Higher Incidence Of Cesarean Section Research Articles

Clinical Significance of Supraventricular Tachycardia During Pregnancy in HealthyWomen.

Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy with unclear clinical significance. This study sought to report the prevalence, describe the management, and explore the association between SVT and adverse obstetric outcomes. Cohort study of primiparous and multiparous women without history of Cesarean section (CS), and with structurally normal hearts admitted in labor. The study group consisted of women with at least 1 SVT episode during pregnancy, and the control group was randomly selected in a 4:1 ratio. Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. A total of 76 (age 33.2 ± 4.8 years) had at least 1 symptomatic and documented episode during pregnancy. In women with a known SVT diagnosis before pregnancy, medical therapy was not associated with a lower risk of SVT recurrence (OR: 1.07; 95%CI: 0.41-2.80). However, catheter ablation before pregnancy was associated with significantly lower risk of SVT recurrence (OR: 0.09; 95%CI: 0.04-0.23). Women with SVT during pregnancy had higher incidence of CS (39.5% vs 27.0%; P=0.03), and preterm labor (PTL) (30.3% vs 8.6%; P< 0.001). Adjusting for age and parity, SVT during pregnancy was an independent predictor of CS (OR: 1.80; 95%CI: 1.03-3.10), particularly planned CS (OR: 2.89; 95%CI: 1.06-7.89) and PTL (OR: 4.37; 95%CI: 2.30-8.31). SVT during pregnancy is associated with increased risk for CS and PTL in healthy women. History of SVT should be sought as early as preconception counseling, and a multidisciplinary approach is warranted for both prevention and management of SVT occurrence.

Abstract 12902: Supraventricular Tachycardia During Pregnancy is Independently Associated With Adverse Obstetrical Outcomes

Introduction: Supraventricular tachycardias (SVT) are the most frequently encountered arrhythmias in pregnancy, however, their clinical significance is unclear. Hypothesis: We report the prevalence, describe the management and explore the association between SVT and adverse obstetric outcomes in women with structurally normal hearts. Methods: This is a case-control study of primiparous and multiparous women without history of cesarean section (CS), and no known cardiac diagnosis admitted in labor to one of 8 Northwell Health hospitals between January 2015 and August 2022. The study group consisted of women with at least one SVT episode during pregnancy and the control group was randomly selected in a 4:1 ratio. Multivariate analysis was used to examine the association between occurrence of SVT during pregnancy and incidence of cesarean section (CS), preterm labor (PTL), and length of stay (LOS). Results: Of 141,769 women meeting the inclusion criteria, SVT diagnosis was confirmed in 122. Of those, 76 (age 33.2±4.8 years) had at least 1 symptomatic episode during pregnancy. For the women with known SVT diagnosis prior to pregnancy, medical therapy with any antiarrhythmic agent was not associated with reduction of SVT recurrence during pregnancy (OR 1.07, 95% CI 0.41-2.80 p=0.89). On the contrary, catheter ablation prior to pregnancy was associated with significant reduction of SVT recurrence (OR 0.09, 95% CI 0.04-0.23, p&lt;0.0001). Women with SVT during pregnancy had a higher incidence of CS (39.5% vs 27.0%. p=0.03), and PLT (30.3% vs 8.6%, p&lt;0.001) compared to the control group. After adjusting for age and parity, SVT during pregnancy was independent predictor of CS, particularly elective CS (OR 2.89 95% CI 1.06-7.89) and PTL (OR 4.37 95%CI 2.30-8.31). Conclusions: SVT occurs in about 1 in every 1,000 women during pregnancy and is associated with higher rates of CS, particularly scheduled, and PLT. Any history of SVT should be sought and addressed during preconception counselling and SVT episodes during pregnancy should be approached in a multidisciplinary way to mitigate the risk of CS and associated complications.

Postpartum Depression Is Associated with Maternal Sociodemographic and Anthropometric Characteristics, Perinatal Outcomes, Breastfeeding Practices, and Mediterranean Diet Adherence.

This is a cross-sectional survey, which was performed on 3941 women during the postpartum period. Postpartum depression was assessed by the Edinburgh Postnatal Depression Scale (EPDS). Anthropometric parameters and perinatal outcomes were retrieved from mothers' medical records. Sociodemographic data and breastfeeding practices were recorded by face-to-face interviews between enrolled mothers and trained personnel. Mediterranean diet adherence was assessed by MedDietScore. Both univariate and multivariate binary logistic regression were applied for analyzing our data. Postpartum depression was significantly associated with lower educational level, Greek nationality, higher prevalence of multiparity and overweight/obesity postpartum, higher incidence of caesarean section and not breastfeeding, and lower levels of MD adherence. In multivariate analysis, postpartum depression was independently associated with mothers' educational level, postpartum BMI status, type of delivery, breastfeeding practices, and MD adherence after adjusting for multiple confounding factors. This study has provided evidence that elevated MD compliance was related to a decreased risk of postpartum depression. Additionally, postpartum depression was associated with multiple sociodemographic and anthropometric parameters, perinatal outcomes, and breastfeeding practices. Future well-designed, prospective studies with high-quality methodology should be performed to obtain conclusive results.

Fetal and post-natal growth in infants of mothers with multiple sclerosis: A case-control stud

BackgroundMultiple sclerosis does not seem to adversely affect fetal and neonatal outcomes, although some studies reported a possible reduction in mean birth weight and length, and a higher incidence of preterm delivery, mainly in relation to the exposure to disease-modifying drugs (DMDs) during pregnancy. Few data are available on intrauterine fetal growth and postnatal somatic development of newborns from mothers with multiple sclerosis compared to those from healthy women. For these reasons, we decided to investigate fetal growth, neonatal anthropometric parameters, and postnatal somatic development up to 12 months of life in offsprings from MS mothers. MethodsThis retrospective cohort study included 211 women with multiple sclerosis, and 384 healthy women paired for maternal age and parity as controls. Fetal biometric parameters (biparietal diameter, head circumference, abdominal circumference, and femur length) measured during the third trimester of pregnancy (30–34 weeks’ gestation) were retrieved from the computerized database of the Department (EcoPlus*) where the results of ultrasound exams performed in the hospital are stored. Newborn measurements (weight, length and head circumference) at birth were obtained from the hospital's computerized obstetric and neonatal database (Trackare* and Remote* data base); measurements at 6 and 12 months of life were obtained from the regional database (ECWMED*) of family pediatricians of our region. ResultsNo differences between the two groups were observed for all the fetal parameters considered, expressed as centiles of growth according to gestational age (biparietal diameter: p = 0.40; head circumference: p = 0.40; abdominal circumference: p = 0.32; femur length: p = 0.32). No differences in gestational age at delivery, birthweight, and in the incidence of low birthweight and small for gestational age newborns were observed between the two groups. In the multiple sclerosis group a significantly higher incidence of caesarean section (p = 0.01) and late preterm delivery (at less than 37 weeks'gestation, p = 0.001) were registered. The trends of postnatal growth in weight (F = 0.53; p-value = 0.590) and length (F = 0.44; p-value = 0.645) were superimposable between the two groups. The trends of growth for head circumference showed a slightly, not significantly greater head circumference of infants from mothers with multiple sclerosis at 6 months of life, but the values at twelve months of life in the two groups were similar (F = 0.85; p-value = 0.427) . Moreover, the trends of postnatal increase of weight (F = 1.016; p-value = 0.331), length (F = 2.001; p-value = 0.146) and head circumference (F = 1.591; p-value = 0.212) of newborns/infants (from birth to twelve months of life) born to mothers with multiple sclerosis who breastfed, mothers who did not, and in the control group were similar. ConclusionMultiple sclerosis in pregnancy does not seem to affect fetal growth and postnatal development during the first year of the offspring life. We think that these results represent an important and reassuring information to provide the patients with during preconception counseling.

Vitamin D: Before, during and after Pregnancy: Effect on Neonates and Children.

A worldwide high prevalence of vitamin D (VD) deficiency has become of growing concern because of potential adverse effects on human health, including pregnant women and their offsprings. Beyond its classical function as a regulator of calcium and phosphate metabolism, together with its fundamental role in bone health in every stage of life, its deficiency has been associated to multiple adverse health effects. The classic effects of VD deficiency in pregnancy and neonates have been late hypocalcemia and nutritional rickets. Nevertheless, recent studies have linked VD to fertility and 25(OH)D with several clinical conditions in pregnancy: preeclampsia, gestational diabetes, higher incidence of cesarean section and preterm birth, while in infants, the clinical conditions are low birth weight, lower bone mass and possible relationship with the development of such diseases as bronchiolitis, asthma, type 1 diabetes, multiple sclerosis and autism included as VD non-classical actions. The supplementation with Vitamin D and achievement of optimal levels reduce maternal-fetal and newborn complications. Supplementation in children with VD deficiency reduces the risk of respiratory infections and possibly autoimmune diseases and autism. This review emphasizes the roles of Vitamin D deficiency and the consequences of intervention from preconception to infancy.

Study of the Feto-Maternal Outcomes at Late-Term Pregnancy in a Tertiary Level Hospital in Western Nepal

Introduction: The incidence of prolonged pregnancy is 7%. There is an increased risk to the fetus after 41 weeks of gestation due to a decrease in placental function, oligohydramnios, and meconium aspiration. The risk to the mother also increases leading to an increased incidence of cervical tear, perineal injury, labour dystocia, operative deliveries, and postpartum hemorrhage.&#x0D; Method: This was an observational, prospective cross-sectional study. A hundred and eleven women at and beyond 41 weeks of gestation fulfilling the inclusion criteria, were included in the study. Data entry and analysis were done using the latest SPSS software version 21 Fisher exact test was used and were depicted in tables, diagrams and charts as required.&#x0D; Result: Majority of the women had cesarean section 62.2% (n=69), 33.7% (n=37) delivered vaginally and 4.5% (n=5) had assisted vaginal delivery. The most common indication for cesarean section was meconium-stained liquor (20.3%, n=14). Only one woman had postpartum hemorrhage (PPH), one had retained placenta and one had pre-eclampsia. Altogether 10.8% (n=12) neonates needed admission. The adverse fetomaternal outcomes were similar in 41-41 6/7 weeks and completed 42 weeks and beyond the gestational age (p=0.64).&#x0D; Conclusion: Late-term pregnancy is associated with a higher incidence of cesarean section. However, there was no statistical difference in the feto-maternal outcome at 41-41 6/7 weeks and 42 and beyond weeks of gestation.

STUDY ON THE EFFECT OF ADVANCED MATERNAL AGE AT OBSTETRIC AND PERINATAL LEVEL

INTRODUCTION: Advanced maternal age is commonly considered to be 35 years or older. The association between adverse perinatal outcomes and advanced maternal age has been a matter of controversy in several studies. While some researchers have noted an increased rate of adverse pregnancy outcomes in women older than 35 years, others have failed to nd any association between advanced maternal age and adverse perinatal outcomes. This discordance in conclusions could be attributed to the heterogeneity of study populations, differences in the denition of pregnancy outcomes, and failure to adjust for potential confounders. Therefore, we aimed to investigate the impact of advanced maternal age on obstetric and perinatal outcomes in this study. MATERIALS AND METHODS: The study was carried out among the patients who presented to the labour ward. This is a prospective observational study. The demographic data of these women, gestational age at time of delivery and complication during pregnancy are noted. They will be followed up till discharge and mode of delivery, perinatal outcome and any intrapartum and postpartum complications will be recorded in the research proforma. Sample Size: 252. RESULTS: Though there were higher incidence of Gestational hypertension, PROM, Preterm labour, placenta previa, Malpresentation, Multiple Pregnancy, FGR and treatment taken for infertility among the study group when compared to control group, their statistical signicance could not be established. There was also higher incidence of caesarean section (50.8%) and Operative vaginal delivery (2.6%) in the study group. There was no statistically signicant weight difference among the babies born to mothers in case and control group. CONCLUSION: Pregnant women of Advanced Maternal Age is thought about with great concern among the doctors as well as patients. In this study, there is an increased incidence of antenatal complications like Gestational Diabetes Mellitus, Gestational Hypertension, Caesarean Section and Preterm labour in women aged more than 35 years compared to the women of age 20 to 35 years.

Previous mode of delivery affects subsequent pregnancy outcomes: a Chinese birth register study.

BackgroundWith the comprehensive implementation of the second child policy in China, the proportion of multiparous women has increased dramatically in the past few years. As nearly half of them have a history of previous cesarean delivery, there is widespread concern regarding complications of their pregnancy.MethodsThe aim of this study was to evaluate the effect of the previous delivery mode on subsequent pregnancy outcomes in the real world based on data from a Chinese birth registry. Birth registry data from July 1, 2016 to June 30, 2017 among a Chinese population were collected and analyzed retrospectively. This study included 14 representative hospitals from 10 provinces of China. All delivery data were collected by an internet-based system using a birth registration platform. The study enrolled 36,355 multiparas. Information extracted for analysis included basic demographic characteristics, previous delivery mode, current delivery mode, major maternal complications, and neonatal outcomes. Pregnancy outcomes of women with previous cesarean delivery (PCS group, n=14,774) were compared with the outcomes of women with previous vaginal delivery (PVD group, n=21,581).ResultsThere were statistically significant differences in the major pregnancy outcomes between the PCS group and the PVD group. The PCS group had a higher incidence of cesarean section (CS), placenta previa, postpartum hemorrhage, uterus rupture, hysterectomy, gestational diabetes, gestational hypertension, delivery before 37 weeks of gestation, low birth weight, and Apgar Score at 5 min ≤3.ConclusionsWomen with previous cesarean delivery had poorer pregnancy outcomes than women with previous vaginal delivery. Avoiding unnecessary CS, especially in primiparas is essential to improving maternal and neonatal outcomes in later pregnancies.

Outcomes of Pregnancy in Euthyroid Women with Positive Thyroid Peroxidase Antibodies

Thyroid disorders are among the most common endocrine disorders affecting pregnant women .Thyroid autoimmunity has been associated with poor pregnancy outcomes. Thyroid Peroxidase antibodies being the most common of thyroid antibodies and it can be considered as a surrogate marker for thyroid related adverse pregnancy outcomes. The present study was conducted to further elucidate the association between these antibodies and adverse pregnancy outcomes. A case control study including 150 randomly selected participant was carried out at AL-Khansaa Teaching Hospital in Mosul, Iraq. over the period of three months. All participants enrolled in the study were screened for Thyroid Function Tests TFTs including Thyroid Stimulating Hormone, Free thyroid hormones (Ft3 and Ft4) as well as Anti-Thyroid Peroxidase antibodies. Pregnant women were then classified depending on their Anti-Thyroid Peroxidase antibodies test results into two groups (positive and negative) groups. All women were followed till delivery to record their pregnancy outcomes. Our results showed that 10% of the screened pregnant women showed positive anti-Thyroid peroxidase antibodies. These women reported a higher incidence of cesarean section and preterm deliveries when compared to negative anti-Thyroid peroxidase antibodies control group. So a conclusion was drawn to recommend anti-Thyroid peroxidase antibodies as screening test during pregnancy especially those with bad obstetric history or history of thyroid disorders.

Frequency of caesarean section in diabetic vs. non diabetic females undergoing induction of labour at term

Introduction: Gestational diabetes mellitus (GDM) is a common complication of pregnancy characterized by glucose intolerance recognized during pregnancy. Gestational diabetes is associated with adverse maternal and fetal outcome. Majority of patients with diabetes had induction of labour at term (≥37weeks) to prevent maternal and fetal morbidity especially shoulder dystocia, macrosomia and intrauterine fetal death at term&#x0D; Objectives:&#x0D; &#x0D; To find frequency of gestational diabetes (GDM) in patients undergoing induction of labour.&#x0D; To compare the frequency of caesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour&#x0D; &#x0D; Methodology:&#x0D; Study Type; It was a descriptive case series conducted at the department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Duration of study was six months after approval from IRB.&#x0D; Sample size; Sample size of 214 cases undergoing induction of labour at term during study period; calculated with 95%confidence level and 3.4% margin of error and taking expected percentage of GDM is 6.9%.&#x0D; Sampling Technique; purposive sampling&#x0D; Methodology:&#x0D; 214 females who will fulfill the inclusion criteria were enrolled in the study from labour room of Department of Obstetrics and Gynecology, Shalamar Hospital Lahore. Induction of labour done with tab prostin 3mg single dose and patients having gestational diabetes were identified and frequency of caesarean section in Diabetic and non-diabetic calculated.&#x0D; Results:&#x0D; In current study, mean age of the patients was 27.8±4.4 years. Mean gestational age was 37.1±3.8 weeks and mean BMI was 28.6±4.1 kg/m2. Primigravida were 88 (41.1%) and multigravidas were 126 (58.9%). Gestational diabetes was found to be in 36 patients (16.8%). Caesarean section was performed in 77 patients (36%). Comparison of frequency of cesarean section in diabetic (GDM) and non-diabetic females undergoing induction of labour revealed majority of the caesarean sections performed in GDM patients (p=0.007).&#x0D; Conclusion&#x0D; In conclusion, our study found a higher incidence of cesarean section than normal delivery in pregnant women with gestational diabetes. Major factors for operational delivery in GDM population included: advanced maternal age and high BMI value.

The relationship between epidural analgesia and intrapartum maternal fever and the consequences for maternal and neonatal outcomes: a prospective observational study

Aim To use continuous real-time monitoring of maternal core body temperature during labor and investigate the association between epidural analgesia, intrapartum maternal fever, and maternal and neonatal outcomes. Methods Among 201 pregnant women attending our institution for a vaginal in-hospital delivery, 159 women received epidural analgesia and 42 women did not receive epidural analgesia. Women’s core body temperature was continuously monitored for the duration of labor using a smartphone/iPad-connected wireless thermometer positioned in an axilla. The primary outcome was a change in maternal core body temperature during labor. Among women receiving epidural analgesia, maternal and neonatal outcomes were compared in women who developed an intrapartum fever and those who had no intrapartum temperature elevation. Results Of the women receiving epidural analgesia, 26.4% (n = 42/159) developed intrapartum fever ≥38 °C compared to 7.1% (n = 3/42) of women not receiving epidural analgesia. Among those receiving epidural analgesia, women who developed intrapartum fever had a significantly longer first stage of labor and a higher incidence of cesarean section, assisted vaginal delivery, intrapartum hemorrhage, and turbid amniotic fluid compared to women with no intrapartum temperature elevation. Neonates of women who developed intrapartum fever had lower 1- and 5-min Apgar scores compared to neonates of women with no intrapartum temperature elevation; however, the difference was not significant. Conclusion This study used a precise and accurate method to monitor core body temperature among women receiving epidural analgesia. Results showed that the use of epidural analgesia during labor was associated with intrapartum maternal fever in all stages of labor. Fever after epidural analgesia was associated with adverse maternal outcomes, independent of neonatal complications.

Nutritional status of pregnant women - effects on the course and pregnancy outcome

Introduction. In recent decades, obesity has taken on epidemic proportions and is becoming one of the most significant public health problems today. The results of clinical and epidemiological studies show that obese pregnant women can be considered a high risk group, given the increased risk of maternal and fetal complications. The aim of this study was to examine the relationship between pregnant women?s nutritional status and the development of arterial hypertension, gestational diabetes and obstetric cholestasis during pregnancy, as well as the impact of pregnant women?s nutritional status on newborn birth weight and vital parameters at birth, assessed by Apgar score. Material and Methods. This retrospective study included 71 pregnant women who were divided into two groups, depending on the nutritional status. The first group included 28 pregnant women with a body mass index &lt; 25 kg/m? or less, whereas the second group included obese pregnant women with a body mass index &gt; 30 kg/m? or more. Birth protocol data were used for the newborns. Results. In obese pregnant women, the termination of pregnancy by cesarean section was statistically significant more frequent (p &lt; 0.05). Newborns of obese mothers had a statistically lower Apgar score at 5 minutes, while higher body weight of newborns and a lower Apgar score at 1 minute were at the limit of statistical significance (p = 0.068). Arterial hypertension was more common in obese pregnant women (p = 0.014), while gestational diabetes (p = 0.42) and obstetric cholestasis (p = 0.51) were more common in obese pregnant women, but without statistical significance. Conclusion. Obesity in pregnancy is a risk factor for the development of hypertension, a higher incidence of cesarean section, and a lower Apgar score of newborns.

Nėštumų ir gimdymų baigtys po pagalbinio apvaisinimo

Santrauka. Tyrimo tikslas. įvertinti moterų, pastojusių po pagalbinių apvaisinimo budų (PAB), neštumo, gimdymo eigą ir rezultatus bei išanalizuoti naujagimių baigtis. Tyrimo medžiaga ir metodai. 2016–2018 m. laikotarpiu retrospektyviai tirtos 427 pacientės, gimdžiusios Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikose (toliau – Kauno klinikos), suskirstytos į tiriamąją (n=215) bei kontrolinę (n=212) grupes. Tiriamoji grupė – tai moterys pastojusios po PAB, kontrolinė grupė – tai atsitiktinai atrinktos savaime pastojusios moterys. Analizuoti neštumo, gimdymo eigos ir naujagimių buklės duomenys remiantis gimdymo registro, gimdymo knygų ir ligos istorijomis. Rezultatai. Daugiavaisiai neštumai PAB grupeje sudarė 37,7 proc., o kontrolinėje grupėje – 10,4 proc., p&lt;0,001. Neštumo komplikacijų: preeklampsijos (lengvos, sunkios), neščiųjų hipertenzijos, neščiųjų diabeto dažnis tarp grupių reikšmingai nesiskyrė, p&gt;0,05. Placentos patologijos (įaugusi placenta ir placentos pirmeiga) dažnesnėsPAB grupėje, atitinkamai – p=0,012 ir p=0,004. Priešlaikinio vaisiaus dangalų plyšimo dažnis tarp grupių nesiskyrė. Vaisiaus ydų dažniai abiejose grupėse nesiskyrė, p=0,302. Cezario pjūvio operacijų (CPO) dažnis didesnis PAB grupėje ir siekia 49,8 proc., p=0,016. Placentos atšokos dažnis grupėse nesiskyrė. Apgar balų vidurkis 1 ir 5 min. grupėse nesiskyrė, p1&lt;0,994 ir p5&lt;0,484, tačiau PAB grupėje buvo didesnis neišnešiotų naujagimių, p=0,015, vaisiaus augimo sulėtejimo (VAS), p=0,005 bei mažesnis stambių vaisių dažnis, p=0,005. Išvados. Svarbiausios su PAB susijusios komplikacijos yra daugiavaisiai neštumai, CPO, su placenta susijusios patologijos, priešlaikinis gimdymas, vaisiaus augimo sulėtėjimas.

Análisis de las cesáreas en Uruguay por tipo de centro hospitalario

ObjectiveTo analyse on a comparative basis the incidence of caesarean sections among the different health care systems in Uruguay and with respect to the World Health Organization's (WHO) standards, taking into account the medical-obstetric characteristics of the births, particularly, the Robson classification. MethodsWe examine 190,847 births registered by the Perinatal Information System in Uruguay between 2009 and 2014 by type of health care system. Using logit models, we analyse the probability of caesarean section taking into account the Robson classification, other risk factors and the mothers’ characteristics. We compared the caesarean rates predicted by the different subsystems for a common population. Furthermore, we contrast the caesarean rates observed in each subsystem with the rates that resulted if the Uruguayan hospitals followed the guidelines of the sample of WHO reference hospitals. ResultsPrivate health systems in Uruguay exhibit a much higher incidence of caesarean sections than public ones, even after considering the medical-obstetric characteristics of the births. Caesarean rates are more than 75% higher than those observed if the WHO standards are applied. ConclusionsUruguay has a very high incidence of caesarean sections with respect to WHO standards, particularly, in the private sector. This fact is unrelated to the clinical characteristics of the births.

Induction of Labor at 39 Weeks versus Expecting Labour till 41 Weeks: Randomized Controlled Trial on Class I Obese Egyptian Women, with Mode of Delivery Being a Study Endpoint

Background: Maternal obesity is reported to be associated with increased incidence of gestational diabetes mellitus and hypertension. These cause failure of labour induction, leading to higher incidence of cesarean section (CS). The aim of this study was to assess which reduces CS rate, labor induction at 39 weeks or leaving women for spontaneous labor onset till 41 weeks. Methodology: A randomized controlled trial was conducted in Ain Shams Maternity Hospital in Egypt from 2016 to 2018. Study population consisted of 200 term primigravida pregnant obese women delivered in Ain Shams Maternity Hospital. They were divided into two groups: Group A: induction of labor at 39 + 0 weeks (n = 100) by vaginal administration of 25 μg misoprostol (PGE1) every 6 hours for 5 doses; Group B: waiting spontaneous labor onset till 41 + 0 weeks (n = 100), and if no spontaneous labor occurred at 41 weeks, induction was performed in the same way. Results: Induction (Group A) vs. waiting spontaneous labor (Group B) showed the followings, which were significant: CS: 22% vs 39%, p = 0.009; maternal birth injury: 4% vs 12%, p = 0.037; non-assisted vaginal deliveries: 93.6% vs 78.7%, p = 0.034; APGAR scores at 1 & 5 min: 7.6 ± 0.8 vs 7.3 ± 1.1 p = 0.038, 8.4 ± 1.0 vs 8.1 ± 1.3 p = 0.040, respectively; birth weight; 3.3 ± 0.1 vs 3.5 ± 0.2 kg, p Conclusion: CS rate was significantly lower in women with induction of labor at 39 weeks than those waiting for spontaneous labor onset till 41 weeks in obese Egyptian pregnant women.

Outcomes of Pregnancy in Recipients of Liver Transplants

Despite increasing reports of pregnancy in women who received liver transplants, it is not clear how transplantation and immunosuppression affect pregnancy. We collected data from liver transplant recipients who became pregnant on immunosuppression regimens, pregnancy management, graft morbidity, and outcomes of mothers and neonates. We searched the liver transplant database in Birmingham, United Kingdom, for women who reported pregnancy after liver transplantation from August 1986 through May 2016. We collected information on morbidities and outcomes of 139 pregnancies in 83 women (median age at conception, 27 y; range, 15-46 y). Fisher exact tests were used to compare categoric variables and Mann-Whitney U and Kruskal-Wallis tests were used to compare continuous variables. The primary outcome was the live birth rate in the entire cohort. Additional outcomes analyzed included differences in immunotherapy regimens, and outcomes associated with exposure to cyclosporine and tacrolimus, time to transplantation (<12 vs >12 mo), and time period of pregnancy (1986-2000 vs 2001-2016). Of the pregnancies, 69% resulted in live births, 19% resulted in miscarriages or still births, and 9% were terminated. A higher proportion of patients who conceived more than 1 year after liver transplantation had live births than of women who conceived before this time (98% vs 80%; P= .006). Tacrolimus exposure was associated with higher risks of premature delivery (P= .045) and caesarian section (P= .031) than cyclosporine exposure. Compared with the period from 1986 to 2000, women who conceived from 2001 to 2016 had a significantly shorter time between transplantation and conception (median, 3 vs 7 y; P= .027), frequent use of tacrolimus vs cyclosporine (84% vs 26%; P= .001), and a higher incidence of cesarean section (44% vs 32%; P= .025). Almost 70% of women who conceive after liver transplantation have live births, although this rate is lower than that of women in the overall population. These cases require involvement of hepatologists and obstetricians.

What is the effect of intertwin delivery interval on the outcome of the second twin delivered vaginally?

Objective: Optimal management of twin deliveries is controversial. We aimed to assess if intertwin delivery interval, after vaginal delivery of the first twin, may have an influence on adverse neonatal outcomes of the second twinStudy design: This is a retrospective observational study including diamniotic twin pregnancies with vaginal delivery of the first twin, between January 2000 and July 2017. Inclusion criteria were diamniotic pregnancies and vaginal delivery of the first twin. We excluded higher twin order, monoamniotic pregnancies, cesarean delivery of the first twin and patients with missing data.Results: A number of 400 diamniotic twin pregnancies met the inclusion criteria and were divided, considering intertwin delivery interval into (1) ≤30 minutes (n = 365); and (2) >30 minutes (n = 35). Considering the two study groups, maternal and first twin characteristics and outcomes were similar. Second twin reported higher incidence of cesarean section and vacuum delivery, but similar incidence of neonatal adverse outcomes, in case of intertwin interval >30 minutes. At multivariate analysis, a difference between second and first twin weight ≥25% was correlated to neonatal adverse outcome, while we did not found this correlation with a cut-off of 30 minutes.Conclusions: In our study, growth discrepancy between twins was significantly correlated to adverse neonatal outcomes, while intertwin delivery time was not an influencing factor. So, in line with this result, in our clinical practice, we do not use a fixed time in which both twins should be delivered, neither in monochorionic nor in dichorionic pregnancies, when fetal wellbeing was demonstrated during labor.

Impact of the Great East Japan Earthquake and Fukushima Nuclear Power Plant Accident on Assisted Reproductive Technology in Fukushima Prefecture: The Fukushima Health Management Survey.

BackgroundThe aim of the study was to evaluate the incidences and obstetric outcomes of women who conceived using assisted reproductive technology (ART) procedures in Fukushima Prefecture before and after the Great East Japan Earthquake and Fukushima nuclear power plant accident.MethodsInformation was collected and analyzed from 12,070 women who conceived with or without ART in Fukushima Prefecture during the 9 months before and after the disaster.ResultsDuring the 9 months before and after the disaster, 138 (2.0%) and 102 (1.9%) women conceived with in vitro fertilization-embryo transfer (IVF-ET), respectively. The proportion of women who conceived with IVF-ET decreased during the 2 months immediately after the disaster, but returned to pre-disaster levels 3 months after the disaster. In the case of women who conceived without IVF-ET, the incidences of preterm birth and low birth weight increased after the disaster. In contrast, women who conceived with IVF-ET did not differ significantly in obstetric outcomes before and after the disaster but had a higher incidence of cesarean section and low birth weight compared to those conceived without IVF-ET, regardless of the study period.ConclusionThe influence of the disaster on woman who conceived using ART procedures was minimal.

Combined spinal-epidural analgesia in labour: its effects on delivery outcome

Combined spinal-epidural (CSE) has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n=55) or Non-CSE (n=55) group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%). The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group) was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5min was similar in both groups. There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

Associations of prepregnancy body mass index and gestational weight gain with pregnancy outcomes in nulliparous women delivering single live babies.

The study was to assess the associations of prepregnancy body mass index (BMI) and gestational weight gain (GWG) with pregnancy outcomes. This was a retrospective analysis of 2973 nulliparous women who delivered single live babies. Prepregnancy BMI was categorized as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2) or overweight/obese (≥25.0 kg/m2). GWG was categorized as inadequate, adequate or excessive. 567 (19.1%) women were overweight/obese, and 1600 (53.8%) exhibited excessive GWG. Compared with women of normal weight, overweight/obese women had a higher incidence of cesarean section (odds ratio, 95% confidence interval: 2.02, 1.59–2.56), postpartum hemorrhage (1.50, 1.05–2.14), preterm delivery (2.51, 1.83–3.45), preterm premature rupture of membranes (2.11, 1.32–3.38), gestational diabetes mellitus (2.04, 1.65–2.53), gestational hypertension (7.68, 4.21–14.00), preeclampsia (1.98, 1.18–3.33) and small for gestational age (2.81, 1.21–6.54). Compared with adequate GWG, excessive GWG increased the incidence of cesarean section (2.02, 1.59–2.56), preterm delivery (1.48, 1.05–2.71), preeclampsia (1.78, 1.34–4.27) and macrosomia (2.61, 1.61–4.25), and reduced the incidence of gestational diabetes mellitus (0.75, 0.62–0.92). High prepregnancy BMI and excessive GWG in nulliparous Chinese women are associated with adverse pregnancy outcomes. Weight control before and during pregnancy could reduce the complications of pregnancy.