Eutocic Delivery Research Articles

Efficacy of the Sub-Urethral Transobturator KIM System® for Female Urinary Incontinence: Long Term Results.

Background/Objectives: Female stress urinary incontinence (SUI) surgical treatment has changed since its beginning. Selecting materials that promote constructive tissue remodelling helps to maintain continence after surgery and minimizes complications. To analyze the long-term urinary continence results in women who underwent SUI surgical correction using the transobturator mid-urethral sling KIM system® (Knotless Incontinence Mesh) and analyze the complications associated with this SUI treatment. Materials and Methods: Prospective study of the first 1000 patients undergoing SUI surgery with the Contasure KIM® sling between April 2007 and December 2018. Results and complications were recorded. Group A represented 94.2% of the sample and were the continent patients after surgery (GA = 942), while Group B accounted for incontinent patients after surgery (5.8%) (GB = 58). Results: The mean age at operation was 60 years. Eutocic deliveries (p = 0.0022), high blood pressure (p = 0.0190), anxiety (p = 0.0084), hemorrhoidectomies (p = 0.0016) and hysterectomies (p = 0.0002) were higher in GB. No differences between groups were found regarding body mass index (GA 26.50; GB 26.93) (p = 0.220649), food or drug allergies (p = 0.0.6547), dystocia (p = 0.2365), diabetes mellitus (p = 0.1715), pelvic surgery (p = 0.8842), other surgery (p = 0.8801) or concomitant treatments that would have an impact on bladder function. Correction of SUI was achieved in 94.2% of cases. Continence persisted over time in 97.98% of continent patients at 4-year follow-up and 90.90% of patients at last follow-up. Mesh caused erosion of the urethra in 0.3% of patients and extruded to the vagina in 0.42%. De novo urinary urgency (2.8%), significant chronic pain (3.6%) and urinary tract infections (3.0%) after surgery were lower than complications reported in reviewed publications. Pain was treated with medication, and all patients were pain-free at the one-year follow-up visit. Conclusions: The mid-urethral transobturator sling KIM system® has good initial and long-term results in patients with stress urinary incontinence, with a low recurrence rate and minimal complications.

Oestrogen and progesterone concentrations in intrapartum cows with insufficient cervix dilation

AbstractThe cervix is an important organ that has to dilate sufficiently at delivery to allow the foetus to transition to extrauterine life. Insufficient dilatation of the cervix (IDC) is a frequent cause of dystocia in cattle. The mechanisms underlying cervical opening and the pathogenesis of IDC are still widely unclear. Systematic studies on the relationship between IDC and steroid hormones have been limited and have yielded inconsistent findings. This study aimed to measure oestrogen and progesterone (P4) concentrations in intrapartum cows presented with dystocia due to IDC and in a comparison (C) group of cows with eutocic delivery. Before any obstetrical procedures, and right after the initial evaluation, blood samples were taken from IDC and C animals. Concentrations of P4, oestradiol‐17β (E2), free total oestrogens (FTE) and conjugated total oestrogens (CTE) were measured by established radioimmunoassays. Concentrations of P4 (p = .538), FTE (p = .065) and CTE (p = .605) were not statistically different between C and IDC groups. However, E2 levels in group C were significantly lower when compared to those in the IDC group (p = .013), which is inconsistent with the function of oestrogens in cervical dilatation. The correlation analysis demonstrated significant positive correlations between the pairs P4 versus FTE, P4 versus E2 and FTE versus E2 in group C and between the pair FTE versus E2 in group IDC. In conclusion, the results suggest that local activities of steroids relevant to the aetiology of IDC are not reflected by concentrations in the systemic circulation or that other factors are clearly more important.

Localization of Catecholaminergic Neurofibers in Pregnant Cervix as a Possible Myometrial Pacemaker.

In eutocic labor, the autonomic nervous system is dominated by the parasympathetic system, which ensures optimal blood flow to the uterus and placenta. This study is focused on the detection of the quantitative presence of catecholamine (C) neurofibers in the internal uterine orifice (IUO) and in the lower uterine segment (LUS) of the pregnant uterus, which could play a role in labor and delivery. A total of 102 women were enrolled before their submission to a scheduled cesarean section (CS); patients showed a singleton fetus in a cephalic presentation outside labor. During CS, surgeons sampled two serial consecutive full-thickness sections 5 mm in depth (including the myometrial layer) on the LUS and two randomly selected samples of 5 mm depth from the IUO of the cervix. All histological samples were studied to quantify the distribution of A nerve fibers. The authors demonstrated a significant and notably higher concentration of A fibers in the IUO (46 ± 4.8) than in the LUS (21 ± 2.6), showing that the pregnant cervix has a greater concentration of A neurofibers than the at-term LUS. Pregnant women's mechanosensitive pacemakers can operate normally when the body is in a physiological state, which permits normal uterine contractions and eutocic delivery. The increased frequency of C neurofibers in the cervix may influence the smooth muscle cell bundles' activation, which could cause an aberrant mechano-sensitive pacemaker activation-deactivation cycle. Stressful circumstances (anxiety, tension, fetal head position) cause the sympathetic nervous system to become more active, working through these nerve fibers in the gravid cervix. They might interfere with the mechano-sensitive pacemakers, slowing down the uterine contractions and cervix ripening, which could result in dystocic labor.

Analysis of Heart Rate Variability in Newborns Dogs with Different Types of Delivery during the First 35 Days of Life.

The present study aimed to evaluate the influence of the autonomic nervous system on cardiovascular function during the first 35 days of life in different types of delivery, using heart rate variability (HRV) indices. Thirty newborns were equally divided into two groups based on delivery type: eutocic delivery (EG) and emergency cesarean section (CG). Electrocardiographic evaluation was performed at birth (T0), 24 h postpartum (T1), and at 7, 14, 21, 28, and 35 days of life (T2 to T6). Physical parameters, neonatal reflexes, and Apgar scores were recorded. Over 35 days, the values of the time domain indices were higher in the GE group and increased with age. In the frequency domain, the low frequency (LF) index was higher in the CG, and the opposite occurred for the high frequency (HF) index. Since the CG presented lower HRV than the EG, it was shown that the type of delivery should be considered for the assessment of autonomic nervous system activity in neonates. Thus, as predictive factors of vitality, HRV and Apgar scores can help in the face of neonatal depression, demonstrating that delivery by emergency cesarean section can predispose newborns to delays in the autonomic influence on the heart.

Analysis of Maternal Positions during the Dilation and Expulsive Phase and Their Relationship with Perineal Injuries in Eutocic Deliveries Attended by Midwives.

This cross-sectional descriptive study aimed to analyze the relationship between maternal positions during the expulsion phase and perineal outcomes in 367 eutocic births attended by midwives or midwifery residents at a public hospital in northern Spain in 2018. A total of 94.3% of women opted for horizontal positions. Limited sacral retroversion was observed in 71.7%, potentially influencing perineal outcomes. A low incidence of tears indicated effective management during the expulsive phase, with an episiotomy rate of 15.3%, which was slightly above the 15% standard. Primiparity and maternal age were identified as risk factors associated with episiotomy. Additionally, sacral mobilization and vertical positions during delivery were significantly related to fewer perineal injuries, suggesting benefits for both mother and newborn. The correlation between maternal positions and the need for epidural analgesia highlighted the importance of considering these in pain management during childbirth. Despite limitations, the study provides valuable insight into obstetric practices and advocates for a woman-centered approach that respects autonomy during childbirth. Further research is needed to explore biomechanical parameters and enhance childbirth experiences.

Estudio morfológico macroscópico de un feto acardio

The morphological study of the acardio anceps fetus presented, product of a controlled twin pregnancy, primiparous for 17 years, which was obtained by eutocic delivery. The normal twin did not present alterations and its subsequent development has been normal. Among the characteristics of the acardium, sketches of the skull, thorax, abdomen and limbs were presented, the body cavities being occupied by a substance formed by loose connective tissue. The cord insertion was velamentous.

Citrullinemia and What Else?

Citrullinemia type I (CTLN1) is a rare autosomal recessive metabolic disorder. Symptoms typically include vomiting, lethargy, seizures and coma. In neonatal presentation, death occurs in days if untreated. Survivors may evolve with neurocognitive dysfunction. Two 10 years old, non-identical, twin sisters (S1; S2) with CTLN1 were born after a 36W gestation: S1 by eutocic delivery and S2 by cesarean section with nuchal cord (Apgar score 5/10). On day four, S2 presented hyperammonemia with coma. S1 had no complications. Diagnosis followed that of S2. Neurocognitive development was monitored at 3 months - 4 years of age with Griffiths Scales: global development quotient kept within the average, but S2 had a deficit in language and eye and hand coordination. At 5 years, the neurocognitive abilities were evaluated using Wechsler Preschool and Primary Scale of Intelligence - Revised (WPPSI-R). S2 revealed difficulties in verbal area (vocabulary, comprehension and memorizing sentences), with a lower average verbal intelligence quotient (IQ). S1 had high average IQ. Due to learning difficulties, S2 was reassessment at 8 years old with Wechsler Intelligence Scale for Children - Third edition (WISC-III): full-scale IQ -"extremely low". These non-identical twin sisters share the same citrullinemia type 1 causing variants in the ASS1 gene. Nevertheless, their clinical presentation and neurocognitive evolution are diverse. Other factors, like the different genetic background and perinatal issues such as the type of delivery and its circumstances and the neonatal coma episode of S2 may explain the dissimilar evolution. Maximum ammonium levels (and its duration) are critical for the patients' neurodevelopment: 131 in S1 and 546 umol/l in S2.

Hypoglycaemia management with a hypercaloric supplementation in neonatal puppies delivered by caesarean section.

There is a high perinatal mortality rate in dogs, estimated at 20%, and one of the leading causes of this rate is hypoglycaemia. Therefore, we aimed to evaluate the efficacy of a hypercaloric supplement containing vitamins and amino acids in newborn puppies presenting hypoglycaemia at birth. Ninety-nine pups were divided into four groups: normoglycaemic caesarean section (NORMOCS), hypoglycaemic caesarean section supplemented with the hypercaloric (SUPLCS), hypoglycaemic caesarean section supplemented with glucose (GLICCS) and eutocic delivery (EUT). We evaluated the following parameters glycaemia, Apgar score, neurological reflexes and rectal temperature of neonates at the following moments 5 min (M5), 30 min (M30) and 60 min (M60) after birth. Brachycephalic dogs were 73.3% (22/30) of caesarean sections (c-sections). The puppy's average glycaemia represented about 90% of the maternal glycaemia, while 15.1% (14/99) of the neonates had hypoglycaemia (<90 mg/dL) at M0 and 46.5% (44/99) at M60. Only four neonates had glycaemia below 40 mg/dL at M30 but without showing any clinical signs. The puppy's fasting while waiting for the intraoperative period and the dam's anaesthetic recovery was considered risk factors for hypoglycaemia. There was no difference in mean blood glucose levels or vitality parameters among puppies from the SUPLCS and GLICCS. In conclusion, the hypercaloric supplement can be used as a replacement for glucose in hypoglycaemic puppies and it can also bring nutritional benefits for the puppy. The prepartum glycaemia of the dam is an important parameter to be measured, and the appropriate management of it reduces the chances of the puppies being born with hypoglycaemia.

P-374 Impact of different luteal phase support protocols in fresh embryo transfers on perinatal outcomes of singleton in vitro fertilization pregnancies: a three-decade experience.

Abstract Study question How can stimulation of corpus luteum in the luteal phase with human chorionic gonadotropin (hCG) improve obstetric and perinatal outcomes? Summary answer There is currently no evidence that the use of hCG as an alternative treatment for luteal-phase support (LPS) improves obstetric and perinatal outcomes. What is known already There are different approaches for providing LPS, although none have shown differences in pregnancy rates. However, emerging evidence has also revealed the important role of corpus luteum in obstetric and perinatal outcomes after in vitro fertilization (IVF) (preeclampsia or intrauterine growth restriction, among others) in the production of progesterone (can be administered exogenously) as well as the secretion of multiple vasoactive active substances. Study design, size, duration We performed a retrospective, single centre study between 1991-2021. A total of 2592 singleton pregnancies were analysed after fresh embryo-transfer according to LPS. Participants/materials, setting, methods IVF singleton pregnancies were stratified into two cohorts according to the LPS protocol: 1) trigger with 5000 IU urinary hCG (U-hCG) and LPS protocol with progesterone 200 mg x3/day/vaginally beginning the day after oocyte retrieval and one u-hCG bolus of 2500 IU, the day and 3 days after oocyte retrieval; and 2) trigger with 250 µgr of recombinant hCG and LPS protocol with only progesterone (200 mg x3/day/ vaginally). Main results and the role of chance We compared the reproductive outcomes between cycles in cohort 1) n = 527 and cohort 2) n = 2065. The two cohorts were stratified and analysed in three groups according to maternal age to reduce possible bias: 35 years old or less, between 36 and 39 years old, and 40 or more years old. In cohort 1, all the cycles followed a long agonist GnRH protocol, while in cohort 2, 78.11% received an agonist GnRH protocol and 21.89 % a GnRH antagonist protocol. Recombinant gonadotropins for ovarian stimulation was administered in all cycles. We observed a greater number of eutocic deliveries, a lower number of instrumentalized births and a stable caesarean rate along the study period. There were no statistical differences between the two treatment groups regarding hypertensive pregnancy disorders, intrauterine growth restriction, small for gestational age or large for gestational age. Group 2 showed an apparent greater tendency, albeit not significant, to preeclampsia and a significant increase in very preterm birth. Emerging evidence has also revealed the important role of corpus luteum in obstetric and perinatal outcomes following IVF. Limitations, reasons for caution The large number of pregnancies evaluated is a clear strength of this study. This is the first series comparing different perinatal outcomes according to LPS. In contrast, the retrospective design and long time period involving changes in laboratory and patient profiles is a clear limitation. Wider implications of the findings The optimization of IVF treatments is especially important and is related to multiple factors, including the individualization of treatments to ensure the safety of IVF treatment as well as that of the pregnancies derived thereof. More studies on the different LPS protocols available are needed. Trial registration number not applicable

POSTPARTUM OVARIAN VEIN THROMBOSIS: A CASE REPORT

Ovarian vein thrombosis is a rare pathology that occurs most often in the postpartum period. It usually manifests by a non-specific abdominal pain with or without fever. It can clinically resemble acute appendicitis if the pain is located in the right iliac fossa. We report the case of a 19-year-old female patient who presented with febrile inflammatory pain of the right iliac fossa at 48 hours postpartum of an eutocic delivery, in whom a computed tomography (CT) scan showed an extensive thrombosis of the right ovarian vein with a normal-looking appendix. The treatment was based on broad-spectrum antibiotics and anticoagulant therapy, with a good clinical and biological evolution.

Chorangioma in Multiparous Aged: Clinical Case

Introduction: Chorangioma is a vascular tumor of placental origin that belongs to the group of vascular hemangiomas, the first report of this tumor was due to Clark in 1798; it is the most common primary non-trophoblastic placental tumor of vascular origin; Due to the few cases reported in the literature, the case treated at our hospital is reported. Clinical case: A 37-year-old female has been admitted with the following history: menarche at 12 years of age, IVSA at 13 years of age Gesta 3, Para 2, Caesarean sections 0, Abortions 0, FUP 7 years ago, FPP 06-19-2022 with two follow-up visits prenatal; US pregnancy of 34 SDG, FPP 05-30-2022, Weight 2,250 g. The patient presents obstetric pain of one hour of evolution and, a pregnancy of 35 WG plus labor in the latent phase was diagnosed. Eutocic delivery without complications and placental tumor observed. Conclusions: This tumor teaches us that the placental evaluation by ultrasound-doppler control is essential to detect this type of tumor that when they are small, generally goes unnoticed.

Checklist: A Useful and Safe Tool for the Initiation of Care for Eutocical Vaginal Delivery.

The aim of this study is to present and analyze the vaginal delivery checklist as a safe and useful learning tool for first-year residents in the gynecology and obstetrics and midwifery specialties at different hospitals and to analyze the items that comprise it and the progress of the residents during the first 30 normal deliveries attended in a supervised manner. We present a descriptive, observational and prospective study in which 18 participants from different hospitals in Spain completed a checklist of skills in the first 30 births attended autonomously after learning its use in a simulation workshop. We collected a total of 329 of 330 checklists completed by 11 participants. In addition, the mean responses for each item contained on the checklist and the mean global progression of the participants were subsequently analyzed, detecting statistically significant differences using Student’s t-test for paired data. During the data collection period between September 2020 and August 2021, a total of 329 checklists were analyzed. The global average of positive responses for the 30 questions contained on the checklist was 25.36 out of 30 points. The fulfillment of the different items was variable, with the lowest fulfillment of 2.18 points, although 73% of the items obtained a score greater than 25. A statistically significant difference in the mean compliance of the first five childbirths compared to the last five deliveries using the proposed checklist was obtained, with p < 0.01. In conclusion, knowing the importance of using a checklist to anticipate risk situations and reduce the number of adverse perinatal outcomes, we can say that, for first-year residents in gynecology and obstetrics attending a clinical simulation workshop in eutocic vaginal delivery, it may be interesting to have a tool, such as the checklist proposed in this study, that facilitates the learning process and the suitable progress of the participants.

Congenital malformations in brachycephalic dogs: A retrospective study.

The popularity of brachycephalic dogs has increased in recent years due to their docile temperament and peculiar features. The historical inbreeding and consequent lack of genetic diversity involved in the development of these breeds led to an increase in the manifestation of deleterious genes that may lead to malformations. In addition, there are serious health issues intrinsic to the conformation, mainly attributed to these extreme characteristics. Therefore, this retrospective study aimed to observe the frequency of malformations in brachycephalic dogs compared to the pure and mixed breeds (MB). The medical records of pregnant bitches admitted at the Service of Obstetrics and Animal Reproduction (SORA) from January 2017 to December 2021 were retrieved from the hospital's computer system and analyzed one by one. Seven hundred sixty-eight neonates born from 168 litters were included in this study. Of these litters, 72.6% (122/168) were brachycephalic. Malformations were found in 52 puppies, with an incidence of 6.77% (52/768). Of the 32 litters that produced malformed puppies, 28 were brachycephalic (87.5%). In total, 23 types of malformations were registered, the most common being cleft palate (1.30%) and anasarca (1.17%). Ten of the puppies (10/52; 19.23%) presented two or more associated malformations. Bitches above 7 years were more prone to present malformed puppies in their litters. Brachycephalic breeds were 3.03 times more likely to present malformed neonates when compared to other breeds; the odds ratio increased to 5.07 when modern brachycephalic was compared to ancestral brachycephalic. Regarding the mode of delivery, elective cesarean sections accounted for 66.6% of births while 19.64% were eutocic vaginal deliveries, and 13.69% were dystocic. The presence of malformed puppies in a litter causes suffering for the owner, the bitch and for the puppy itself, therefore, the veterinarian plays a key role in this scenario. Knowledge about congenital abnormalities, their causes, diagnosis, and approach is essential to reduce the incidence of malformations and improve the quality of life of these animals.

Manejo de endometrio refractario en las pacientes que recibieron técnicas de reproducción asistida: presentación de 2 casos clínicos

Background and objectiveThe endometrium is a dynamic tissue that undergoes changes throughout the menstrual cycle, including morphological, biochemical and molecular changes, necessary for a successful embryo implantation process. When insufficient endometrial thickness occurs embryo implantation takes place near the spiral arteries in the endometrial basal layer with high blood flow and high oxygen tension which leads to excess production of oxygen free radicals, a fact that can interfere with embryo implantation and development (Catt and Henman, 2000). Thus, an adequate assessment of this situation is essential to achieve an ongoing pregnancy. PatientsIn this article, we present the clinical cases of 2 patients with insufficient endometrium and how we have managed their situation through hysteroscopic and pharmacological treatment. ResultsPregnancies have been achieved in both clinical cases. One of the patients had an eutocic delivery at 32nd week of pregnancy and a healthy child of 2,100 grams was born. The other patient is still pregnant. ConclusionsThe prevalence of thin endometrium according to published studies is between 2.4% and 8.5% of women (Ribeiro et al., 2018; Kasius et al., 2014). Multiple studies have shown a correlation between thin endometrium, low implantation rates and lower percentages of ongoing pregnancy. A minimum endometrial thickness of 7 mm is suggested to increase these percentages.

Síndrome Crouzon em um paciente de Angola: caso clínico

Introduction: Crouzon syndrome is an autosomal dominant disease characterized by craniosynostosis causing secondary alterations of the facial bones and other facial structures. This article aims to report a case of Crouzon syndrome seen at the Benguela General Hospital. Case: The patient was a female infant, one month and 14 days old, of Angolan nationality, from Benguela province, Kalomanga commune, born from a eutocic delivery at 9 months of gestational age. At the physical and dysmorphological exam, bulging of the frontal region, macrocranium, palpable coronal suture, craniosynostosis, exophthalmos, proptosis, divergent strabismus, hypertelorism, parrot nose, carpal mouth, macroglossia, ogival and cleft palate in the posterior region, short neck, excavated chest, and globous abdomen, among other manifestations, were observed. Conclusion: Early diagnosis of Crouzon syndrome allows for adequate genetic counselling and individual and family clinical follow-up. This case of a rare genetic disease shows that in Angola, in addition to the epidemiological pattern characteristic of infectious diseases, diseases of genetic nature are also represented.

The clinical characteristics of perineal tears: A study carried out on 14 pregnant women in a tertiary center: Case series

BackgroundThe sheer quality of the female genital tract is not always respected at the time of childbirth because no protocol for the management of perineal tears exists in our services these days. The management remains dependent on a gynecologist and obstetrician. The study aimed to describe the characteristics of perineal tears. MethodsOur cross-sectional, retrospective, and descriptive study focused on patients admitted for childbirth and hospitalized in the obstetrics department of the Saint Luc Tertiary Clinic for a period from March 2021 to March 2022. During this period, we recorded 111 deliveries with 14 perineal tears. ResultsA total of 111 deliveries were recorded with a 12.6% frequency of perineal tears. 64.3% of women aged between 26 and 35 and 71.4% of primiparous women were affected by perineal tears. For delivery, 64.3% of births were eutocic deliveries, with 42.9% of children born with a birth weight greater than 4 kg, and the cephalic presentation delivered 86% of children. For degrees of perineal tears, 64.3% of patients had first-degree perineal tears. For postpartum treatment of perineal tears, analgesics help calm the pain, and antibiotic therapy has been considered. For fourth and third-degree tears, episiotomy was performed as a surgical procedure. ConclusionPerineal tears are the trauma often encountered in obstetrics; the first few suffer from it essentially. The high birth weight of children is often the cause. They require immediate management to prevent or avoid infections.

Benefits of continuous suture of perineal injury in adaptation to motherhood

ObjectiveTo assess the effect of the continuous suture technique of the perineal wound on the capacity and functional recovery of women when carrying out their self-care routine, the care of the newborn (NB), breastfeeding (BF) and Activities of Daily Living (ADLs), both basic activities of daily living (BADL) and instrumental (IADL), during the postpartum period. MethodsNon-randomised clinical trial with blinding allocation to study groups, carried out at the Arnau de Vilanova tertiary hospital in Lérida. The intervention group received continuous suture for perineal repair and the control group discontinuous suture. The study population was women with eutocic delivery and second-degree perineal tears or episiotomy. Three postpartum assessment were performed (48 h, 7−10 days and one month). Results126 women with eutocic delivery and second degree perineal tears or episiotomy participated (n = 126); 64 sutured with continuous technique (intervention group) and 62 with discontinuous technique (control group). At 48 h postpartum, 85% of women from the continuous suture technique group were able to perform their self-care and 46,7% of them had recovered functionally. At 7-10 days, 96,7% of women with continuous suturing had acquired the ability to perform instrumental activities of daily living and 60% had recovered functionally compared to 68,3% and 15% respectively of women with discontinuous suturing (p < 0.001). At 7-10 days, 100% of women with continuous suturing achieved functional recovery for newborn care and 80% for breastfeeding and in the control group 81,7% and 30% respectively (p < 0.001 and p < 0.001). ConclusionsWomen who undergo the continuous suture technique restore their ability and functional recovery to perform activities of daily living earlier and with less pain than women with discontinuous suturing, adapting more quickly and satisfactorily way to motherhood.

Advanced Maternal Age as an Obstetric Risk Factor: Current Experience in a Hospital from Northwestern Spain

Studies updating the evidence in advanced maternal age as an independent factor of obstetric risk are needed. The aimof this study was to determine the prevalence of ≥ 35-years-old pregnant women who give birth in a Spanish hospital in NorthwesternSpain, and to describe the incidence of maternal and perinatal morbidity and mortality. Retrospective follow-up observational study including women ≥ 20 years-old who gave birth over one year (n= 1378). Data were collected from medical records, including socio-demographic characteristics, comorbidities, gestational conditions,variables related with the delivery and perinatal outcomes. Multivariable logistic regression analysis was performed to determine theassociation of advanced maternal age with obstetric and perinatal outcomes. Forty-two percent of pregnant women were ≥ 35 years old. In the multivariable analysis, advanced maternal age was associatedwith the likelihood of gestational diabetes (OR = 1.84; 95% CI = 1.10 - 3.07), hypothyroidism (OR = 2.11; 95% CI = 1.17 - 3.80),lower probability of an eutocic delivery (OR = 0.74; 95% CI = 0.56 - 0.98), and a hospital admission > four days (OR = 2.91; 95% CI =1.95 - 4.35). An association with the rate of C-sections was not found (OR = 1.24; 95% CI = 0.89 - 1.72). A high prevalence of pregnant women of advanced maternal age was confirmed. There was a higher rate of comorbiditiesand longer hospital admissions in older women but not a higher rate of higher C-sections and other complications.

Conservative Management of Liver Echinococcal Cysts in Pregnant Women: One Center's Experience in Pavia, Italy.

Human cystic echinococcosis (CE) in pregnancy is rarely reported, with approximately one case of CE for every 20,000 to 30,000 pregnant women in endemic areas. Little information on its management is available. We report our experience with a watch-and-wait approach in this group of patients. We retrieved clinical data from pregnant patients with hepatic CE seen at our clinic from 1989 to 2021. All patients had at least one hepatic CE cyst and received no treatment during pregnancy. Ultrasound was used to monitor cyst evolution; outcome and complications of pregnancy and echinococcal infection were evaluated. Twelve patients with 15 pregnancies were included in this study. At the time of pregnancy, nine patients had a single cyst and two patients had multiple hepatic CE cysts. Cysts were in stage CE3a, CE3b, CE4, and CE5, according to the WHO Informal Working Group on Echinococcosis classification. All cysts except one remained stable in stage and size during and after pregnancy. In one patient with a history of multiple treatments with albendazole and with a CE4 cyst at the start of pregnancy, reactivation of the cyst during pregnancy was observed. All pregnancies except three had eutocic delivery. Cesarean sections were performed for reasons unrelated to CE. In our experience, "watch and wait" in pregnant women with uncomplicated transitional and inactive CE of the liver was a safe option in a small cohort of patients. Pooled data from other referral centers, including cases with CE1 and CE2 cysts, are needed to confirm the safety of this approach.

Dystocia in the Standardbred Mare: A Retrospective Study from 2004 to 2020.

Simple SummaryIn the equine species, dystocia, any impediment to normal parturition, is not frequent, but when it occurs it can quickly evolve into a critical situation. The aim of this study was to retrospectively describe the incidence, causes, categories of dystocia severity, resolution procedures and postpartum complications in Standardbred mares hospitalized in a Veterinary Teaching Hospital and evaluate the effects of dystocia on the clinical and blood parameters of their foals. In normal pregnancy, the incidence of dystocia was 4.9%. Stage II appeared significantly longer in dystocic delivery, and the occurrences of postpartum complications in mares and onset of neonatal disease in foals were more frequent after dystocia. This study also investigated, for the first time, foaling difficulty, dividing all dystocic deliveries into mild, moderate and severe dystocia. Therefore, even a short but physiologically abnormal delivery can pose a risk to the life of the newborn and determine complications in the mare.Dystocia as a prolonged stage II parturition (>30 min) was associated with a higher risk of complications. The hypothesis of the study was that any type of dystocia could affect the foal’s health, even when the stage II was <30 min. Clinical reports on 222 Standardbred mares and their foals hospitalized at the Veterinary Teaching Hospital of the University of Bologna from 2004 to 2020 were reviewed. Mares were divided into the Eutocia Group (165, eutocic delivery) and the Dystocia Group (57, dystocic delivery). The incidence of dystocia was 4.9%. Stage II was longer in the Dystocia Group (median 20 min) than in the Eutocia Group (median 12 min). All occurrences of dystocia were retrospectively classified into three categories of severity: mild, moderate and severe dystocia. The occurrence of postpartum complications in mares and neonatal diseases and failure of passive transfer of immunity in foals was higher in the Dystocia Group. Foal venous lactatemia and serum creatine kinase were significantly higher in the Dystocia Group (median 3.9 mmol/L; 262 UI/L respectively) than in the Eutocia Group (median 3.1 mmol/L; 187 UI/L respectively). The APGAR score was lower in the Dystocia Group (median 8) than in the Eutocia Group (median 10) and significantly lower in severe dystocia (median 3). The duration of stage II should not be considered the only parameter of dystocia in mares: even a rapid resolution of dystocia could pose health risks to the foal and the mare.