Rate Of Dystocia Research Articles

Analysis of the Influence of Nursing Intervention on Maternal Dystocia Rate and Neonatal Asphyxia Rate in Delivery Room Nursing

Analysis of the Influence of Nursing Intervention on Maternal Dystocia Rate and Neonatal Asphyxia Rate in Delivery Room Nursing

Antenatal risk score for prediction of shoulder dystocia with focus on fetal ultrasound data

Shoulder dystocia is one of the most threatening complications during delivery, and although it is difficult to predict, individual risk should be considered when counseling for mode of delivery. This study aimed to develop and validate a risk score for shoulder dystocia based on fetal ultrasound and maternal data from 15,000 deliveries. Data were retrospectively obtained of deliveries in 3 tertiary centers between 2014 and 2017 for the derivation cohort and between 2018 and 2020 for the validation cohort. Inclusion criteria were singleton pregnancy, vaginal delivery in cephalic presentation at ≥37+0 weeks' gestation, and fetal biometry data available within 2 weeks of delivery. Independent predictors were determined by multivariate regression analysis in the derivation cohort, and a score was developed on the basis of the effect of the predictors. The derivation cohort consisted of 7396 deliveries with a 0.91% rate of shoulder dystocia, and the validation cohort of 7965 deliveries with a 1.0% rate of shoulder dystocia. Among all women, 13.8% had diabetes mellitus, and 12.1% were obese (body mass index ≥30 kg/m2). Independent risk factors in the derivation cohort were: estimated fetal weight ≥4250 g (odds ratio, 4.27; P=.002), abdominal-head-circumference ≥2.5 cm (odds ratio, 3.96; P<.001), and diabetes mellitus (odds ratio, 2.18; P=.009). On the basis of the strength of effect, a risk score was developed: estimated fetal weight ≥4250 g=2, abdominal-head-circumference ≥2.5 cm=2, and diabetes mellitus=1. The risk score predicted shoulder dystocia with moderate discriminatory ability (area under the receiver-operating characteristic curve, 0.69; P<.001; area under the receiver-operating characteristic curve, 0.71; P<.001) and good calibration (Hosmer-Lemeshow goodness-of-fit; P=.466; P=.167) for the derivation and validation cohorts, respectively. With 1 score point, 16 shoulder dystocia cases occurred in 1764 deliveries, with 0.6% shoulder dystocia incidence and a number needed to treat with cesarean delivery to avoid 1 case of shoulder dystocia of 172 (2 points: 38/1809, 2.1%, 48; 3 points: 18/336, 5.4%, 19; 4 points: 10/96, 10.5%, 10; and 5 points: 5/20, 25%, 4); 40.8% of the shoulder dystocia cases occurred without risk factors. The presented risk score for shoulder dystocia may act as a supplemental tool for the clinical decision-making regarding mode of delivery. According to our score model, in pregnancies with a score ≤2, meaning having solely estimated fetal weight ≥4250 g, or abdominal-head-circumference ≥2.5, or diabetes mellitus, cesarean delivery for prevention of shoulder dystocia should not be recommended because of the high number needed to treat to avoid 1 case of shoulder dystocia. Conversely, in patients with a score of ≥4 with or without diabetes mellitus, cesarean delivery may be considered. However, in 40% of the shoulder dystocia cases, no risk factors had been present.

Effects of farrowing induction using cloprostenol on sow farrowing characteristics.

Background and Aim:Previous findings regarding the effects of farrowing induction on the farrowing characteristics of sows are controversial. This study aimed to investigate the effects of farrowing induction on the following characteristics: (1) Proportion of sows that farrowed during working hours, (2) stillbirth rate, (3) number of stillbirths per farrow, (4) dystocia rate per farrow, (5) dystocia rate (the proportion of farrowings that had at least one dystocia event), (6) number of dystocia events per farrow, (6) farrowing duration, (7) birth interval, and (8) birth weight.Materials and Methods:Thirty-eight Landrace x Yorkshire sows were randomly allocated into two groups; the control group and the treatment group. In the control group (n = 18), sows farrowed spontaneously. In the treatment group (n = 20), farrowing was induced approximately 2 days earlier than the herd’s average length of gestation (7:00 am on day 114) by injecting cloprostenol into the perivulval region. All sows were supervised throughout their farrowing. We recorded the interval between induction and farrowing; total number of births; number of live, stillborn, and mummified piglet births; number of dystocia events; birth interval; farrowing duration; and birth weight. A generalized linear mixed model, a linear mixed-effects model, the Chi-squared test, and Student’s t-test were used to compare outcomes between the two groups.Results:Farrowing induction did not influence the percentage of sows that farrowed during working hours (7 am–5 pm), stillbirth rate, birth weight, and number of dystocia events per farrow. Farrowing induction led to an increase in birth interval, dystocia rate, dystocia per farrow (p < 0.05) and in addition to the percentage of sows that farrowed on the day following induction (60% vs. 27.8%; p < 0.05).Conclusion:Farrowing induction using a single dose of cloprostenol 2 days before the expected farrowing date can be performed with care to concentrate farrowing into a short interval. This can enhance the optimization of cross-fostering and the practice of an all-in-all-out strategy in the swine breeding industry.

Evolution in caesarean section practices in North Kivu: Impact of caregiver training.

A caesarean section is a major obstetric procedure that can save the life of mother and child. Its purpose is to protect the mother's health from the complications of childbirth and to protect the baby's health. In sub-Saharan Africa (SSA), there are major inequalities in access to caesarean sections and significant variations in practices to determine the indications for the procedure. Periodic analyses of maternal deaths have shown that more than half of maternal and new born deaths are due to suboptimal care and are therefore potentially preventable. The objective of our study is to assess the impact of health staff training under the PADISS project (to support the health system's integrated development) on the quality of CS procedures in North Kivu, by comparing two periods. The populations compared were recruited from the referral hospitals in North Kivu, DRC (Democratic Republic of Congo). The first (group 1) was made up of patient files studied retrospectively for the period from 01/11/2013 to 01/01/2016. The second group (group 2), studied prospectively, comprised patient files from June 2019 to January 2020. Obstetric, maternal and foetal data were compared. Statistical analyses were performed using STATA/IC 15.0 for Windows. Univariate and multiple logistic regression was performed to determine which characteristics are associated with maternal and perinatal morbidity and mortality. A p value < 0.05 was considered statistically significant. CS frequency was approximately 17% in both study periods. We observed a CS frequency of about 34% at North Kivu provincial hospital for the two populations studied. The main indications for CS were dystocia, foetal distress and scarred uterus for both populations. In the population studied prospectively, after the implementation of health staff training, there were fewer incidence rate of dystocia, foetal distress and neonatal death, a more complete patient record, shorter hospital stay, and fewer blood transfusions but more incidence rate of scarred uterus, post-operative complications and low birth weight. Intervention had no statistically significant impact on low birth weight (OR = 1.9, p = 0.13), on neonatal mortality (OR = 0.69, p = 0.21). Our study shows a decrease in neonatal deaths, dystocia and foetal distress, but an increase in post-operative complications, maternal deaths and cases of scarred uterus and low birth weight. However, multiple logistic regression did no support the conclusion.

The Challenges of Treating Glucokinase MODY during Pregnancy: A Review of Maternal and Fetal Outcomes.

Background: The optimal treatment strategy for the follow-up and management of women with glucokinase maturity-onset diabetes of the young (GCK−MODY)during pregnancy remains unknown. Data regarding maternal and fetal outcomes are lacking. Aim: This paper summarizes the existing literature regarding the maternal and fetal outcomes of women with glucokinase MODY to guide future treatment strategy. Methods: A literature search was conducted in Pubmed, Embace, and Cochrane library with citation follow-up using the terms: glucokinase, MODY, diabetes, pregnancy, gestation, and outcomes. We searched for articles with known fetal mutational status. Relevant outcomes included: birthweight, large for gestational age (LGA), small for gestational age (SGA), macrosomia, cesarean delivery (CD), shoulder dystocia, congenital anomalies, miscarriages, preterm births, and long-term outcomes. Results: Fourteen relevant manuscripts were identified describing maternal and fetal outcomes. The percentage of LGA and macrosomia in 102 glucokinase -unaffected offspring (GCK−) was significantly higher than in the glucokinase -affected offspring (GCK+) (44% vs. 10%, p < 0.001 and 22% vs. 2%, p < 0.001, respectively). Among the 173 GCK(+) offspring, only 5% were SGA, which can be expected according to the normal distribution. We observed higher rates of CD and shoulder dystocia in the GCK(−) offspring. Conclusions: GCK(−) offspring have significantly higher birthweights and more birth complications. The optimal treatment strategy to guide management should take into consideration multiple variables other than fetal mutational status.

Evaluation of the Effects on Uninfected Pregnant Women and Their Pregnancy Outcomes During the COVID-19 Pandemic in Beijing, China.

BackgroundPeople's lifestyles may have changed during the COVID-19 pandemic, which may have a profound impact on pregnant women and newborns. This study aims to assess the effects of the COVID-19 pandemic on uninfected pregnant women and their newborns, including potential environmental factors.MethodsWe retrospectively analyzed the pregnancy complications of 802 cases in the pandemic group and 802 controls in the pre-pandemic group in a matched nested case-control study, and evaluated the association with sociodemographic features, lifestyles, and other factors in 311 pregnant women with adverse pregnancy outcomes.ResultsCompared to the pre-pandemic group, the rates of anemia, vaginitis, shoulder dystocia, and adverse pregnancy outcomes such as preterm birth were increased in the pandemic group. After controlling for the covariates, we observed a higher risk of adverse pregnancy outcomes in the pandemic group. Pregnant women with adverse pregnancy outcomes had an increased rate of anemia and vaginal candidiasis.ConclusionCOVID-19 pandemic has profound effects on adverse pregnancy outcomes, suggesting the importance of ensuring regular prenatal checkups and keeping a healthy lifestyle.

Evaluation of obstetric management of women with macrosomic foetuses in two Level 3 maternity hospitals in France and identification of predictive factors for obstetric and neonatal complications

ObjectiveFoetal macrosomia is associated with high maternal and neonatal morbidity; however, obstetric management of suspected macrosomia has not been well defined. This study aimed to analyse obstetric management in a population of women who delivered macrosomic new-borns and assess maternal and neonatal outcomes and risk factors for complications in such cases. Study designThis two-centre retrospective study conducted in France over a 10-year period comprised 1724 women who had delivered macrosomic new-borns (defined as those whose weight was > 90th percentile according to the Association of Users of Computerised Records in Perinatology, Obstetrics, and Gynaecology curve) from 37SA. ResultsIn this study, the caesarean section and instrumental extraction rates were 24.1% and 15.7%, respectively, and the postpartum haemorrhage rate was 7%. The rate of shoulder dystocia was 23.1% (including brachial plexus injuries, 0.4%; and clavicular fractures, 2.0%). Significant risk factors for caesarean section were maternal height < 160 cm, nulliparity, history of caesarean section, excessive uterine height, induction of labour and duration of labour > 10 h. The risk factors for shoulder dystocia were maternal height < 160 cm and instrumental extraction. ConclusionThe study findings may help determine predictive factors for an unfavourable outcome at the time of delivery of a macrosomic foetus, thus allowing clinical teams to better anticipate and manage potential complications.

Identification of cow-level risk factors and associations of selected blood macro-minerals at parturition with dystocia and stillbirth in Holstein dairy cows

A deeper understanding of the risk factors for dystocia and stillbirth could help farmers make decisions about dairy cow management. The objectives of this study were to investigate cow-level risk factors associated with dystocia and stillbirth in a relatively large sample of dairy cows using multivariable linear regression models. The data consisted of 51,405 calving records of 14,546 Holstein cows from 3 dairy herds in Isfahan Province, Iran, collected between April 2011 and September 2017. To investigate the association between selected blood macro-minerals and the incidence of dystocia and stillbirth, blood samples were collected at the time of parturition from a random subset of these cows, which included 1311 animals. The incidence of dystocia and stillbirths averaged 14.7% and 4.3%, respectively. Results showed that calving year, calving season, dry period length, BCS, parity, calf sex, calf birth weight, twin status, and stillbirth were significantly associated with the incidence of dystocia. According to the Random Forest (RF) classifier, we found that dry period length, calf birth weight, and parity were the most important cow-level risk factors for the incidence of dystocia. Calving year, calving season, parity, twin status, dry period length, calf birth weight, calf sex, and dystocia were significantly associated with the incidence of stillbirths. The most important risk factors identified by the RF classifier for stillbirths were twin status, parity, dry period length, and calf birth weight. Also, interactions between the cow-level risk factors associated with dystocia and stillbirth were identified. The incidence of dystocia was associated with the interactions of twin status × calf birth weight and twin status × stillbirth. According to our analysis, the incidence of stillbirth is caused by interactions among several factors, such as twin status × length of dry period, twin status × calving season, and twin status × parity. The highest incidence of dystocia (21.3%) and stillbirths (5.4%) was observed in hypo-calcemic cows. In conclusion, twin status seems to be a determining factor for the incidence of stillbirths but not for dystocia. Finally, the results of this study may help the dairy industry make management decisions aimed at reducing dystocia and stillbirth rates.

Screening for late-onset gestational diabetes: Are there any clinical benefits?

To determine whether screening for gestational diabetes mellitus (GDM) in the third trimester and managing those who are screen positive on a diabetes pathway affects obstetric and neonatal outcomes. Retrospective study of prospectively collected data. London Teaching Hospital. A total of 14 366 women delivering between 1 January 2018 and 31 December 2020. Retrospective chart analysis. Diagnosis of late-onset GDM, obstetric and neonatal outcomes. Five hundred and thirty-one women were tested by home glucose monitoring for late-onset GDM from 33 weeks of gestation. In all, 244 were diagnosed as having GDM (group 1) and managed accordingly, and 287 (group 2) were returned to normal care. A total of 1415 women had GDM diagnosed by oral glucose tolerance test before 33 weeks of gestation (group 3). Of the women in group 2, 49.5% had a spontaneous onset of labour compared with only 25.8% and 27% in groups 1 and 3. However, women in group 2 were significantly more likely to have a macrosomic baby (≥4000 g, 25.4%) than groups 1 (16.0%) or 3 (7.2%), and their babies were more likely to be admitted to special care (5.2% versus 2% in group 1). Macrosomic babies were associated with significantly higher rates of shoulder dystocia, third- and fourth-degree tears and postpartum haemorrhage. Apparent late-onset GDM affects a significant proportion of women, and targeted intervention was associated with better obstetric and neonatal outcomes. These results suggest that all pregnancies with risk factors for late-onset GDM might benefit from active GDM management irrespective of specific glucose thresholds. Women with risk factors for GDM in the third trimester, and their babies, would probably benefit from active management of their blood sugars irrespective of threshold values.

Incidence of dystocia at piglet level in cloprostenol-induced farrowings and associated risk factors

Few studies have investigated risk factors for dystocia in swine, although this birthing abnormality can compromise welfare of both sows and piglets by increasing stillbirth rate and decreasing sow productivity. This study aimed to determine risk factors associated with dystocia at piglet level in cloprostenol-induced farrowings. A dystocia event was recorded when a birth interval exceeded 45 or when manual extraction was applied. Data were collected from 898 piglets born from 77 Landrace Yorkshire crossbred sows, which were induced for farrowing on day 114 of gestation. Generalized linear mixed models (GLMMs) were used to evaluate the association between dystocia and parity, gestation length, litter size, relative birth order (RBO (%) 100 birth order/litter size), birth weight, crown rump length, body mass index, ponderal index, piglet's sex, use of oxytocin, and stillbirth. Sows nested in farrowing batches were fitted as random factors in GLMMs. Incidence of dystocia at piglet and farrowing levels was 11.0 % and 75.3 %, respectively. The final multivariate model explained 20.1 % variation of dystocia. RBO had a quadratic effect on dystocia in which incidence of dystocia decreased from RBO 40 % to RBO 60 %–70 %, and then increased to the end of parturition. Piglets with birth weight 1700 and stillborn piglets had higher odds of dystocia in comparison with piglets with a birth weight of 900–1700 (OR 2.63; 95 % CI 1.66–4.18) and live-born piglets (OR 2.62; 95 % CI 1.12–6.15), respectively. This study indicates that dystocia is very common in cloprostenol-induced farrowings and suggests that the last one-third of parturitions is the most important stage to be supervised, and selection for homogenous litters and moderate high birth weight may reduce the rate of dystocia.

Reproduction Performance of Kashmir Merino Sheep at an Organized Farm of Kashmir

Background: Kashmir Merino sheep breed is being developed by croosing native sheep breeds like poonchi, bakerwal and gadi with exotic sheep breeds like Australian Merino Rams. Currently Kashmir Merino sheep breed is being maintained at the 8 Government sheep breeding farms of Kashmir Valley. Methods: The data pertaining to Kashmir Merino sheep ranging over 18 years (2001 to 2010 and 2012 to 2019) was analysed using descriptive stastics to estimate lambing and twining percentage, incidence of abortion, dystocia and still births. Data was obtained from lambing records of Kashmir Merino sheep, maintained at Sheep Breeding Farm Kralpathri. Result: In present investigation, overall percentage of lambing and twining was 82.49% and 0.33%, respectively and incidence of rate of abortions, still births and dystocia of 1.29%, 1.20% and 0.91%, respectively were observed in Kashmir Merino sheep. It was observed that with increase incidence of still births, dystocia and abortions, there is decrease in lambing percentage whereas incidence of twining percentage increases lambing percentage significantly. The lambing percentage can be increase by improving management and Fec-B intrograssion in Kashmir Merino sheep.

Increased abdominal circumference as predictor of macrosomia without evidence of adverse obstetrical or neonatal outcomes

Ultrasound is used as a screening tool for suspected fetal macrosomia, primarily focused on estimated fetal weight (EFW). The interpretation of isolated increased abdominal circumference (AC), however, is unclear. We aimed to determine if increased AC alone, in the setting of normal EFW and the absence of diabetes, is associated with any adverse obstetric or neonatal outcomes. This is a secondary analysis of a prospective observational study of individuals with negative diabetes screening between 2016-2020. Third trimester ultrasound data was examined to develop our study group (AC ≥ 95%tile, EFW< 95%tile) and comparison group (AC< 95%tile, EFW< 95%tile). Obstetric (induction, shoulder dystocia, primary Cesarean rate, postpartum hemorrhage) and neonatal (large for gestational age (LGA) phototherapy, hypoglycemia, NICU admission) outcomes were compared using chi-square analyses. We performed logistic regression to evaluate which antepartum factors may be most predictive of AC ≥ 95%tile and created ROC curves with gestational weight gain (up to 28weeks) and glucose tolerance testing (GTT). A total of 1239 individuals were included in the study population. Those with AC ≥ 95%tile (n = 40) had an increased rate of LGA (17% vs 2.4%, p< 0.001). There were no differences between rates of induction, shoulder dystocia, primary Cesarean, postpartum hemorrhage, phototherapy, neonatal hypoglycemia, or NICU admission (Table 1). Using logistic regression, weight gain and GTT values were found to be significant in predicting AC ≥ 95%tile. ROC curves were developed, the better model being GTT (AUC 0.637), suggesting a 1 hour GTT > 105 may be predictive of AC ≥ 95%tile (Figure 1). AC ≥ 95%tile was associated with macrosomia, but not with other adverse obstetric/neonatal outcomes. Additionally, a 1 hour GTT > 105, while normal, seems to be a risk factor for AC ≥ 95%tile and should be considered indication for a third trimester growth scan. Further studies are needed to determine if antepartum surveillance should be recommended in this population.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Comparison Between Reproductive Performance in Synchronized and Spontaneous Estrus Sheep

Purpose: The objective of the present study was to compare the reproductive performance in synchronized and spontaneous estrus sheep raised under farm conditions. Subjects and Method: Two hundred Karadi and Two hundred Awassi were used in this study. Of each breed, 100 ewes were allowed to come in estrus spontaneously and the other 100 ewes were synchronized using intravaginal sponges (ESPONJAVET, HIPRA, Amer, Girona, SPAIN). Ewes were injected with intramuscular injection of 500 IU of PMSG when sponges were removed on day 14. Results: This study revealed that estrus synchronization had a higher rate of lambing (P=0.014), twining (P&lt;0.001), dystocia (P=0.024), and barrenness (P=0.012) in Karadi ewes. Estrus synchronization also had a significantly higher rate of lambing (P=0.018), twining (P=0.017), abortion (P&lt;0.001), barrenness (P=0.012) and productivity (P=0.010) in Awassi ewes. the result of the current study shows that the barrenness rate was higher in spontaneously ovulated ewes compared to synchronized Awassi ewes. The result of the current study shows that the abortion rate was higher in spontaneous ewes compared to synchronized ewes. The twinning rate was higher in synchronized compared to spontaneous Karadi ewes. Conclusion: In both breeds, synchronized ewes had higher reproductive efficiency compared to ewes that had spontaneous estrus.

Maternal and neonatal outcomes in prolonged second stage deliveries in nulliparous

Introduction: The prolongation of the second stage of labor in pregnant women, in order to reduce the rate of cesarean sections, constitutes a scientific and clinical dilemma. This controversy is generated because the increase in the prolonged second stage time can increase the maternal and neonatal risks. Objective: To analyze differences in maternal and neonatal outcomes between pregnant women who have a prolonged vs non-prolonged delivery. To study those pregnant women who have prolonged second stage (&gt;180 minutes) and identify differences between them according to mode of delivery (non-operative, operative or cesarean delivery). Material and methods: Prospective cohort study of all nulliparous pregnant women treated at the Hospital Universitario de Fuenlabrada between January 1, 2018 and December 31, 2019. Differences in pregnant women with prolonged versus non-prolonged delivery are analyzed. Those cases in which the prolonged second stage period was equal to or greater than 180 minutes were selected and differences according to the mode of delivery were studied. During the study period, 944 women met the inclusion criteria, of which 445 (47.1%) had prolonged second stage periods equal to or greater than 180 minutes. Results: Prolonged second stage is associated with a higher rate of operative delivery 44.5% vs. 28.1% and a higher rate of cesarean section 6.7% vs. 2% (p: 0.000), a higher rate of shoulder dystocia 3.8% vs. 1.6%, greater weight at birth of the newborn 3279 g vs 3119 g and greater perinatal trauma 13.3 vs 6.6% compared with non-prolonged second stage delivery. By selecting only pregnant women with prolonged delivery, we observed a higher rate of complications of surgical wound in caesarean sections 13.3%, vs 1.5% in operative delivery and 0% in spontaneous vaginal delivery and a higher rate of grade III-IV degree perineal lacerations in deliveries eutocic and instrumental. With respect to the neonate, a greater weight of the newborn is observed in caesarean sections 3445 grams compared to eutocic deliveries 3230 grams and operative delivery 3275 grams (p: 0.001), a higher rate of type III resuscitation in those neonates born by caesarean section 26, 7% vs 4.2% in spontaneous vaginal delivery and 5.6% in operative delivery and a higher rate of admission to the neonatal ICU in caesarean sections 26.7% vs 6.9% spontaneous vaginal delivery and 9.1% operative delivery (p: 0.002) . Conclusion: A higher rate of operative delivery and cesarean sections has been observed in pregnant women with prolonged second stage, as well as a higher rate of shoulder dystocia, newborn weight, and perinatal trauma compared with non-prolonged delivery. When studying the cohort of pregnant women with prolonged second stage, there is a higher rate of cesarean section in pregnant women with a previous suspicion of fetal macrosomia, a higher weight of the newborn at birth, a higher rate of type III neonatal resuscitation and admission of the newborn to the neonatal ICU in pregnant women. that end in caesarean section with respect to spontaneous vaginal delivery or operative delivery.

Difference in Body Weight at Breeding Affects Reproductive Performance in Replacement Beef Heifers and Carries Consequences to Next Generation Heifers.

Simple SummaryThe effect of prebreeding feeding to attain 55% vs. 65% of mature cow body weight (MBW; 545 kg) at breeding on the reproductive performance of beef heifers and its offspring was investigated. Angus-cross dam heifers from weaning were randomly fed to attain 55% (n = 1622) vs. 65% (n = 1578) of MBW and off-spring (F1) heifers born to dam heifers in both 55% (n = 1285) vs. 65% (n = 1324) groups were fed to attain 65% of MBW. Results showed that restricted feeding negatively affected puberty, breeding season pregnancy and 21-day calving rates. F1 generation heifers that were fed normal diets but were born to dams that were fed restricted diets also had reduced puberty, breeding season pregnancy and 21-day calving rates. In conclusion, restricted feeding during the prebreeding period of dam heifers reduced post-pubertal fertility and fertility of their heifer offspring that were fed normal prebreeding diets.Nutrition imprinting carries consequences across generations. The effect of 55% vs. 65% of mature cow body weight (MBW; 545 kg) at breeding on the reproductive performance of heifers and their offspring was investigated. Angus-cross dam heifers were randomly fed to attain 55% (n = 1622) vs. 65% (n = 1578) of MBW, and offspring (F1) heifers born to dam heifers [55% (n = 1285) vs. 65% (n = 1324)] were fed to attain 65% of MBW. Bodyweight and reproductive indices were recorded throughout the study. In dam heifers, puberty (44% vs. 53%), breeding season pregnancy (86.4% vs. 90.6%) and 21-day calving rates (55.2% vs. 65.4%) did vary, but dystocia rate (8.7% vs. 9.0%) did not differ between 55% and 65% MBW groups. Puberty (49.2% vs. 58.2%), breeding season pregnancy (87.2% vs. 92.8%) and 21-day calving rates (53.8% vs. 64.1%) did differ (p < 0.05), but dystocia rate (8.4 vs. 9.2%) did not differ between F1 heifer groups. In conclusion, 55% of MBW at breeding negatively affected the reproductive performance of heifers and its offspring heifers. The recommendation is to feed heifers a balanced diet to reach 65% of MBW at breeding with consideration of production traits.

Predictors of successful vaginal birth after cesarean without an epidural among women with no prior vaginal delivery.

Data are scarce on predictors for success of labor after cesarean (LAC) among women delivering without epidural anesthesia (EA). We aimed to study the predictors for success of LAC among women with no prior vaginal delivery that did not use EA. A retrospective study including all women undergoing LAC between 3/2011 and 1/2021 with no prior vaginal delivery that did not use EA. Factors associated with successful vaginal birth after cesarean were examined using multivariable analysis. Of the 466 no EA LAC, 339 (72.7%) delivered vaginally. Women in the successful LAC group had lower pregestational and predelivery BMI as compared to those who had a repeat cesarean [odds ratio (OR) 95% confidence interval (CI) 0.90 (0.85-0.94), P<0.001, and 0.89 (0.85-0.93), P<0.001, respectively]. The rate of labor dystocia in previous cesarean was lower in the LAC success group [92 (27.1%) vs 50 (39.4%), OR 95% CI 0.57 (0.37-0.88)]. Mean gestational age at LAC was lower in the LAC success group (385/7 ±25/7 vs 395/7 ±15/7 , P=0.014). In a multivariable logistic regression analysis, the following factors were negatively and independently associated with LAC success: higher predelivery BMI [adjusted odds ratio (aOR) 95% CI 0.90 (0.86-0.95)], higher gestational age at previous cesarean and at LAC [aOR 95% CI 0.81 (0.70-0.93) and 0.97 (0.94-0.98), respectively], induction of labor [aOR 95% CI 0.08 (0.03-0.25)], and duration of ruptured membranes [aOR 95% CI 0.97 (0.96-0.99)]. We have identified that lower BMI, lower gestational age, shorter ruptured membranes duration, and spontaneous labor are associated with successful LAC among nonusers of EA with no prior vaginal delivery at one tertiary care facility in Israel.

Greater Reproductive Performance in Holstein Dairy Cows with Moderate Length of Anogenital Distance at First Service Postpartum

BACKGROUND: Previous studies have indicated negative association of anogenital distance (AGD) with fertility in dairy cows; however, the mechanism of inverse relationship is not completely understood. In this regard, postpartum uterine infections and their corresponding risk factors could diminish fertility of cows, yet there has been no research exploring the relationship between AGD and postpartum disorders. OBJECTIVES: The aim of this study was to investigate the relationship between AGD and postpartum reproductive performance in dairy cows. METHODS: AGD of Holstein dairy cows of a commercial dairy herd (n = 290) was measured at the first postpartum examination (days 28 to 32 postpartum) in millimeter. Cows were classified into three categories based on AGD length, including short anogenital distance (20% of cows with lowest values), intermediate anogenital distance (60% of cows with moderate values) and long AGD (20% of cows with highest values). Additionally, data of postpartum reproductive variables were retrieved form herd database. Dara were analysed using SAS software version 9.4.RESULTS: Rate of dystocia, twinning, retention of fetal membranes, puerperal metritis and clinical endometritis, calf birth weight and days to first service did not differ among the various AGD categories (P > 0.05). However, proportion of male offspring was lower in short AGD cows than intermediate and long AGD cows (P < 0.05). Furthermore, first service conception rate was greater in intermediate anogenital distance group than short and long anogenital distance groups (P < 0.05). CONCLUSIONS: In conclusion, the present study showed suboptimal first postpartum conception rate in cows with minimal and maximal length of anogenital distance and indicated that this inferior fertility was not mediated through alteration in rate of postpartum reproductive disorders.

Diabetic Uterine Environment Leads to Disorders in Metabolism of Offspring.

AimsResearch evidence indicates that epigenetic modifications of gametes in obese or diabetic parents may contribute to metabolic disorders in offspring. In the present study, we sought to address the effect of diabetic uterine environment on the offspring metabolism.MethodsType 2 diabetes mouse model was induced by high-fat diet combined with streptozotocin (STZ) administration. We maintained other effect factors constant and changed uterine environment by zygote transfers, and then determined and compared the offspring numbers, symptoms, body weight trajectories, and metabolism indices from different groups.ResultWe found that maternal type 2 diabetes mice had lower fertility and a higher dystocia rate, accompanying the increased risk of offspring malformations and death. Compared to only a pre-gestational exposure to hyperglycemia, exposure to hyperglycemia both pre- and during pregnancy resulted in offspring growth restriction and impaired metabolism in adulthood. But there was no significant difference between a pre-gestational exposure group and a no exposure group. The deleterious effects, no matter bodyweight or glucose tolerance, could be rescued by transferring the embryos from diabetic mothers into normal uterine environment.ConclusionOur data demonstrate that uterine environment of maternal diabetes makes critical impact on the offspring health.

Risk factors associated with dystocia in swine.

Background and Aim:Dystocia in swine can increase the stillbirth rate; however, its importance in pig-breeding systems has been underestimated. Until now, few studies have investigated dystocia and associated risk factors. Therefore, in this study, we aimed to evaluate the effects of various risk factors on dystocia in swine.Materials and Methods:Out of 5,557 piglets, we included 4,997 piglets in risk analysis study. The dependent variable was dystocia, which was recorded when a birth interval exceeded 45 min or when obstetric assistance was applied. The independent variables were parity, gestation length, litter size, birth order, gender, presence of a dead piglet, birthweight, crown rump length, body mass index, ponderal index, and oxytocin use. We used generalized linear mixed models to examine the associations between potential risk factors and dystocia at the piglet level.Results:A total of 6% of the piglets were born with a dystocia event, and 47.2% of the farrowing experienced at least one event. Dead piglets and piglets with a crown rump length of >31 cm were associated with an increased dystocia rate. This rate decreased from birth order 2 to 7, stabilized to 11, and then increased till the end of the fetal expulsion process.Conclusion:Dystocia is common in swine. Therefore, this condition should be carefully addressed by veterinarians and farrowing house personnel so that its adverse effect on welfare and productivity of sows and survivability of piglets can be reduced. Further studies investigating dystocia status and risk factors in different swine farrowing systems should be undertaken to provide more knowledge about this neglected condition.

Estimated impact of introduction of new diagnostic criteria for gestational diabetes mellitus.

BACKGROUNDImplementation of new diagnostic criteria for gestational diabetes mellitus (GDM) are still a subject of debate, mostly due to concerns regarding the effects on the number of women diagnosed with GDM and the risk profile of the women newly diagnosed.AIMTo estimate the impact of the World Health Organization (WHO) 2013 criteria compared with the WHO 1999 criteria on the incidence of gestational diabetes mellitus as well as to determine the diagnostic accuracy for detecting adverse pregnancy outcomes. METHODSWe retrospectively analyzed a single center Dutch cohort of 3338 women undergoing a 75 g oral glucose tolerance test where the WHO 1999 criteria to diagnose GDM were clinically applied. Women were categorized into four groups: non-GDM by both criteria, GDM by WHO 1999 only (excluded from GDM), GDM by WHO 2013 only (newly diagnosed) and GDM by both criteria. We compared maternal characteristics, pregnancy outcomes and likelihood ratios for adverse pregnancy outcomes. RESULTSRetrospectively applying the WHO 2013 criteria increased the cohort incidence by 13.1%, from 19.3% to 32.4%. Discordant diagnoses occurred in 21.3%; 4.1% would no longer be labelled as GDM, and 17.2% were newly diagnosed. Compared to the non-GDM group, women newly diagnosed were older, had higher rates of obesity, higher diastolic blood pressure and higher rates of caesarean deliveries. Their infants were more often delivered preterm, large-for-gestational-age and were at higher risk of a 5 min Apgar score < 7. Women excluded from GDM were older and had similar pregnancy outcomes compared to the non-GDM group, except for higher rates of shoulder dystocia (4.3% vs 1.3%, P = 0.015). Positive likelihood ratios for adverse outcomes in all groups were generally low, ranging from 0.54 to 2.95.CONCLUSIONApplying the WHO 2013 criteria would result in a substantial increase in GDM diagnoses. Newly diagnosed women are at increased risk for pregnancy adverse outcomes. This risk, however, seems to be lower than those identified by the WHO 1999 criteria. This could potentially influence the treatment effect that can be achieved in this group. Evidence on treatment effects in newly diagnosed women is urgently needed.