Severe asphyxia due to delivery-related malpractice in Sweden 1990–2005

In 2008, an American College of Obstetricians and Gynecologists (ACOG) committee opinion1 defined late-preterm (LPT) infants as infants born between 34 0/7 weeks and 36 6/7 weeks of gestation. However, this is often mistakenly believed by authors to represent 34–36 completed weeks of gestation, as in this article.2 As a matter of fact, 34–36 completed weeks of gestation includes babies born between 34 0/7 and 36 0/7 weeks gestational age. This is because 36 weeks is completed the day after 35 6/7, which is 36 0/7. With ongoing evidence that LPT babies have poor outcomes when compared to full-term infants, it is imperative that we use standardized terminology for LPT infants when planning future studies. In 2005, the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health (NIH) defined LPT birth (LPTB) as births between 34 completed weeks (34 0/7 weeks, or day 239) and less than 37 completed weeks (36 6/7 weeks, or day 259) of gestation.3 This therefore represents a 3-week period as opposed to the definition used in this paper, wherein the authors defined LPTB as birth between 34 and 36 completed weeks gestation. The definition used in this paper is incorrect, as it excludes babies between 36 0/7 and 36 6/7 gestational age, and this subset should be included in the late preterm4 cohort. The authors seem to have misinterpreted the ACOG committee opinion (34 0/7 to 36 6/7 weeks of gestation) by defining LPTB as birth between 34 and 36 completed weeks of gestation. Their conclusion that 45% of respondents correctly defined LPTB as birth between 34–36 completed weeks gestation (which is an incorrect definition) is thus inaccurate. Simply stated,4 36 weeks of gestation are completed at 36 0/7, and therefore, 36 completed weeks is numerically represented as 36 0/7 and not 36 6/7. I would like to urge all providers to have uniformity in utilization of standardized definitions when using the terminology “completed weeks of gestation.” The use of universally accepted terminology is important for consistency in literature and future studies evaluating outcomes of LPT infants.

A retrospective study comparing maternal and neonatal outcome of singleton fetuses delivered at 37–38 weeks of completed gestation with those delivered at 39 completed weeks of gestation or longer by elective caesarean section at the University of Nigeria Teaching Hospital, Enugu between January 1, 2004 and December 31, 2008. There were 164(21.3%) elective caesarean deliveries during the study period. 117 (71.3%) were performed between 37–38 weeks of completed gestation and 47(28.7%) at 39 completed weeks of gestation. Elective caesarean births at 37-38 weeks were associated with significantly higher rates of admission to the neonatal care unit, neonatal jaundice, and a higher proportion of newborns with Apgar score <6 at 5minutes. As a result of increased morbidity and iatrogenic prematurity in the developing countries due to elective caesarean delivery at 37-38weeks associated with increased cost of admissions in the newborn special care units, elective caesarean delivery should be advised at or after 39 weeks of gestation unless there is evidence of fetal lung maturity. At 39 completed weeks of gestation, elective caesarean delivery is associated with better fetal outcomes than at 37-38 weeks of completed gestation.

There are only few reports worldwide on the outcome of very pre-term infants and very low birthweight infants for a whole country. In Switzerland official population statistics are based on birthweight only, gestational age not yet being documented. The aim of the present study was to assess the outcome at two years of age for a geographically defined high-risk neonatal population based on both birthweight and gestational age. All infants born in 1996 included in the Swiss Neonatal Network (a national anonymous registry established by the Swiss Society of Neonatology for liveborn infants before 32 completed gestational weeks or weighing less than 1500 g) were divided into three groups according to gestational age and birth weight: Group 1: born <32 completed gestational weeks and weighing =1500 g; group 2: born after 32 completed gestational weeks and weighing <1500 g; group 3: born <32 gestational weeks and weighing <1500 g. Information at 24 months corrected age about growth, neurological outcome, frequency of respiratory infections, prescription of antibiotics and medical consultations during this period was obtained from the paediatricians caring for the infants. Fair outcome was defined as survival without serious neonatal complications or abnormal neurological findings at 24 months corrected for prematurity. 723 infants were born alive in Switzerland between 1.1. and 31.12.1996 before 32 completed weeks or weighing less than 1500 g at birth. Mortality was 4.3% for a total of 163 infants in group 1 (<32 weeks, =1500 g), 4.6% for 108 infants in group 2 (>32 weeks, <1500 g) and 18.6% for 452 infants in group 3 (<32 weeks, <1500 g). 6.5% of group 1 survivors followed up to 24 months corrected age had a poor neurological outcome as compared to 9.3% in group 2 and 10.9% in group 3. Infants in group 1 needed antibiotics less often after hospital discharge (interquartile range IQR: 0-2 courses) than infants in group 2 (0-3 courses) and 3 (0-3 courses). Infants in group 2 suffered from fewer airway infections (interquartile range 2-5 times) than in group 1 (2-6 times) and 3 (1-7 times). Infants in group 3 needed more medical consultations (IQR 12-21) than those in group 1 (10-16) and 2 (11-16). The overall fair outcome at 24 months corrected age was 85.3% in group 1, 80.7% in group 2 and 59.6% in group 3. A close correlation between overall fair outcome and gestational age at birth on the one hand and with birthweight on the other can be observed. This study gives estimates for mortality, poor and fair outcome at 24 months corrected age for very low birth weight infants (<1500 g) and for very pre-term infants (<32 completed gestational weeks). Gestational age is as important for predicting outcome as birthweight and should therefore be integrated into national statistics.

This publication offers an in-depth study of the fish and other organisms that live in Lakes Mead and Mohave. The history and background of the two lakes is offered, as well as information about diseases, parasites, and unusual fish occurrences. Food sources, predation and competition are also discussed.

Singleton birthweight by gestational age following in vitro fertilization in the United States

Introduction: Postdated and prolonged pregnancy are accepted terms by WHO and the International Federation of Gynecology and Obstetrics to describe pregnancy beyond dates (expected date of delivery). It complicates up to 10% of all pregnancies and carries an increased risk to the mother and fetus. This study aimed to analyze the outcome of combined induction of labor in post-dated pregnancy. Methods: This prospective interventional study was conducted at the Department of Obstetrics and Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Bangladesh, from March 2013 to August 2013. A total of 50 patients with post-dated pregnancies were selected as study subjects by purposive sampling technique. In this study, 34.0% of patients' labor induction was given by oxytocin drip followed by ARM, and 20.0% of patients' labor induction was given by ARM followed by oxytocin drip. In 46.0% of patients with an unfavorable cervix, prostaglandin was used followed by ARM. Collected data were analyzed using different methods of statistics. Statistical analyses were carried out by using the Statistical Package for Social Sciences version 20.0 for Windows. Result: It was observed that intrapartum fetal distress occurred in a total of 12 babies. 10 babies needed resuscitation and 40 babies needed no resuscitation. In this series, among the healthy babies majority (20) were born at 40 completed weeks of gestation, 18 babies at 41 completed weeks, and 2 babies were born at 42 completed weeks of gestation. Among the asphyxiated baby 6 babies were borne at 42 completed weeks of gestation, no one at 41 completed weeks, and 2 asphyxiated babies were borne at 40 completed weeks of gestation. All babies with other complications like LBW, birth trauma, and post-maturity syndrome. Conclusion: This study concludes most frequent indication was fetal distress and unfavorable cervix in postdated pregnancy. Abnormal uterine action and asphyxiated baby were the more frequent maternal and fetal complications respectively. A small number of LBW, birth trauma, and post-maturity syndrome were observed but no maternal and fetal death was found in this study.

Impacts of embracing 39-week elective induction across an entire labor and delivery unit

To review our experience with a screening programme that included four sequential cervical length (CL) measurements from 16 to 22() weeks of gestation. Historical cohort study. Tertiary-care centre in a university hospital. There were 312 singleton pregnancies in 321 women with a previous large loop excision of the transformation zone (LLETZ), and 62 pregnancies after a second-trimester miscarriage in a previous pregnancy. The CL measurements were performed by transvaginal ultrasound at 16, 18, 20, and 22 completed weeks of gestation. Early preterm delivery before 34 completed weeks of gestation. Early preterm delivery was found in 7.4%. The CL at 16 completed weeks of gestation was smaller in the LLETZ group (36mm, interquartile range 30-40mm) compared with the control group (38mm, interquartile range 32-42mm; P=0.040). For the analysis of risk factors for early preterm delivery after LLETZ, only cases with a complete data set were included (n=145). In a multivariate analysis, two parameters remained significantly predictive, with CL at 16 completed weeks of gestation being the most significant measure (P<0.001, OR0.90, 95%CI 0.83-0.98), followed by conception using IVF treatment (P=0.031, OR0.64, 95%CI 1.54-34.80). Even as early as 16weeks of gestation, women with early preterm delivery reveal a significantly lower CL than those without. Dynamics in the CL do not add to this information.

Objective The objective of this study was to establish twin-specific birth weight percentiles by gestational age using U.S. twin births resulting from in vitro fertilization (IVF). Study Design A retrospective analysis of birth weight by completed weeks of gestation for 76,710 twin IVF births reported to the Society for Assisted Reproductive Technologies from 2006 to 2010. Mean and median birth weights and 3rd, 5th, 10th, 25th, 50th, 75th, 90th, and 97th percentiles were calculated by completed week of gestation and infant sex. Results IVF twin birth weight accelerates until term and then declines. The deceleration in twin birth weight occurs at 39 completed weeks of gestation for larger twins, those at or above the 50th percentile in weight. For smaller twins, the growth deceleration occurs earlier, at 38 weeks of gestation. IVF female and male twin birth weights for gestational age were similar to all IVF twins, showing similar decelerations near term. Conclusion Using U.S. IVF twin-specific growth charts, with known date of conception, twins demonstrate a deceleration in birth weight near term. Larger twins demonstrate a deceleration in birth weight by 39 completed weeks of gestation; smaller twins show a deceleration at 38 weeks. These data may assist in the clinical management of twins near term.

Quantifying the burden of stillbirths before 28 weeks of completed gestational age in high-income countries: a population-based study of 19 European countries

The gestational age at which the delivery occurs is important in determining the perinatal outcome. In this study, the foetal outcome was analysed according to the gestational age in weeks in spontaneous vaginal delivery occurring between 36 completed weeks to 40 completed weeks of gestation. To study the foetal outcome according to the weeks of gestation in spontaneous vaginal delivery occurring between 36 completed weeks to 40 completed weeks of gestation. A retrospective study of women who spontaneously delivered vaginally, at gestational age between 36 completed weeks to 40 completed weeks from 1 July 2019 to 30 September 2019 was conducted at GMERS Medical College and Hospital, Sola.Total 390 cases were studied.Foetal outcome in terms of birth weight, APGAR score at 1 minute, and NICU admissions were noted and analysed according to the weeks of gestation at delivery, and entered into a database.The results were analysed and presented in the form of tables and graphs. The average birth weight increased with increase in the weeks of gestation at the time of the spontaneous delivery. The average birth weight of neonates born in 36th, 37th and 38th week was 2.314Kg, 2.623Kg and 2.704Kg, respectively. 14.28% of the babies born in the 36th week of gestation were admitted to the NICU. 4.705% and 4.347% of the babies born in the 37thand 38th week of gestation respectively, were admitted to the NICU.The Mean APGAR score of the neonates born in 36th, 37th, 38th and 39th week were 8.714, 9.235, 9.347, and 9.645, respectively. Thus, the mean APGAR score increased by the weeks of gestation at the time of the spontaneous delivery. Unnecessary induction of labour or elective LSCS before 39 weeks should be discouraged. In case of elective deliveries, unless there is a health risk to the mother or baby, it is best to wait to deliver until reaching full term at 39 weeks.

There is general agreement among obstetricians that women with preterm prelabor rupture of membranes (PPROM) should be expectantly managed at least until 34 completed weeks of gestation. However, there is little agreement concerning the choice between active management (AM) and expectant management (EM) from 34 to 36 weeks of gestation, and the choice during this period remains highly controversial. Four randomized trials compared EM with AM in cases of PPROM before 37 weeks. These studies reported no overall difference between these 2 types of management for length of stay in the neonatal intensive unit, respiratory distress syndrome (RDS), or confirmed neonatal sepsis, but clinical chorioamnionitis was found less frequently in AM than in EM. Because of design problems, the external validity of these 4 studies is unclear. This retrospective multicenter study compared the effect of management with AM or EM on maternal and neonatal outcomes among a population of women who had PPROM at 34 to 36 completed weeks of gestation. Outcomes examined included maternal chorioamnionitis and neonatal morbidity including neonatal infection, respiratory problems, and metabolic disorders. Respiratory problems examined included RDS and the need for oxygen supplementation for more than 2 hours. Data were obtained from medical charts for deliveries occurring between 1999 and 2005 at 3 university hospital centers. Of the 51,997 women who gave birth during the study period, 634 were admitted for PPROM at 34 to 36 completed weeks of gestation. A total of 393 women did not meet eligibility criteria and were excluded from analysis, leaving 241 women—126 in the EM group and 115 in the AM group. The incidence of clinical chorioamnionitis was significantly higher in the EM group compared with the AM group (4.8% vs. 0.9%; (P = 0.07). Although there was no significant difference between the 2 groups in RDS rates, more babies in the AM compared with the EM group required oxygen at 24 hours (7.0 vs. 1.6%, P = 0.05). Only delivery at 34 weeks of gestation remained associated with the need for neonatal oxygen at 24 hours following adjustment for gestational age at delivery. The rate of hypoglycemia or hypocalcemia was higher in the AM group (AM: 12.3% vs. EM: 5.6%, P = 0.07). No neonatal deaths occurred. These findings indicate that management of PPROM using a policy of AM, especially at 34 weeks of gestation, is associated with greater neonatal morbidity, and an EM policy with a higher rate of clinical chorioamnionitis. The choice between AM or EM at 34 to 36 weeks of gestation remains controversial.

To compare maternal and neonatal outcomes in deliveries managed by a policy of expectant management and active management of women with preterm prelabor rupture of membranes (pPROM), at 34-36 completed weeks of gestation. Retrospective multicenter cohort study. Three tertiary care teaching hospitals in France. Women with pPROM were identified from the databases of three perinatal centers. Maternal and neonatal complications were compared according to the hospital policy in effect at pPROM--expectant or active management. Clinical chorioamnionitis, neonatal morbidity including neonatal infection, respiratory problems, and metabolic disorders. During the seven-year study period, 634 women were admitted for pPROM at 34-36 completed weeks of gestation, 241 of whom were included in the study: 126 in the group with a policy of expectant management and 115 in the active management group. The incidence of clinical chorioamnionitis was 4.8% in the former and 0.9% in the latter (p = 0.07). Neonatal oxygen was still needed at 24 hours significantly more often in the active than in the expectant management group (7.0 vs. 1.6%, p = 0.05). However, after adjustment for gestational age at birth, only delivery at 34 weeks of gestation remained associated with the need for neonatal oxygen at 24 hours. The rate of hypoglycemia or hypocalcemia was 5.6% in the expectant management group versus 12.3% in the active management group (p = 0.07). There were no neonatal deaths. A policy of active management, especially at 34 weeks of gestation, was associated with greater neonatal morbidity, whereas an expectant management policy tended to be associated with an increased rate of clinical chorioamnionitis.

There are only few reports worldwide on the outcome of very pre-term infants and very low birthweight infants for a whole country. In Switzerland official population statistics are based on birthweight only, gestational age not yet being documented. The aim of the present study was to assess the outcome at two years of age for a geographically defined high-risk neonatal population based on both birthweight and gestational age. All infants born in 1996 included in the Swiss Neonatal Network (a national anonymous registry established by the Swiss Society of Neonatology for liveborn infants before 32 completed gestational weeks or weighing less than 1500 g) were divided into three groups according to gestational age and birth weight: Group 1: born <32 completed gestational weeks and weighing =1500 g; group 2: born after 32 completed gestational weeks and weighing <1500 g; group 3: born <32 gestational weeks and weighing <1500 g. Information at 24 months corrected age about growth, neurological outcome, frequency of respiratory infections, prescription of antibiotics and medical consultations during this period was obtained from the paediatricians caring for the infants. Fair outcome was defined as survival without serious neonatal complications or abnormal neurological findings at 24 months corrected for prematurity. 723 infants were born alive in Switzerland between 1.1. and 31.12.1996 before 32 completed weeks or weighing less than 1500 g at birth. Mortality was 4.3% for a total of 163 infants in group 1 (<32 weeks, =1500 g), 4.6% for 108 infants in group 2 (>32 weeks, <1500 g) and 18.6% for 452 infants in group 3 (<32 weeks, <1500 g). 6.5% of group 1 survivors followed up to 24 months corrected age had a poor neurological outcome as compared to 9.3% in group 2 and 10.9% in group 3. Infants in group 1 needed antibiotics less often after hospital discharge (interquartile range IQR: 0-2 courses) than infants in group 2 (0-3 courses) and 3 (0-3 courses). Infants in group 2 suffered from fewer airway infections (interquartile range 2-5 times) than in group 1 (2-6 times) and 3 (1-7 times). Infants in group 3 needed more medical consultations (IQR 12-21) than those in group 1 (10-16) and 2 (11-16). The overall fair outcome at 24 months corrected age was 85.3% in group 1, 80.7% in group 2 and 59.6% in group 3. A close correlation between overall fair outcome and gestational age at birth on the one hand and with birthweight on the other can be observed. This study gives estimates for mortality, poor and fair outcome at 24 months corrected age for very low birth weight infants (<1500 g) and for very pre-term infants (<32 completed gestational weeks). Gestational age is as important for predicting outcome as birthweight and should therefore be integrated into national statistics.

Due to the high incidence of neonatal complications in diabetic pregnancies, the aim of our study was to investigate whether elective cesarean section could prevent adverse neonatal outcome. Population-based study. Data were extracted from the Swedish Medical Birth Registry. All women (n=13 491) with diabetic pregnancies during the period 1990-2007. Neonatal outcome in diabetic pregnancies was compared after elective cesarean section at 38 completed gestational weeks with planned vaginal delivery at 39 completed weeks of gestation or later. Odds ratios with 95% confidence intervals for Apgar scores <7 at 5 min after birth were calculated using multiple logistic regression. Apgar score <7 at 5 min after birth. A significantly decreased risk of Apgar score <7 at 5 min after birth in the group who underwent an elective cesarean section at 38 completed gestational weeks was found compared with those who continued pregnancy to 39 completed weeks of gestation or more, irrespective of final mode of delivery. Our results indicate a protective effect of planned cesarean section on the risk of low Apgar scores in diabetic pregnancies.