Improvements In Perinatal Outcomes Research Articles

Correlation of Cardiotocography with neonatal outcome in term pregnancies at a tertiary care centre in Bihar, India: A prospective observational study

Early recognition of foetal distress by intrapartum cardiotocography (CTG) has a pivotal role in the improvement of perinatal outcome. So, the aim of this study was to correlate the findings of CTG with neonatal outcome.This Prospective Observational study was conducted on 300 pregnant women in labour having singleton term pregnancy with cephalic presentation. Intrapartum cardiotocography was done. CTG pattern was correlated with neonatal outcomes by analysing Apgar score, NICU admission and neonatal mortality rate. Statistical analysis was done by using chi square test and Fisher Exact test and p value < 0.05 was considered as statistically significant.Out of 300 patients, reactive CTG pattern was observed in 67% while suspicious and pathological pattern was observed in 22% and 11% of pregnancies respectively. The percentage of caesarean deliveries were significantly more among abnormal CTG group as compared to reactive group (p value < 0.0001). The sensitivity and specificity of CTG for predicting foetal distress and NICU admission was 80 % and 78.75% respectively. There was high NPV of 94.03%, and the diagnostic accuracy of test was 79%.Reactive CTG is more predictive of favourable neonatal outcomes while Pathological CTG tracing requires immediate intervention. Suspicious CTG requires close observation during intrapartum period after correcting underlying causes and taking conservative measures and Immediate delivery is not required unless it became pathological and hence caesarean section rate can be reduced in this group Overall, intrapartum CTG is an important screening tool for early identification of foetal distress.

Коррекция истмико-цервикальной недостаточности при помощи анкерных лигатур с титановым фиксатором. Первый опыт

This article presents a pilot study of surgical correction of isthmic-cervical insufficiency (ICI) in 5 patients aged 29 to 45 years with singleton pregnancies at gestational ages ranging from 13–14 to 19–20 weeks. An original method of cerclage using a spiral suture, anchor ligatures, and a titanium fixator was developed, the main purpose of which is to prevent cervical injury by the erupting suture of the terminal fixing block of the anchor ligature. This method of ICI correction is expected to contribute to optimization of the results of surgical treatment and improvement of perinatal outcomes. Key words: isthmic-cervical insufficiency, anchor ligatures, titanium fixator, cerclage, spiral suture

The role of platelet microvesicles in the pathogenesis of preeclampsia

Among the diverse picture of preeclampsia, the hematological component, thrombocytopenia, attracts attention. Platelets are able to form microvesicles by budding the plasma membrane from the cell surface during apoptosis, stimulation, and also in a small amount in normal conditions. The membrane of these particles has a negative charge and contains phospholipids and an integral glycoprotein on the outer monolayer, due to which platelet microvesicles are involved in the process of blood coagulation and angiogenesis. Microvesicles are of platelet origin, they were first discovered in the middle of the last century in England when describing the phenomenon of plasma and serum coagulation in the absence of platelets in them. The number of platelet microvesicles dynamically changes during the formation of preeclampsia in pregnant women and in women with risk factors for the development of preeclampsia, which include obesity, arterial hypertension, diabetes mellitus, antiphospholipid syndrome. Exposure to these risk factors for preeclampsia before pregnancy leads to a change in the concentration of cells that produce microvesicles, which in turn can create conditions favorable for the development of preeclampsia during pregnancy. A special risk group are women with a history of preeclampsia. Taking into account the direct role of microvesicles in the processes of angiogenesis and blood coagulation, the study of these particles will allow a more detailed study of the pathophysiological aspects of the preeclampsia development, which will expand the possibilities for early prediction of this pathology and improvement of perinatal outcomes.

Trends in maternal characteristics and perinatal outcomes among Japanese pregnant women with type 1 and type 2 diabetes from 1982 to 2020.

Aims/IntroductionThis study investigated the time trends of the maternal characteristics and perinatal outcomes of Japanese pregnant women with diabetes.Materials and MethodsThis retrospective study included 621 deliveries in 429 Japanese women with diabetes between 1982 and 2020. The association of the delivery date with clinical features was analyzed using the generalized estimating equations to adjust for the within‐person correlation.ResultsThe mean age of delivery and the mean diabetes duration increased over time (both P < 0.001), while the prevalence of diabetic retinopathy decreased (P = 0.006). The mean HbA1c values during pregnancy decreased significantly over time (all P < 0.001). The decreasing trends were associated with preterm delivery (P = 0.021) but not with other perinatal outcomes. The time trends were significantly different between patients with type 1 diabetes mellitus and with type 2 diabetes mellitus in large for gestational age (LGA) and stillbirth (both P for interaction <0.05). The rate of LGA decreased among patients with type 2 diabetes (P = 0.003) but not those with type 1 diabetes (P = 0.413). In contrast, the prevalence of stillbirth was decreased among those with type 1 diabetes (P < 0.001) but not those with type 2 diabetes (P = 0.768). The proportion of major congenital anomalies did not change in the overall population (P = 0.259) and among patients with type 2 diabetes (P = 0.229), but it increased among those with type 1 diabetes (P = 0.044), although the difference between those with type 1 diabetes and type 2 diabetes was not statistically significant (P for interaction = 0.166).ConclusionsMaternal glycemic control has improved over the decades, whereas the improvement of perinatal outcomes has been limited. Perinatal outcomes still need to be improved in Japanese women with diabetes.

Prediction of birth weight in pregnancy with gestational diabetes mellitus using an artificial neural network.

Gestational diabetes mellitus (GDM) is common during pregnancy, with the prevalence reaching as high as 31.0% in some European regions (McIntyre et al., 2019). Dysfunction of the glucose metabolism in pregnancy can influence fetal growth via alteration of the intrauterine environment, resulting in an increased risk of abnormal offspring birth weight (McIntyre et al., 2019). Infants with abnormal birth weight will be faced with increased risks of neonatal complications in the perinatal period and chronic non-communicable diseases in childhood and adulthood (Mitanchez et al., 2015; McIntyre et al., 2019). Therefore, accurate estimation of birth weight for neonates from women with GDM is crucial for more sensible perinatal decision-making and improvement of perinatal outcomes. Timely antenatal intervention, with reference to accurately estimated fetal weight, may also decrease the risks of adverse long-term diseases.

Prediction of Neonatal Acidosis Based on the Type of Fetal Hypoxia Observed on the Cardiotocograph (CTG)

Cardiotocograph (CTG) was introduced into clinical practice to promptly recognize the features of intrapartum fetal hypoxic stress, so that timely action could be taken to avoid hypoxic-ischaemic encephalopathy (HIE) and perinatal deaths. However, the current systematic evidence suggests that the introduction of CTG into clinical practice over 50 years has not resulted in improvement in the rates of cerebral palsy or perinatal deaths. This is because most fetuses are able to withstand intrapartum hypoxic stresses without sustaining damage, and if the features of fetal compensatory responses are erroneously considered as “pathological”, “Abnormal” or “Category III” CTG tracing, it would lead to an exponential increase in unnecessary operative interventions without any improvement in perinatal outcomes. Neonatal acidosis at birth, determined by the estimation of pH in the umbilical artery has been considered as a surrogate marker of poor perinatal outcome. This is because significant intrapartum fetal hypoxic stress which leads to fetal decompensation, would lead to the onset of anaerobic metabolism and production of lactic acid in fetal tissues and organs. Entry of lactic acid into the fetal systemic circulation may cause damage to fetal central organs resulting in organ damage and death, and this lactate may lower the pH in the umbilical artery. Understanding the different types of fetal hypoxia on the CTG trace may help practicing clinicians to predict the rate of fall in fetal pH, and therefore, predict the umbilical cord pH at birth. It is important to appreciate that non-hypoxic pathways of fetal compromise such as chorioamnionitis may not be associated with low umbilical arterial pH at birth. Fetal pathophysiological approach to CTG interpretation based on deeper understanding of types of intrapartum hypoxia and features of non-hypoxic pathways of injury may help avoid the onset of neonatal metabolic acidosis and improve perinatal outcomes.

Use of Corticosteroids in Prenatal Treatment of Congenital Pulmonary Adenomatoid Malformation: Integrative Review.

To review data on the use of corticosteroids for the treatment of fetuses with high-risk congenital pulmonary adenomatoid malformation (CPAM). Integrative review based on the literature available on MEDLINE and LILACS, including articles published until November, 2020. The initial search resulted in 87 articles, 4 of which were selected for analysis, with all of them being retrospective descriptive observational studies. In the group of fetuses that received only a single corticosteroid cycle, the hydrops resolution rate was 70%, and the survival rate was 83.8%. In fetuses treated with 2 or more cycles of corticosteroids, there was an improvement in the condition of hydrops or edema in a single body compartment in 47%, and survival of 81.8% of the fetuses. The use of corticosteroids for the prenatal treatment of high-risk CPAM appears to be associated with an improvement in perinatal outcomes.

A comparative study of induction of labour with intravaginal misoprostol and intracervical dinoprostone gel and its fetomaternal outcome in a tertiary care hospital

The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.This is prospective case-control study conducted in department of obstetrics and gynecology, C. U. Shah Medical College and Hospital, Surendranagar over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.

MANAGEMENT OF GARBHODAKAVRIDDHI W.S.R. TO POLYHYDRAMNIOS THROUGH AYURVEDA - A CASE REPORT

Introduction: Polyhydramnios is a relatively common clinical presentation in pregnancy with a varying incidence of 1-2% of cases. There is yet no data suggestive of improvement in perinatal outcome with antenatal fetal surveil- lance. Since it is associated with significant perinatal morbidity and mortality, fixing up a standard treatment pro- tocol for its management is needed. Case Description: A 28-year-old female patient consulted Prasutitantra and Streeroga OPD, NIA Hospital, Jaipur complaining of difficulty in breathing, palpitations, hyperacidity for 15 days with 8 months of amenorrhea. Diagnosis: Based on abdominal examination and radiological findings, the case was diagnosed with polyhydramnios. On the correlation of symptoms as stated by Acharya Sushruta, Ayurvedic diag- nosis of Garbhavriddhi was made. Intervention: As in the management of garbhavriddhi, practices involving appropriate samshodhana (purifying) and sanshamana (suppressive) yet kshaya-avirodhi karma (not causing loss of dosha or dhatu below optimal range) are prescribed. Hence, an intervention of Ksheerabasti with Punar- navashtaka Kwatha was done along with the oral medication in the present study. Outcome: USG done after 7 days of treatment course showed significant correction in AFI as well relief from clinical symptoms. Conclusion: This case illustrates that Polyhydramnios can be managed effectively and safely with Punarnavashtaka kwatha ksheera basti. Mutrajanana, Srotoshodhana, Kledapachana, and Shothaghna are the main actions essential in its manage- ment. Keywords: Garbhavriddhi, Polyhydramnios, Punarnavashtaka kwatha, Ksheera basti

“My whole room went into chaos because of that thing in the corner”: Unintended consequences of a central fetal monitoring system

ObjectiveTechnologies for fetal heart rate monitoring have been widely introduced despite evidence of no improvement in perinatal outcomes. A significant body of research has raised concerns that healthcare information technologies can have unintended consequences. We sought to describe an unintended consequence of central fetal monitoring technology. DesignThe research was conducted as an Institutional Ethnography. Data generated from interviews, focus groups, and observations were analysed to generate an account of midwives’ experiences with the central fetal monitoring system. SettingThe birthing unit of one Australian maternity service with a central fetal monitoring system. Informants34 midwives and midwifery students who worked with the central fetal monitoring system. FindingsMidwives described a disruptive social event they named being K2ed. Clinicians responded to perceived cardiotocograph abnormalities by entering the birth room despite the midwife not having requested assistance. Being K2ed disrupted midwives’ clinical work and generated anxiety. Clinical communication was undermined, and midwives altered their clinical practice. Midwives performed additional documentation work to attempt to avoid being K2ed. Key conclusionsThis is the first report of an unintended consequence relating to central fetal monitoring, demonstrating how central fetal monitoring technology potentially undermines safety by impacting on clinical and relational processes and outcomes in maternity care. Implications for practiceCurrent evidence does not support implementation or ongoing use of central fetal monitoring systems. Further research is needed to inform scaling down central fetal monitoring systems in a safe and supported way.

Impact of Coronavirus Diseases-2019 (COVID-19) on Utilization and Outcome of Reproductive, Maternal, and Newborn Health Services at Governmental Health Facilities in South West Ethiopia, 2020: Comparative Cross-Sectional Study.

BackgroundIn low-and middle-income countries, it is challenging to provide basic health-care services even before the COVID-19 pandemic outbreak. The purpose of this study was to evaluate the early indirect impact of COVID-19 on the utilization of reproductive, maternal, and newborn health services at government health facilities in South West Ethiopia, and its consequences.MethodsA comparative cross-sectional study was employed. The collected data were entered into Microsoft excel 2010 and then exported to SPSS 25 and R3.5.0 software for analysis. Independent sample t-test and two-sample test of proportion were computed, and the results were presented in text, tables, and graphs. P-value <0.05 was considered statistically significant.ResultsThis study showed that there was a significant reduction in mean utilization of antenatal care (943.25 visits vs 694.75 visits), health facility birth (808.75 births vs 619 births), family planning (4744.5 visits vs 3991.25 visits), and newborn immunization (739.5 given vs 528.5 given) between March–June 2019 and March–June 2020. However, there were significant increases in proportion of teenage pregnancy (7.5% vs 13.1%), teenage abortion care user (21.3% vs 28.5%), institutional stillbirth (14% vs 21.8%) and neonatal death (33.1% vs 46.2%) during the same period.Conclusion and RecommendationThis study showed that utilization of reproductive, maternal, and newborn health-care services was affected by the pandemic with deterioration of maternal and perinatal outcomes. An increase in the proportion of teenage pregnancy who seeks abortion care and the rising cesarean section rate with no improvement in perinatal outcome is a great concern that needs further investigation. Further research is also needed to explore the main reason for an increase in teenage pregnancy, abortion care users, stillbirth, and neonatal death during COVID-19.

999 Patients with which high risk complication benefits the most from patient navigation?

Maternal Morbidity Review Committees recognize social determinants of health contribute to poor maternal outcomes. Historically, low income women have a poor postpartum follow up (49.4%) and contraception use rate (47.5%). Racial disparities are prevalent within low income population. Our objective was to determine which group of patients with high risk conditions in our low income population had improvement in perinatal outcomes as a result of patient navigation. A retrospective cohort study was performed on low income pregnant patients from January 2016 to December 2017. Our patient navigation model was an interdisciplinary team, consisting of a physician, care coordinator, patient navigator, and social worker. Cohorts were determined by high risk condition: history of obstetric vs. medical complications. The primary outcomes were delivery at our institution and postpartum follow up. Secondary outcomes included rates of breastfeeding, contraception use, > 4 prenatal visits, and prenatal tetanus, diphtheria, acellular pertussis (Tdap) vaccination. Outcomes were compared using bivariate analysis. 724 patients were included in analysis. Baseline demographics were similar between groups. 691 (95%) of patients delivered at the institution where they had obtained prenatal care. Overall postpartum follow up rate was 72%. There was a significant difference in postpartum follow up rate, and delivery at home institution between the two groups. There were no significant differences found between contraception use or breast feeding. There was a high rate of delivery at a single urban institution. The postpartum follow up, contraception use, and breastfeeding rates in both groups was higher than historically reported in a similar population. This suggests that patient navigation models can be used to mitigate socio-economic disparities in healthcare. There was a statistically significant lower postpartum follow up rate in the obstetric complication group, which may reflect a need to increase education regarding recurrences risk in future pregnancies.

Improvement of perinatal outcomes in patients with recurrent miscarriages by correction of fibrinolytic reactions

Improvement of perinatal outcomes in patients with recurrent miscarriages by correction of fibrinolytic reactions

Modifiable socio-cultural beliefs and practices influencing early and adequate utilisation of antenatal care in rural Bangladesh: A qualitative study

ObjectiveOur objective was to explore the socio-cultural factors that influence women's early and adequate utilisation of antenatal care (ANC) in rural Bangladesh. MethodsA qualitative study was conducted in two rural settings of Bangladesh, including 32 in-depth interviews with pregnant or recently delivered women, husbands whose wives were pregnant or had a recent birth, mothers-in-law whose daughters-in-law were pregnant or had a recent birth; 2 focus group discussions with husbands; and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data. FindingsANC initiation in the first trimester was not a priority for most women. Women's lack of awareness about the appropriate timing of the first ANC contact, lack of decision-making autonomy and fear of caesarean section were the major barriers to the early and adequate ANC utilisation. There were many superstitions around pregnancy in rural settings which prevented women seeking early and adequate antenatal care and led them to seek care from traditional care providers instead of formal care providers. ConclusionANC utilisation in rural Bangladesh was associated with several socio-cultural beliefs which are modifiable with interventions that have been used in similar settings. Targeting these socio-cultural barriers with context- and community-specific interventions is important to improve overall ANC utilisation at the community-level which can lead to significant improvements in perinatal outcomes.

Evaluation of the new expert consensus-based definition of selective fetal growth restriction in monochorionic pregnancies

Objective To compare the outcomes of a cohort of monochorionic pregnancies with selective fetal growth restriction (sFGR) diagnosed according to the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) definition published in 2015 with a cohort considered as sFGR according to new expert consensus-based diagnostic parameters published in 2019. Methods This was a retrospective study, conducted between January 1st 2010 and July 30th 2019. We reviewed the medical records of all the monochorionic pregnancies followed in our center including perinatal outcomes. Pregnancies complicated by fetal anomalies, infection, twin-twin transfusion syndrome, twin anaemia-polycythemia sequence and twin reversed arterial perfusion sequence were excluded. Patients were grouped according to the 2015 ISUOG definition into: normal (Group 1), sFGR (Group 2), and monochorionic pregnancies with abnormal growth that did not fulfill the full criteria for sFGR (Group 3). After the initial classifications were made, an additional group, was created, including all pregnancies reclassified as sFGR according to the 2019 expert consensus parameters (Group 4). Results During the study period, 291 monochorionic pregnancies were followed in our center, 132 of whom were eligible for inclusion in the final analysis. The prevalence of sFGR increased from 17.4% to 26.5% after applying the expert consensus-based parameters to the study population. Compared to group 1, group 2 had higher rates of emergency cesarean, neonatal intensive care admissions, invasive and noninvasive ventilation, surfactant use, metabolic disorders and lower gestational ages at birth. In contrast, the neonatal outcomes of Groups 1 and 4 were not significantly different. Conclusion When the 2019 consensus-based diagnostic parameters for sFGR were applied to our study population, the number of sFGR cases increased by over 50%, without any improvements in perinatal outcomes. Larger prospective studies are needed to examine the potential clinical implications of these new parameters for sFGR in monochorionic pregnancies.

Про можливість таргетної профілактики кальцитріол-асоційованих ускладнень вагітності на доклінічному етапі

According to recent studies, in the vitamin D deficiency state (VDD), pregnancy can be complicated and the optimal level of VD in the blood is one of the conditions for the realization of reproductive potential. The objective: the possibility to preventing calcitriol-associated pregnancy complications by the correcting VD deficiency at the preconception period. Materials and methods. 57 women with VDD were examined. A history of all women had a pregnancy complicated by placental dysfunction (PD); 27 of them were observed from the preconception period (main group – IA) and 30 – from the 1st trimester of pregnancy (comparison group – IB). The VD status by the blood level of the 25-hydroxyvitamin D by ELISA was determined. Women of both groups, in addition to the vitamin-mineral complex (VMC) were prescribed supplementation colecalciferol at a dose of 4.000 IU per day. Pregnant women of both groups received VMCs up to 16 weeks. After optimizing the level (3–4 months), women continued to take VD at a dose of 2.000 IU per day throughout pregnancy. Results. At the initial study, the VD level was 15.72±2.59 ng/ml in ІА and 16.1±1.99 ng/ml in ІВ group (U=883; p&gt;0.05); after treatment increased to 38.31±3.29 ng/ml and 36.13±2.99 ng/ml (U=900; p&gt;0.05). In group IA, the course of pregnancy was characterized by a lower frequency of complications: PD was diagnosed in 22.2% in group IA and 50% in group IB (F=0.0001; p&lt;0.01); fetal distress in 3.7% and 10% (F=0.16; p&lt;0.05): signs of amnionitis – in 18.5% and 33.3% (F=0.035; p&lt;0.05); placental hypertrophy or hypotrophy – in 7.4% and 36.7% (F=0.00001; p&lt;0.01), preeclampsia in 3.7% and 6.7% of women (F=0,54; p&lt;0.05). The frequency of cesarean section in the comparison group was significantly higher (40% VS 25.9%, F=0.034; p&lt;0.05). Conclusions. During pregnancy, which occurred in conditions of VDD, the frequency of some pregnancy complications, including preeclampsia, the threat of miscarriage, placental dysfunction was in 2–4 times higher than in women with optimized VD status. One of the directions of the individual management plan for women with a negative obstetric history can be the determination of the level of VD in the blood and correction of the VDD at the preconception period. This approach is a pathogenetically substantiated and promising direction for the prevention of some pregnancy complications and improvement of perinatal outcomes. Keywords: pregnancy, deficiency vitamin D, placental dysfunction, preconception period.

Perinatal outcomes of African refugees after their integration into the Israeli health care system

ObjectiveEvaluate whether the incorporation of the refugees into the Israeli medical system resulted in improvements in perinatal outcomes, namely a reduction in the number of preterm deliveries and a decrease in NICU admissions. MethodsRetrospective cohort study. Electronic medical records of all African immigrants who delivered in our tertiary referral center between January 2018 and September 2019 were reviewed. African patients’ demographics, maternal and perinatal outcomes were compared to those of native Israeli population. In addition, the results were compared to the cohort from our previous study from 2010. ResultsA total of 20,796 deliveries took place at our labor and delivery department during the study period. Of these, 3% of all deliveries were of African refugees. Total rates of preterm deliveries <37 weeks was similar between groups, while rate of premature deliveries <34 week was higher among refugees. Rates of extreme prematurity <28 weeks were also similar between groups. Rate of meconium stained amniotic fluid, neonatal weight <2000 g as well as NICU admissions were significantly higher among refugees. ConclusionThough perinatal results have not substantially improved with the incorporation of a refugee population into a healthcare system, some progression has indeed been achieved in some perinatal parameters.

Influence of Medicaid Expansion on Short Interpregnancy Interval Rates in the US [OP03-1C

INTRODUCTION: To assess the impact of improved access to contraception through Medicaid expansion (ME) on the rate of short interpregnancy intervals (IPIs) in the US. METHODS: Population-based retrospective cohort study using US live birth data of multiparous women with data on IPI in 2012 and 2016 (pre and post expansion in 2014). Rate differences of short IPI (&lt;12 months) from 2012 to 2016 were compared between ME vs non-ME states. RESULTS: The rate of short IPI in the US was slightly lower in 2016 (17.3%) compared to 2012 (17.4%), p=0.0006; rate difference 0.13% (95% CI 0.05-0.20). Short IPIs occurred more frequently in non-ME states compared to ME states in both 2012 (18.08% vs 16.55%, p&lt;.001) and 2016 (18.12% vs 16.44%, p&lt;.001). The rate of short IPI decreased 0.11% (95% CI 0.01%-0.22%) in ME states vs increased 0.04% (95% CI 0.09-0.17) in non-ME states over the time period. CONCLUSION: The rate of short interpregnancy interval increased over time in non-expansion states but decreased in the states that adopted Medicaid expansion. If non-ME states had experienced the same rate of decrease in short IPI as ME states, 1122 fewer women would have experienced a short IPI in the US in 2016. Considering the known association between short IPI and adverse maternal and infant outcomes, these findings indicate Medicaid expansion could have an impact on improvement of perinatal outcomes in the US.

The future of electronic fetal monitoring.

Continuous electronic fetal monitoring (EFM) was first introduced commercially over 50 years ago with the hope of improving perinatal outcomes during labor. However, despite the increased use of EFM, definitive improvements in perinatal outcomes have not been demonstrated. Variance in tracing interpretation and intervention has led to increased rates of cesarean and operative vaginal deliveries and perhaps increased maternal and neonatal morbidity. Since its inception, several strategies have been developed in hopes of optimizing EFM and improving these outcomes. We discuss the current standards of intrapartum fetal monitoring and review optimization strategies and technologies in development to improve intrapartum fetal monitoring.

Gestational Weight Gain: Update on Outcomes and Interventions.

Gestational weight gain is a modifiable risk factor for adverse perinatal outcomes. After the Institute of Medicine (IOM) released updated recommendations for gestational weight gain in 2009, a multitude of studies were released examining the recommendations, particularly for women with obesity. As the obesity epidemic continues, many physicians are interested in minimizing gestational weight gain for all women. Our aim was to review the evidence for the association of gestational weight gain and perinatal outcomes, particularly for weight gain outside the IOM guidelines. Gestational weight gain is associated with several adverse perinatal outcomes including fetal growth, preterm delivery, cesarean delivery, gestational diabetes, hypertensive disorders of pregnancy, and infant mortality as well as with long-term offspring metabolic health outcomes. Multiple randomized controlled trials have been conducted evaluating the efficacy of lifestyle intervention on gestational weight gain, and while lifestyle interventions may alter gestational weight gain, they have not been associated with improvement in perinatal outcomes. Weight loss during pregnancy is associated with decreased risks of macrosomia and cesarean delivery; however, given an association with low birth weight, it is not currently recommended. Excessive gestational weight gain is known to be associated with multiple adverse fetal and maternal outcomes. Lifestyle interventions during pregnancy may be helpful in decreasing excessive weight gain, but have not shown to be beneficial for most adverse pregnancy outcomes. More research is needed before making recommendations for weight loss in women with obesity during pregnancy.