Delivery Group Research Articles

Maternal and fetal outcomes of autoimmune hepatitis in pregnancy: A United States hospitalized patient study.

Autoimmune hepatitis (AIH) is a chronic inflammatory disease primarily affecting the liver, with a higher prevalence among women of reproductive age. The latest nationwide statistics regarding its impact on maternal and fetal outcomes during pregnancy are lacking. To analyze the real impact of AIH on maternal and fetal outcomes in hospitalized delivery patients, and provide theoretical guidance for comprehensive clinical management. A retrospective analysis was conducted using data from the 2016-2020 National Inpatient Sample database in the United States. Multivariate logistic regression analysis was used to assess the influence of AIH on maternal and fetal outcomes during pregnancy. A total of 17,825,445 hospitalized delivery patients were included, among which 1,185 had AIH. After adjusting for potential confounding factors, compared to hospitalized delivery patients without AIH, the AIH group exhibited significantly higher rates of adverse maternal and fetal outcomes, including hypertension complications of pregnancy (AOR 1.68, 95 % CI 1.09-2.58), preterm birth (AOR 2.89, 95 % CI 1.91-4.38), fetal growth restriction (AOR 2.21, 95 % CI 1.34-3.64), and fetal death (AOR 4.13, 95 % CI 1.33-12.83). AIH showed no association with cesarean section or large fetus. In the group of delivery in patients with AIH, patients who develop hypertensive disorders have a higher probability of concomitant diabetes mellitus (OR 6.85, 95 % CI 2.19-21.45), hypertension (OR 4.64, 95 % CI 1.68-12.82), and obesity (OR 3.06, 95 % CI 1.26-7.42). Additionally, AIH patients incurred higher total costs and longer hospital stays during the delivery hospitalization. Patients with AIH face an increased risk of hypertensive disorders of pregnancy, preterm birth, fetal growth restriction, and fetal death during delivery. It is crucial to enhance awareness of these potential occurrence risks.

Risk of postpartum hemorrhage according to the planned mode of delivery among pregnant women with one previous cesarean delivery: a secondary analysis of the Lower Uterine Segment Trial (LUSTrial).

Postpartum hemorrhage is the most common complication in obstetrics and is a leading cause of serious maternal morbidity. Women with one previous cesarean delivery are at risk for postpartum hemorrhage. The aim of this study was to compare the risk of postpartum hemorrhage according to the planned mode of delivery among women with one previous cesarean delivery. This study was a secondary analysis of the Lower Uterine Segment Trial. The primary outcome was postpartum hemorrhage, and the secondary outcome was a composite of severe postpartum hemorrhage including the need for blood transfusion, second-line therapy to stop bleeding, or hysterectomy. The exposure was the planned mode of delivery, which was decided at around 36 weeks of gestation. Multivariate logistic regression analysis with a random intercept of the maternity unit was used to assess the relationship between the planned mode of delivery and postpartum hemorrhage. A secondary analysis using inverse probability weighting was performed to limit indication bias. Of the 2948 women included in the Lower Uterine Segment Trial, 2889 women were included in this secondary analysis; 2689 (93.0%) chose planned vaginal delivery and 200 (7.0%) planned cesarean delivery. The rate of postpartum hemorrhage was lower in the planned cesarean delivery group than in the planned vaginal delivery group (2.5% versus 7.5%, adjusted odds ratio 0.28 [0.11-0.69] P<.01). The rate of the composite maternal outcome of severe postpartum hemorrhage was similar between the two groups (2.9% versus 2.0%, adjusted odds ratio 0.66 [0.24-1.83] P=.42). These results were consistent in the secondary analysis involving inverse probability weighting (odds ratio 0.35 [0.24-0.51] P<.01). Planned cesarean delivery was associated with a lower percentage of women with postpartum hemorrhage compared with planned vaginal delivery after one previous cesarean delivery. However, the use of transfusion, second-line therapies, or hysterectomy was rare, and the rates were similar between the 2 groups.

The role of D-dimer changes in predicting delivery time in preterm premature rupture of membranes: a retrospective analysis.

Pregnancy induces a hypercoagulable state, characterized by increased coagulation factors and decreased anticoagulants, alongside ongoing fibrinolysis marked by elevated D-dimer (DD) levels. Reference values for DD in pregnancy often exceed the non-pregnant cutoff due to these changes. Elevated DD levels are common in late pregnancy and may correlate with complications such as gestational diabetes, hypertension, and preterm delivery, particularly in cases of preterm premature rupture of membranes (PPROM). This study investigates the association between DD levels, the duration from PPROM diagnosis to delivery, and neonatal outcomes. This retrospective study was conducted at the Department of Perinatology, Etlik City Hospital, Ankara, Turkey, from October 2022 to May 2023. Eighty patients with PPROM between 24 and 36weeks of gestation were included. Routine blood tests and coagulation parameters, including DD, were monitored every other day for 2weeks. Patients were classified into two subgroups based on whether labor occurred within 7days of PPROM diagnosis. Statistical analyses included the Mann-Whitney U test, Student's t test, Chi-square test, Friedman test, Durbin-Conover test, generalized estimating equations (GEE), and ROC analysis. Gestational age at admission was significantly lower in patients who delivered later than 7days post-PPROM. Significant differences were observed in ultrasonographic measurements, with larger fetal parameters in the early delivery group. Higher DD levels at the third follow-up correlated with shorter durations to delivery (p = 0.021). Longitudinal analysis showed significant fluctuations in DD levels over time, particularly near delivery. The GEE analysis demonstrated a strong inverse relationship between DD levels and time to delivery (p = 0.004), supported by ROC analysis (AUROC = 0.811). Elevated DD levels are associated with shorter durations from PPROM diagnosis to delivery, indicating their potential utility in predicting labor onset. Monitoring DD levels may help in clinical decision-making for managing PPROM, including planning neonatal care and timing of interventions.

Mediolateral episiotomy and obstetric anal sphincter injuries in nullipara: a propensity score matching study

BackgroundObstetric anal sphincter injuries are a notable adverse outcome of vaginal deliveries, with incidence rates ranging from 0.25% to 6%. Key risk factors for these injuries include primiparity and operative vaginal deliveries. In recent decades, the use of episiotomy as a preventive measure for obstetric anal sphincter injuries has been subject to extensive scrutiny. The objective of this study was to investigate the role of mediolateral episiotomy in preventing obstetric anal sphincter injuries during vaginal deliveries or vacuum-assisted deliveries within the context of selective use.MethodsRetrospective study of all nulliparous women with a singleton gestation who underwent term vaginal delivery or vacuum-assisted delivery. A propensity score matching with a 1:1 ratio was employed to adjust for confounders. Primary outcome was obstetric anal sphincter injury rate, and the secondary outcome was a composite neonatal outcome (umbilical artery pH < 7.1, neonatal intensive care unit admission, and 5-min Apgar score < 7).ResultsThe study cohort comprised 22,738 deliveries: 77.0% vaginal deliveries (17,518/22,738) and 23.0% vacuum-assisted deliveries (5,220/22,738) with episiotomy rates of 38.5% (6,751/17,518) and 75.8% (3,959/5,220), respectively. Separate analyses were conducted for the matched vaginal delivery group (n = 13,500) and the matched vacuum-assisted delivery group (n = 2,518). No significant differences in obstetric anal sphincter injury rates were observed in the vaginal delivery (OR 1.15, 95% CI 0.78–1.69) or vacuum-assisted delivery (OR 0.58, 95% CI 0.31–1.05) groups. However, in the vacuum-assisted delivery group, episiotomy demonstrated a borderline protective effect against obstetric anal sphincter injuries. Further adjustment for the duration of the second stage of labor duration in vacuum-assisted deliveries revealed a significant protective effect of episiotomy against obstetric anal sphincter injuries, with a number needed to treat of 28 (95% CI 15—224) in cases of prolonged second stages of labor. Episiotomy in vaginal deliveries was associated with a higher rate of composite neonatal outcome (OR 1.23, 95% CI 1.04–1.45), while vacuum-assisted deliveries showed no such association (OR 1.11, 95% CI 0.86–1.44).ConclusionsIn context of selective use, mediolateral episiotomy has no significant protective effect on obstetric anal sphincter injuries in women undergoing vaginal delivery. However, there is a possible benefit in vacuum-assisted delivery, especially when considering the duration of the second stage of labor.

Exploration of CCL11 and sTNFR2 as potential biomarkers for the efficacy of lymphocyte immunotherapy in women with unexplained recurrent spontaneous abortion

Objective: To explore biomarkers for the efficacy of lymphocyte immunotherapy (LIT) treating women with unexplained recurrent spontaneous abortion (URSA). Methods: Serum samples from 24 URSA potients who received LIT were collected at Peking University Third Hospital from December 2014 to June 2015. Semiquantitative sandwich-based antibody arrays containing 40 cytokines were used to screen target immune cytokines in the peripheral blood of URSA patients before and after LIT. Multifactor quantitative microsphere flow cytometry detection validated the levels of target cytokines. Based on the final pregnancy outcome after LIT, 24 URSA patients were divided into the full-term delivery group (15 cases) and the abortion group (9 cases). Furthermore, linear regression analysis were applied to evaluate the relationship between target cytokines and pregnancy outcomes. Results: Semiquantitative sandwich-based antibody arrays suggested that, among all 24 URSA patients included in this study, the intensities of the fluorescence signal were significantly lower post-LIT versus pre-LIT for the following cytokines: interleukin-15 (IL-15), monokine induced by γ-interferon (MIG), C-C motif chemokine ligand (CCL) 1 (all P<0.05). In the full-term delivery group, the intensities of the fluorescence signal post-LIT were significantly lower than pre-LIT for the following cytokines: IL-15, CCL1, macrophage inflammatory protein (MIP) 1α (all P<0.05). In the abortion group, the intensities of the fluorescence signal post-LIT were significantly lower than pre-LIT for the following cytokines: MIG, MIP-1δ (all P<0.05). Linear regression analysis showed that the intensity of the fluorescence signal of CCL11 was increased and the intensity of the fluorescence signal of soluble tumor necrosis factor receptor 2 (sTNFR2) was decreased in the full-term delivery group after LIT, the differences were statistically significant (P=0.012, 0.029). Validation results of multifactor quantitative microsphere flow cytometry detection showed that the level of CCL11 was significantly increased (P=0.001) and the level of sTNFR2 was significantly decreased (P=0.001) in the full-term delivery group after LIT. Conclusion: CCL11 and sTNFR2 maybe serve as potential biomarkers that could predict pregnancy outcomes after LIT in women with URSA.

Obstetric Anal Sphincter Injury: Vaginal Birth After Cesarean Versus First Vaginal Delivery.

Modern data regarding the relationship between vaginal birth after cesarean (VBAC) and obstetric anal sphincter injury (OASI) are minimal with mixed results. The aim of the study was to determine if VBAC is associated with an increased risk of OASIs. This was a retrospective cohort study of liveborn deliveries from 2018 to 2022 within a large, multihospital academic health system. The primary outcome was the proportion of OASIs compared between patients who underwent a first vaginal delivery (primiparous vaginal delivery group) versus patients who underwent a first VBAC (VBAC group). A total of 17,044 patients were included. A total of 16,208 had a primiparous vaginal delivery and 836 underwent VBAC. Vaginal birth after cesarean patients were older (29.9 vs 27.0 years, P < 0.01), more likely to self-identify as Black or Asian race (26.1% vs 18.0%, P < 0.01), and had lower maternal weight (182.7 vs 187.2 lbs, P < 0.01). The proportion of OASIs was significantly higher in the VBAC group (6.9% vs 5.1%, P = 0.02). Vacuum-assisted vaginal deliveries were more common in the VBAC group (7.7% vs 5.4%, P < 0.01).On multivariable logistic regression, VBAC was not significantly associated with OASIS (odds ratio [OR] = 1.01, 95% confidence interval [CI] = 0.75-1.36, P = 0.95). Operative vaginal delivery (OR = 6.44, CI = 5.51-7.52, P < 0.01), older maternal age (OR = 1.05, CI = 1.03-1.07), and Asian race (OR 2.62, CI = 2.10-3.26) demonstrated increased odds of OASIs. Patients who identified as Black demonstrated lower odds of OASIs (OR = 0.68, CI = 0.50-0.93). While there was a greater proportion of OASIs in the VBAC group compared to the primiparous vaginal delivery group, VBAC was not an independent risk factor.

The effect of maternal and fetal weight on the risk of emergency cesarean section in nulliparous women.

Although many studies based on different ethnic groups have analyzed the impact of maternal and infant weight on overall cesarean section rates in recent years, research on the impact of maternal and infant weight on emergency cesarean section (EmCS) rates is lacking, especially in the Chinese population. This study aimed to analyze whether maternal and fetal weight could influence the risk of EmCS. A total of 8427 nulliparous women who delivered vaginally (full-term, singleton, and cephalic presentation) were included in this study and divided into the normal vaginal delivery (VD) and EmCS groups. Of 8427 cases, 909 (10.8%) were delivered by EmCS because of failed VD. Compared with pregnant women with a normal body mass index, the risk of EmCS in overweight women increased significantly (P < .001). Birth weight > 3550 g was associated with an increased risk of EmCS. Subgroup analyses showed that among women with underweight and normal weight, old age, inadequate gestational weight gain, and large for gestational age were independent high-risk factors for EmCS (P < .05), whereas small for gestational age was the low-risk factor. Compared with the fetal distress group, the weight of newborns in the nonfetal distress group was significantly higher (P < .001), and the main cause of EmCS in women with macrosomia, large for gestational age, or birth weight ≥ 3550 g was fetal distress (P < .05). The prepregnancy maternal and fetal weights can affect the risk of EmCS. Weight management should be enhanced to control gestational weight gain according to the prepregnancy body mass index to reduce the risk of EmCS due to failed VD.

Freedom to experiment? Design as an impetus for collaboration

ABSTRACT This contribution is a collective autoethnography conducted by the co-authors to capture their experiences within the Discovery Delivery Group, a group which has been tasked with re-imagining complementary learning opportunities to broaden students' horizons beyond programme boundaries as part of the Discovery offering at the University of Leeds, U.K., aligned to its ambition for flexible, inclusive and transformative student education. Design thinking and further participatory curriculum design strategies were used to experiment and to explore more novel approaches in this two-year project. In this autoethnographic work, the researchers and members of the Discovery Delivery Group participated in an inquiry to share and gain insights into the experience of participation in this group, reflecting on a shared appetite for change and innovation as transformative educators and colleagues. The study reveals how such transformational pedagogical project groups can create a space for learning, experimentation and innovation.

The significance of ultrasound parameters and clinical factors in predicting successful labor induction among nulliparous women.

To compare the values of ultrasound and clinical parameters for predicting outcomes of induction of labor (IOL) among healthy nulliparous women with a singleton, term cephalic pregnancy. The cervical length, cervical strain elastography, posterior cervical angle, head-perineum distance, Bishop score, and maternal parameters were assessed before IOL with a combined method-Foley catheter and Misoprostol perorally. The main outcome was vaginal delivery. Variation in cervical tissue elasticity, represented by elasticity index (E), was significantly different between outcome groups-vaginal delivery and cesarean section (CS) in internal os, in the anterior lip near the cervical canal and the midpoint of the anterior and posterior lip (p < 0.05). The E was higher-softer in the vaginal delivery group. The overall elasticity was significantly higher in the middle part of the cervix in the vaginal delivery group. However, other ultrasound metrics did not differ significantly across the outcome groups. Overall, women who delivered vaginally were taller and had a lower pre-pregnancy BMI (p = 0.02 for both variables). Univariate and multivariate analyses showed maternal height was the significant independent predictor of CS (AOR 0.91, 95% CI 0.84-0.98). The prognostic value for vaginal delivery, based on cervical length, maternal height, Bishop score, and parameters of cervical strain elastography, was poor (AUC < 0.7). The study underscores the importance of cervical tissue elasticity in predicting vaginal delivery outcomes, while also highlighting that maternal height is a significant independent predictor of cesarean delivery. However, evaluated metrics in the study have limited prognostic value for predicting vaginal delivery. This suggests a need for further research to identify more reliable predictors of delivery outcomes.

Maternal and neonatal short-term outcome after vaginal breech delivery >36weeks of gestation with and without MRI-based pelvimetric measurements: a Hannover retrospective cohort study.

Planning the mode of delivery of a full-term breech singleton remains a challenging task. The aim of this work is to compare the neonatal and maternal short-term outcomes after planned vaginal delivery and caesarean section and to evaluate the influence of an MRI pelvimetry on the short-term outcomes in order to provide appropriate advice to pregnant women with breech presentation. This is a retrospective monocentric analysis of all deliveries with singleton pregnancies from breech presentation >36+0weeks of gestation between 08/2021 and 09/2023. Short-term maternal and neonatal morbidity data were collected for intended vaginal deliveries and caesarean sections. Neonatal and maternal short-term outcomes of intended vaginal deliveries with and without MRI pelvimetry were compared. In the planned vaginal delivery group, APGAR scores and arterial umbilical cord pH were significantly lower than in the planned caesarean group. The rate of asphyxia was similar in both groups. Although not significant, the rate of NICU admission was higher in the vaginal birth group (6.7 % vs. 2.7 %; p=0.27), and infants born by caesarean remained in the NICU longer (1.3 % vs. 1.8 %; p=1.0). Neonates born to women who underwent MRI prior to attempted vaginal delivery had better short-term neonatal outcomes and shorter NICU stays compared with women who did not undergo MRI, after multivariate analysis for fetal birth weight, parity, and gestational age. Vaginal breech delivery is associated with lower APGAR scores and umbilical arterial pH compared with caesarean section but does not result in increased neonatal asphyxia or NICU admission. Length of stay in the NICU is shorter when a newborn is admitted after vaginal delivery. MRI pelvimetry may improve the outcome of the newborn by further selection.

Neonatal outcomes between trial of labor and cesarean delivery for extreme preterm infants.

To compare adverse neonatal outcomes between trial of vaginal delivery and upfront cesarean delivery for singleton infants born at 24 to 28 weeks of gestation. This is a retrospective cohort study that was conducted at a university-affiliated tertiary medical center between 2011 and 2022, involving singleton pregnancies delivered between 240/7 and 276/7 weeks of gestation. Participants were divided into two groups based on their intended mode of delivery: a trial of labor (TOL) group and an upfront cesarean delivery (CD) group. The primary outcome was defined as neonatal death. The secondary outcome was defined as any of the following: intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia, neonatal sepsis, periventricular leukomalacia, disseminated intravascular coagulation, umbilical cord arterial PH <7.1, or use of postpartum mechanical ventilation. Analyses were performed using an intention-to-treat approach. Overall, 199 patients were enrolled, with 64 in the TOL group and 135 in the upfront CD group. Neonatal deaths occurred in 48 cases (24.2%) across the entire cohort, with no significant difference between the TOL (18.8%) and upfront CD (26.7%) groups (P = 0.223). Rates of other composite adverse outcome were comparable between the groups (26.6% vs. 31.9%, P = 0.448), respectively. A sub-analysis comparing patients with pre-existing contraindications for vaginal delivery, without maternal or fetal indications for delivery, to those in the TOL group who experienced spontaneous onset of labor showed no differences in primary or secondary outcomes between the groups. We found no difference in adverse neonatal outcomes between TOL and upfront CD for singletons born at 24-28 weeks gestation.

Low Reproductivity of Giant Pandas May Be Associated with Increased Vaginal Escherichia-Shigella.

The poor reproductive capacity of giant pandas significantly hinders the development of captive populations, with 80.88% of adult individuals being unable to successfully become pregnant and deliver offspring. The disturbance of vaginal microbiota has been proven to potentially lead to miscarriage, abortion, and stillbirth in mammals. To elucidate the potential relationship between the vaginal microbiota and the reproductive capacity of giant pandas, we performed high-throughput sequencing of vaginal microbiota at the time of fertilization and conducted comparative analyses based on different pregnancy outcomes. We found that the microbial diversity in the delivery (D) group exceeded that in the non-delivery (ND) group and the vaginal microbial community structure was statistically different between the two groups. The vaginal microbiota in the delivery pandas consisted of unclassified Pseudomonadaceae which was gradually replaced by the Escherichia-Shigella type of vaginal microbiota in the ND group. A function predictions analysis showed that infectious disease, glycan biosynthesis, and metabolism were significantly enriched in the ND group. Additionally, an analysis of the microbial community phenotypic categories indicated that the ND group exhibited a significantly higher abundance of Gram-negative bacteria, facultative anaerobes, potential pathogens, and stress-tolerant species compared to the D group, predominantly driven by the elevated abundance of Escherichia-Shigella. Escherichia-Shigella can be used within LDA and ROC analyses to diagnostically distinguish the vaginal microflora associated with bad pregnancy outcomes during estrus. Our results will help to identify potential pathogens causing reproductive tract diseases, reduce the number of reproductive tract disease infections in pandas, and increase the birth rate of giant pandas in conservation breeding programs.

Epidural Anesthesia and Pelvic Floor Outcomes in Primiparas: A Retrospective Transperineal Ultrasound Study.

This study evaluated pelvic organ positions in primiparas with painful and painless deliveries using transperineal ultrasound (TPU) and assessed the effects of epidural anesthesia on pelvic floor function. From January 2022 to March 2023, 512 primiparas with vaginal deliveries at our hospital underwent pelvic floor ultrasound examinations 42days postpartum. The study included 138 women with painful deliveries and 375 with painless deliveries. Measurements included the urethral tilt angle (UTA), retrovesical angle at rest (RVA-R), bladder neck-symphysis pubis distance (BSD) at rest, retrovesical angle at Valsalva maneuver (RVA-V), urethral rotation angle (URA), bladder neck descent (BND), rectal ampulla distance, and levator hiatal area (LHa) at maximum Valsalva maneuver. Statistical analysis was performed using SPSS 26.0. No significant differences were found between the painful and painless delivery groups in terms of age, gestational age, newborn birth weight, BMI, UTA, RVA-R, RVA-V, URA, and BND (P > 0.05). Although the second stage and total duration of labor were significantly longer in the painless delivery group, there were no significant differences in the incidences of cystocele, internal urethral orifice opening, uterine prolapse, rectocele, and LHa expansion between the groups (P > 0.05). Transperineal ultrasound showed no significant difference in pelvic floor dysfunction incidence between primiparas with painful and painless deliveries. Epidural anesthesia did not significantly affect pelvic floor function in the early postpartum period.

Contact Force Increases During Radiofrequency Ablation: A Novel Catheter Assessment of Myocardial Response to Thermal Injury.

Contact force (CF) changes after onset of radiofrequency (RF) delivery are not well understood and often ascribed to catheter instability. This study sought to characterize CF changes during RF-based pulmonary vein (PV) isolation. Catheter-tip parameters including CF for all RF sessions were extracted from a novel catheter-mapping system from 6 patients undergoing PV isolation. Of a total 416 RF sessions, 241 demonstrated progressive increases in CF during RF delivery (group 1). Zero to 5 seconds of RF delivery demonstrated the greatest increase in CF, with no differences between right and left PV sites (2.2 ± 2.2 vs 1.9 ± 2.3 g, P=0.26). Subsequent 5-second intervals demonstrated greater increases for right vs left PV sites (eg, 1.2 ± 1.3 vs 0.5 ± 0.3 g, P=0.01 for 20 to 25 seconds). CF increment was greater for posterior vs anterior PV sites (3.4 ± 3.1 vs 1.4 ± 1.4 g, P< 0.001), but similar for roof and floor sites. Higher power and greater impedance drops were associated with greater CF increases. Perpendicular contact had greater CF increases, followed by diagonal and parallel contact. The remaining 175 of 416 sessions demonstrated at least 1 CF decrement, typically occurring after 15 seconds of RF (group 2). This was observed least frequently at inferior PV sites. Except for minor differences in power, there were no differences in CF, tip excursion, and impedance drop between groups. Progressive CF increase during RF ablation is a distinct phenomenon that likely reflects the "push-back" effect of local myocardial swelling against the catheter tip. This may explain certain catheter-tip behaviors such as tip displacement and instability during ablation.

Diagnostic accuracy of strain cervical elastography as a predictor for preterm delivery: A single tertiary care centre study.

Preterm delivery is a grave and demanding problem that accounts for the major cause of neonatal deaths and long-term morbidities. It remains an unresolved health issue of global dimensions. Cervical elastography is evolving as a useful diagnostic tool for its timely prediction so that individualised management can be done. To assess the diagnostic accuracy of transvaginal strain cervical elastography in prediction of preterm delivery. This prospective observational study was conducted from June 2021 to August 2022 in a tertiary care institute of North India. A total of 75 low-risk asymptomatic women were included. Transvaginal ultrasound was performed for the cervical length in the second and third trimesters. In addition, we collected strain elastography data such as colour codes from six regions of the cervix, that is, at the anterior and posterior lips of internal os, middle one-third of the cervix and the external os, and the strain ratios from these three cervical levels were also calculated. Then these parameters were compared with cervical length, second and third trimester groups and also with preterm and term delivery groups. The red colour (soft colour) at the anterior lip of internal os was the best predictor of preterm delivery in our study with a sensitivity and specificity of 63.64% and 96.87%, respectively. The elastography strain ratio of >2 at the internal os and cervical length ⩽2.8 cm were the additional predictors for the same. Cervical elastography can serve as a potential and reliable predictor for preterm delivery.

Differences in Time of Birth between Spontaneous and Operative Vaginal Births.

Previous studies have identified an association between obstetric interventions and the time of day in which they are performed; however, they do not account for granular variations in the temporality of delivery interventions, which is influenced by both health care providers and resource availability. We sought to assess differences in time of birth among spontaneous vaginal births (SVBs) versus operative (forceps- and vacuum-assisted) vaginal births (OVBs). This cross-sectional study used birth certificate data from the National Vital Statistics System from 2016 to 2021, which includes the time of birth and delivery method for recorded U.S. births. The number of SVBs and OVBs at each minute was normalized relative to the total births within each delivery group to facilitate balanced comparisons between groups. Logistic regression analysis assessed the odds of OVBs per time of day. A total of 15,412,129 subjects who underwent vaginal birth were included in this analysis, 690,905 (4.5%) of whom underwent OVBs. Compared to births at other time intervals, those between 4:30 and 7:30 p.m. were more likely to be OVBs (odds ratio [OR] = 1.13, 95% confidence interval [CI]: 1.12-1.14). Conversely, births between 3:00 and 6:00 a.m. were less likely to be OVBs (OR = 0.87, 95% CI: 0.86-0.88). After adjusting for adjusting for maternal age, gestational age, and induction of labor, births between 4:30 and 7:30 p.m. remained more likely to be OVBs (adjusted odds ratio [aOR] = 1.09, 95% CI: 1.08-1.10) and births between 3:00 and 6:00 a.m. remained less likely to be OVBs (aOR = 0.91, 95% CI: 0.90-0.92). In this population-based study, we identified temporal differences between SVBs and OVBs with increased use of instrumentation during the late afternoon and reduced use in the early morning. These findings prompt further investigation into the indications for OVBs and root causes of these temporal variations, which are likely multifactorial and involve provider and resource availability. · This study identifies temporal differences between SVBs and OVBs.. · Compared to SVBs, operative births are more likely in the late afternoon.. · OVBs are also less likely in the early morning.. · These temporal trends suggest the influence of provider and resource availability..

Predictive values of cervix length measurement based on transvaginal ultrasonography

BACKGROUND: Pregnancy is an important process in women’s life, which is widely concerned by women. In recent years, the incidence of premature delivery (PTD) becomes more and more higher due to the development of auxiliary reproduction and ovulation induction technologies and the changes of pregnant women’s lifestyle and physical quality. PTD not only affects postpartum recovery and causes great physical pains, but it also has adverse effects on the birth state of neonates and even leads to neonatal death OBJECTIVE: The predictive values of cervix length (CL) measurement based on transvaginal ultrasonography (TVUS) and pathological examination of placenta for premature delivery (PTD) were investigated and the correlation between PTD and infection was analyzed. METHODS: 120 pregnant women with PTD or high-risk factors for PTD admitted to The Affiliated Hospital of Southwest Medical University between February 2020 and March 2022 were included as the subjects and underwent pathological examination of placenta and TVUS for CL measurement. The final gestational age was set as the standard for the evaluation on the predictive values of pathological examination of placenta and TVUS. What’s more, 36 subjects in PTD group and 84 in normal delivery group (control group) underwent pathological examination of placenta for the analysis of the correlation between PTD and infection. RESULTS: The joint inspection method showed significantly better sensitivity, specificity, PPV, and NPV compared to single CL or pathological examination of the placenta (P&lt; 0.05). Among pregnant women, those with CL ⩽ 30 mm and positive placental pathology had a higher proportion compared to those with CL &gt; 30 mm and negative placental pathology (P&lt; 0.05). Furthermore, the incidence of Ureaplasma Urealyticum (UU), Chlamydia Trachomatis (CT), and Chorioamnionitis (CA) in vaginal discharge of the preterm delivery (PTD) group was significantly higher than that of the control group (P&lt; 0.05). CONCLUSION: The combination of CL ⩽ 30 mm and positive placental pathology could effectively predict PTD and placental infection was notably correlated with the occurrence of PTD.

Creating an inclusive workforce in 2024: Are pharmacy teams across England committed to embedding equality, diversity, and inclusion?

Abstract Introduction The Pharmacy Workforce Race Equality Standard (PWRES) published in 2023 provided evidence of the varied experiences that registered pharmacy professionals in NHS trusts face, particularly in relation to gender and ethnicity.1 Following this, the Inclusive Pharmacy Practice delivery group at NHS England set out to raise awareness of the data and to support regions in developing action plans to drive improvements in equality, diversity and inclusion (EDI) within pharmacy teams. Aim The aim of this study was to identify current initiatives within NHS providers that promote EDI within the pharmacy workforce with a view to enabling the sharing of good practice, and identifying implementation barriers. Methods A questionnaire was created by the Chief Pharmaceutical Officer’s Clinical Fellows and distributed by the 6 regional chief pharmacists within NHS England to their networks. The questionnaire was also promoted in regional pharmacy leadership meetings. Responses were collected between 1st February and 31st May 2024. Data was collected on an Excel spreadsheet. London was excluded from data collection as a similar questionnaire was distributed in 2023. No ethical approval was needed for non-sensitive anonymised data. Results There were 77 responses: 75% (n = 58) from hospital trusts, 13% (n = 10) from integrated care boards and the remaining 9 responses included the Local Pharmaceutical Committee, Hospice and Mental Health Trust. 86% of respondents (n = 66) indicated that their organisation has EDI initiatives in place. These have been summarised into six key themes: 1) EDI network/steering group (n = 44), 2) action plan (n = 14), 3) EDI training/accreditation (n =14), 4) reverse/reciprocal mentoring (n = 11), 5) awareness days (n = 10) and 6) inclusive recruitment practices (n = 10). In contrast, only half of respondents indicated that their team had EDI initiatives. The impact of any initiatives was measured by feedback from staff (e.g. Internal staff survey, NHS staff survey, focus groups, open staff forums) and regular staff demographic data collection. 55% of respondents (n = 36) indicated that recruitment panel members received compulsory EDI training for interviews and 54% of respondents (n = 35) received mandatory recruitment training. Barriers and challenges identified with implementing EDI initiatives included organisational change, workforce capacity, competing priorities and staff apathy. Discussion The survey results highlight a strong commitment to EDI initiatives at an organisational level, with most organisations having established EDI frameworks. However, the lower prevalence of EDI initiatives within individual pharmacy teams suggests a gap in implementation. This discrepancy indicates a need for better dissemination and integration of EDI practices within pharmacy team settings. There is evidence of varied practice in terms of EDI training requirements of interview panellists, and these variations are opportunities where improvements can be made in terms of IPP. The survey was only sent to the managed NHS sector and is not reflective of primary care or community pharmacy. One of the next steps is for regions to use the results of the questionnaire in combination with the PWRES data to develop and implement local action plans to address these issues. Reference 1. NHS England. Pharmacy Workforce Race Equality Standard Report 2023. [Accessed 4th June 2024]. Available from https://www.england.nhs.uk/long-read/pharmacy-workforce-race-equality-standard-report/

Comparison of Second-Trimester Uterine Artery Doppler Indices between Pregnant Women with and without Prior Cesarean Delivery and Effect on Perinatal Outcomes

Objective: To evaluate the effects of prior cesarean delivery on second-trimester Uterine Artery (UtA) Doppler and its effect on perinatal outcomes. Materials and Methods: This study was conducted at the Maternal Fetal Medicine unit of Bhumibol Adulyadej Hospital, Thailand between June 2023 and January 2024. Healthy pregnant women aged between 18 and 45 years old were recruited and divided into prior (PCD) and non-prior cesarean delivery (non-PCD) groups. Both groups underwent UtA Doppler study from 18 to 24 weeks of gestation. UtA Doppler indices consisted of pulsatility index (UtA-PI), resistance index (UtA-RI) and systolic/diastolic ratio (S/D). Demographics, maternal and neonatal outcomes were collected. Results: Total of 416 participants were recruited and divided equally. The mean age of participants was 30.5 years old. Diabetes mellitus in pregnancy and hypertensive disorder were reported as 18.9 (79/416) and 5.5 (23/416) percent, respectively. From univariate analysis, subjects in the PCD group had higher UtA-PI, UtA-RI and UtA S/D than the non-PCD group with statistical significance. After multiple logistic regressions, only UtA-RI was greater in the PCD group with any statistical significance. The mean gestational age at delivery was 38.41 weeks. Prevalence of small for gestational age deliveries, preeclampsia, and preterm birth were 4.4 (17/376), 3.1 (12/376) and 10 percent (38/376), respectively. Maternal and neonatal outcomes of both groups were comparable. Number of cesarean deliveries, parity, miscarriage, and anterior placentation were not associated with UtA Doppler indices. Conclusion: UtA-RI of prior cesarean delivery participants were higher than non-prior cesarean delivery participants and not associated with maternal and neonatal adverse outcomes.

Does intermittent nutrition enterally normalise hormonal and metabolic responses to feeding in critically ill adults? A protocol for the DINE-Normal proof-of-concept randomised parallel-group study

IntroductionOver half of patients who spend >48 hours in the intensive care unit (ICU) are fed via a nasogastric (NG) tube. Current guidance recommends continuous delivery of feed throughout the...