Increased length of active labor is associated with adverse perinatal outcomes among nulliparous women undergoing labor induction

Perinatal outcome of pregnancies with intrauterine passage of meconium at 37-39 compared with 40-42 weeks' gestation

Evaluate the association between spontaneous active labor duration utilizing contemporary labor curves and risk of adverse outcomes. This is a retrospective cohort study from January 2012 to January 2015. Subjects were nulliparous, 18 to 44 years, with a cephalic, singleton ≥37 weeks in spontaneous labor. Subjects were placed into three subgroups, defined by active labor duration from 6 to 10 cm as less than the median, the median-95th, and >95th percentile based on contemporary labor curves published by Zhang et al. We evaluated the association between subgroups and cesarean delivery, chorioamnionitis, estimated blood loss, Apgar score < 7 at 5 minutes, and neonatal intensive care unit admission using logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI). Six-hundred forty two women met the inclusion criteria. Compared with women whose active labor was less than the median, the risk of cesarean was higher in the median-95th percentile ([adjusted OR, aOR] 3.1, 95% CI 1.8-5.5) and the >95th percentile ([aOR] 6.8, 95% CI 3.9-11.7) subgroups. There was an increased odds of chorioamnionitis in the median-95th percentile subgroup ([aOR] 2.5, 95% CI 1.1-5.9). Chorioamnionitis and cesarean delivery increased significantly as labor duration exceeded the median. This study provides a better understanding regarding the potential risk of cesarean and chorioamnionitis using contemporary labor curves.

694 Impact of neonatal birth weight on adverse perinatal outcomes in cesarean deliveries in nulliparous women

Determining fetuses at risk of adverse perinatal outcomes at term remains a clinical challenge, particularly among pregnancies that appear low risk and appropriately grown for gestational age (AGA). While the cerebroplacental ratio (CPR) and amniotic fluid index (AFI) are established non-invasive indicators of fetal well-being, their combined predictive ability in low-risk AGA pregnancies is not well defined. To evaluate and compare the predictive value of AFI alone and AFI combined with CPR in forecasting adverse perinatal outcomes among term AGA pregnancies. This prospective observational study included 236 term AGA pregnancies, spanning 37 to 40 weeks of gestation. Participants were randomly assigned to two groups: Group 1 (AFI + CPR) and Group 2 (AFI only). Maternal characteristics, intrapartum findings, and neonatal outcomes were recorded. Statistical analyses, including receiver operating characteristic (ROC) curves, were used to assess the predictive performance of AFI and CPR for low Apgar (appearance, pulse, grimace, activity, respiration) scores, neonatal intensive care unit (NICU) admissions, and caesarean delivery. Baseline maternal and fetal characteristics were comparable between the groups. Normal vaginal delivery was the predominant mode of delivery, with no significant difference in neonatal morbidity or caesarean section rates between groups. ROC analysis demonstrated poor discriminatory ability of both AFI and CPR in predicting low Apgar scores, NICU admissions, or caesarean delivery. However, both parameters exhibited high negative predictive values, indicating utility in ruling out adverse outcomes. The addition of CPR did not significantly improve diagnostic accuracy compared to AFI alone. In low-risk term AGA pregnancies,AFIremains a practical and widely used component of routine fetal surveillance, primarily reflecting its high negative predictive value rather than strong discriminatory capability for adverse outcomes. The inclusion of CPRdoes not provide a significant incremental benefit in predicting adverse perinatal outcomes, as both parameters demonstrate poor discriminatory performance. These findings support the role of AFI and CPR in excluding adverse outcomes rather than in predicting fetal compromise.

Systematic review of maternal Placental Growth Factor levels in late pregnancy as a predictor of adverse intrapartum and perinatal outcomes

Applying Tension to the Transcervical Foley Balloon and Delivery Times in Term Nulliparous Women Undergoing Induction of Labor: A Randomized Controlled Trial.

Unexpected term NICU admissions: a marker of obstetrical care quality?

Adverse perinatal outcomes in pregnancies affected by severe COVID-19 infection

Amniotic fluid volume (AFV) is examined via ultrasound often several times in pregnancy and can be an indicator of the overall health of a fetus. However, disorders of amniotic fluid can arise without complications for the fetus; excess of amniotic fluid without any accompanying fetal conditions is referred to as idiopathic polyhydramnios. Previous research has shown conflicting results with regard to outcomes related to idiopathic polyhydramnios, with some finding it increases adverse outcomes and others reporting an increase in adverse outcomes only in moderate or severe cases. This study is a systematic review and meta-analysis meant to assess the relationship between idiopathic polyhydramnios and perinatal outcomes for singleton pregnancies. Eligibility criteria included studies that had a control group with normal AFV and defined polyhydramnios as an amniotic fluid index of 24 cm or greater or a single deepest pocket of 8 cm or greater. Similar methods of defining polyhydramnios were considered as long as they were evidence-based. Studies with known causes of polyhydramnios were excluded to ensure cases analyzed for this study were idiopathic. The primary outcome was intrauterine fetal demise, with secondary outcomes of neonatal death, neonatal intensive care unit (NICU) admission, macrosomia, 5-minute Apgar score, malpresentation, and cesarean delivery. Final review and analysis included 12 articles, with a total of 2392 patients with idiopathic polyhydramnios and 160,135 patients with normal AFV. Risk of bias was determined to be low for these studies, although the comparability was not well-defined. Analysis for the primary outcome included 8 of the 12 studies and showed that the risk of intrauterine fetal demise was increased in those with idiopathic polyhydramnios (odds ratio [OR], 7.64; 95% confidence interval [CI], 2.50–23.38). Secondary outcome analysis for neonatal death showed that individuals with polyhydramnios were 8.68 times more likely to experience neonatal death than controls (95% CI, 2.91–25.87). Examining other secondary outcomes, the association between NICU admission and idiopathic polyhydramnios showed that patients with polyhydramnios were more likely to be admitted to the NICU (OR, 1.94; 95% CI, 1.45–2.59). When assessing 5-minute Apgar scores, results showed that individuals with polyhydramnios were more likely to have an Apgar score of less than 7 (OR, 2.21; 95% CI, 1.34–3.62). In addition, rates of cesarean delivery were significantly higher with idiopathic polyhydramnios (OR, 2.31; 95% CI, 1.79–2.99), as was macrosomia (OR, 2.93; 95% CI, 2.39–3.59). Malpresentation was also higher in the polyhydramnios group than in the control group (OR, 2.73; 95% CI, 2.06–3.61). The authors of this meta-analysis conclude that in pregnancies with idiopathic polyhydramnios, there is an elevated risk of both intrauterine fetal demise and neonatal death. In addition, all other negative pregnancy outcomes analyzed were more common in pregnancies affected by idiopathic polyhydramnios. One limitation of this review is the heterogeneity inherent in analyzing many studies with different sample characteristics and different analysis methods. Although efforts were made to reduce bias, there is some inherent bias that cannot be accounted for completely. Further research is needed to fully characterize the clinical implications of the increased risk for adverse pregnancy outcomes shown here. This study also showed an increased risk based on the current clinical threshold for polyhydramnios, but more data are needed on accurate AFV thresholds and the clinical implications stemming from various thresholds.

Association between interpregnancy interval and adverse perinatal outcomes among subsequent twin pregnancies: a nationwide population-based study

This study aimed to evaluate the FIB-4 and APRI scores in patients with gestational diabetes mellitus (GDM) and investigate their associations with neonatal outcomes. Additionally, the predictive value of these non-invasive fibrosis indices for GDM and adverse perinatal outcomes was assessed. In this retrospective case-control study, 200 pregnant women diagnosed with GDM and 200 healthy controls were analyzed. Data on maternal demographics, laboratory parameters (ALT, AST, platelet count), FIB-4 and APRI scores, perinatal and neonatal outcomes including fetal growth restriction (FGR), oligohydramnios, polyhydramnios, birth weight, gestational age at birth, neonatal cord blood pH, neonatal hypoglycemia, Apgar 1min. and 5min. scores, and neonatal intensive care unit (NICU) admission were collected. Logistic regression analyses were performed to identify independent predictors of adverse perinatal outcomes among GDM patients. ROC analysis was used to determine the diagnostic performance of both indices. FIB-4 and APRI scores were significantly higher in GDM patients compared to controls (p < 0.05). Among GDM patients, those with FGR, NICU admission, or neonatal death had significantly elevated FIB-4 scores. Stratification by FIB-4 risk categories revealed that patients with high FIB-4 scores had increased rates of FGR, fetal hypoglycemia, adverse perinatal outcomes, and NICU admission (p < 0.01). ROC analysis for predicting GDM yielded AUC values of 0.577 for FIB-4 and 0.571 for APRI. For predicting adverse perinatal outcomes, the FIB-4 AUC was 0.590, while APRI showed limited predictive ability (AUC = 0.511). FIB-4 can serve as a valuable non-invasive marker for liver dysfunction in GDM and is significantly associated with adverse perinatal outcomes. Despite limited predictive power, these scores may serve as early indicators of hepatic involvement in GDM.

Risk Factors for Neonatal Intensive Care Unit Admission After Term Twin Deliveries

Discrete glucose profiles identified using continuous glucose monitoring data and their association with adverse pregnancy outcomes

Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission. Retrospective cohort study (2014-2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared. From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96-1.34; high SVI aOR: 1.12, 95% CI: 0.95-1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001-1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (p < 0.001). Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes. · Mean SVI scores are higher in those with a neonate admitted to the NICU.. · There was no observed association between moderate and high SVI scores and NICU admission.. · Moderate SVI is associated with an increased odds of overall neonatal morbidity.. · Greater exposure to low income may be associated with NICU admission..

PurposePregnancies complicated by placenta accreta spectrum (PAS) are associated with severe maternal morbidities. The aim of this study is to describe the neonatal outcomes in pregnancies complicated with PAS compared with pregnancies not complicated by PAS.MethodsA retrospective cohort study conducted at a single tertiary center between 03/2011 and 01/2022, comparing women with PAS who underwent cesarean delivery (CD) to a matched control group of women without PAS who underwent CD. We evaluated the following adverse neonatal outcomes: umbilical artery pH < 7.0, umbilical artery base excess ≤ − 12, APGAR score < 7 at 5 min, neonatal intensive care unit (NICU) admission, mechanical ventilation, hypoxic ischemic encephalopathy, seizures and neonatal death. We also evaluated a composite adverse neonatal outcome, defined as the occurrence of at least one of the adverse neonatal outcomes described above. Multivariable regression analysis was used to determine which adverse neonatal outcome were independently associated with the presence of PAS.Results265 women with PAS were included in the study group and were matched to 1382 controls. In the PAS group compared with controls, the rate of composite adverse neonatal outcomes was significantly higher (33.6% vs. 18.7%, respectively, p < 0.001). In a multivariable logistic regression analysis, Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.ConclusionNeonates in PAS pregnancies had higher rates of adverse outcomes. Apgar score < 7 at 5 min, NICU admission and composite adverse neonatal outcome were independently associated with PAS.