Labor Delivery Research Articles

Impact of labor characteristics on maternal and neonatal outcomes of labor: A machine-learning model.

Since Friedman's seminal publication on laboring women, numerous publications have sought to define normal labor progress. However, there is paucity of data on contemporary labor cervicometry incorporating both maternal and neonatal outcomes. The objective of this study is to establish intrapartum prediction models of unfavorable labor outcomes using machine-learning algorithms. Consortium on Safe Labor is a large database consisting of pregnancy and labor characteristics from 12 medical centers in the United States. Outcomes, including maternal and neonatal outcomes, were retrospectively collected. We defined primary outcome as the composite of following unfavorable outcomes: cesarean delivery in active labor, postpartum hemorrhage, intra-amniotic infection, shoulder dystocia, neonatal morbidity, and mortality. Clinical and obstetric parameters at admission and during labor progression were used to build machine-learning risk-prediction models based on the gradient boosting algorithm. Of 228,438 delivery episodes, 66,586 were eligible for this study. Mean maternal age was 26.95 ± 6.48 years, mean parity was 0.92 ± 1.23, and mean gestational age was 39.35 ± 1.13 weeks. Unfavorable labor outcome was reported in 14,439 (21.68%) deliveries. Starting at a cervical dilation of 4 cm, the area under receiver operating characteristics curve (AUC) of prediction models increased from 0.75 (95% confidence interval, 0.75-0.75) to 0.89 (95% confidence interval, 0.89-0.90) at a dilation of 10 cm. Baseline labor risk score was above 35% in patients with unfavorable outcomes compared to women with favorable outcomes, whose score was below 25%. Labor risk score is a machine-learning-based score that provides individualized and dynamic alternatives to conventional labor charts. It predicts composite of adverse birth, maternal, and neonatal outcomes as labor progresses. Therefore, it can be deployed in clinical practice to monitor labor progress in real time and support clinical decisions.

Cohort Study: Pregnant Exercise with Primigravida Stage II of Labor Delivery

Pregnancy exercise is a program for healthy pregnant women to prepare for the mother's physical condition. Suppose the mother does not do pregnancy exercise. In that case, she will experience aches, get tired quickly during pregnancy, and her delivery is not smooth in the second stage, thereby increasing fetal distress. This study determined the relationship between pregnancy exercise and the duration of the second stage of labor in primigravida in the Ambunten Health Center Work Area. The study design used a cohort analytic using a retrospective approach. The population was all primigravida women giving birth from September 2019 to September 2021. The sample taken was 179 respondents using a non-probability sampling technique. The second stage of labor They were then analyzed using the chi-square test. The results obtained from 179 respondents who did pregnancy exercise during the second stage of labor (74%) and did not do pregnancy exercise were not smooth (9%). The data analysis obtained the results with a p-value (0.000) and an error rate of the p-value (0.05). Conclusion H0 is rejected, and H1 is accepted. This means that there is a relationship between pregnancy exercise and the duration of the second stage of labor in primigravida in the Ambunten Health Center Work Area. This study concludes that respondents who did pregnancy exercise experienced a smooth process of the second stage of labor. Thus, it is recommended that respondents be more active in carrying out pregnancy exercises and that health workers intensify pregnant women to participate in classes for pregnant women.

Compassionate and respectful maternity care for mothers who gave birth in public health facilities in North Gondar, Ethiopia: a cross-sectional study

Background Improving the prevalence of compassionate and respectful maternity care is a critical agenda and an important component of healthcare provider quality assurance. Making compassionate and respectful maternity care available is an important way to increase facility-based childbirth use in Ethiopia. However, evidence on compassionate and respectful maternal care during labour delivery services is limited. Therefore, this study aimed to assess compassionate and respectful maternity care, and its predictors, among those who gave birth in health facilities in North Gondar. Methods An institution-based cross-sectional study was conducted from May to July 2020 in a public health facility in North Gondar, Ethiopia. Systematic random sampling was used to select 398 study participants. Data were collected from participants using a pretested structured questionnaire. Bivariate and multivariate logistic regression model analyses with 95% confidence intervals were carried out to identify predictors of compassionate and respectful maternity care. Results A total of 398 respondents participated in the study. The overall prevalence of compassionate, respectful maternal care was 52.5%. Having primary school level education (adjusted odds ratio: 1.96), having attended antenatal care (adjusted odds ratio: 2.92), labour lasting for less than 6 hours (adjusted odds ratio: 2.22), and the intention to give birth in a health facility (adjusted odds ratio: 3.06) were significant predictors of compassionate and respectful maternity care. Conclusions The prevalence of compassionate and respectful maternity care was low and violations of women's rights are an important barrier to women seeking to give birth in a health facility. Hence, to promote high-quality maternal health services, health professionals must practice women-friendly approaches to improve the relationship between health workers and mothers during their stay at health facilities. Enforcing respectful maternity care is vital to strengthen maternal services and improve the rate of institution-based birth.

Cytokines and pregnancy complications: modulation for prevention and treatment

“There is many a slip twist the cup and the lip” is a proverb that dates back to the 3rd century. This proverb comes to mind while writing a review on pregnancy loss; so many complications can occur between fertilization and development of the embryo through the long period of gestation until successful delivery of the baby. These include failure of implantation of the embryo, spontaneous miscarriage in the first trimester, pre-eclampsia in the second trimester, premature rupture of fetal membranes, pre-term labour, and pre-term delivery. The maternal immune system which does a phenomenal job of protecting the host from a daunting variety of infections, sometimes also mounts adverse reactions that complicate pregnancy and endanger the fetus. Maternal immune reactions that can adversely affect pregnancy have been shown to be mediated by lymphocytes, macrophages and natural killer cells, and by cytokines secreted by these cellular effectors. This review summarizes the deleterious effects of cytokines leading to recurrent spontaneous miscarriage, pre-eclampsia and pre-term delivery, which are the major complications of pregnancy. It then goes on to discuss the potential use of progesterone and dydrogesterone, an orally-administered progestogen, as immunomodulatory molecules that can be considered for the prevention and/or treatment of these complications.

Labor induction in China: a nationwide survey

BackgroundOvermedicalization in labor management and delivery, including labor induction, is an increasing global concern. But detailed epidemiological data on labor induction in China remains unclear.MethodsThis was a cross-sectional study of data (2015–2016) from 96 hospitals in 24 (of 34) Chinese administrative divisions. Multivariable logistic regression analysis was used to assess the association between medical conditions and cesarean delivery among women undergoing induction. Linear regression analysis was performed to assess the association between the prelabor cesarean delivery and labor-induction rates in each hospital. The impacts of labor induction and prelabor cesarean delivery on maternal and neonatal outcomes were compared in low-risk women.ResultsAmong 73 901 eligible participants, 48.1% were nulliparous. The overall weighted rate of labor induction in China was 14.2% (95% CI, 11.1–17.2%), with 18.4% (95% CI, 14.5–22.3%) in nulliparas and 10.2% (95% CI, 7.7–12.8%) in multiparas. Regardless of the induction method, the overall vaginal delivery rate was 72.9% (95% CI, 68.6–77.3%) in nulliparas and 86.6% (95% CI, 79.7–93.5%) in multiparas. Hospitals with a higher rate of nonmedically indicated cesarean delivery had a lower labor-induction rate in nulliparas (β = − 0.57%; 95% CI, − 0.92 to − 0.22%; P = 0.002). Compared with prelabor cesarean delivery, labor induction in low-risk women was not associated with adverse maternal and neonatal outcomes.ConclusionThe 2015–2016 labor-induction rate in China was 18.4% in nulliparas and 10.2% in multiparas. The proportion of prelabor cesarean delivery may contribute to regional differences in the labor-induction rate. Compared with prelabor cesarean delivery, labor induction in low-risk women may not increase severe maternal and neonatal morbidity.

Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial.

Cesarean scar defect (CSD) is a long-term outcome of cesarean section (CS) and associated with numerous gynecological and obstetric problems. Previous studies indicate that infection may be a risk factor for CSD. Adjunctive azithromycin was shown to reduce the risk of postoperative infection in patients undergoing non-elective primary cesarean delivery in labor or after the rupture of membranes compared with standard antibiotic prophylaxis. This study investigated the protective effect of adjunctive azithromycin in combination with single-dose cephalosporin against CSD in women undergoing non-elective cesarean delivery. A randomized, double-blind, controlled clinical trial was conducted in a University hospital in Shanghai, China. A total of 242 women who underwent their first non-elective CS were randomly assigned to receive 1500 mg cefuroxime sodium plus 500 mg intravenous azithromycin (n=121; experimental group) or 1500 mg cefuroxime sodium plus a placebo (n=121; placebo group). The primary outcome was CSD prevalence, as determined by transvaginal ultrasound and saline infusion sonohysterography within 6months of delivery. Secondary outcomes were changes in infectious indicators (eg hypersensitive C-reactive protein and procalcitonin), postoperative morbidity, and use of postoperative antibiotics. We also examined the operative procedure, pathogenic microorganism cultures, and fetal outcomes. Outcomes were compared between groups with the chi-squared test, Fisher's exact test, or Student's t test. Between May 2018 and May 2021, 121 women were randomized to each arm. Because the sonographic follow up was disrupted by the coronavirus disease 2019 pandemic and strict management policies, we merged the follow-up time points (6 weeks and 6months) into a single time period (6 weeks to 6months); 104 and 108 women in the experimental and placebo groups, respectively, completed the first sonographic follow up. CSD was diagnosed by sonography in 34/104 (32.7%) and 50/108 (46.3%) patients in the experimental and placebo groups, respectively (relative risk 0.71, 95% confidence interval 0.50-0.99; p=0.043). Characteristics of CSD and short-term infection outcomes did not differ between groups. A single dose of intravenous 500 mg azithromycin adjunctive to single-dose cefuroxime prophylaxis significantly reduced the incidence of CSD in women undergoing non-elective CS.

Development of a comprehensive database for research on foetal acidosis

ObjectiveTo develop a research database for mother-and-child clinical and laboratory data and digital foetal heart rate (FHR) recordings. MethodsThe Base Bien Naître (BBN) database was derived from a single-centre health data warehouse. It contains exhaustive data on all parturients with a singleton pregnancy, a vaginal or caesarean delivery in labour with a cephalic presentation after at least 37 weeks of amenorrhea, and a live birth between February 1st, 2011, and December 31st, 2018. On arrival in the delivery room, the FHR was recorded digitally for at least 30 min. A cord blood sample was always taken in order to obtain arterial pH (pHa). More than 6,000 recordings were analyzed visually for the risk of foetal acidosis and classified into five groups (according to the French College of Gynaecologists and Obstetricians (CNGOF) classification) or three groups (according to the International Federation of Gynaecology and Obstetrics (FIGO) classification). ResultsOf the 16,089 files in the health data warehouse, 11,026 were complete and met the BBN’s inclusion criteria. The FHR digital recordings were of good quality, with low signal loss (median [interquartile range]: 7.0% [4.3;10.9]) and a median recording time of 304 min [190;438]). In 3.7% of the children, the pHa was below 7.10. We selected a subset of 6115 records with good-quality FHR recordings over 120 min and reliable cord blood gas data: 692 (11.3%) had at least a significant risk of acidosis (according to the CNGOF classification), and 1638 (26.8%) were at least suspicious (according to the FIGO classification). ConclusionThe BBN database has been designed as a searchable tool with data reuse. It currently contains over 11,000 records with comprehensive data.

Designing a respectful maternity care guideline: a multiphase study

BackgroundThere is no comprehensive guideline for respectful maternity care (RMC) promotion in Iran. This study aimed to design a RMC guideline based on a multiphase study.MethodsIn this multiphase mixed-methods study, recommendations were made for RMC promotion through the data obtained from Phase I (i.e., the quantitative section with a cross-sectional design), Phase II (i.e., the qualitative section with a content analysis method), and Phase III (i.e., focus group discussions with birth attendants as well as opinions of the specialized panel through the Delphi technique). The composed recommendations were then analyzed and finalized by relevant specialists in terms of execution capacity, approvability, and cost-effectiveness within the current context of Iran. Eventually, the resultant guideline were evaluated and approved by two members of the research team specializing in the research area in accordance with the Appraisal of Guideline for Research and Evaluation (AGREE).ResultsThe results of this multiphase study led to 80 recommendations for RMC promotion. The recommendations were classified as eight areas called recommendations for the pregnancy period, recommendations for the labor period and delivery, recommendations for the neonatal period, occupational recommendations, supervision recommendations, national policy recommendations, recommendations for training students and staff, and general public recommendations.DiscussionBased on the outcomes of disrespect and abuse, it is recommended to provide comprehensive guideline for policymakers and planners to formulate plans through the RMC promotion approach. Healthcare service policymakers can use this guideline to design some interventions to meet women’s financial, psychological, and legal needs.

Obstetric outcomes of young women following in-vitro fertilization: a case\u2013control study

BackgroundWomen undergoing in-vitro fertilization (IVF) treatments are at increased risk for maternal and neonatal complications compared to women who conceive spontaneously. Though spontaneous pregnancies of young women and adolescents have an increased risk for adverse maternal and neonatal outcomes, pregnancy outcomes of this age group, following IVF treatment have been scarcely reported. The aim of this study was to report maternal and neonatal outcomes of young women who conceived following IVF compared to women in the same age group with spontaneous conception.MethodsWe performed a multicenter case–control study. The study group included women aged 17–25 years who conceived by IVF with an ongoing singleton pregnancy. For the purpose of the study, a control group matched (1:2 ratio) for maternal age at delivery and parity was constructed. Demographic, medical history, pregnancy related characteristics and maternal and neonatal outcomes were compared between groups. Finally, factors associated with spontaneous vaginal delivery were assessed for the entire cohort using a univariate and multivariate logistic regression model.ResultsBetween 2005 and 2021, we identified 80 women aged 19–25 years who conceived by IVF. A control group of 160 women was matched to the study group by age and parity. The unmatched maternal characteristics and pregnancy associated complications were similar among the groups. However, the IVF group had a significantly higher rate of induction of labor (48.1% vs. 26.6%, p = 0.001), meconium-stained amniotic fluid (27.6% vs. 14.1%, p = 0.025), prolonged second stage of labor (26.0% vs. 7.3%, p = 0.001) and operative vaginal delivery (22.5% vs.12.5%, p = 0.048).Neonatal outcomes were for the most part comparable; nevertheless, we found a higher rate of neonates with an umbilical artery pH < 7.1 in the IVF group (9.8% vs. 0.0%, respectively; p = 0.022).A logistic regression analysis for spontaneous vaginal delivery (vs. cesarean or operative vaginal deliveries) found that spontaneous onset of labor (vs. induction of labor) (OR = 2.08; 95% CI = 1.07–4.05, p = 0.03) was positively associated with spontaneous vaginal delivery while prolonged second stage of labor (OR = 0.35; 95% CI = 0.13–0.95, p = 0.04) was negatively associated with this parameter.ConclusionYoung women who conceive by in-vitro fertilization are expected to reach favorable pregnancy outcomes, comparable to women who conceived spontaneously.

EFFECT OF MATERNAL BODY MASS INDEX ON THE MODE OF DELIVERY AND NEONATAL OUTCOME: A TERTIARY CARE HOSPITAL BASED STUDY IN SOLAN, HIMACHAL PRADESH.

INTRODUCTION: Obesity is a global health problem characterised as a pandemic issue by the World Health Organization (WHO), with a higher prevalence in females than males. During pregnancy, it is considered a high-risk state because it is associated with maternal complications like preeclampsia, gestational diabetes, obstetric interventions like caesarean delivery, postpartum haemorrhage; and fetal complications like macrosomia, poor apgar scores. BMI is a commonly used indicator which can be used to classify subjects on the basis of weight.AIM: This study aims to find the prevalence of normal weight, overweight and obese pregnant women defined by body mass index (BMI) according to the WHO classification and to study the associations between maternal BMI, the mode of delivery and neonatal outcome.MATERIAL AND METHODS: 200 pregnant women admitted for delivery in the department of Obstetrics &amp; Gynaecology were studied, height and weight were recorded from reliable antenatal records (recorded within two months of gestation). The Body Mass Index was calculated and patients were divided into four categories: Category I: underweight; Category II: normal BMI; Category III: Overweight; Category IV: Obese. The feto-maternal outcomes were studied.RESULTS: On evaluation of 200 nulliparous antenatal women with singleton term gestation, 1.5% were underweight, 33% had normal BMI, 56% were overweight and 9.5% were obese. The prolongation of labour was seen in subjects with BMI more than 25 kg/m2. Overweight patients had more instrumental deliveries and obese patients had a higher tendency for prolonged labour and caesarean deliveries. Neonatal outcomes were poor for obese and overweight patients as compared to normal BMI because more neonates required resuscitation at birth, had low Apgar scores and were small for gestational age. Maternal complications like Hypothyroidism, preeclampsia and gestational diabetes occurred more commonly in the obese category.CONCLUSION: In our institution, majority of patients were found to be overweight. Adverse perinatal outcomes were seen more often in the obese patients. Hence, obesity must be identified as a risk factor for adverse pregnancy outcomes.

Reduced live birth rates after embryo transfer in patients with prior cesarean delivery: A retrospective cohort study

ObjectiveTo evaluate whether live birth rates following first embryo transfer (ET) among patients after cesarean delivery are lower compared to patients with only prior vaginal delivery. Study designRetrospective cohort study including patients with prior delivery who underwent first subsequent embryo transfer (fresh or frozen) between January 2013 and September 2019. The primary outcome was live birth rate among patients with at least one prior cesarean delivery compared to vaginal delivery only. Secondary outcomes included positive serum hCG, clinical intrauterine pregnancy and miscarriage rates. We performed a subgroup analysis with the cesarean delivery group based on labour status at the time of delivery. We fit a multivariable log-binomial regression model. ResultsTotal of 962 patients met inclusion criteria: 351 in the cesarean delivery group and 611 in the vaginal delivery group. Live birth rate was significantly lower in the cesarean delivery group compared to vaginal delivery group at 30.0% vs 36.9% [aRR 0.81, 95% CI 0.67–0.98]. We also found lower positive hCG [aRR 0.82, 95% CI 0.72–0.94] and clinical pregnancy [aRR 0.85, 95% CI 0.73–0.99]. There was no significant difference in miscarriage rate. A subgroup analysis within the cesarean delivery group in active labour demonstrated significantly lower live birth rates compared to the vaginal delivery group [aRR 0.67, 95% CI 0.49–0.92]. ConclusionsLive birth rates following first ET were significantly lower after cesarean delivery compared to vaginal delivery. These findings may be largely attributable to a subgroup of patients with prior cesarean delivery in active labour who may be at particular risk of reduced live birth rates after ET.

Prediction of neonatal subgaleal hemorrhage using first stage of labor data: A machine-learning based model

BackgroundSubgaleal hemorrhage (SGH) is a rare neonatal condition, mainly associated with instrumental delivery, mainly vacuum extractor (VE). The aim of this study was to develop a machine learning model that would allow a personalized prediction algorithm for Subgaleal hemorrhage (SGH) following vacuum extraction (VE), based on maternal and fetal variables collected during the first stage of labor. Materials and methodsA retrospective cohort study on data from a university affiliated hospital, recorded between January 2013 and February 2017. Balanced random forest algorithm was used to develop a machine learning model to predict personalized risk of the neonate developing SGH, in the eventuality that vacuum extraction was used during delivery. ResultsDuring the study period, 35,552 term, singleton spontaneous or induced trials of labor deliveries were included in this study. Neonatal SGH following vacuum extraction (SGH-VE) occurred in 109 cases (0.3%). Two machine learning models were developed: a proof of concept model (model A), based on a cohort limited to the (n=2955) instances of vacuum extraction, and the clinical support model (model B), based on all spontaneous or induced trials of labor (n=35,552). The models stratified parturients into high- and low-risk groups for development of SGH-VE.Model A showed a 2-fold increase in the high-risk group of parturients compared to the low risk group (OR=2.76, CI 95% 1.85-4.11). In model B, a 4-fold increase in the odds of SGH was observed in the high-risk group of parturients compared to the low risk group (OR=4.2, CI 2.2-8.1), while identifying 90.8% (99/109) of the SGH cases. ConclusionsOur machine learning-based model stratified births to high or low risk for SGH, making it an applicable tool for personalized decision-making during labor regarding the application of VE. This model may contribute to improved neonatal outcomes.

Vaginal cleansing before cesarean delivery in labor to reduce infection: a randomized trial

Surgical site infections following cesarean delivery (CD) are a significant source of postoperative morbidity. Vaginal cleansing prior to CD may reduce infections; however, the quality of evidence regarding efficacy of vaginal preparation is low to moderate. We tested the hypothesis that preoperative vaginal cleansing with povidone-iodine among women undergoing CD after labor would decrease postoperative infectious morbidity.

Comparison of dinoprostone, misoprostol and amniotomy in labor induction.

Comparison of dinoprostone, misoprostol and amniotomy in labor induction. The study group included a total of 437 women who underwent consecutive induction of labor after evaluation of the indication and Bishops score. The most common indications were: postmaturity, hypertensive disease, diabetes mellitus and fetal growth restriction. In 327 cases we chose to induce labor using vaginal tablets of dinoprostone at a dose of 0.75mg, in 36 cases dinoprostone at a dose of 3mg, in 16 cases we used a vaginal insert of misoprostol (200 µg), and in 58 cases amniotomy was performed. In the subgroup of dinoprostone (0.75mg) the rate of vaginal delivery (including extraction delivery) was 90.2%, in the subgroup of dinoprostone (3mg) it was 91.6%, in the subgroup of misoprostol it was 100% and in the subgroup of amniotomy it was 93.1%. The time period between onset of labor induction and delivery was an average of 15.75 hours in the dinoprostone (0.75mg) subgroup, 21.41 hours in the dinoprostone (3mg) subgroup, 17.41 hours in the misoprostol subgroup and 7.49 hours in the amniotomy subgroup. Subgroup of patients with misoprostol showed the highest rate of vaginal delivery after labor induction. In the subgroup with amniotomy, the shortest time period between onset of induction and delivery was reached.

Pregnancy Outcomes among Women with Class III Obesity with Pre-diabetic Early Hemoglobin A1C.

We aimed to assess the risk of developing gestational diabetes mellitus (GDM) in women with a normal A1C (<5.7) compared with those with an A1C in the pre-diabetic range (5.7-6.4). This study comprises of a retrospective cohort of non-anomalous singleton pregnancies with maternal body mass index (BMI) ≥40 at a single institution from 2013 to 2017. Pregnancies with multiple gestation, late entry to care, type 1 or 2 diabetes, and missing diabetes-screening information were excluded. The primary outcome was development of GDM. Secondary outcomes included fetal growth restriction, macrosomia, gestational age at delivery, large for gestational age, delivery BMI at delivery, total weight gain in pregnancy, induction of labor, shoulder dystocia, and cesarean delivery. Bivariate statistics were used to compare demographics, pregnancy complications, and delivery characteristics of women who had an early A1C < 5.7 and A1C 5.7 to 6.4. Multivariable analyses were used to estimate the odds of the primary outcome. Eighty women (68%) had an early A1C <5.7 and 38 (32%) had a A1C 5.7 to 6.4. Women in the lower A1C group were less likely to be Black (45 vs. 74%, p = 0.01). No differences in other baseline demographics were observed. The median A1C was 5.3 for women with A1C < 5.7 and 5.8 for women with A1C 5.7 to 6.4 (p < 0.001). GDM was significantly more common in women with A1C 5.7 to 6.4 (3.8 vs. 24%, p = 0.002). Women with pre-diabetic range A1C had an odd ratio of 11.1 (95% CI 2.49-48.8) for GDM compared with women with a normal A1C. Women with class III obesity and a pre-diabetic range A1C are at an increased risk for gestational diabetes when compared with those with a normal A1C in early pregnancy. · One in 3 women with class III obesity had a pre-diabetic range early A1C.. · Class III obese women who have a pre-diabetic A1C have a higher risk of gestational diabetes.. · In this high-risk population, early A1C results in the pre-diabetic range are associated with higher rates of gestational diabetes..

Feto-Maternal Outcomes of Breastfeeding during Pregnancy: A Systematic Review and Meta-Analysis.

Breastfeeding is beneficial to both mother and infant. However, overlap of lactation with pregnancy and short recuperative intervals may impact mothers nutritionally. We aimed to investigate the possible effects of pregnancy during breastfeeding. In October 2018, we searched systematically in nine electronic databases to investigate any association of breastfeeding during pregnancy with fetal and/or maternal outcomes. The study protocol was registered in PROSPERO (CRD41017056490). A meta-analysis was done to detect maternal and fetal outcomes and complications during pregnancy. Quality assessment was performed using the Australian Cancer Council bias tool for included studies. With 1992 studies initially identified, eight were eligible for qualitative analysis and 12 for quantitative analysis. Our results showed no significant difference in different abortion subtypes between lactating and non-lactating ones. In delivery, no difference between two groups regarding the time of delivery in full-term healthy, preterm delivery and preterm labor. No significant difference was detected in rates of antepartum, postpartum hemorrhage and prolonged labor between two groups. The women with short reproductive intervals may have higher supplemental intake and greater reduction fat store. The present studies showed that breastfeeding during pregnancy does not lead to adverse outcomes in the mother and her fetus in normal low-risk pregnancy, although it may lead to the nutritional burden on the mother. The present studies showed that breastfeeding during pregnancy did not lead to the adverse outcomes in the mother and her fetus.

731. Puerperal Sepsis Among Women with In-facility Births in Western Tanzania

BackgroundPuerperal sepsis is an important cause of maternal mortality worldwide. As access to emergency obstetric services expands in resource-limited settings, rapid recognition and treatment of sepsis, and prevention of nosocomial infections that might lead to sepsis, is critical. We describe puerperal sepsis cases among women with in-facility births in the Kigoma region of Tanzania.MethodsDemographic, obstetric history, pregnancy complication and outcome, as well as mortality data were collected for women who delivered in hospitals, health centers and dispensaries in the Kigoma region, Tanzania 2016 – 2018. Up to 3 maternal complications were recorded as free text. Puerperal sepsis included women where ‘sepsis’ was recorded as a complication during hospitalization. We calculated rates of puerperal sepsis and completed a descriptive analysis of patients.Results203,604 women delivered infants in 197 participating facilities during the data collection period. Of these, 2228 (1.1%) had sepsis recorded, for an overall rate of 10.9 sepsis cases per 1000 deliveries. Although 48% of births occurred in dispensaries, sepsis complications were reported almost exclusively in hospitals and health centers (37.7 and 10.3 per 1000 deliveries, respectively). Sepsis rates varied across individual facilities, from 15.5 to 45.2 cases per 1000 deliveries in hospitals and 0 to 38.6 cases per 1000 deliveries in health centers. Women who developed sepsis had a median age of 25 (IQR 22 – 30) years and 1113 (56%) were nulliparous. 1763 (90%) of women who had sepsis delivered by caesarian delivery. Obstructed labor (827; 42%) was a common co-complication of sepsis; obstetric hemorrhage and uterine rupture were seen in 93 (5%) and 77 (4%) women with sepsis, respectively. 49 women with sepsis (3%) died prior to hospital discharge. Stillbirths and pre-discharge neonatal deaths complicated 107 (5%) and 74 (4%) deliveries to women with sepsis.ConclusionIn the Kigoma region of Tanzania puerperal sepsis frequently occurs in women with obstructed labor and caesarian delivery. Further evaluation of both facility-level and individual factors that contribute to the incidence of sepsis in this population, particularly those related to invasive procedures, is critical for early recognition and prevention. issueDisclosures All Authors: No reported disclosures

Effects of Modes and Timings of Delivery on Feto-Maternal Outcomes in Women with Severe Preeclampsia: A Multi-Center Survey in Mainland China.

BackgroundPregnancy termination is the only effective treatment for preeclampsia. However, there are controversies on the selection of modes of delivery. The objective was to evaluate whether mode of delivery in labor differentially affected the rate of adverse maternal outcomes related to severe preeclampsia.ObjectiveThis study aimed to evaluate whether the modes and timings of delivery affects adverse maternal outcomes in pre-eclampsia.MethodsClinical data from 2516 singleton pregnant women with severe preeclampsia were collected in a multicenter, large-sample, cross-sectional study in mainland China. The patients were divided into cesarean-delivery (CD) and vaginal-delivery (VD) categories and then into Group 1 (≤27+ 6 weeks), Group 2 (28–33+ 6 weeks), Group 3 (34–36+ 6 weeks), and Group 4 (≥37 weeks) according to the mode of delivery and gestational weeks. All data were exported into the SPSS software and analyzed by the Student’s t-tests or Mann–Whitney U-tests and the chi-squared test.ResultsA total of 2516 singleton pregnant women with severe preeclampsia were collected and the overall cesarean section rate was 84.9%. The vaginal delivery rates among the four groups were significantly different with 70%, 19.7%, 6.6%, 15.1% in groups 1, 2, 3, 4, respectively (P<0.05), while perinatal mortality was lower in the CD groups than VD groups (3.3% vs 50.4%, P<0.05). The neonatal asphyxia rate was significantly higher with CD than with VD in Group 2 (36.4% vs 12.9%, P<0.05). The perinatal mortality with CD, 3, and 4 was significantly lower than with VD (10.0% vs 68.5% in Groups 2, 2.3% vs 28.3% in Groups 3, 0.8% vs 5.6% in Groups 4, all P<0.05).ConclusionMost pregnant women with severe preeclampsia opted for a cesarean section in China. The lower perinatal mortality was associated with cesarean section, but the rate of maternal PPH or mortality was not related with the mode of delivery. So cesarean section is the safer delivery mode for the pregnant women complicated with severe preeclampsia.

Risk of caesarean delivery in labour induction: a systematic review and external validation of predictive models.

Despite the existence of numerous published models predicting the risk of caesarean delivery in women undergoing induction of labour (IOL), validated models are scarce. To systematically review and externally assess the predictive capacity of caesarean delivery risk models in women undergoing IOL. Studies published up to 15 January 2021 were identified through PubMed, CINAHL, Scopus and ClinicalTrials.gov, without temporal or language restrictions. Studies describing the derivation of new models for predicting the risk of caesarean delivery in labour induction. Three authors independently screened the articles and assessed the risk of bias (ROB) according to the prediction model risk of bias assessment tool (PROBAST). External validation was performed in a prospective cohort of 468 pregnancies undergoing IOL from February 2019 to August 2020. The predictive capacity of the models was assessed by creating areas under the receiver operating characteristic curve (AUCs), calibration plots and decision curve analysis (DCA). Fifteen studies met the eligibility criteria; 12 predictive models were validated. The quality of most of the included studies was not adequate. The AUC of the models varied from 0.520 to 0.773. The three models with the best discriminative capacity were those of Levine et al. (AUC 0.773, 95% CI 0.720-0.827), Hernández et al. (AUC 0.762, 95% CI 0.715-0.809) and Rossi et al. (AUC 0.752, 95% CI 0.707-0.797). Predictive capacity and methodological quality were limited; therefore, we cannot currently recommend the use of any of the models for decision making in clinical practice. Predictive models that predict the risk of cesarean section in labor inductions are currently not applicable.

Prototype of Prefabricated Brick with Special Passes for Functional and Safe Electrical and Sanitary Installations on Confined Masonry

For years, construction processes and materials have evolved and are standardized to be more efficient. One of the most used materials in construction, specifically in walls, is brick. Whether concrete or clay, which includes the installation of water pipes, light and / or ventilation becoming one of the most laborious and noisy processes that generate more unusable waste when making the passes. Based on this problem, this research proposes a solution using a brick prototype for efficient construction in water, light and/or ventilation pipe installation issues. This alternative helps reduce labor, costs, sound pollution, element damage, waste, environmental impact and project delivery time, which is the most desired achievement of any contractor.