Archive for category: News

Recent study aimed to analyze the incidence, management, and outcomes of prolonged second stage of labor in a rural hospital in Malawi. Prolonged second stage labor can lead to maternal and perinatal complications, and the options for management include oxytocin augmentation, instrumental vaginal birth, or second-stage cesarean section. The study assessed a dataset of 3,426 births over a two-year period in St Luke’s Hospital in Malawi. About 9% of women experienced a prolonged second stage, with interventions including oxytocin augmentation (7.2%), vacuum extraction (10.1%), or cesarean section (20.8%). The majority of women (69.1%) had spontaneous vaginal births.

Challenges and Outcomes

The study revealed that a considerable proportion of women arrived at the hospital already in the second stage of labor, which posed challenges in monitoring and timely intervention. Despite this, outcomes for these women were generally good without significant differences in maternal and neonatal complications compared to women admitted in earlier stages of labor. Women who were admitted during the second stage had higher parity, older age, and fewer antenatal care consultations. However, they had lower rates of previous cesarean sections.

Documentation and Interventions

Among the women admitted in the second stage, only a small percentage had a documented prolonged second stage on the partograph. Women in this subgroup experienced higher rates of instrumental vaginal births, cesarean sections, and complications. The study emphasized the need to enhance the use of vacuum extraction as an alternative to second-stage cesarean sections, which have higher risks. Training on instrumental vaginal birth, like vacuum extraction, was identified as crucial for clinicians to improve the quality of care and reduce complications associated with prolonged labor.

Implications for Maternal Health

The implications of the study suggest that timely attention, proper monitoring of labor progress, and the availability of instrumental birth methods can help prevent prolonged labor and its adverse outcomes. Enhancing the use of vacuum extraction, alongside appropriate training, can lead to significant improvements in maternal and neonatal health outcomes. This study provides valuable insights into clinical practices in low-resource settings and highlights the importance of tailored interventions to address the challenges associated with prolonged second stage labor in rural areas of Malawi.

Key Points

– The study focused on analyzing the incidence, management, and outcomes of prolonged second stage of labor in a rural hospital in Malawi, where 9% of women experienced this condition. Interventions for prolonged second stage labor included oxytocin augmentation, vacuum extraction, or cesarean section, with the majority (69.1%) having spontaneous vaginal births.

– A notable challenge identified was that a significant number of women arrived at the hospital already in the second stage of labor, which hindered monitoring and timely intervention. However, women admitted during the second stage did not show significant differences in maternal and neonatal complications compared to those admitted earlier, despite having higher parity, older age, and fewer antenatal care consultations.

– Documented cases of prolonged second stage on the partograph among women admitted in the second stage were minimal. This subgroup experienced more instrumental vaginal births, cesarean sections, and complications, highlighting the importance of improving documentation and considering vacuum extraction as an alternative to cesarean sections in such cases.

– The study underscored the necessity of training healthcare providers in instrumental vaginal birth techniques like vacuum extraction to enhance the quality of care and decrease complications related to prolonged labor. This training can potentially reduce the risks associated with second-stage cesarean sections and improve maternal and neonatal health outcomes.

– Timely attention, proper monitoring of labor progression, and the availability of instrumental birth methods were suggested as key factors in preventing prolonged labor and its adverse effects. Enhancing the use of vacuum extraction, coupled with appropriate training, has the potential to significantly enhance maternal and neonatal health outcomes, especially in low-resource settings such as rural areas of Malawi.

– The study provides valuable insights into clinical practices in low-resource settings, emphasizing the importance of tailored interventions to tackle the challenges associated with prolonged second stage labor. By addressing issues related to management and interventions, healthcare systems can improve outcomes for women experiencing prolonged labor, thus benefiting maternal and neonatal health in such regions.

Reference –

Wouter Bakker et al. (2025). Incidence, Management And Outcomes Of Prolonged Second Stage Of Labour In A Rural Setting In Malawi: A Retrospective Cohort Study. *BMC Pregnancy And Childbirth*, 25. https://doi.org/10.1186/s12884-025-07392-8.

A new study published in the Journal of American Medical Association showed that simvastatin did not provide additional antidepressant benefits when combined with escitalopram in patients with major depressive disorder (MDD) and obesity, although it did improve cardiovascular risk factors.

Obesity and major depressive disorder are prevalent noncommunicable diseases with significant disease burdens that commonly co-occur. Interestingly, a biological connection between obesity, metabolic syndrome, and depression has been proposed by convergent lines of evidence from genetic and observational research as well as animal models.

The antidepressant potential of statins has been suggested by a number of modest randomized clinical studies (RCTs). Thus, to determine if simvastatin added to escitalopram is more effective than a placebo at reducing depressive symptoms, this trial was carried out.

This investigation included adults with MDD and concomitant obesity from nine German tertiary care settings. Analysis of the data took place between July and October of 2024. In addition to escitalopram (10 mg during the first two weeks, then raised to 20 mg until the completion of the research), simvastatin (40 mg daily) or a placebo was administered in a double-blind manner for 12 weeks. The Montgomery-Åsberg Depression Rating Scale (MADRS) score change from baseline (week 0) to week 12 was the main result.

The intention-to-treat analysis comprised 160 of the 161 patients who were recruited at 9 locations in Germany between August 21, 2020, and June 06, 2024 (mean [SD] age, 39.0 [11.0] years; 126 female [79%]; placebo: n = 79, simvastatin: n = 81). Blinding was successfully maintained throughout the experiment, and retention was outstanding (95.6%).

Four severe adverse events occurred, and there was no difference between the groups. Simvastatin addition did not significantly affect MADRS scores in the intention-to-treat population, according to primary endpoint analysis (mixed models for repeated measures least squares mean difference, 0.47 points; 95% CI, -2.08 to 3.02; P =.71).

Simvastatin substantially decreased LDL cholesterol (-40.37 mg/dL), total cholesterol (-39.07 mg/dL), and C-reactive protein (-1.04 mg/L) when compared to a placebo (all P <.01), but it had no effect on secondary outcomes relating to mental health. Overall, the study showed that even while simvastatin improved the cardiovascular risk profile, it had no extra antidepressant benefits when used with escitalopram in individuals who had both obesity and concomitant MDD.

Source:

Otte, C., Chae, W. R., Dogan, D. Y., Piber, D., Roepke, S., Cho, A. B., Trumm, S., Kaczmarczyk, M., Brasanac, J., Wingenfeld, K., Koglin, S., Wieditz, J., Junghanns, K., Lucht, M., Prvulovic, D., Krüger, T. H. C., Terock, J., Haaf, M., Hofmann, T., … Gold, S. M. (2025). Simvastatin as add-on treatment to escitalopram in patients with major depression and obesity: A randomized clinical trial. JAMA Psychiatry (Chicago, Ill.). https://doi.org/10.1001/jamapsychiatry.2025.0801

A relatively new therapy used to treat pulmonary arterial hypertension in those with mild to moderate disease was found to be effective at preventing death in those with more advanced disease. Results were published on Wednesday, May 28, in The New England Journal of Medicine and could have “transformative implications” for patients, according to an editorial that accompanied the study written by Bradley Maron, MD, Professor of Medicine and Director of the Hypertension Program at the University of Maryland School of Medicine.

When the US Food and Drug approved the first-in-its-class drug, called sotatercept, last year, it was indicated only for those with mild pulmonary arterial hypertension to increase exercise capacity and prevent clinical worsening of the lung condition which is rare but progressive, often leading to premature death. About 1,000 Americans are diagnosed with the condition every year, and women under age 60 are at higher risk. The condition, caused by a narrowing of small arteries throughout the lungs, triggers the heart to work harder and eventually lose its ability to effectively pump blood.

The clinical trial, called Zenith, was led by researchers in France and conducted at several clinical sites in the U.S. and internationally. It involved 172 patients with advanced pulmonary arterial hypertension who were randomly assigned to get an injection of sotatercept along with their usual treatments or to get a placebo injection along with their usual treatments.

“The authors observed a 76 percent lower risk of a primary endpoint event [death from any cause, lung transplantation, or hospitalization] with sotatercept than with a placebo – a staggering effect by any standard by uniquely relevant in pulmonary arterial hypertension, since previous trials have typically shown comparatively modest results with weaker end points,” wrote Dr. Maron, who is also Director of the University of Maryland Institute for Health Computing. Dr. Maron was not involved in the study and provided an independent assessment of the study findings.

The trial was stopped early after it became clear that the sotatercept group had significant benefits over those taking a placebo: 50 percent of the placebo group were hospitalized during the trial compared to only 9 percent of the sotatercept group. Death occurred in 15 percent of those on a placebo compared to 8 percent of those on sotatercept.

Vascular malformations and bleeding events occurred in some patients taking sotatercept, but this did not lead them to stop taking the drug. Nonetheless, better understanding of how these side effects could relate to patient adherence to sotatercept in actual clinical practice is needed, according to Dr. Maron.

“Results from the Zenith trial,” he wrote, “offer a key measure of optimism to patients with advanced-stage pulmonary arterial hypertension with limited or no options.”

Reference:

Bradley A. Maron, Sotatercept and the Clinical Transformation of Pulmonary Arterial Hypertension, New England Journal of Medicine, DOI: 10.1056/NEJMe2503944.