Common Obstetric Practice Research Articles

Outcome Of Cervical Cerclages In Semino Specialist Hospital: A 5-Case Series

Background: Cervical cerclage is simply the use of a specialized non-absorbable suture to tie the cervix at the level of the internal os to prevent recurrent abortions, preterm labour and delivery especially in women with short cervix or cervical weakness. It was introduced in the 1950s by Shirodkar and McDonald and has since become a common obstetric practice. There still exist a lot of controversies concerning its efficacy and the factors determining its success. This study is aimed at unraveling the factors that determined a successful cerclage in a private hospital setting in Enugu, south-east Nigeria. Aim: To audit the pregnancy outcomes and its determinants following prophylactic cervical cerclage in a private centre Methodology: This was a case series of five women who had prophylactic cerclage between 2020 and 2022 in SEMINO Hospital, Enugu, following either a clinical or ultrasound diagnosis of cervical incompetence or both. SEMINO Hospital receives referrals from some maternity homes and other private centres not manned by obstetrician/gynaecologist in and around Abakpa-Nike. These women were seen and managed by the authors in SEMINO Hospital over the period under review. Data were collected from the patients’ case notes and presented in tabular form for easy analysis and comparison. Conclusion: The use of adjunctive therapies and insertion of cerclages at earlier gestational ages may enhance the outcome of cervical cerclages.

Exogenous oxytocin administration during labor and autism spectrum disorder

Oxytocin is a neuropeptide hormone that plays a key role in social behaviour, stress regulation, and mental health. Synthetic oxytocin administration is a common obstetrical practice, and importantly, previous research has suggested that intrapartum exposure may increase the risk of neurodevelopmental disorders, such as autism spectrum disorder (ASD). To examine the association between synthetic oxytocin exposure during labor and ASD diagnosis in the child. This population-based retrospective cohort study compared two cohorts of children: 1) all children born in British Columbia (BC), Canada between April 1, 2000 and December 31, 2014 (n = 414,336 births), and 2) all children delivered at Soroka University Medical Center (SUMC) in Be'er Sheva, Israel between January 1, 2011 and December 31, 2019 (n = 82,892 births). Nine different exposure groups were examined. Cox proportional hazards models were used to estimate crude and adjusted hazard ratios of ASD in both cohorts based on induction and/or augmentation exposures status. To further control for confounding by indication, we conducted sensitivity analyses among a cohort of healthy, uncomplicated deliveries and among a group that was induced only for post-dates. Additionally, we stratified our analyses by infant sex to assess for potential sex differences. In the BC cohort, 170,013 of 414,336 deliveries (41.0%) were not induced or augmented, 107,543 (26.0%) were exposed to oxytocin, and 136,780 (33.0%) were induced or augmented but not exposed to oxytocin. In the Israel cohort, 51,790 of 82,892 deliveries (62.5%) were not induced or augmented, 28,852 (34.8%) were exposed to oxytocin, and 2,250 (2.7%) were induced or augmented but not exposed to oxytocin. Upon adjusting for covariates in the main analysis, significant associations were observed in the Israel cohort, including adjusted hazard ratios (aHRs) of 1.51 (95% CI 1.20, 1.90) for oxytocin augmented births and 2.18 (95% CI 1.32, 3.57) for those induced by means other than oxytocin and not augmented. However, oxytocin induction was not significantly associated with ASD in the Israel cohort. In the Canadian cohort, there were no statistically significant aHRs. Further, no significant sex differences were observed in the fully adjusted models. This study provides support that induction of labor through oxytocin administration does not increase the risk of ASD in the child. Our international comparison of two countries with differences in clinical practice regarding oxytocin administration for induction and/or augmentation suggests that previous studies reporting a significant association were likely confounded by the underlying indication for the induction.

Prospective randomized comparative study between Sustained release vaginal insert and intracervical gel in women with unfavourable cervix at term pregnancy

Background-Induction of Labour (artificially initiated labour) is a common obstetric practice in pregnant women throughout the world, accounting for 20% of all births. Induction of Labour should be performed only when there is a clear medical indication for it and the expected benefits overweigh its potential harms. Objectives- to compare between the two formulations of dinoprostone and study the better option among the two, in cervical ripening and labour induction in women with unfavourable cervix. Methods- It was a Prospective randomized comparative study done in total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A - sustained release vaginal insert and Group B - Intracervical gel. Informed consent was taken from each patient. SPSS (Version 22.0) was used for analysis. Results- Statistically significant increase in final Bishop’s score (p=0.01) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups.

Transvaginal Ultrasound Cervical Length as an Indicator for Successful Induction of Labor

Background: Induction of labour is a common obstetric practice which refers to the process where the uterine contractions are initiated by medical and surgical means before the onset of spontaneous labour. The aim of this work was to evaluate the role of Preinduction transvaginal ultrasonographic measurement of cervical length as an indicator of a successful induction of labor. Methods: A cross-sectional study was carried out in Zagazig University Maternity Hospital during the period from May 2017 till November 2018. Included 171 pregnant women admitted for induction of labour.40 women delivered by Cesarean section (positive group) and 131 women delivered vaginally (negative group). All patients were subjected to full history taking, general, abdominal and pelvic examinations and investigations (including CBC, Rh, transvaginal ultrasound and non-stress test). All patients had vaginal examination for assessing the Bishop score before induction of labour and transvaginal ultrasound for assessment of cervical length. Results: Our study showed that the cervical length was significantly higher (31 ± 5.93 mm versus 22.61 ±3.67, p-value =0.00) and the Bishop Score significantly lower (5.95 ± 1.13 versus 7.87 ± 1, p-value = 0.00, respectively) in patients undergoing cesarean delivery compared with those delivering vaginally. Conclusions: Transvaginal ultrasonography proved to be better in predicting the success of induction of labor by having higher sensitivity, specificity, higher predictive value and better tolerability and less inter and intra observer variation.

Cerebral Cysticercosis Masquerading as Eclampsia: A Case Report

Neurocysticercosis is a preventable parasitic disease of nervous system caused by Taenia solium. It may present with seizures, focal neurological deficits, decreased visual acuity and altered mental status. Eclampsia is a neurological manifestation of hypertensive disorders of pregnancy presenting as seizures. In common obstetric practice, all cases of unexplained seizures are managed as eclampsia unless proven otherwise. Neurocysticercosis presenting first time in pregnancy with seizures can be confused with eclampsia. The index case was referred to us in a similar manner in the second trimester of pregnancy with a diagnosis of eclampsia. Patient was evaluated further for the cause of seizures and was found to have neurocysticercosis on imaging. She was then conservatively managed and the pregnancy was continued till term rather than termination of pregnancy which is the standard management of eclampsia.

European minimum standards for obstetric analgesia and anaesthesia departments

: An important variability of anaesthetic standards of care was discovered in the obstetric departments of many European Union countries. After discussing this issue in various meetings of the European Society of Anaesthesiology (ESA) board and its obstetric subcommittee, European Board of Anaesthesiology of the European Union of Medical Specialists (EBA-UEMS) executive members, ESA obstetric subcommittee members and European experts in obstetric anaesthesiology have participated in the elaboration of this document. This experts' opinion is focused mainly on obstetric patients and safety concerns in terms of minimum standards of practice. An initial bibliographical search was performed in medical databases and general literature, searching for obstetric anaesthesiology standards to select the most important safety issues. After the initial presentation of the project during EBA-UEMS and ESA obstetric subcommittee meetings, participants were asked to review the document; several rounds of revisions were performed by the experts, to reach a common opinion concerning the topics considered central to patient safety in the obstetric setting. After three rounds of revision, a consensus was reached and is presented in this document, which includes the list of topics considered relevant by the involved areas, and the respective recommendations. These recommendations covered some EBA-UEMS strategic key areas, in addition to several clinical aspects of common obstetric practice.

The effects of a postmiscarriage menstrual period prior to reconceiving

The optimal interpregnancy interval after a single pregnancy loss is controversial. It is common obstetrical practice to recommend that women who have had a miscarriage in the first trimester of pregnancy should wait for 1 or more menstrual cycles before attempting to conceive again. This study aimed to assess whether conception before the first menstrual period after a spontaneous pregnancy loss is associated with a risk of repeat miscarriage or adverse perinatal outcomes. This retrospective cohort study included 107 women who had a spontaneous miscarriage in the first trimester of pregnancy followed by a subsequent pregnancy with an interpregnancy interval of <12 weeks. All miscarriages had ended in either spontaneous expulsion of the products of conception or medical or surgical evacuation of the uterus. The perinatal outcome measures of 57 women who conceived after the first menstrual period following a spontaneous miscarriage were compared with perinatal outcome measures of 50 women who conceived before the first menstrual period following a spontaneous miscarriage. The primary outcome was rate of pregnancy loss, and the secondary outcomes were gestational age at delivery and birthweight. The rate of recurrent miscarriage was 10.4% for women who conceived before the first menstrual period following a spontaneous miscarriage and 15.8% for those who conceived after (P=.604). There were no differences in the gestational age at delivery (38.9 vs 38.7 weeks; P=.66) or the birthweight (3347±173 vs 3412±156 g; P=.5) between the 2 groups. Other outcomes, such as mode of delivery and 5-minute Apgar score, were also similar for both groups. A multiple logistic regression analysis confirmed that conception before the first menstrual period following a spontaneous miscarriage was not associated with a higher incidence of subsequent miscarriage (odds ratio, 1.74; P=.46) or any other untoward outcome. Conception shortly after a spontaneous miscarriage without waiting for at least the first postmiscarriage menstrual period is not associated with adverse maternal or neonatal outcomes compared with those of women with similar interpregnancy intervals who conceived after their next menstrual period.

Pregnant women\u2019s clinical characteristics, intrapartum interventions, and duration of labour in urban China: a multi-center cross-sectional study

BackgroundThere is an increasing global trend towards the widespread over-medicalisation of labour and childbirth. The present study aimed to investigate pregnant women’s clinical characteristics, intrapartum interventions, duration of labour and its associated factors; and to compare the differences of these variables between nulliparas and multiparas in China.MethodsA multi-center cross-sectional study was carried out in three tertiary hospitals of Fudan University in Shanghai, China. A total of 1523 participants were approched and assessed for eligibility. Data on women’s sociodemographic characteristics, intrapartum interventions, and duration of labour were measured and collected. Kaplan-Meier survival analysis was performed to present the curves of total duration of labour by parity. After z-transformation of labour duration, multivariable linear regression was used to control for confounding and to identify independent associations between potential associated factors and the primary outcome of labour duration.ResultsOverall, 1209 eligible women agreed to participate and were investigated. Rates of different intrapartum interventions were 27.4% in use of amniotomy, 37.9% in use of oxytocin, 53.0% in continuous electronic fetal monitoring, and 52.9% in epidural use, respectively. The curve of total duration of labour was significantly different between nulliparas and multiparas (P < .001). Of the 1209 participants, 983 (81.3%) women eventually achieved successful vaginal birth while 226 (18.7%) women ended in intrapartum caesarean section. The median duration of total stage of labour was significantly longer in the nulliparous group [9.38 (6.33,14.10) hours] than that in the multiparous group [5.08 (3.00,7.83) hours] (P < .001). The following factors were independently associated with longer duration of total stage of labour: epidural analgesia (P < .001), primiparity (P < .001), continuous electronic fetal monitoring (P = .035), and increased birth weight (P = .005).ConclusionsIntrapartum medical interventions become common obstetric practices in urban China. Multifactorial variables independently associated with longer duration of labour were identified, including epidural analgesia, primiparity, continuous electronic fetal monitoring, and increased birth weight. Further research is required to validate these variables and to determine the modifiable factors for labour management. And models of care with lower intervention rates such as midwife-led models of care should be developed and implemented in China.

ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth

Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Admission during the latent phase of labor may be necessary for a variety of reasons, including pain management or maternal fatigue. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring. The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated or proscribed. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor. Birthing units should carefully consider adding family-centric interventions that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode. This Committee Opinion has been revised to incorporate new evidence for risks and benefits of several of these techniques and, given the growing interest on the topic, to incorporate information on a family-centered approach to cesarean birth.

801: Episiotomy: evolution of a common obstetric practice at a single public hospital

801: Episiotomy: evolution of a common obstetric practice at a single public hospital

Quantitative assessment of physical activity in pregnant women with sonographic short cervix and the risk for preterm delivery: A prospective pilot study.

ObjectiveBed rest or activity restriction is a common obstetrical practice, despite a paucity of data to support its efficacy. The aim of this study was to determine whether physical activity, as assessed by a smart band activity tracker, is associated with preterm birth in pregnant women at high risk for preterm delivery.MethodsThis was a pilot prospective cohort study including pregnant women at high risk for preterm delivery between 24 and 32 weeks-of-gestation. Physical activity level was assessed by smart band activity. Patients with sonographic short cervical length (≤ 20 mm) were asked to wear the smart band activity tracker continuously for at least one week, including one weekend. Both physicians and patients were blinded to the data stored in the smart band activity tracker. No specific recommendations were given to participants as to the level or intensity of physical activity. The primary outcome was the rate of preterm birth (< 37 weeks-of-gestation). Secondary outcomes included the rate of delivery before 34 weeks of gestation and neonatal outcome. Parametric and nonparametric statistics were used for analysis.ResultsStudy population included 49 pregnant women: 37 women (75.7%) delivered preterm and 12 (24.5%) delivered at or after 37 weeks-of-gestation. The median steps per day was significantly lower in patients who delivered preterm (3576, IQR: 2478–4775 vs. 4554, IQR: 3632–6337, p = 0.02). Regression analysis revealed that the median number of steps per day was independently inversely associated with preterm birth, after adjustment for maternal age, body mass index, gestational age at recruitment, cervical length, cervical dilatation and plurality.ConclusionThis pilot study represents the first quantitative assessment of the association between physical activity and preterm birth. The results of this pilot study do not support the efficacy of decreased physical activity in the prevention of preterm birth in patients with sonographic short cervical length.

EFFECT OF DELAYED VERSUS EARLY CORD CLAMPING ON HAEMOGLOBIN LEVEL OF NEONATES BORN TO ANEMIC MOTHERS

ABSTRACT Introduction: In common obstetric practice, the cord is clamped soon after birth. Deferring cord clamping for 2 – 3 minutes after birth or when cord pulsations stop allows blood flow between baby and placenta to continue for a few moments. Recent research provides evidence for the beneficial effect of delayed cord clamping on infant iron status and haemoglobin levels. Iron deficiency anemia is a major public health problem in young children worldwide. The increase in neonatal blood volume seen with delayed cord clamping has the potential both to increase iron stores and hemoglobin concentrations. This study is conducted as anemia is highly prevalent among the pregnant females in Pakistan thus they are likely to reproduce children with low haemoglobin levels. Presently early cord clamping is a common practice in labour suites across Pakistan but hypothetically speaking huge benefits were anticipated from delayed clamping. Methodology: All patients, fulfilling the inclusion and exclusion criteria were selected from Labour Room / Emergency Department of hospital. The patients were not aware of the randomization arm and were selected via lottery method. All patients underwent Spontaneous Vaginal Delivery and informed consent was taken for taking baby’s blood sample within 24 hours after birth. Delayed or early cord clamping was done according to randomization. Blood sample of the neonates was sent to a standard laboratory within 24 hours after birth for analyzing full blood counts. Results: The average neonatal hemoglobin level in group A (delayed cord clamping) was 18.7mg/dl and range was 16.2-19.8 mg/dl but in group B (early cord clamping) average Neonatal Hb level was 17.6mg/dl and range was 16.7-19.2 mg/dl. The calculated ’t’ value is 8.290 (p = 0.000) and thus shows statistically significant difference between the two groups. Hence alternative hypothesis is accepted. Conclusion: Our study support that delaying cord clamping >180 sec in low and middle-income countries, where iron deficiency anemia is prevalent among mothers and new borns, may be beneficial as it improves neonatal haemoglobin. Thus delayed clamping of cord should become a standard protocol in obstetrical practice due to its proven benefits over early clamping of cord.

Characteristics of induced labors at Marqués de Valdecilla University Hospital

ObjectiveInduction of labor (IOL) is a common obstetric practice which has increased in recent decades. The main objective of this study is to describe the characteristics of induced labor at Marqués de Valdecilla University Hospital. MethodA descriptive, retrospective study was performed between January 1st and April 30th of 2014, by reviewing medical histories. A standardised registration has been used to collect data. ResultsThere were a total of 376 IOL, the incidence was 35.1%. The most frequent indications were premature rupture of membranes (33.9%) and gestational age of 41 completed weeks or more (16.7%). Oxytocin was used to start 66.8% of the IOL. Of all births, 61.4% were spontaneous vaginal births and 25.3% caesarean sections. An increase in the rate of caesarean sections was observed in the group of gestational age of 41 completed weeks or more (27.3%) and hypertensive disorders of pregnancy (29.8%). The main cause of dystocia was suspected foetal compromise (36.4%). Adaptation to extrauterine life was within the parameters of normality in 94% of the newborn infants. ConclusionsComparing the IOL with spontaneous labor, a decrease in spontaneous vaginal births and an increase in caesarean sections and operative vaginal births was observed in the inductions. This study provides relevant information to the professionals in the fields of gynaecology and obstetrics, and opens the way for future research to obtain results transferable to the clinical practice.

Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth.

Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that are associated with minimal interventions and high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted, a process of shared decision making is recommended. Admission during the latent phase of labor may be necessary for a variety of reasons. A pregnant woman with term premature rupture of membranes (also known as prelabor rupture of membranes) should be assessed, and the woman and her obstetrician-gynecologist or other obstetric care provider should make a plan for expectant management versus admission and induction. Data suggest that in women with normally progressing labor and no evidence of fetal compromise, routine amniotomy is not necessary. The widespread use of continuous electronic fetal heart-rate monitoring has not improved outcomes when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated nor proscribed. Nulliparous women who have an epidural and no indication for expeditious delivery may be offered a period of rest for 1-2 hours before initiating pushing efforts. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches for the intrapartum management of low-risk women in spontaneous labor.

North American Nurses' and Doulas' Views of Each Other

ObjectiveTo analyze factors that lead nurses and doulas to have positive views of each other. DesignA multivariate analysis of a cross-sectional survey, the Maternity Support Survey. SettingOnline survey with labor and delivery nurses, doulas, and childbirth educators in the United States and Canada. ParticipantsA convenience sample of 704 labor and delivery nurses and 1,470 doulas. MethodsMultiple regression analysis was used to examine five sets of hypotheses about nurses' and doulas' attitudes toward each other. Scales of nurses' attitudes toward doulas and doulas' attitudes toward nurses included beliefs that nurses/doulas enhance communication, are collaborative team members, enhance a woman's birth experience, interfere with the ability to provide care, or interfere with relationships with the women for whom they care. ResultsFor nurses, exposure to doulas in their primary hospitals was associated with more positive views, whereas working more hours, feeling overworked, and a preference for clinical tasks over labor support were associated with more negative views of doulas. For doulas, working primarily in one hospital and certification were associated with more positive views of nurses. Nurses with more positive attitudes toward common obstetric practices had more negative attitudes toward doulas, whereas doulas with more positive attitudes toward common obstetric practices had more positive attitudes toward nurses. ConclusionOur findings show factors that influence mutual understanding and appreciation of nurses and doulas for each other. These factors can be influenced by educational efforts to improve interprofessional collaboration between these maternity care support roles.

Antibiotics prior to amniotomy for reducing infectious morbidity in mother and infant.

Amniotomy (the deliberate rupture of membranes) was described almost two centuries ago and since then has been used both for induction and augmentation of labour - which are common obstetric practices. Trends have shown a rise in the induction rates over the last decade and data suggest that the rate of labour inductions is increasing faster than the rate of pregnancy complications. Recent years have seen the emergence of a variety of other methods of induction of labour but amniotomy combined with oxytocin infusion remains the most commonly used method of augmentation of labour. The newer agents for induction are expensive and in resource-poor settings amniotomy is still the chosen method for both induction and augmentation.As with any invasive procedure amniotomy can lead to infection, ascending from the vagina into the uterine cavity and can contribute significantly to both maternal and neonatal infectious morbidity. The objective of this review was to evaluate the prophylactic use of antibiotics versus placebo or no treatment prior to amniotomy on maternal and neonatal infectious morbidity and mortality. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2014), the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov (12 September 2014). Randomised controlled trials or cluster-randomised trials comparing antibiotics prior to amniotomy versus placebo (or no treatment) were eligible for inclusion in this review but none were identified. Quasi-randomised trials or cross-over trials were not eligible for inclusion. Two review authors independently assessed one trial report for inclusion. In future updates of this review, two review authors will independently assess risk of bias and carry out data extraction. Data will be checked for accuracy. We identified one trial report but this was excluded. No studies met the inclusion criteria for this review. High-quality trials are needed to justify or refute the routine use of antibiotics at amniotomy for prevention of infection in the mother and infant.Future studies should be conducted, especially in resource-constrained settings where amniotomy is still used as a means of induction of labour, in order to evaluate the routine use of antibiotics at amniotomy in these settings. Future research in this area should include important maternal and infant outcomes listed in this review and also consider cost effectiveness and side effects of antibiotic use, including the emergence of antibiotic-resistant strains.

Two-Step Delivery May Avoid Shoulder Dystocia: Head-to-Body Delivery Interval Is Less Important Than We Think

A belief that prolonged head-to-body delivery interval endangers the newborn underpins the common obstetrical practice of delivering the baby’s trunk immediately after the head is born. Without intervention, however, birth typically occurs in two steps: once the fetal head is delivered there is usually a pause, and the rest of the infant is born with the next contraction. Allowing a two-step delivery does not increase the risk of fetal harm, and may lower the incidence of shoulder dystocia. A two-step approach to delivery should be considered physiologically normal. This has implications for the definition of shoulder dystocia.

Disappearing art of forceps delivery and the trend of instrumental vaginal deliveries at Abakaliki, Nigeria

Background: Instrumental vaginal deliveries are conducted for either maternal or fetal indication in well-selected cases to optimize feto-maternal outcome. The trend is changing from forceps toward vacuum deliveries in many countries. Objectives: The aim was to determine the rate of instrumental deliveries, the trend and the feto-maternal outcome. Materials and Methods: This was a retrospective study of all women that had instrumental delivery over 10 year period (between January 1, 2003 and December, 2012) at Federal Teaching Hospital, Abakaliki. Ethical approval was obtained from the Research and Ethics Committee of our hospital. The retrieved information were coded, entered and analyzed using the 2008 Epi-Info™ version 3.5.1 Statistical Software (Centre for Disease Control, Atlanta GA, USA). Results: A total of 768 instrument deliveries was conducted during the study period giving an instrument delivery rate of 768/20977 (3.7%) of total deliveries and 4.4% (768/17627) of the total vaginal deliveries. Vacuum delivery accounted for 764/768 (99.5%) giving a delivery rate of 764/20977 (3.6%), while forceps was 4/768 (0.5%) with a delivery rate of 4/20977 (0.1%). Within the study period, the trend waned from the maximum of 16.3% in 2003 to 79 (10.3%) in 2005 after which it had an upward spike to 83 (10.8%) in 2006. Thereafter, it decreased in the subsequent years reaching the lowest rate of 37 (4.8%) in 2009 and rose progressively till 2012 to the third highest level of 94 (12.3%). This pattern of trend is similar to findings in vacuum deliveries while forceps deliveries was only conducted in 2004 and 2011 with a percentage of 2 (2%) each. The most common fetal complication was birth asphyxia. No maternal mortality was recorded. Conclusion: Vacuum delivery was a common obstetric practice and has almost replaced forceps deliveries in our setting.

354: Estimated placental volume (EPV): generation of normative growth curves

Antepartum estimate of fetal growth using ultrasound has become common obstetrical practice. Often the intention is to identify abnormal fetal growth with hopes of minimizing perinatal morbidity. The placenta is a key regulator of fetal growth and development and is subject to its own aberrations in growth. The aim of our study was to create antepartum normative growth curves of estimated placental volume (EPV).

État néonatal et durée des efforts expulsifs chez les primipares à bas risque : données observationnelles dans 138 maternités françaises

In agreement with national guidelines published in 2007, limiting duration of expulsive efforts to 30 minutes is a common obstetrical practice in France. In many other countries, there is no fixed limit for pushing duration. The objective of our work is to analyze mode of delivery and neonatal issues according to duration of expulsive efforts. It is a secondary analysis of an observational prospective study, among low-risk primiparous women, in 138 French maternity units. According to duration of expulsive efforts, we determined proportions of spontaneous and instrumental vaginal deliveries. Then, we analyzed the risk of neonatal asphyxia (defined by pH <or=7.10 and/or 5-minute Apgar score <or=7) according to duration of expulsive efforts, with stratification on mode of delivery. Three thousand three hundred and thirty low-risk primiparous women were included. Median duration of expulsive efforts was 15 minutes and 18.5 % (n=602) of women pushed more than 30 minutes. Among women with a duration of expulsive efforts longer than 30 minutes, 57 % had a spontaneous vaginal delivery. In our population, 1.4 % of neonates had an arterial pH at birth <or=7.10 and 1.0 % a 5-minute Apgar score <or=7. We found no association between duration of expulsive efforts and risk of neonatal asphyxia in the spontaneous delivery group (p=0.38) as well as in the instrumental delivery group (p=0.21). Moreover, we found no association between duration of expulsive efforts and adverse neonatal outcomes. In a context of adequate surveillance of the fetal well-being during labor, a duration of expulsive efforts longer than 30 minutes does not increase the risk of neonatal asphyxia or adverse neonatal outcomes. Expulsive efforts could be continue beyond 30 minutes in case of normal FHR.