37th Week Of Gestation Research Articles

Expectant management of triplets or multifetal reduction to twins; comparison of preterm delivery and live birth rates

ObjectiveThe management of multiple pregnancies is still a challenge. The aim of this study was to compare the outcome of triplet pregnancies managed expectantly or by multifetal pregnancy reduction to twins. Study designFor this retrospective, comparative and monocentric study, the medical files of all women with triplets who admitted to our institution over a 13-year period were examined. Women requesting multifetal pregnancy reduction to have twins formed the study group, and women with triplets who wished to continue their pregnancies formed the control group. Main outcome measures were durations of pregnancies presented as number of weeks gestation, abortion rates, term and preterm birth rates, fetal loss and live birth rates. ResultsDuring the study period, 171 women with triplets admitted to our institution. One hundred fifty one patients are included in this study. Forty-five women carrying triplets wished to continue their pregnancies and 106 women requested multifetal pregnancy reduction to have twins. Fetal reduction of triplets to twins was associated with a significantly lower incidence of birth before 34th gestational week and higher incidence of late preterm and term birth rates without changing live birth rates. ConclusionMultifetal pregnancy reduction of triplet pregnancies to twins resulted in a later gestational age at birth compared with the triplet gestations managed expectantly.

Can ultrasound predict the delivery time of patients with previous cesarean section in the 37th gestational week? A prospective cross-sectional study

Background The aim was to investigate factors that predict when patients with previous cesarean section will undergo cesarean section (CS) using ultrasonography in the 37th gestational week. Material and methods In this prospective cross-sectional study, a total of 166 patients with previous CS who presented to the hospital for routine checks at the 370/7th gestational week were included in the study. Uterine-related, fetus-related, and patient-related factors that affect labor time were analyzed by the same physician at admission, and the patients were then divided into two groups as those having CS at early term (370/7 to 386/7 weeks of gestation) and full-term (390/7 to 406/7 weeks of gestation). Ninety-four patients underwent CS at full-term and 72 patients underwent CS at the early term in the study. Results There was no significant difference for age (years), parity, weight gain, previous cesarean number, cervical length, myometrial thickness, estimated fetal weight, and full lower uterine segment thickness between the groups (p>.05). In the full-term group, 58% had a history of vaginal birth, whereas, in the early-term group, 42% had a history of vaginal birth (p < .05). Vaginal birth history was found to be independently associated with reaching full-term (respectively, OR: 2.876, 95% CI: [1.227–6.738]; p = .015) in all patients. Two different regression models were created to predict different CS times after the 37th week of pregnancy. Weight gain was found to be independently associated with CS time within the first seven days after admission (OR: 1.267, 95% CI: [1.003–1.599]; p = .047). Vaginal birth history and estimated fetal weight were found to be independently associated with CS time in the 8th day and further after admission (OR: 0.244, 95% CI: [0.089–0.675]; p = .007 and OR: 1.002, 95% CI: [1.000–1.003]; p = .047) Conclusion Vaginal birth history can be useful to predict reaching full-term in patients with previous CS. Determination of such risk factors is important in terms of reducing the frequency of emergency cesarean delivery.

Automated Medical Care: Bradycardia Detection and Cardiac Monitoring of Preterm Infants.

Background and Objectives: Prematurity of birth occurs before the 37th week of gestation and affects up to 10% of births worldwide. It is correlated with critical outcomes; therefore, constant monitoring in neonatal intensive care units or home environments is required. The aim of this work was to develop solutions for remote neonatal intensive supervision systems, which should assist medical diagnosis of premature infants and raise alarm at cardiac abnormalities, such as bradycardia. Additionally, the COVID-19 pandemic has put a worldwide stress upon the medical staff and the management of healthcare units. Materials and Methods: A traditional medical diagnosing scheme was set up, implemented with the aid of powerful mathematical operators. The algorithm was tailored to the infants’ personal ECG characteristics and was tested on real ECG data from the publicly available PhysioNet database “Preterm Infant Cardio-Respiratory Signals Database”. Different processing problems were solved: noise filtering, baseline drift removal, event detection and compression of medical data using the à trous wavelet transform. Results: In all 10 available clinical cases, the bradycardia events annotated by the physicians were correctly detected using the RR intervals. Compressing the ECG signals for remote transmission, we obtained compression ratios (CR) varying from 1.72 to 7.42, with the median CR value around 3. Conclusions: We noticed that a significant amount of noise can be added to a signal while monitoring using standard clinical sensors. We tried to offer solutions for these technical problems. Recent studies have shown that persons infected with the COVID-19 disease are frequently reported to develop cardiovascular symptoms and cardiac arrhythmias. An automatic surveillance system (both for neonates and adults) has a practical medical application. The proposed algorithm is personalized, no fixed reference value being applied, and the algorithm follows the neonate’s cardiac rhythm changes. The performance depends on the characteristics of the input ECG. The signal-to-noise ratio of the processed ECG was improved, with a value of up to 10 dB.

BLEEDING MANAGEMENT DURING DELIVERY AND POSTPARTUM PERIOD IN GLANZMANN THROMBASTHENIA: EXPERIENCES FROM TWO CASES

Glanzmann thrombasthenia (GT) is a hereditary bleeding disorder. The platelets lack αIIbβ3integrin and fail to aggregate. Pregnancy can also lead to isoantibody formation when fetal cells with β3integrins pass into the circulation of a mother lacking them; a consequence is neonatal thrombocytopenia and a high risk of mortality. We here present our experience with two GT patients, in which rFVIIa was our choice for bleeding prophylaxis and/or control during delivery and postpartum period. Case 1: A 28-year-old woman with GT was hospitalized. She was on 38th gestational week (GW). Vaginal delivery was completed with rFVIIa prophylaxis. Postpartum 5th day rFVIIa stopped. The patient discharged with a minimal vaginal bleeding. Postpartum10th day, she developed severe bleeding. GT seemed to be the only related factor. rFVIIa restarted with tranexamic acid and misoprostol. Two apheresis units of platelets were transfused. That time, rFVIIa continued 7 days. Case 2: A 26-year-old woman with GT developed hematuria on 30th GW. No urinary system pathology was found. With. rFVIIa treatment, hematuria was ceased. On 39th GW, during labor she developed massive bleeding. As urgent management, 8 random units of platelet and 5 units of packed red blood cell were transfused with local vaginal compress. rFVIIa treatment was initiated. On 10th days of rFIIa with minimal vaginal bleeding the patient was discharged from the hospital. In both of the patients, no major neonatal bleeding problem was experienced. GT patients are at risk for heavy bleeding during labor, deliver or postpartum. Platelet transfusion is simple and easy option for bleeding control. In alloimmunized patients pooled platelet should be used. The use of rFVIIa appears to be safe and relatively effective.

Actual Birth Weight Versus Sonographic Estimation of Fetal Weight

Objective: To assess the correlation of fetal weight at full-term pregnancy by ultrasound method and its authenticity with actual birth weight in obstetrics department of Creek general hospital of Karachi. Methodology: A Prospective cross-sectional study was conducted at Obstetrics and Gynecology department of Creek General hospital affiliated with United Medical and Dental College Karachi from October 2020 to June 2021. Non-Probability Sampling technique was employed. Estimated sample size was n=114, however to increase the precision of study 163 samples were collected. All the pregnant singleton women were enrolled in this study who were examined for fetal weight calculation sonographically at 37th to 40th weeks of gestation. Post-natal neonatal weight was recorded. Results: The mean fetal weight estimated by ultrasound in our survey was 2.9 kg, while mean, actual birth weight was 2.89 Kg. Conclusion: Our study found positive association between the actual birth weight and the estimated fetal weight. Keywords: Fetus, Correlation, Mean, Ultrasound, Birth weight

Prenatal phenotype of PNKP-related primary microcephaly associated with variants affecting both the FHA and phosphatase domain

Biallelic PNKP variants cause heterogeneous disorders ranging from neurodevelopmental disorder with microcephaly/seizures to adult-onset Charcot–Marie–Tooth disease. To date, only postnatal descriptions exist. We present the first prenatal diagnosis of PNKP-related primary microcephaly. Pathological examination of a male fetus in the 18th gestational week revealed micrencephaly with extracerebral malformations and thus presumed syndromic microcephaly. A recessive disorder was suspected because of previous pregnancy termination for similar abnormalities. Prenatal trio-exome sequencing identified compound heterozygosity for the PNKP variants c.498G>A, p.[(=),0?] and c.302C>T, p.(Pro101Leu). Segregation confirmed both variants in the sister fetus. Through RNA analyses, we characterized exon 4 skipping affecting the PNKP forkhead-associated (FHA) and phosphatase domains (p.Leu67_Lys166del) as the predominant effect of the paternal c.498G>A variant. We retrospectively investigated two unrelated individuals diagnosed with biallelic PNKP-variants to compare prenatal/postnatal phenotypes. Both carry the splice donor variant c.1029+2T>C intrans with a variant in the FHA domain (c.311T>C, p.(Leu104Pro); c.151G>C, p.(Val51Leu)). RNA-seq showed complex splicing for c.1029+2T>C and c.151G>C. Structural modeling revealed significant clustering of missense variants in the FHA domain with variants generating structural damage. Our clinical description extends the PNKP-continuum to the prenatal stage. Investigating possible PNKP-variant effects using RNA and structural modeling, we highlight the mutational complexity and exemplify a PNKP-variant characterization framework.

Retinopathy of prematurity in the period 2015-2019 in a tertiary referral centre in Slovenia

Background: Retinopathy of prematurity (ROP) is the leading cause of blindness among prematurely born children. The incidence of any stage of ROP in children born before the 31st gestational week in Europe and the USA is between 10-45%. The purpose of this study was to show characteristics of ROP between 2015 and 2019 at the Neonatal Intensive Care Unit of the University Medical Centre Ljubljana (NICU-Lj), which is the larger of the two tertiary referral centres in Slovenia and in which more than two thirds of Slovenian very low birth weight children are treated.&#x0D; Methods: All prematurely born children screened for ROP at NICU-Lj between 2015 and 2019 were included in the study. The following parameters were recorded: number of children screened, total number of exams, number of exams per child, number of children with ROP, ROP stages, number of children who needed ROP treatment and number of treatments per child treated.&#x0D; Results: Between 2015 and 2019, 82-130 prematurely born children fulfilled ROP screening criteria each year. A total of 1,412 exams were performed over the period of five years (range: 239-386 per year). Every child had one or more ROP screening exams (range: 1-10). Extremely preterm children born before the 27th week of gestation had more exams (average: 5 exams/child) compared to other prematurely born children (average: 1.5 exams/child). The number of prematurely born children with any stage of ROP ranged from 17 to 30 per year. ROP of any stage was present in 18.75% (2015), in 17.7% (2016), in 23% (2017), in 29.3% (2018), and in 24.1% (2019). More than 70% of all babies with ROP were born before the 27th gestational week. The most mature baby with ROP was born with 29 6/7 weeks of gestational age. Every year, 15-35% of babies with ROP received laser treatment.&#x0D; Conclusions: ROP is an important disease in prematurely born children. During the period 2015-2019, the incidence of any stage of ROP and of serious ROP requiring treatment was comparable. The screening and treatment of ROP requires intense cooperation between paediatric ophthalmologists and neonatologists in order to prevent blindness in prematurely born children.

Giant cervical cystic hygroma treated with EXIT procedure and bleomycin sclerotherapy

Cystic hygroma are macrocystic benign lymphatic manifestations, developing around 6th gestational week. Treatment options include surgery with associatedcomplications, sclerotherapyusing bleomycin injections. Herein, the case presented was a complicated case of CH. A 31-years-old female, with a history of two previous cesarean-section, was diagnosed with cystic hygroma. A septated cystic lesion was seen in the fetal-MRI, originating at the left lateral neck, below the mastoid bone, down to the level of thoracic inlet, extending to posterior chest wall and crossed the midline. Delivery was performed using EXIT-procedure with head out first to perform intubation. Neonate was successfully treated for CH with tapering doses of Bleomycin injection and a drain inserted for continuous drainage between the injections to avoid fluid re-accumulation. A complicated case of CH was completely treated with tapering doses of bleomycin injection. Bleomycin sclerotherapy could serve as future standard management for cystic hygromas.

Pharmacotherapy in Anaemia of Pregnancy: Comparison of Oral Ferrous Sulphate, Intravenous Iron Sucrose

Aim: To analyse the outcome of oral and intravenous therapy of iron preparations in treating anaemia in pregnant women. Study Design: Prospective Study. Place and duration of study: Department of Pharmacology and department of Gynaecology and obstetrics, Khawaja Muhammad Safdar Medical College, Sialkot from May 2020 to July 2021. Methods: Between May 2020 and July 2021; A total of 1200 patients presenting to obstetric department with anaemia were included in the study after fulfilling inclusion criteria. Pregnant patients with haemoglobin level 7-8gm/dl at 24th week of gestation were included in the study. The therapy was started on 24th week of gestation. The haemoglobin levels were determined at 24th week and then at 37th week of gestation. The increase in the haemoglobin level was then determined. Serum ferritin levels were done at 37th week of gestation. Results: It was observed that there was an increase in the haemoglobin level after all the treatment regimes. The increase in haemoglobin in the group B and C was statistically significant with P value of &lt; 0.001 when compared with the group A. However, no statistical significant difference was observed between group B and group C. Conclusion: The haemoglobin and serum ferritin level were significantly increased in the subjects after oral ferrous sulphate, however parenteral formulation are more effective in noncompliant patient where quick improvement in haemoglobin levels are to be achieved. Keywords: Anaemia, pregnancy, iron deficiency, pharmacotherapy

Young Maternal Death Caused by COVID-19

Maternal death refers to the death of a woman during pregnancy, during delivery, or within 42 days after the termination of pregnancy, and for any reason exaggerated by the pregnancy condition or pregnancy process regardless of the duration and location of the pregnancy. Starting on 11 March 2020 in Turkey, the COVID-19 pandemic resulted in a total of 5,638,178 confirmed cases and 51,048 deaths. Our case aged 24 years was a young mother having severe weight loss since the beginning of pregnancy because of malnutrition due to depression, smoking, and nausea. The weight loss of the patient, who was infected by COVID-19 in a short while after the last visit in family healthcare, became more severe, the general appearance became worse, and she gave preterm birth in the 30th gestational week. The cardiopulmonary arrest occurred during the delivery. Although necessary interventions were made, the patient was lost on the same day. Since it is a rare case, this case is presented together with a literature review. Keywords: COVID-19, pandemics, maternal mortality

Choledochal cyst theories going pear‐shaped? Evolution of choledochal cyst during intrauterine life in a case evaluated using magnetic resonance imaging and postnatal outcomes

A choledochal cyst is a rare abdominal malformation and was first reported almost three centuries before. There are few theories describing the evolution of the cyst through the lifespan of affected patients until diagnosis and prompt treatment; however, there is no image documentation of the evolution of the malformation. In this report, we demonstrate the evolution of a type I choledochal cyst in a fetus from the 24th to the 37th week of gestation using magnetic resonance imaging and perinatal outcomes with correlation with pathophysiological mechanisms.

Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels

BackgroundPrenatal maternal stress can have adverse effects on birth outcomes and fetal development. Relaxation techniques have been examined as potential countermeasures. This study investigates different relaxation techniques and their effect on self-reported stress levels and physiological stress levels in pregnant women.MethodsIn this cross-sectional study, 38 pregnant women in their 30th to 40th gestational week were assigned to one of three, 20-min lasting relaxation groups: listening to music (N = 12), following a guided imagery (N = 12) or resting (N = 12). The intervention, i.e., acute relaxation (music, guided imagery or resting) took place once for each study participant. Study inclusion criteria were age over 18 years, German speaking, singleton and uncomplicated pregnancy during the 30th and 40th week of gestation. The stress levels were determined during the study. Current stress level during the study was assessed by a visual analogue scale. Chronic stress levels were assessed by the Trier Inventory of Chronic Stress and the Pregnancy Distress questionnaire. Multivariate analyses of covariance were performed and dependent measures included stress levels as well as physiological measures, i.e., cardiovascular activity (electrocardiogram) and skin conductance levels.ResultsAll three forms of relaxation led to reduced maternal stress which manifested itself in significantly decreased skin conductance, F(3,94) = 18.011, p = .001, ηp2 = .365, and subjective stress levels after the interventions with no significant group difference. Post-intervention stress ratings were further affected by gestational age, with less subjective relaxation in women later in gestation, F (1, 34)=4.971, p = .032, ηp2 = .128.ConclusionIndependent of relaxation technique, single, 20-min relaxation intervention (music, guided imagery or resting) can significantly reduce maternal stress. Notably, women at an earlier stage in their pregnancy reported higher relaxation after the intervention than women later in gestation. Hence, gestational age may influence perceived stress levels and should be considered when evaluating relaxation or stress management interventions during pregnancy.Trial registrationNot applicable.

Cerebrovascular disease at young age is related to mother's health during the pregnancy-The Northern Finland Birth Cohort 1966 study.

For prevention of cerebrovascular diseases at younger age, it is important to understand the risk factors occurring early in life. We investigated the relationship between mothers' general health during pregnancy and the offspring's risk of cerebrovascular disease in age of 15 to 52 years. Within the population-based prospective Northern Finland Birth Cohort 1966, 11,926 persons were followed from antenatal period to 52 years of age. Information on their mother's ill health conditions, i.e., hospitalizations, chronic diseases, medications, vitamin or iron supplement, fever, anemia, mood, and smoking was collected from 24th gestational week onwards. Ischemic and hemorrhagic cerebrovascular diseases of the offspring were identified from national registers in Finland. Cox proportional hazard models were used to estimate the association of mother's health conditions with incidence of cerebrovascular disease in the offspring, with adjustments for potential confounders. During 565,585 person-years of follow-up, 449 (2.8%) of the offspring had a cerebrovascular disease. Hospitalization during pregnancy was associated with an increased risk of cerebrovascular disease in the offspring (hazard ratio (HR) = 1.49; 95% confidence interval (CI) 1.06-2.08) after adjustment for confounders, as was having more than three ill health conditions (HR = 1.89; CI 1.14-3.11). Not using vitamin or iron supplement was associated with increased risk for cerebrovascular disease in the offspring (HR = 1.39; CI 1.01-1.89). The results suggest that the risk of cerebrovascular disease may start as early as during the antenatal period, and the health characteristics of mothers during pregnancy may play a role in cerebrovascular disease risk of the offspring.

Case report: Spinal anesthesia for cesarean section in a parturient with Potocki-Lupski syndrome

BackgroundPotocki -Lupski syndrome is an uncommon disorder caused by a micro-duplication in chromosome 17p11.2. Variable clinical manifestations bring troubles to the general and neuraxial anesthesia, including mental retardation, facial dysmorphisms, structural cardiovascular anomalies, scoliosis, and malignant hyperthermia. Until now, the anesthesia management for cesarean section in these patients has not been reported yet.Case presentationHere we present a 23-year-old Chinese parturient with Potocki -Lupski syndrome who underwent elective cesarean section under spinal anesthesia. She was transferred to our hospital in her 40th week of gestation. She had a history of IgA nephropathy for more than three years and was diagnosed with Potocki -Lupski syndrome (17p12p11.2 segment 3.1 Mb repeat) in the 29th week of pregnancy. Amniocentesis showed the fetus had no abnormal autosomes. Preoperative multidisciplinary consultation suggested that she should terminate the pregnancy as soon as possible. She was ASA II. Her BMI was 26.43 kg/m2. Her airway evaluation was normal. Her spine could bend well and her spinal interspace could be touched clearly. We did the single spinal anesthesia at L2-3 interspace and gave 0.5% bupivacaine 1.7 ml. The absolute anesthesia level reached T8. The Apgar score for the newborn infant was 10 for 1st minute, 5th minute, and 10th minute. The vital signs were steady without using any vasoactive drugs. The patient had a good prognosis, and was subsequently discharged from hospital.ConclusionTo date, the case may be the first reported spinal anesthesia for the parturient with Potocki -Lupski syndrome. Although its manifestations are variable, the spinal anesthesia is feasible under careful and comprehensive preoperative evaluation.

Serum Kisspeptin-1 at time of Pregnancy Diagnosis is superior to serum βhCG for prediction of Early Pregnancy Loss

Objectives: Estimation of serum Kisspeptin-1 (Kiss-1)and beta human chorionic gonadotropin (βhCG) levels attime of pregnancy diagnosis (Booking time) and at the 12thgestational week; S1 and S2 samples, in trial to evaluatethe predictability of these levels for the possibility of earlypregnancy loss (EPL).Patients & Methods: 283 women gave S2 samples, 76women (26.9%) developed EPL (EPL group) and 207women had viable fetus (Control group). Blood sampleswere obtained for ELISA estimation of serum Kiss-1 andβhCG. The study outcome was the predictability of S1 levels of both parameters for the possibility of oncoming pregnancy loss.Results: S1 sample βhCG levels showed non-significantdifferences between both groups, while serum Kiss-1 levels were significantly lower in EPL than in control women.Serum levels of both parameters in S2 sample were significantly lower in EPL than both control women and levelsestimated in S1 samples of EPL women. Incidence of EPLwas negatively correlated with S1 sample serum levels ofboth parameters. Regression analysis defined 6500 IU/Land 318 pmol/L as cutoff points for βhCG and Kiss-1 topredict 50% hazard for EPL. These cutoff points defined158 and 181 true cases, respectively with significant difference in favor of Kiss-1 value. ROC curve analysis assuredthe sensitivity of lower S1 levels of both parameters forprediction of 50% hazard of EPL, but area difference underROC was significant in favor of low serum Kiss-1 as a significant sensitive predictor for EPL.Conclusion: Estimation of serum kiss-1 at time of pregnancy diagnosis inversely correlates with incidence ofEPL. Lower serum Kiss-1 levels had significantly higherpredictability for EPL than βhCG. Lower serum Kiss-1 atthe 12th GW or development of EPL assured the predictability of the result obtained at booking time and spared theneed for sequential estimations.

Maternal outcome of selective feticide due to fetal anomaly in late trimester: A retrospective 10 years' experience in Taiwan.

Feticide was suggested to avoid delivering children with abnormalities. Recently, twin pregnancies have increased. Selective feticide was proposed to achieve a good outcome of pregnancy. This study aimed to evaluate the performance of feticide in twin pregnancy with fetal anomaly. This was a retrospective study enrolled from 2009 to 2018. A total of 68 pregnancies with fetal anomalies received feticide. Potassium chloride was injected into the left ventricle to induce fetal asystole. Maternal and fetal characteristics of 16 dichorionic twins were documented to compare before and after 24th gestational week. All pregnant women received feticide without any maternal or fetal complication. The reasons for choosing feticide were divided into four groups, including morphologic defect (61.8%), genetic-chromosomal abnormality (30.9%), obstetrical complication (5.9%), and maternal request (1.5%). Mean gestational age at delivery was significantly higher in dichorionic twins who underwent selective feticide before than after 24th gestational week (36.7 vs 33.4, p = 0.04). Intracardiac injection of potassium chloride was effective for feticide and safe for mothers and fetuses. Selective feticide served as an alternative approach for twin pregnancy with fetal anomaly after sufficient discussion.

Can preterm birth affect the palate morphology? A systematic review

The purpose of this review was to evaluate whether preterm birth affects palate morphology. Opened electronic search in PubMed (MEDLINE), Lilacs, Scopus and Web of Science was conducted and a partial search of the gray literature using Google Scholar, Open Gray and ProQuest. We included studies with infants born prematurely (born up to the 37th week of gestation and weighing less than 2.500 g) and not preterm infants; intubated and not intubated. Two independent reviewers performed study selection, data extraction, and bias risk assessment. Selection criteria included observational, retrospective and prospective, randomized or nonrandomized cohort studies and control studies. There was no restriction on publication time and article language. A total of 2344 articles were found after the duplicates were removed, of which 7 met the inclusion criteria and were submitted to a Bias Risk analysis using MASTARI. Scientific evidence was found for altered palate morphology among premature infants, and oral intubation was a contributing factor for such alterations. Based on this review, it is concluded that premature birth changes palate morphology, when prematurity is associated with the use of the orotracheal tube.

Timing of cesarean delivery in women with ≥2 previous cesarean deliveries

The rate of cesarean delivery is continuously increasing with the leading indication being a previous cesarean delivery. For women with 1 previous cesarean delivery, it is generally agreed that the optimal timing of delivery by elective cesarean delivery is during the 39th week of gestation, whereas for women with ≥2 previous cesarean deliveries, the optimal delivery time remains debatable. To assess the maternal and neonatal risks associated with elective delivery at different gestational ages ranging from 37 0/7 to 39 6/7 weeks' gestation and to compare it with expectant management among women with at least 2 previous cesarean deliveries. This was a retrospective, population-based cohort study of all women with at least 2 previous cesarean deliveries who delivered after 36 6/7 weeks of gestation in Ontario, Canada, between April 2012 and March 2019. Women with multifetal pregnancies or major fetal anomalies were excluded. For each completed gestational week, outcomes of women who had an elective repeat cesarean delivery at that week solely because of 2 previous cesarean deliveries were compared with the outcomes of those who were managed expectantly and delivered at a later gestational age. The primary outcome was a composite of maternal outcomes including mortality and severe maternal morbidity. Secondary outcomes were adverse neonatal outcomes. A total of 26,522 women met the inclusion criteria. The maternal risk was similar for elective delivery at 37 0/7 to 38 6/7 weeks of gestation compared with expectant management. However, elective delivery at 39 0/7 to 39 6/7 weeks' gestation was associated with a decreased risk for adverse outcomes when compared with expectant management (adjusted risk ratio, 0.51; 95% confidence interval, 0.29-0.91). For the neonate, elective delivery during the 37th week of gestation significantly increased the incidence of the composite adverse outcome than in an ongoing pregnancy (adjusted risk ratio, 1.68; 95% confidence interval, 1.39-2.01), but was comparable for elective delivery at 38 0/7 to 39 6/7 weeks' gestation and expectant management. The risk for an unplanned cesarean delivery increased from 6.5% before 38 weeks' gestation to 21.7% before 39 weeks' gestation and to 32.6% before 40 weeks' gestation. For women with ≥2 cesarean deliveries, elective delivery at 38 0/7 to 38 6/7 weeks' gestation likely represents the optimal balance between neonatal and maternal risk while decreasing the likelihood of an unplanned cesarean delivery.

Association of Self-Reported Physical Fitness during Late Pregnancy with Birth Outcomes and Oxytocin Administration during Labour-The GESTAFIT Project.

We explored (a) the associations between self-reported maternal physical fitness and birth outcomes; (b) whether self-reported maternal physical fitness (PF) is related to the administration of oxytocin to induce or stimulate labour. Pregnant women from the GESTAFIT project randomized controlled trial (n = 117) participated in this prospective longitudinal study. Maternal physical fitness was assessed through the International Fitness Scale at the 34th gestational week. Maternal and neonatal birth outcomes and oxytocin administration were collected from the obstetric medical records. Umbilical arterial and venous cord blood gas were analysed immediately after birth. Self-reported overall fitness, cardiorespiratory fitness, muscular strength and flexibility were not related to any maternal and neonatal birth outcomes (all p > 0.05). Greater speed-agility was associated with a more alkaline arterial (p = 0.04) and venous (p = 0.02) pH in the umbilical cord blood. Women who were administered oxytocin to induce or stimulate labour reported lower cardiorespiratory fitness (p = 0.013, Cohen’s d = 0.55; 95% confidence interval (CI): 0.14, 0.93) and flexibility (p = 0.040, Cohen´s d = 0.51; 95% CI: 0.09, 0.89) compared to women who were not administered oxytocin. Greater maternal physical fitness during pregnancy could be associated with better neonatal birth outcomes and lower risk of needing oxytocin administration.

Maternal BMI, 25-Hydroxyvitamin D serum level and Cervical Length Measurements: Markers for Preterm Delivery

ABSTRACT Background: Preterm delivery is the delivery between 20th - 37th weeks of gestation. The study aimed to study the maternal BMI, 25-Hydroxyvitamin D (25(OH)D) serum level, and uterine cervical length (CL) as predicting factors for PTD. Methods: A prospective study included 188 pregnant women recruited during 20th - 24th weeks of gestation. The maternal BMI was calculated, the serum level of 25(OH)D was measured, and the uterine CL was measured via transabdominal and transvaginal ultrasound. All women followed until delivery time and then were divided into 2 groups; group1 (n=54) women who delivered preterm, and group2 (n=134) women who delivered at term. Results: BMI results showed statistical significance between women who delivered preterm and those who delivered at term ‎(29.7±1.7 vs. 23.6±2.2 kg/m2, P 25kg/m2 had significantly longer cervix than those who had BMI <25kg/m2. Regarding the effect of CL on the mode of delivery, 65.4% of women with CL Conclusions: Maternal BMI had a significant relation with PTD. Measuring the CL during 20th - 24th weeks helps predict preterm delivery and the mood of delivery. There is an association between BMI and cervical length. Keywords: BMI; 25-Hydroxyvitamin D; Cervical Length; Preterm Delivery.