normal group, with a mean difference of 1.4 cm/s (95% confidence interval [CI]: 0.27–2.65; p value = 0.017). There were no significant differences between groups in terms of IAA pulsatility index (PI), resistance index (RI), or systolic/diastolic (S/D), with p values of 0.438, 0.441, and 0.658, respectively. The volumes of the corrected whole adrenal gland and the corrected neocortex were significantly larger in the FGR group, with p values of 0.031 and 0.020, respectively.Conclusion: Both increased IAA PSV and enlarged volumes of the corrected whole adrenal gland and neocortex were found in fetuses with FGR, suggesting significant adrenal gland adaptation in response to chronic intrauterine stress.

Objectives: The objective of the study is To to determine the incidence of superimposed preeclampsia among pregnant women with chronic hypertension and associated factors of superimposed preeclampsia:preeclampsia. Material and Methods: A retrospective multicenter cohort study was conducted at Srinagarind Hospital, Khon Kaen University, and Khon Kaen hospitalHospital, Thailand, involving women who were admitted between November 1, 2017, to and October 31, 2022. The pregnant women who had been diagnosed with chronic hypertension were identified and their medical records were reviewed for incidence of superimposed preeclampsia. Various characteristics were examined to compare maternal complications, perinatal outcomes, and associated factors. Logisticfactors.Logistic regression analysis was performed to identify factors associated with superimposed preeclampsia. Results: There was a total of 33,018 deliveries during the study period, out of which 406 (1.2%) women with chronic hypertension were identified. Superimposed preeclampsia occurred in 199 women, accounting for a rate of 49.0% (95% confidence interval; [CI] 44.1–53.9). One hundred and nineteen women (59.8%) were diagnosed with superimposed preeclampsia with severe features, and 80 (40.2%) without severe features. A mean arterial pressure (MAP) ≥100≥ 100 mmHg during pregnancy, the requirement of two or more antihypertensive agents, and a history of previous preeclampsia were significantly associated with an increased risk of superimposed preeclampsia (adjusted odds ratio; [OR] 9.97, 95% CI95%CI 5.95 – 16.71, adjusted OR 2.31, 95% CI95%CI 1.30 – 4.12, and adjusted OR 4.52, 95% CI95%CI 1.86 – 10.98, respectively). Conclusion: Approximately half of the women with chronic hypertension developed superimposed preeclampsia. MAP ≥ 100 mmHg, the requirement of two or more antihypertensive agents, and a history of previous preeclampsia might be useful tools for predicting superimposed preeclampsia.

We reported two cases of posterior placenta previa managed with elective cesarean delivery and adjunctive autologous platelet‐rich plasma (PRP) gel. Twelve milliliters of PRP gel were used to cover both the sutured implantation site and the denuded area in both cases. Case 1, gravida 1, para 0 with 37 1/7 weeks′ gestation, intra‐ and 24‐h postoperative blood loss were 400 and 10 mL, respectively, whereas the hematocrit decreased from 34.4% to 29.4%. Case 2, gravida 2, para 1, with a gestation of 37 4/7 weeks, had intra‐ and 24‐h postoperative blood loss of 500 and 50 mL, respectively. The hematocrit changed from 32.8% to 32%. No blood transfusion was required in either case. Conclusion: Adjuvant autologous PRP gel may reduce blood loss in posterior placenta previa. Further optimization of PRP preparation protocols for pregnant women, along with validation through large‐scale clinical trials, is warranted to confirm their effectiveness and generalizability.