Incidence Of Cesarean Delivery Research Articles

The “Quiet Revolution” and the cesarean section in the United States

This paper estimates how changes in family structure and women’s labor market attachment during the last fifty years have affected the incidence of cesarean delivery in the United States. Both sets of factors are strongly related to cesarean utilization, and have generally changed so as to increase the rate of cesarean delivery over time. Altogether, changes in these factors, complemented by demographic changes, raised the U.S. cesarean section rate by eleven percentage points since the late 1970s, nearly two-thirds of the increase over that period. Today’s elevated cesarean section rate is in part a social phenomenon.

Outcome of Inducing Labor in Pregnancies with Suspected Fetal Growth Restriction: Oxytocin Discontinuation during the Active Phase of Labor versus Conventional Management.

Although fetal growth restriction (FGR) is associated with an increased risk of cesarean delivery during induced labor, there is limited evidence to guide labor management. This study aimed to investigate the prognosis of induced labor in pregnancies with suspected FGR and whether oxytocin discontinuation during the active phase of labor affects maternal and neonatal outcomes. This retrospective cohort study investigated singleton pregnancies with vertex presentation and indications for labor induction owing to FGR after 34.0 weeks of gestation at Osaka University Hospital. From January 2010 to December 2013, women were conventionally managed, and oxytocin was continued until delivery unless there was an indication for discontinuation (conventional management group). From January 2013 to December 2020, oxytocin was routinely discontinued, or the dose was reduced at the beginning of the active phase of labor (oxytocin discontinuation group). A total of 161 women (conventional management group, n = 74; oxytocin discontinuation group, n = 87) were included. After the active phase of induced labor, the total incidence of cesarean delivery was very low (3.1%), and the duration was short (173 ± 145 minutes). Oxytocin discontinuation was associated with lower cesarean delivery (1.1 vs. 5.4%; p = 0.12) and uterine tachysystole (9.8 vs. 23.0%; p = 0.08) rates and longer duration of the second stage of labor (mean: 56.5 ± 90 vs. 34.2 ± 45 minutes; p = 0.08) than conventional management; however, the difference was not significant. The other maternal and neonatal outcomes, including postpartum hemorrhage, did not also significantly differ between them. After the active phase of induced labor for suspected FGR, the risk of cesarean delivery is low, and the high incidence of uterine tachysystole and rapid labor progression should be considered cautiously. Oxytocin can be safely discontinued during the active phase of labor in women undergoing labor induction for FGR without an increased risk of cesarean delivery or other unfavorable outcomes. · The cesarean delivery rate was low after the active phase.. · The labor progress after the active phase was rapid.. · Oxytocin can be safely discontinued during the active phase..

Caesarean Scar Pregnancy: Surgical Obstacles

As a rare phenomenon, caesarean scar pregnancy has been found to be managed in many ways in literature. However, to date there lacks a general consensus on the management of caesarean scar pregnancy. In modern obstetrics nowadays, the incidence of caesarean deliveries has been rising. Due to the increase in caesarean section rates, the incidence of caesarean scar pregnancies is also on the rise. Even though the optimal management of caesarean scar pregnancy is unclear, the basic management is tailored according to the clinical presentation and fertility concerns of the individual. Herein, we report a case of a ruptured caesarean scar pregnancy which was managed surgically via emergency laparotomy and hysterectomy.

Socio-demographic profiles and obstetrics outcomes of pregnant women with epilepsy in a vulnerability State, Brazil.

IntroductionThe socio-demographic profile of pregnant women in low- and middle- income countries is characterized by low educational attainment and unemployment, leading to social and economic morbidity. characterized by limited opportunities for education, employment, and marriage, which are strongly related to the stigmatization of the disease. The study of the socio- profile and obstetric outcomes of pregnant women with epilepsy in Alagoas, Brazil, may help understand this scenario and facilitate the development of public policy strategies to reduce local morbidity.ObjectivesWe aimed to describe the sociodemographic profile of pregnant women with epilepsy and obstetric outcomes in Alagoas, Brazil.MethodsThis cohort study was based on medical records of pregnant women with epilepsy in Brazilian high-risk maternity hospitals from 2008 to 2020. The following data were collected: age, race, education, marital status, occupation, number of pregnancies, delivery, and abortion. The inclusion criteria were pregnant women with and without epilepsy (control group) aged < 40 years.ResultsThe prevalence of PWWE was 0.49% (n = 224/44,917). Cesarean delivery was more frequent in PWWE than in pregnant women without epilepsy (adjusted odds ratio [OR] = 22.0; 95% confidence interval [CI] = 14.35–33.73; p<0,01). Abortion was associated with PWWE (OR adjusted = 1.72; 95% CI = 1.13–2.61; p = 0.01). Pregnant women in the countryside were more likely to develop epilepsy than those born in the capital (OR = 1.55; 95% CI = 1.12–2.14; p <0.01).ConclusionThe PWWE socio-demographic profile of the Alagoas had a predominance of brown- colored skin, single status, homemakers, and illiteracy with a high proportion residing in the interior of the state. The obstetrics data show a higher incidence of cesarean deliveries and miscarriages.

Recognition of the Type of Cesarean Scar Pregnancy in First Trimester Sonography

This case series is presented to illustrate the clinical value of identifying, sonographically, the type of cesarean scar ectopic pregnancy that may present, as this has become more frequently encountered. The choice of surgical treatment appears to be dependent on the sonographic typing, of this specific type of ectopic pregnancy. This case study illustrates the importance of this topic, given the rising incidence of cesarean deliveries coupled with the increase in first trimester sonograms being more commonly performed. The value of proper diagnostic detection is important, given the contemporary management of this new type of ectopic pregnancy.

Risk factors and adverse pregnancy outcomes in older pregnant women with hypertensive disorders of pregnancy

To assess the independent risk factors and pregnancy outcomes of hypertensive disorders of pregnancy (HDPs) in Chinese advanced age pregnancy women. Secondary analysis of international published data. PubMed, Web of Science, Scopus, Embase, Cochrane library, and Chinese databases from inception to February 23, 2022 were searched to identify eligible studies. Meta-analysis was conducted to provide meaningful summative outcomes. The quality evaluation of included study was performed. The analyses were done with Review Manager 5.3 and Stata 14.0 software. Totally, 13 eligible articles were included, among which 3 articles investigated the risk factors, 6 articles studied pregnancy outcomes, and 4 articles examined both risk factors and pregnancy outcomes. Chinese older pregnant women with the HDPs had high pooled incidences of abnormal body mass index, maternal education, family history of hypertension, history of chronic hypertension, gestational diabetes, irregular delivery inspection, psychosocial factors, and primiparity compared to those without HDPs. The incidence of cesarean delivery, placental abruption, premature rupture of membranes, postpartum hemorrhage, preterm birth, fetal asphyxia, fetal distress, fetal growth restriction, and low birth weight in Chinese older pregnant women with HPDs were significantly higher than those without HDPs. This study identified several possible risk factors which promoted the onset of HDPs in Chinese older pregnant women, and HDPs significantly increases risk of adverse pregnancy outcomes (APOs). Further research is needed to take targeted measures to prevent HDPs and explore efficient management methods to minimize the risk of APOs associated with HDPs in Chinese older pregnant women.

A Comparative Study of Maternal-Fetal Outcomes in Pregnant Women With Induction of Labor and Spontaneous Onset of Labor in a Rural Tertiary Care Center

OBJECTIVEThe present prospective observational study was conducted to study the incidence, indications, and outcomes of induction of labor in a tertiary care center.MATERIAL AND METHODThe study group of this prospective cross-sectional study was constituted by all term pregnant women underwent trial of labor. The whole study group was further subdivided in two groups, group 1: Was having all pregnant women with spontaneous onset of labor pains and group 2 was containing all pregnant women underwent induction of labor. For induction only prostaglandins (PGE1 25 microgram tablet and PGE2 gel) were used. The measure of outcome included assessment of the incidence of induction in term pregnant women, major indications of induction of labor, duration of labor, mode of delivery, intrapartum and postpartum maternal-fetal complications and duration of hospital stay. The study group included 3264 pregnant women and was differentiated into group 1 with 2,588 pregnant women and group 2 with 676 pregnant women.RESULTSThe incidence of induction was 20.71%. Major indications of induction were a fetus who was postdates, premature rupture of membranes, and preeclampsia. The average duration of the induction to delivery interval was 19.13 ± 15.14 hours (hrs.) and admission to delivery interval in the spontaneous labor group was 8.79 ± 07.18 hrs. The incidence of cesarean delivery was 19.52% in the induction group (gp2). Failed induction was the most common indication of lower segment cesarean section (CS). The incidence of CS was 15.99% in spontaneous group (gp1) and fetal distress was most common indication in this group. With this study, we found the importance of rest after the induction process was completed. During this watchful rest period, 51 pregnant women delivered vaginally. The neonatal intensive care unit (NICU) admission and neonatal death rate was more in group 1.CONCLUSIONThis study revealed that the incidence and indications of induction of labor among term pregnant women were similar to developed countries in spite of active physical life. The complication rate, operative intervention and hospital stay was more with induction group.

Pre-Pregnancy Physical Fitness, Body Mass Index and Gestational Weight Gain as Risk Factors for Cesarean Delivery: A Study of Active Duty Women.

The World Health Organization considers the optimal rate of delivery by Cesarean among healthy nulliparous women to be <15%. In 2020, the rate of primary Cesarean delivery (CD) in the US among nulliparous women with singleton, vertex pregnancies was 26%. An enhanced understanding of factors associated with women undergoing CD may assist in reducing this rate. One potential factor is the level of physical fitness in women before pregnancy. Active duty (AD) soldiers provide a cohort of women who begin pregnancy while actively pursuing physical fitness. The research team sought to assess the effects of pre-pregnancy physical fitness of AD soldiers as measured by the Army Physical Fitness Test (APFT) on the incidence of CD in AD women, in addition to examining known demographic and pregnancy risk factors in this cohort. We conducted a retrospective study of healthy AD nulliparous women who delivered their singleton pregnancy of >32 weeks at a tertiary medical center between 2011 and 2016. Soldiers undergoing non-labored CD were excluded. Demographics, pre-pregnancy APFT results, antepartum and labor and delivery data were collected from the Digital Training Management System, the outpatient, and inpatient medical records respectively. Weight gain in pregnancy was assessed using the Institute of Medicine Guidelines for pregnancy. Fisher's exact tests and chi-squared tests assessed associations between categorical outcomes, and unpaired t-tests assessed differences in APFT scores between women who underwent CD vs. vaginal delivery. Multivariable logistic regression analysis was used to assess for independent risk factors among all collected variables. The protocol was approved by the Regional Health Command-Pacific Institutional Review Board. Five-hundred-and-twenty-three women delivering singleton pregnancies between 2011 and 2016 were reviewed for this study. Three-hundred ninety women met inclusion criteria: 316 in the vaginal delivery cohort, and 74 in the CD cohort, with a CD rate of 19%. Twenty non-labored CDs were excluded. Neither total APFT performance nor performance on the individual push-up, sit-up or run events in the 15 months prior to pregnancy was associated with mode of delivery. Excessive gestational weight gain (EWG) and neonatal birth weight were the only two factors independently associated with an increased rate of cesarean delivery. Women who had excessive gestational weight gain, were twice as likely to undergo CD as those who had adequate or insufficient weight gain (24% vs. 12%, p = 0.004). Soldiers delivering a neonate ≥4,000 g were 2.8 times as likely to undergo CD as those delivering a neonate <4,000 g (47% vs. 17%, p < 0.001). Age, race, and rank, a surrogate marker for socioeconomic status, were not associated with mode of delivery. Pre-pregnancy fitness levels as measured by the APFT among healthy physically active nulliparous AD women showed no association with the incidence of labored CD. EWG is one modifiable factor which potentially increases the risk for CD in this cohort and has been documented as a risk factor in a recent metanalysis (RR-1.3). Counseling on appropriate weight gain in pregnancy may be the most effective way to reduce the rate of CD among this population of healthy and physically active women.

Efektivitas Massage Effleurage dan Teknik Relaksasi terhadap Tingkat Nyeri Punggung Ibu Hamil Trimester III di Puskesmas Kenali Besar Kota Jambi

Back pain is one of the most frequently reported complaints by pregnant women, varying from 50% to 70%, even 8% of them result in severe disability. Back pain is described as one of the minor disorders in pregnancy and is one of the causes of the incidence of cesarean delivery. From the initial survey, it was found that 4 out of 6 third trimester pregnant women had back pain complaints. The purpose of this study was to determine the effectiveness of Massage Effleurage and Relaxation Techniques on back pain in third trimester pregnant women at Kenali Besar Health Center Jambi City in 2021. This study was a quasi-experimental study using a two group pre-test and post-test design approach. The population of this study was 78 pregnant women in the third trimester using purposive sampling technique, the sample in this study used the SLOVIN formula so that a sample of 66 people was obtained. In the Mann-Whitney test for the effectiveness of Massage Effleurage and Relaxation Techniques, p value = 0.094 (p &gt;0.05) which shows statistically there is no difference in average between Massage Effleurage and Relaxation Techniques on the level of back pain in third trimester pregnant women

External cephalic version: Success rates with and without nitrous oxide

BackgroundExternal cephalic version (ECV) is a technique used to reduce the incidence of cesarean deliveries due to malpresentation. Nitrous oxide is an inhaled analgesic that may be used for pain relief for women undergoing external cephalic version. ObjectiveTo compare the conversion rate of non-cephalic to cephalic presentation in ECV with and without nitrous oxide. Study designA retrospective cohort analysis was performed including all singleton, term gestation ECVs between January 2016 and June 2017 at a single institution. Multivariable logistic regression was used to compare women who had ECV with nitrous oxide versus ECV without nitrous oxide. The primary outcome was successful rate of conversion to cephalic presentation and the secondary outcome was the rate of vaginal delivery. ResultsDuring the study period, 167 women underwent ECV: 77 with nitrous oxide and 90 without nitrous oxide. Of the 77 women who used nitrous oxide, 25 (32.5%) were successful and 17 of these women delivered vaginally (68%). Of the women who underwent ECV without nitrous oxide, 29 (32.2%) successfully converted and 21 of these delivered vaginally (72%). After controlling for confounders, the use of nitrous oxide had no clinically or statistically significant difference on ECV success rates (OR 1.08, 95% CI 0.52–2.23). ConclusionNitrous oxide does not seem to affect conversion rate to cephalic presentation in ECV. Further studies are needed to determine the impact of nitrous oxide on women’s decision to undergo ECV and on patient satisfaction and tolerability.

Exploring the incidence and causes of cesarean Delivery : Partially Mixed Concurrent quantitative and Qualitative analysis from a Medical College

Background: India has seen a rise in the incidence of cesarean deliveries (CD) especially in the last decade. The present national average stands at 17.2%, which if taken as a stand alone figure represents an almost ideal statistical measurement. However, the country has widespread regional variations in the CD rate, ranging from 4.4% to 35.9%. Auditing individual CD rates by each institution, and exploring reasons for high incidence remains an essential component of maternal care. Aim of the study: The present study was done to find out the incidence of CD at our facility, compare it with the national average and explore reasons for high incidence of CD. Methodology: It is a partially mixed concurrent quantitative and qualitative study including retrospective analysis of one year data and filling up of questionnaire from resident doctors. Data extraction was done from Maternity Ward, for all women who delivered during the aforementioned period in our facility, including socio-demographic profile, number of births, mode of delivery, reasons for induction of labour and any complications during childbirth. Statistical analysis was done using appropriate tests. Results: A total of 621 deliveries were studied, out of which 44.6% delivered vaginally and 55.3% had CD. Conclusion: The incidence of CD in the present study is 55.3% . The main reasons for high incidence of CD are high risk pregnancies, previous CD, fear of litigation and logistical delays in performing Category I cesarean section, prompting early decision for CD. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 284-290

Maternal and Perinatal Outcomes of Hospitalized COVID-19 Positive Pregnant Women

IntroductionThe consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) /Coronavirus disease 2019 (COVID-19) on mothers and neonates are uncertain due to the lack of robust evidence from various available studies. Furthermore, conflicting data exist regarding the vertical transmission of coronavirus. Therefore, a hospital-based study was conducted to evaluate the effect of COVID-19 on maternal and perinatal outcomes of COVID-19 infected pregnant women.MethodologyA hospital-based retrospective observational study was conducted between July-December 2020 in Rajarshi Dashrath Autonomous State Medical College, Ayodhya, Uttar Pradesh, a designated level-2 COVID-19 Hospital. A total of 37 confirmed COVID-19 positive pregnant women (mean age 27.5 ± 05 years) of more than 28 weeks of gestation were included in this study to evaluate the effect of COVID-19 on maternal and perinatal outcomes. Maternal symptoms related to COVID-19, comorbidities, intensive care unit (ICU) admissions, intrauterine growth retardation (IUGR), leaking per vagina, mode of delivery, preterm deliveries, and maternal deaths were recorded. Birth weight of newborns, neonatal intensive care unit (NICU) admissions, neonatal illness, neonatal deaths, and COVID-19 testing reports were recorded. ResultOut of 37 COVID-19 positive pregnant women, 27 (72.9%) women were asymptomatic, nine (24.4%) women were having mild disease, and one (2.7%) developed severe disease requiring ICU admission. No maternal deaths were observed. Twenty-six (70.3%) women were delivered by caesarean section, 11 (29.7%) women by normal vaginal delivery, four (10.8%) were of leaking per vagina. Among newborns, five (13.5%) were preterm, one (2.7%) newborn require NICU admission, two (5.4%) were tested COVID-19 positive on the 5th day of life but were asymptomatic, and four (10.8%) newborns developed a fever but were COVID-19 negative. One case (2.7%) was of stillbirth. No neonatal deaths were observed.ConclusionThe present study did not reveal any direct evidence for vertical transmission of SARS-CoV-2 virus through the placenta and during vaginal delivery, but the possibility of mother-to-child infection cannot be completely ignored. SARS-CoV-2 infection during late pregnancy may have a maternal and neonatal impact. COVID-19 infections in late pregnancy might lead to an increased incidence of caesarean deliveries as observed in the present study. This study reveals that most of the COVID-19 positive pregnant women remained asymptomatic or had mild infections. Hence, efforts to limit exposure to COVID-19 of pregnant women should be strengthened for saving mother and child.

Maternal and fetal outcome of severe pre-eclampsia and eclampsia in cesarean section and normal delivery

Aims: To evaluate the maternal and fetal outcomes in severe preeclampsia and eclampsia in Cesarean Section and normal delivery .&#x0D; Methods: An observational descriptive study of severe pre-eclampsia-eclampsia conducted in the Department of Obstetrics and Gynaecology, Basaveshwara Medical College Hospital. Gestational age 32-42 weeks were included and imminent deliveries were excluded from the study. Primary outcome variables were mode of delivery, maternal morbidity-mortality, and perinatal morbidity-mortality.&#x0D; Results: 63.2% in severe pre-eclampsia, 50% in eclampsia group delivered vaginally; 15.1% in severe preeclampsia and 25% in eclampsia group underwent elective LSCS; 21.7% in severe preeclampsia and 25% in eclampsia group underwent emergency LSCS. Incidence of cesarean deliveries in severe pre-eclampsia was 36.8% and in eclampsia it was 50%. No maternal death was observed in elective LSCS. Maternal death in vaginal delivery cases was 0.94% in severe preeclampsia and 4.76% in eclampsia. In emergency LSCS cases maternal mortality was 1.4% in severe preeclampsia and 4.76% in eclampsia group. No perinatal mortality was observed in elective LSCS group; 4.7% perinatal mortality occurred in normal delivery, 20.5% in emergency LSCS in severe preeclampsia and 7.1% in eclampsia who were delivered vaginally.&#x0D; Conclusion: In eclampsia, feto-maternal outcome is better in the cesarean deliveries than in the vaginal deliveries

Very Early Onset Eosinophilic Esophagitis Is Common, Responds to Standard Therapy, and Demonstrates Enrichment for CAPN14 Genetic Variants

To determine if very early onset eosinophilic esophagitis (V-EoE) represents a separate disease endotype, with worse clinical features and prognosis, distinct molecular properties, and specific risk factors, compared with that of later-onset pediatric eosinophilic esophagitis (L-EoE).In this study, researchers included patients diagnosed with eosinophilic esophagitis (EoE) at the age of ≤12 months (V-EoE: n = 57) and at the age of 14 to 18 years (L-EoE: n = 70). The diagnostic criteria for EoE included symptoms of esophageal dysfunction or inflammation and at least 15 eos/hpf in distal esophageal biopsy despite proton pump inhibitor use.A single-center retrospective chart review was focused on demographics and clinical history. Pretreatment histologic and gross endoscopic features were graded by using the EoE Histology Scoring System and the EoE Endoscopic Reference Score. RNA was extracted from a cohort of 15 pretreatment patients and analyzed via the EoE Diagnostic Panel, which is used to distinguish EoE from gastroesophageal reflux. With genetic analysis, the researchers examined whether single-nucleotide polymorphisms in CAPN14 and TSLP were associated with age of diagnosis.EoE was most commonly diagnosed at the age of 0 to 24 months. The V-EoE group was more likely to present with feeding issues, weight concerns, and vomiting, compared with that of dysphagia in the L-EoE group. Patients with V-EoE were more likely to have a history of cesarean delivery. Dietary restriction was more likely to be the initial and successful therapy in in the V-EoE group, whereas the L-EoE group was more likely to respond to swallowed steroids. Histologic remission was sustained in patients with V-EoE and was less common in patients with L-EoE, likely due to therapy nonadherence. The V-EoE group demonstrated higher levels of inflammation on histology, whereas esophageal strictures and fibrosis were more common in the L-EoE group. EDP molecular expression was similar between the 2 groups. Genetic analysis–identified single-nucleotide polymorphisms in CAPN14 were associated with V-EoE.V-EoE is associated with unique clinical, histologic, and genetic features. The increased incidence of cesarean delivery in patients with V-EoE may indicate a role of early-life dysbiosis. Patients with V-EoE can be managed successfully with standard therapy and achieve sustained remission. Fibrostenosis and esophageal dilation were more likely in L-EoE.V-EoE is a clinically important entity, requiring prompt recognition and diagnosis to initiate treatment. In a patient with recurrent emesis, feeding difficulties, and poor weight gain, consider endoscopy to evaluate for EoE. Risk factors include cesarean delivery and CAPN14 variants. Successful management of V-EoE can be attained with standard therapy and may prevent late-stage complications related to esophageal remodeling.

A randomized prospective comparative study to evaluate the efficacy of prostaglandin E2 (Dinoprostone) controlled release vaginal insert versus sublingual prostaglandin E1(Misoprostol) in induction of labor in term gestation

In modern obstetrics, one of the common challenges is induction of labour (IOL). WHO Global Survey reported that IOL accounted for 9.6% of all deliveries. Prostaglandins have evolved and frequently used pharmacologic agents for IOL, owing to their dual action of cervical ripening and uterine contraction inducing effect. : 1. To compare the efficacy and induction to delivery interval (IDI) of PGE2 vaginal insert and Sublingual PGE1 in induction of labor in term pregnant women; 2. To study the maternal and fetal outcome in both groups.: This a randomized, prospective, comparative study of 100 term pregnant women for induction of labour. Group 1-(50 women) PGE2-10mg vaginal insert and group 2-(50 women) PE1 Sublingual tablets – maximum 200 mcg in 24 hrs, at Dr LH Hiranandani Hospital, Mumbai, India.: In my study the mean induction to delivery interval in Dinoprostone group was 17.47 hours and 23.44 hours in Misoprostol group. So the mean IDI was shorter in Dinoprostone insert group than Misoprostol group by about 6 hours. There was no significant difference noted in terms of overall incidence of caesarean deliveries among the groups. Our study concluded that Dinoprostone 10mg vaginal insert was more efficacious than sublingual Misoprostol in reducing induction to delivery interval without maternal and fetal complications.Our study suggests that the Dinoprostone vaginal insert can be used as both inducing as well as augmentating agent in labour. Dinoprostone vaginal insert maybe more effective in reducing the incidence of caesarean sections.

English

BACKGROUND Corona virus disease 2019 (COVID 19) outbreak have evolved rapidly throughout the world. The knowledge on severe acute respiratory disease-corona virus-2 (SARS-CoV-2) infection in pregnant women and newborn is incomplete. Understanding the impact of COVID 19 in pregnancy in terms of morbidity mortality, perinatal and neonatal outcome is essential to propose a strategy for the management of pregnant women with COVID 19 infection. METHOD It is a prospective study of all pregnant women who have delivered in the period of April 2020 to December 2020 at Government T.D. Medical College, Alappuzha. In this study, the mode of delivery, neonatal outcome, maternal mortality, morbidity were evaluated. The outcome of pregnancies includes vaginal delivery, caesarean delivery, vacuum delivery and intrauterine fetal demise. RESULTS A total of 265 pregnant women infected with COVID 19 delivered during the period. Out of these, 49.4 % was full term caesarean delivery, 3.8 % was preterm caesarean delivery, 39.3 % was full term vaginal delivery and 4.9 % was preterm vaginal delivery. Moreover, 1.1 % of the total pregnant women had intrauterine fetal demise on admission. Among 265 new-borns, 2.3 % babies became COVID 19 positive, of this, 83.3 % were mothers who delivered within 7 days of COVID 19 infection. 0.75 % needed resuscitative emergency caesarean delivery for COVID 19 pneumonia. 0.38 % maternal mortality occurred during the period due to COVID 19 infection. CONCLUSIONS Obstetric outcome in most COVID 19 infected term pregnant patients is comparable to non-COVID 19 pregnant women except for a higher incidence of caesarean delivery. Most of the neonates who became positive were born to mothers delivered within 7 days of COVID 19 infection. Severe morbidity among COVID 19 pregnant women were seen only in a small proportion complicated by COVID 19 pneumonia, who required ventilator support. KEYWORDS COVID 19, Pregnancy, Maternal, Perinatal, Neonatal Outcome

P-646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p &amp;lt; 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p &amp;lt; 0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p &amp;lt; 0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p &amp;lt; 0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p &amp;lt; 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p = 0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p = 0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p = 0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78-1.97), gestational hypertension (95%CI:0.14-1.41), preeclampsia (95%CI:0.96-2.99), gestational diabetes (95%CI:0.30-1.01), preterm delivery (95%CI:0.74-1.91), preterm premature rupture of membranes (95%CI:0.17-2.82), operative vaginal delivery (95%CI: 0.23-1.19), small for gestational age neonates (95%CI:0.27-2.02) or intra-uterine fetal demise (95%CI:0.13-6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number not applicable

P–646 Pregnancy outcomes in women with panhypopituitarism - A population-based study

Abstract Study question What are the consequences of panhypopituitarism on pregnancy outcomes? Summary answer After controlling for confounding effects, women with panhypopituitarism have a higher prevalence of adverse obstetrical (including post-partum hemorrhage, hysterectomy and maternal death) and neonatal outcomes. What is known already Panhypopituitarism is a condition of inadequate or absent anterior pituitary hormone production. Pregnancy in women with panhypopituitarism is uncommon and there is only limited data (mainly case reports) regarding pregnancy outcomes in these women. Given the scarcity of data we sought to assess the association between panhypopituitarism and obstetrical and neonatal outcomes. Study design, size, duration A retrospective population-based study utilizing data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). A dataset of all deliveries between 2004 and 2014 inclusively, was created. Within this group, all deliveries to women who had a diagnosis of panhypopituitarism during pregnancy were identified as part of the study group (n = 179), and the remaining deliveries comprised the reference group (n = 9,096,609). Participants/materials, setting, methods The HCUP-NIS is the largest inpatient sample database in the USA, and it is comprised of hospitalizations throughout the country. It provides information relating to 20% of US admissions and represents over 96% of the American population. Multivariate logistic regression analysis, controlling for confounding effects, was conducted to explore associations between panhypopituitarism and delivery and neonatal outcomes. According to Tri-Council Policy statement (2018), IRB approval was not required, given data was anonymous and publicly available. Main results and the role of chance Women with a diagnosis of panhypopituitarism were more likely to be older, to have a diagnosis of chronic hypertension, to have a diagnosis of pre-gestational diabetes mellitus and to be carrying twins or a higher order pregnancy (all p &amp;lt; 0.0001), than the controls. A significantly higher risk of post-partum hemorrhage (adjusted odds ratio-aOR:3.52; 95%CI:2.18–5.69,p&amp;lt;0.0001), maternal infection (aOR:3.97; 95%CI:2.30–6.85,p&amp;lt;0.0001), pulmonary embolism (aOR:14.90; 95%CI:2.06–107.82,p&amp;lt;0.007), disseminated intravascular coagulation (aOR:20.29; 95%CI:10.60–38.85,p&amp;lt; 0.0001), maternal death (aOR:31.90; 95%CI:3.33–234.85,p=0.001) and congenital anomalies (aOR:4.55; 95CI:1.86–11.16,p=0.001), were found among the panhypopituitarism patients. Surprisingly, there was a lower incidence of caesarean delivery (aOR:0.69; 95%CI:0.50–0.96,p=0.026) in the panhypopituitarism patients than the controls. No significant difference was found in the rate of pregnancy induced hypertension (95%CI:0.78–1.97), gestational hypertension (95%CI:0.14–1.41), preeclampsia (95%CI:0.96–2.99), gestational diabetes (95%CI:0.30–1.01), preterm delivery (95%CI:0.74–1.91), preterm premature rupture of membranes (95%CI:0.17–2.82), operative vaginal delivery (95%CI:0.23–1.19), small for gestational age neonates (95%CI:0.27–2.02) or intra-uterine fetal demise (95%CI:0.13–6.71). Limitations, reasons for caution The limitations of our study are its retrospective nature and the fact that it relies on an administrative database. The severity of specific hormonal deficiencies and the presence and magnitude of posterior pituitary hormone deficiencies could not be assessed, nor could compliance with hormone replacement. Wider implications of the findings: Until now, no control studies of outcomes with panhypopituitaryism in pregnancy are available in the medical literature. Physicians should be aware of and try to prevent the above possible maternal and fetal complications related to this endocrinopathy. Future studies should evaluate the role of medication compliance with pregnancy outcomes. Trial registration number Not applicable

Outpatient Cervical Ripening: A Systematic Review and Meta-analysis.

To assess the comparative effectiveness and potential harms of cervical ripening in the outpatient compared with the inpatient setting, or different methods of ripening in the outpatient setting alone. Searches for articles in English included MEDLINE, EMBASE, CINAHL, Cochrane Library, ClinicalTrials.gov, and reference lists (up to August 2020). Using predefined criteria and DistillerSR software, 10,853 citations were dual-reviewed for randomized controlled trials (RCTs) and cohort studies of outpatient cervical ripening using prostaglandins and mechanical methods in pregnant women at or beyond 37 weeks of gestation. Using prespecified criteria, study data abstraction and risk of bias assessment were conducted by two reviewers, random-effects meta-analyses were conducted and strength of evidence was assessed. We included 30 RCTs and 10 cohort studies (N=9,618) most generalizable to women aged 25-30 years with low-risk pregnancies. All findings were low or insufficient strength of evidence and not statistically significant. Incidence of cesarean delivery was not different for any comparison of inpatient and outpatient settings, or comparisons of different methods in the outpatient setting (most evidence available for single-balloon catheters and dinoprostone). Harms were inconsistently reported or inadequately defined. Differences were not found for neonatal infection (eg, sepsis) with outpatient compared with inpatient dinoprostone, birth trauma (eg, cephalohematoma) with outpatient compared with inpatient single-balloon catheter, shoulder dystocia with outpatient dinoprostone compared with placebo, maternal infection (eg, chorioamnionitis) with outpatient compared with inpatient single-balloon catheters or outpatient prostaglandins compared with placebo, and postpartum hemorrhage with outpatient catheter compared with inpatient dinoprostone. Evidence on misoprostol, hygroscopic dilators, and other outcomes (eg, perinatal mortality and time to vaginal birth) was insufficient. In women with low-risk pregnancies, outpatient cervical ripening with dinoprostone or single-balloon catheters did not increase cesarean deliveries. Although there were no clear differences in harms when comparing outpatient with inpatient cervical ripening, the certainty of evidence is low or insufficient to draw definitive conclusions. PROSPERO, CRD42020167406.

The vertical dimension of obesity: adverse pregnancy outcomes in the short obese versus tall obese parturient

The objective of this study was to examine the effect of maternal height on adverse perinatal outcomes in obese parturients. This retrospective study was conducted from January 2015 to December 2015. Patients with BMI ≥ 35.0 kg/m2 before delivery were included and divided into 2 groups based on height. Patients ≤63 inches were in the short stature group and those > 63 inches were in the tall stature group. One hundred and twenty-five patients were in the short stature cohort and 124 in the tall stature cohort. Patients in short cohort had a significantly higher risk of preterm delivery <37 weeks (RR = 4.21 [1.24, 12.88]), spontaneous rupture of membranes (RR 1.47 [1.01–2.16]), and second stage caesarean delivery (CD) (RR 2.64 [1.1–6.39]). After multiple regression analysis, Hispanic race and short stature were independent predictors of preterm birth for obese patients. IMPACT STATEMENT What is already known on this subject? Compared to normal weight individuals, those who are obese have at a higher risk of adverse obstetric and perinatal outcomes including gestational diabetes, hypertension, pre-eclampsia, thromboembolism, macrosomia, higher incidence of caesarean deliveries and perinatal mortality. What do the results of this study add? Our findings show that short stature is an independent predictor for adverse perinatal outcomes in obese women. Specifically, short obese patients had significantly higher risk of preterm delivery before 37 weeks and second stage CD. What are the implications of the findings for clinical practice and/or further research? Our findings highlight the need for formulating a tailored plan for preconception health including pregnancy weight goals in short obese women. Additionally, maternal fat distribution and its effect on pro-inflammatory cytokine profiles is a potential area for future research, as maternal body composition may be a better predictor of perinatal outcome than BMI.