Delivery In Term Pregnancies Research Articles

Fetal Fibronectin and Cervical Length as Predictors of Spontaneous Onset of Labour and Delivery in Term Pregnancies.

(1) Objective: This study aimed to determine whether qualitative fetal fibronectin and transvaginal sonographic measurement of cervical length are effective in predicting delivery in term pregnancies within 5 days of the test. (2) Methods: We examined 268 women with singleton pregnancies presenting themselves at 37+0–40+4 weeks (median 38 weeks + 1 day) of gestation with irregular and painful uterine contractions, intact membranes and cervical dilatation less than 2 cm. All women were admitted to hospital up to 72 h after birth. On admission, a qualitative fetal fibronectin test was performed in cervicovaginal secretions and transvaginal sonographic measurement of cervical length was carried out. The primary outcome measure was delivery within 5 days of presentation. RESULTS: Among the women who delivered within 5 days after admission, 65.2% had positive fFN assessment, 43.5% had cervical length below 26 mm, 52.2% had the age > 32.5 years, 34.8% were nulliparous and 56.5% had gestational age ≥ 275 days. Logistic regression analysis demonstrated that significant contributors to the prediction of delivery within 5 days were fibronectin positivity, cervical length ≤ 26 mm, maternal age > 32.5 years and gestational age ≥ 275 days, with no significant contribution from parity. (3) Conclusions: Qualitative fetal fibronectin test and transvaginal cervical length measurement in term pregnancies are useful tests for predicting spontaneous onset of labour within 5 days. It helps women and healthcare providers to determine the optimum time for hospital admission.

Birth weight prediction by Lee formula based on fractional thigh volume in term pregnancies - is it helpful?

IntroductionUltrasonographic estimation of fetal weight (EFW) is a standard obstetrical procedure in daily clinical practice. Formulas for calculating EFW most commonly are a combination of two-dimensional measurements. A relatively new approach is the use of three-dimensional measurements such as fractional thigh volume (TVol) incorporated into specific regression equations. The objective of this study was to compare the Lee formula based on three-dimensional ultrasonographic TVol in the estimation of fetal weight before delivery in term pregnancies to the Hadlock I formula.Material and methods2D/3D abdominal ultrasonography was performed in 104 women, 37–41 gestational weeks, and measurements of biparietal diameter, head circumference, abdomen circumference, and femur length, TVol were taken. Using these measurements, we compared the Lee to the Hadlock formulas in EFW. The timing of procedures was measured in 20 randomly chosen patients by an independent observer.ResultsMean percentage errors of formulas, Lee vs. Hadlock, were 2.13 ±9.31% vs. –2.02 ±8.79%, (p = 0.001). There was no statistically significant difference in median absolute percentage errors between the two formulas (6.09% vs. 6.10%, p = 0.56). The proportion of newborns with estimated birth weights (BW) within ±10% of actual BW was not significantly different between the two formulas (73% vs. 71%, p = 0.11). There was a significant difference in the proportion of the newborns with estimated BW within ±5% (33% vs. 42%, p = 0.000006). Statistical measurements for test performance in detecting fetuses with BW ≥ 4000 g were sensitivity 85% vs. 60%, specificity 88% vs. 96%, and accuracy 88% vs. 89%. There was no significant difference in the time to perform the measurements (69 s for Lee formula vs. 58 s for Hadlock formula, p = 0.16).ConclusionsThigh volume measurement incorporated into the Lee single parameter formula is comparable to the Hadlock I formula in terms of accuracy in predicting fetal weight before delivery. There was no significant difference in the time needed for taking necessary measurements between the two groups.

Sonographic prediction of macrosomia in pregnancies complicated by maternal diabetes: finding the best formula.

To evaluate the best performing formula for macrosomia prediction in pregnancies complicated by diabetes. A retrospective analysis was performed of 1060 sonographic fetal biometrical measurements performed within 7days of delivery in term pregnancies (37-42 gestational weeks) complicated by diabetes. Sonographic prediction of macrosomia (≥ 4000, ≥ 4250, and ≥ 4500 g) was evaluated utilizing ten previously published formulas by: (1) calculating for each macrosomia threshold the sensitivity, specificity, positive and negative predictive value, and ± likelihood ratio for macrosomia prediction; (2) comparing the systematic and random error and the proportion of estimates < 10% of birth weights between macrosomic and non-macrosomic neonates. Best performing formula was determined based on Euclidean distance. 97 (9.2%) macrosomic neonates (> 4000 g) were included. Median birth weight was 3380 (1866-3998)g for non-macrosomic and 4198 (4000-5180)g for macrosomic neonates. Higher macrosomia cutoff was associated with higher specificity and lower sensitivity. We found a considerable variation between formulas in different accuracy parameters. Hadlock's formula (1985), based on abdominal circumference, femur length, head circumference and biparietal diameter, had the shortest Euclidean distance, reflecting the highest accuracy. Prediction of macrosomia among women with diabetes differs significantly between formulas. In our cohort, the best performing formula for macrosomia prediction was Hadlock's formula (1985).

Sonographic prediction of small and large for gestational age in breech-presenting fetuses

Abstract Introduction: To evaluate various sonographic estimated fetal weight (sEFW) formulas’ accuracy for small- and large-for-gestational age (SGA/LGA) prediction in breech-presenting fetuses. Materials and methods: A retrospective analysis of all ultrasound-based fetal biometrical measurements performed within 3 days of delivery in term pregnancies, in one medical center (2007–2014). Overall, 274 breech-presenting fetuses (study group) were compared to 274 vertex-presenting fetuses (control group) matched by gender, gestational age and birth weight. sEFW was calculated by six previously published formulas. Accuracy was compared utilizing systematic error and random error for every formula. Prediction precision of SGA and LGA was evaluated by calculating each formula’s sensitivity, specificity, +/− predictive value, and the area under the receiver-operating characteristic (ROC) curve (AUC). Results: Systematic error and random error varied greatly between formulas, ranging from −7.4% to 3.1%, 7.3% to 8.3% for the vertex-presenting fetuses and −8.9% to 1.9%, 7.9% to 8.6% for the breech-presenting fetuses, respectively. There was no statistical difference in small- or large-for-gestational age prediction parameters between the groups. The highest sensitivity and specificity for prediction was achieved by same formula regardless of presentation. Conclusion: In our cohort, overall accuracy was slightly superior among vertex-presenting fetuses without difference in prediction accuracy for small- and large-for-gestational age neonates.

Correlation analysis between social support and primipara parent-child relationship

Objective To explore the effects of social support on primipara parent-child relationship. Methods Two hundred and forty primiparas who had a full term pregnancy delivery in a level three class A hospital between April 2014 and March 2015 were included according to the convenience sampling method. All the primiparas were investigated with postpartum social support scale and Chinese version parent-child relationship scale designed by Lu Hong in Peking University School of Nursing. Results The primipara parent-child relationship showed a medium level. The educational level of the primiparas and their family income influenced the effects of their parent-child relationship (P<0.05). In the social support scale, the emotional support was positively correlated with children consciousness (r=0.502, P=0.004); the information support showed a negative correlation with mother-child conflicts (r=-0.405, P=0.003); the evaluation support and the emotional support were positively correlated with mother consciousness (r=0.498, P=0.002). Conclusions It is very significant to improve social support contents of primiparas actively for establishing parent-child relationship of high quality, promoting primipara′s adaption of the mother role and the good development of newborns′ psychology and physiology. Key words: Social support; Primipara; Parent-child relationship

Transvaginal ultrasound of cervical length and its correlation to digital cervical examination, time to spontaneous labor and mode of delivery

The objective of this study was to determine if transvaginal ultrasound (TVUS) examination of cervical length correlates to digital pelvic examination and if it can predict time to and mode of delivery in term pregnancies. We conducted a prospective cohort study of 726 consecutive non-laboring, term pregnant women presenting to University-based antenatal testing unit between 1 July 2001 and 31 March 2002. Subjects underwent a TVUS for cervical length followed by a digital cervical examination by a physician blinded to the results of the ultrasound. Linear regression analysis was used to correlate the findings of cervical length by ultrasound with cervical dilatation and effacement by digital examination. In 726 women, the relationship between TVUS cervical length and cervical dilatation and effacement measured digitally were found to be significantly related (p < 0.001), but weak, with a 15 and 23% goodness of fit, respectively, based on the linear model. Using multivariate logistic and linear regression, respectively, TVUS cervical length predicted mode of delivery but did not predict time to spontaneous labor. Digital measurement of cervical dilatation was predictive of time to spontaneous labor. There is a statistically significant correlation between TVUS measurement of cervical length and digital cervical exam though the correlation is weak. TVUS measurement of cervical length was predictive of mode of delivery while controlling for digital cervical examination, parity and time to spontaneous labor. Digital cervical dilatation was predictive of time to spontaneous delivery.

Randomized Trial of Vaginal Prostaglandin E2 Versus Oxytocin for Labor Induction in Term Premature Rupture of Membranes

The aim of this study was to compare the efficacy and safety of a prostaglandin E(2) (PGE(2)) vaginal insert with those of oxytocin for labor induction. The present study also examined whether its use reduces the rate of cesarean delivery in term pregnancies with premature rupture of membranes (PROM) and low Bishop scores. A total of 240 women with singleton pregnancies at >or= 37 weeks, no prior uterine scar, vertex presentations, reactive nonstress tests, PROM for >or= 12 hours and Bishop scores of <or= 6 were randomly assigned to receive either oxytocin or vaginal PGE(2). The primary outcomes were time from induction to delivery and mode of delivery. The time from labor induction to active labor onset was significantly shorter in the oxytocin group than in the PGE(2) group (4.9 +/- 4.1 vs. 8.5 +/- 3.6 hours; p = 0.02). The time from induction to delivery was also significantly shorter in the oxytocin group (3.4 +/- 1.5 vs. 9.6 +/- 4.7 hours; p = 0.02). Cesarean delivery rates were statistically similar in the oxytocin and PGE(2) groups (18.3 vs. 20.0%; p = 0.81). Neonatal outcomes were comparable in both groups. Comparable results were observed for nulliparous women included in the study population. Oxytocin treatment seems to be superior to vaginal administration of PGE(2) to induce labor in term pregnancies complicated with PROM and unfavorable services.

C-Reactive Protein and the Mode of Onset of Labor in Term Pregnancies

Wiser, A.; Sivan, E.; Dulitzki, M.; Chayen, B.; Schiff, E.; Bar-Chaim, A.; Simchen, M. J. Author Information

C‐reactive protein and the mode of onset of labor in term pregnancies

To evaluate whether C-reactive protein (CRP) levels in maternal serum at post-date follow-up can predict the mode of onset of spontaneous delivery in term pregnancies and the interval to delivery. Women at 40 completed weeks of gestation were recruited. The interval from CRP sampling to delivery and mode of onset of delivery were noted. Sixty women were divided into 3 groups according to the mode of onset of labor. Group A presented with spontaneous onset of contractions, Group B presented with pre-labor ruptured membranes (PROM), and Group C completed 42 weeks without spontaneous initiation of labor. There was no association between CRP values and latency from time of sampling to delivery. Mean serum CRP in Group B (12.7 mg/l) was significantly higher than in either Group A(7.2 mg/l) or Group C (10.2 mg/l) (p=0.01). In addition, CRP values in the upper quartile (>12.2 mg/l) had a 37.5%positive predictive value for PROM, with a negative predictive value of 93%. Women whose labor will start with PROM have higher CRP values at post-date follow-up than women whose labor starts otherwise.

Pathogens in Maternal Blood and Fetal Cord Blood Using Q-Pcr Assay

To evaluate the rates of infection of asymptomatic fetuses and mothers through fetal cord blood and maternal blood examination results. Quantitative PCR (Q-PCR) was used to detect pathogens in maternal peripheral blood and fetal cord blood after delivery of term pregnancy at Buddhist Tzu Chi Medical Center, Hualien, between July 2002 and June 2003. We used Q-PCR to detect pathogens in 29 samples of maternal blood. The maternal hepatitis B virus (HBV) DNA detection rate was 51.72% (15/29); for human cytomegalovirus DNA, the detection rate was 10.34% (3/29) and for Chlamydia trachomatis DNA the detection rate was 3.45% (1/29). No Neisseria gonorrhoeae DNA was detected. Whereas, in 29 samples of paired fetal cord blood, the detection rates were 27.59% (8/29), 10.34% (3/29), and 3.45% (1/29) for HBV DNA, C. trachomatis DNA, and N. gonorrhoeae DNA, respectively. No human cytomegalovirus DNA was detected in fetal cord blood. Our results revealed an unexpectedly high incidence of pathogens in fetal cord blood. Screening for the above pathogens in donor cord blood in cord blood banks using Q-PCR is strongly urged to decrease morbidity and mortality rates in fetal cord blood stem cell transplant recipients.

Prospective delivery of reliably dated term infants of diabetic mothers without determination of fetal lung maturity: comparison to historical control

Objective: To determine whether omitting fetal lung maturity (FLM) testing prior to delivery in term pregnancies complicated by gestational (GDM) and pregestational diabetes mellitus would increase the risk of neonatal respiratory distress syndrome (RDS). Methods: In a 2-year study (1990-91), 1457 pregnant women with accurately dated pregnancies were enrolled after 37 completed weeks and prospectively followed through delivery without FLM testing (study group). The prevalence of RDS and other neonatal outcomes was compared with a historical control group (n = 713, 1988-89) who had undergone determination of lecithin/sphingomyelin ratio prior to delivery at term. Logistic regression analysis was performed to determine independent predictors of RDS. Results: The study group compared to the control group had less severe diabetes: diet-controlled GDM, 35% vs. 18%, respectively; insulin-requiring GDM, 42% vs. 42%, respectively; undiagnosed type-2 diabetes, 14% vs. 31%, respectively; and pre-existing diabetes, 9.6% vs. 8.8%, respectively, p < 0.001. RDS rates in the study group (0.8%) and control group (1.0%) were not significantly different, nor were rates of resuscitation at delivery, neonatal intensive care admission or hospitalization days. Logistic regression analysis found only Cesarean delivery to be independently predictive (adjusted OR 2.21, 95% CI 2.04-2.27) of RDS. Non-predictive variables included FLM testing, diabetic classification, insulin use, poor third-trimester glycemic control, chronic hypertension, pre-eclampsia, labor, neonatal gender, gestational age or large-for-gestational-age fetuses. Conclusions: Routine FLM testing did not change the RDS prevalence in reliably dated, term infants of diabetic mothers and should be abandoned. Delivery by Cesarean section was associated with increased RDS.

The effect of intrapartum magnesium sulfate therapy on fetal cardiac troponin I levels at delivery

Objective: To determine whether intrapartum magnesium sulfate (MgSO4) therapy for seizure prophylaxis in pre-eclampsia-eclampsia is associated with biochemical evidence of subacute fetal myocardial damage at delivery. Study design: Troponin I, a cardiac-specific protein used to detect myocardial injury, was measured from the umbilical vein at delivery in term pregnancies complicated by pre-eclampsia and uncomplicated control pregnancies. Women with pre-eclampsia received intravenous MgSO4 as a 6-g load followed by 2 g/hour until delivery. Clinical characteristics and fetal troponin levels were compared between groups. Results: There was no difference in troponin I concentrations between term patients with intrapartum MgSO4 therapy and controls who did not receive MgSO4 (median 0.86 ng/ml, range 0.72-1.10 vs. 0.89 ng/ml, range 0.68-1.50; p = 1.0). There was also no statistically significant difference in the number of patients with a troponin I level of ≥ 1.0 ng/ml between groups (30.8% (4/13) vs. 15.4% (4/26); p = 0.4). Conclusions: Our findings suggest that, in term fetuses that are not growth impaired, exposure to intrapartum MgSO4 is not associated with subacute myocardial injury.

Prospective delivery of reliably dated term infants of diabetic mothers without determination of fetal lung maturity: comparison to historical control

Objective: To determine whether omitting fetal lung maturity (FLM) testing prior to delivery in term pregnancies complicated by gestational (GDM) and pregestational diabetes mellitus would increasethe risk of neonatal respiratory distress syndrome (RDS).Methods: In a 2-year study (1990-91), 1457 pregnant women with accurately dated pregnancies were enrolled after 37 completed weeks andprospectively followed through delivery without FLM testing (study group). The prevalence of RDS and other neonatal outcomes was compared with a historical control group (n = 713, 1988-89) who hadundergone determination of lecithin/sphingomyelin ratio prior to delivery at term. Logistic regression analysis was performed to determine independent predictors of RDS.Results: The study groupcompared to the control group had less severe diabetes: diet-controlled GDM, 35% vs. 18%, respectively; insulin-requiring GDM, 42% vs. 42%, respectively; undiagnosed type-2 diabetes, 14% vs. 31%, respectively;and pre-existing diabetes, 9.6% vs. 8.8%, respectively, p < 0.001. RDS rates in the study group (0.8%) and control group (1.0%) were not significantly different, nor were rates of resuscitationat delivery, neonatal intensive care admission or hospitalization days. Logistic regression analysis found only Cesarean delivery to be independently predictive (adjusted OR 2.21, 95% CI 2.04-2.27) of RDS.Non-predictive variables included FLM testing, diabetic classification, insulin use, poor third-trimester glycemic control, chronic hypertension, pre-eclampsia, labor, neonatal gender, gestational age orlarge-for-gestational-age fetuses.Conclusions: Routine FLM testing did not change the RDS prevalence in reliably dated, term infants of diabetic mothers and should be abandoned. Delivery byCesarean section was associated with increased RDS.

Why are cesarean delivery rates so high in diabetic pregnancies?

The purpose of this study was to examine factors relevant to mode of delivery in term pregnancies complicated by gestational and pre-gestational diabetes. A retrospective chart review of term (> or = 37 weeks) singleton pregnancies complicated by Class A2 through Class R pregnancies which delivered from 1991-1997 was performed. Exclusion criteria were prior cesarean delivery, non-vertex presentation, fetal structural defects, or any contraindications to vaginal delivery. Maternal and fetal factors relevant to mode of delivery were examined and compared. Stepwise logistic regression analysis was performed to examine factors predictive of delivery mode. A total of 148 patients met study criteria. Induction rates were 60.9% for gestational and 79.8% for pre-gestational diabetics. The overall cesarean delivery rate by Diabetes Class for A2, B, C, D-F pregnancies was 20.3%, 40%, 37%, and 57.1% respectively. In Class A2 pregnancies no factor was associated with cesarean delivery and only nulliparity (p = 0.03) was associated in Class B-F pregnancies. These results suggest that physician factors may play an important role in the risk for cesarean delivery in our diabetic population.

Immediate maternal and neonatal effects of low-forceps delivery according to the new criteria of The American college of Obstetricians and Gynecologists compared with spontaneous vaginal delivery in term pregnancies

OBJECTIVE: Our purpose was to investigate the maternal and neonatal effects of elective low-forceps delivery, as currently defined by the 1988 criteria of The American College of Obstetricians and Gynecologists. STUDY DESIGN: During a 6-month period we conducted a prospective study that included 50 nulliparous term parturients who were randomly allocated to spontaneous or elective low-forceps delivery. Patients with either maternal or fetal disorders that could affect the outcome were excluded. All deliveries were attended by three experienced obstetricians. RESULTS: Spontaneous and forceps delivery groups were similar regarding maternal or gestational age, fetal scalp pH, antepartum maternal hemoglobin and hematocrit levels, maternal outcome, mean birth weight, and number of neonates with low Apgar scores or cord arterial pH <7.20. In the spontaneous delivery group the time elapsed since randomization to delivery was significantly longer (18 vs 10.2 minutes, p < 0.001) and the mean cord arterial pH was significantly lower (7.23 vs 7.27, p = 0.01) than in the forceps delivery group. CONCLUSION: Elective low forces delivery may be used to shorten the second stage of labor without immediate maternal or neonatal side effects.