Large Fetal Head Circumference Research Articles

The proportion of obstetric anal sphincter injuries and associated factors among mothers who gave birth vaginally at Habru Woreda public health institutions, Amhara region, Northeast, Ethiopia, 2022

BackgroundPerineal tear is a common complication of vaginal delivery. This study aimed to assess the proportion of obstetric anal sphincter injuries and associated factors among mothers who gave birth vaginally at Habru Woreda public health institutions, Amhara region, Northeast Ethiopia. MethodsA facility-based cross-sectional study was conducted from August to September 2022, with 600 participants recruited through a multi-stage sampling technique. Data were collected through interviews, observations, clinical examinations, and patient chart reviews. Multivariable regression analysis was performed to identify statistically significant variables, with an adjusted odd ratio (AOR) and 95 % confidence interval (CI) used to declare significance at p < 0.05. FindingsThe proportion of obstetric anal sphincter injuries was 3.0 %(18/600), with (95 % CI: 1.7–4.3). Factors significantly associated with these injuries included antenatal care attendance (AOR: 0.13, 95 % CI: 0.03–0.47), fundal pressure (AOR: 4.71, 95 % CI: 1.29–17.10), perineal support (AOR: 0.12, 95 % CI: 0.03–0.43), head circumference ≥36 cm (AOR: 4.81, 95 % CI: 1.39–16.65), and age at marriage <18 years (AOR: 4.25, 95 % CI: 1.11–16.24). ConclusionsThe proportion of obstetric anal sphincter injuries was low, and the associated factors included fundal pressure, large fetal head circumference, and early marriage, while antenatal care attendance and perineal support were protective factors. Recommendations include reducing perineal tears by supporting the perineum, avoiding fundal pressure, detecting large fetal heads early, discouraging early marriage, and promoting regular antenatal care.

Re-evaluation of modifiable risk factors for obstetric anal sphincter injury in a real-world setting.

The objective was to identify modifiable risk factors for obstetric anal sphincter injury (OASI) in primiparous women. This was a retrospective cohort study of primiparous women with a singleton vaginal delivery. Main outcome measures were incidence of OASI and odds ratios for possible risk factors: maternal age, body mass index and height, fetal birthweight and head circumference, gestational age, epidural analgesia, mediolateral episiotomy, and instrumental deliveries. Univariate and multivariate logistic regressions were performed using forward methods for variable selection. Of 19,786 primiparous women with a singleton vaginal delivery, 369 sustained an OASI (1.9%). Risk factors were identified: vacuum extraction (adjusted OR 2.06, 95% CI, 1.59-2.65, p < 0.001), increased fetal weight (aOR 1.06, 95% CI, 1.02-1.11, p = 0.002, per 100-g increments); head circumference (aOR 1.24, 95% CI, 1.13-1.35, p < 0.001, per 1-cm increments); gestational week (aOR 1.11, 95% CI, 1.02-1.2, p = 0.012, per week). Protective factors: mediolateral episiotomy (aOR 0.75, 95% CI, 0.59-0.94, p = 0.013) particularly in vacuum deliveries (aOR 0.50, 95% CI, 0.29-0.97, p = 0.040); epidural analgesia (aOR 0.64, 95% CI, 0.48-0.84, p = 0.001); maternal height ≥157 cm (aOR 0.97, 95% CI, 0.96-0.98, p = 0.006, risk decreases by 2.6% per 1 cm increase in height). Mediolateral episiotomy was protective against OASI in both spontaneous and instrumental deliveries of primiparae. Increased fetal weight and large fetal head circumference, particularly in short women, were significant risk factors. These findings support the performance of ultrasound to acquire updated fetal measures before admission to the labor ward.

Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study.

We aimed to examine the effect of gestational weight gain (GWG) on perinatal outcomes, quality of life (QoL) during pregnancy, and medical costs of childbirth. The observational cohort comprised 2210 pregnant women who were classified into three groups based on their pre-pregnancy body mass index (BMI) and GWG in relation to the 2020 Institute of Medicine (IOM) recommendations. The data were collected on perinatal outcomes, urinary incontinence (UI) during pregnancy, changes in sexual function, and medical costs of hospitalization for delivery. Univariate and multivariable logistic regression models were employed to explore those associations. Only 42.1% of women met the 2020 IOM guidelines. After adjustments for potential confounding factors, women with above-normal GWG had adverse pregnancy outcomes, including a large fetal head circumference and macrosomia, and women with below-normal GWG were more likely to deliver low-birthweight fetuses preterm than women with normal GWG. Only 16.8% of women reported sexual activity during pregnancy. There were not significant differences in sexual activity and satisfaction, or QoL among the three GWG groups. Child-bearing expenses were higher for women with above-normal GWG than for women with normal GWG. Although the child-bearing expenses were higher for the above-normal GWG, the proportion of women with expenses above the median increased according to pre-pregnancy BMI. Our results show that inappropriate GWG is associated with a greater risk of adverse perinatal outcomes and increased medical expenses for delivery. Healthcare providers are advised to counsel women to maintain their GWG following the 2020 IOM recommendations throughout pregnancy.

Impact of prepregnancy body mass index on pregnancy outcomes, incidence of urinary incontinence and quality of life during pregnancy - An observational cohort study

BackgroundTo evaluate the effects of prepregnancy body mass index (BMI) on pregnancy outcomes, prevalence of urinary incontinence, and quality of life. MethodsThe observational cohort included 2210 pregnant women who were divided into 4 groups according to their prepregnancy BMI: underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), and obese (≥30). Data were analyzed for pregnancy outcomes, prevalence of urinary incontinence during pregnancy, scores of the Short Form 12 health survey (SF-12) and changes in sexual function. ResultsCompared with normal weight, overweight and obesity were associated with advanced maternal age, low education level, multiparity, preterm delivery, cesarean section, gestational weight gain above the Institute of Medicine (IOM) guidelines, preeclampsia, gestational diabetes, macrosomia and large fetal head circumference. After adjusting for confounding factors, women with overweight and obesity were more likely to have adverse maternal outcomes (gestational weight gain above the IOM guidelines, preeclampsia and gestational diabetes) and fetal outcomes (large fetal head circumference and macrosomia) compared to normal weight women. Overweight and obese women (BMI ≥ 25) were more likely to have urinary incontinence than normal weight and underweight women. There were no significant differences in SF-12 scores among the 4 BMI groups, but more than 90% of pregnant women had reduced or no sexual activities regardless of BMI. ConclusionsMaternal prepregnancy overweight and obesity are associated with greater risks of preeclampsia, gestational diabetes, macrosomia and urinary incontinence. Health care providers should inform women to start their pregnancy at a BMI in the normal weight category.

604: Fetal biometry to predict labor dystocia indicated term primary cesarean delivery: NICHD fetal growth studies

Labor dystocia is the commonest indication of primary cesarean delivery (PCD). Our objective was to determine whether fetal biometry obtained close to delivery was associated with or predicted term labor dystocia-indicated PCD in a low risk population. Analysis of a prospective multicenter NIH-sponsored study. Women with a non-anomalous and uncomplicated singleton gestation delivering at ≥37 0/7 weeks were included. Serial sonographic exams with the final exam at 37.5 +/- 1.9 weeks were performed. Estimated fetal weight (EFW), individual biometric parameters, derived fetal asymmetry measurements (i.e. biparietal diameter (BPD) - abdominal diameter (AD) difference), and amniotic fluid deepest vertical pocket measured at this last scan and categorized as < 10th, 10th- 90th(reference), >90th percentiles were compared between women who had labor dystocia-indicated PCD versus spontaneous vaginal delivery. Multivariable logistic regression analysis was conducted to assess the association of fetal biometry with labor dystocia-indicated PCD. A model providing optimal predictive ability measured by area under the curve (AUC) was determined. Of 1,472 pregnancies analyzed, 126 (8.5%) had labor dystocia-indicated PCD. Compared to the reference group, EFW and head circumference (HC) >90th, and BPD-AD difference < 10th percentile doubled the odds of labor dystocia-indicated PCD (Table). A model that included fetal HC >90th percentile (OR [95% CI]: 3.00 [1.34, 6.71]), maternal age (1.08 [1.03,1.13]), gestational weight gain (1.06 [1.02,1.10]), gestational age at delivery (1.26 [0.97, 1.64]), induction of labor (1.76 [1.03, 3.01]), and nulliparity (21.95 [8.59, 56.11]) predicted labor dystocia-indicated PCD with an AUC of 0.84. Sensitivity, specificity, positive and negative predictive values of this model were 76%, 76%, 23%, and 97%, respectively. Several fetal biometric parameters were associated with labor dystocia-indicated PCD. Large fetal HC (>90th percentile) at term along with multiple maternal factors constituted the best predictive model of labor dystocia-indicated PCD.

The Influence of Fetal Head Circumference and Fetal Weight Measurement Assessed By Intrapartum Ultrasound on Labor Outcome

Background: labor is a clinical diagnosis characterized by regular, painful uterine that increase in frequency and intensity is associated with progressive cervical effacement or dilatation. More specifically, it is associated with a change in the myometrial contractility pattern from irregular contractures (long-lasting, low-frequency activity) to regular contractions (high-intensity, high frequency activity). Aim of the work: it was to determine if fetal head circumference and fetal weight could predict the rate of caesarian section and operative vaginal deliveries in nulliparous women in labor. Patients and Methods: this study was carried out at Al Alamein Hospital from January 2017 to January 2018 on two hundred (200) primigravida women; their ages ranged from 20 to 30 years and the gestational ages ranged from 38-40 weeks with normal singleton pregnancy with cephalic presentation in labor. Results: there were highly statistically significant relations between mode of delivery and fetal head circumference and estimated fetal weight as p value (0.001).it was found that large fetal head circumference relative to maternal pelvic diameter is the main cause of prolonged labor and therefor increased risk of primary caesarian section. Conclusion: the numerical data have a significant relation between intra partum head circumference and fetal weight and the incidence of primary caesarian section, maternal and fetal complications. Recommendations: according to numerical results obtained from this study. The study recommends strict labor monitoring by partogram in cases where fetal head circumference is more than 35cm or fetal weight is more than 3950gms.

Vacuum extraction failure is associated with a large head circumference

Objective: To determine whether large head circumference increases the risk of vacuum extraction failure.Study design: This EMR-based study included all attempted vacuum extractions performed in a tertiary center between January 2010 and June 2015. All term singleton live births were eligible. Cases were divided into four groups: head circumference ≥90th percentile both with birth weight ≥90th percentile and <90th percentile and fetal head circumference <90th percentile with birth weight ≥90th and <90th percentile. Risk of failed vacuum extraction was compared among these groups. Other neonatal and maternal parameters were also evaluated as potential risk factors. Multinomial multivariable regression provided adjusted odds ratio for vacuum extraction failure while controlling for potential confounders.Results: During the study period, 48,007 deliveries met inclusion criteria, of which 3835 had an attempt at vacuum extraction. We identified 215 (5.6%) cases of vacuum extraction failure. The adjusted odds ratios (aOR) for vacuum extraction failure in cases of large fetal head circumference was 2.31 (95%CI, 1.7–3.15, p < .001). Primiparity, prolonged second stage and occipito-posterior presentation were also found to be significant risk factors for failed vacuum extraction.Comments: In this study, we found that large head circumference was associated with vacuum extraction failure rather than high birth weight.

Sonographic large fetal head circumference and risk of cesarean delivery

Persistently high rates of cesarean deliveries are cause for concern for physicians, patients, and health systems. Prelabor assessment might be refined by identifying factors that help predict an individual patient's risk of cesarean delivery. Such factors may contribute to patient safety and satisfaction as well as health system planning and resource allocation. In an earlier study, neonatal head circumference was shown to be more strongly associated with delivery mode and other outcome measures than neonatal birthweight. In the present study we aimed to evaluate the association of sonographically measured fetal head circumference measured within 1 week of delivery with delivery mode. This was a multicenter electronic medical record-based study of birth outcomes of primiparous women with term (37-42 weeks) singleton fetuses presenting for ultrasound with fetal biometry within 1 week of delivery. Fetal head circumference and estimated fetal weight were correlated with maternal background, obstetric, and neonatal outcome parameters. Elective cesarean deliveries were excluded. Multinomial regression analysis provided adjusted odds ratios for instrumental delivery and unplanned cesarean delivery when the fetal head circumference was ≥35 cm or estimated fetal weight ≥3900 g, while controlling for possible confounders. In all, 11,500 cases were collected; 906 elective cesarean deliveries were excluded. A fetal head circumference ≥35 cm increased the risk for unplanned cesarean delivery: 174 fetuses with fetal head circumference ≥35 cm (32%) were delivered by cesarean, vs 1712 (17%) when fetal head circumference <35 cm (odds ratio, 2.49; 95% confidence interval, 2.04-3.03). A fetal head circumference ≥35 cm increased the risk of instrumental delivery (odds ratio, 1.48; 95% confidence interval, 1.16-1.88), while estimated fetal weight ≥3900 g tended to reduce it (nonsignificant). Multinomial regression analysis showed that fetal head circumference ≥35 cm increased the risk of unplanned cesarean delivery by an adjusted odds ratio of 1.75 (95% confidence interval, 1.4-2.18) controlling for gestational age, fetal gender, and epidural anesthesia. The rate of prolonged second stage of labor was significantly increased when either the fetal head circumference was ≥35cm or the estimated fetal weight ≥3900 g, from 22.7% in the total cohort to 31.0%. A fetal head circumference ≥35 cm was associated with a higher rate of 5-minute Apgar score ≤7: 9 (1.7%) vs 63 (0.6%) of infants with fetal head circumference <35 cm (P= .01). The rate among fetuses with an estimated fetal weight ≥3900 g was not significantly increased. The rate of admission to the neonatal intensive care unit did not differ among the groups. Sonographic fetal head circumference ≥35 cm, measured within 1 week of delivery, is an independent risk factor for unplanned cesarean delivery but not instrumental delivery. Both fetal head circumference ≥35 cm and estimated fetal weight ≥3900 g significantly increased the risk of a prolonged second stage of labor. Fetal head circumference measurement in the last days before delivery may be an important adjunct to estimated fetal weight in labor management.

Fetal head circumference, operative delivery, and fetal outcomes: a multi-ethnic population-based cohort study.

BackgroundOperative delivery procedures, such as primary cesarean section, vacuum-assisted, and forceps-assisted vaginal delivery increase maternal and fetal morbidity, and the cost of care. We evaluated whether large fetal head circumference (FHC) independently increases risk of such interventions, as well as fetal distress or low Apgar score, in anatomically normal infants.MethodsWe conducted a population-based retrospective cohort study using Washington State birth certificate data. We included singleton, term infants born to nulliparous mothers from 2003–2009. We compared mode of delivery and fetal outcomes in 10,750 large-FHC (37-41 cm) infants relative to 10,750 average-FHC (34 cm) infants, frequency matched by birth-year.ResultsLarge-FHC infants were nearly twice as likely to be delivered by primary cesarean section as average-FHC infants (unadjusted relative risk [RR] 1.84, 95% confidence interval [CI]: 1.77, 1.92). The RR for primary cesarean section associated with large-FHC was largest for mothers aged 19 years or less (RR 2.28; 95% CI: 1.99, 2.61), and smallest for mothers aged 35 years or greater (RR 1.51; 95% CI: 1.37, 1.66) [test of homogeneity, p < 0.001]. Large-FHC infants were at increased risk of vacuum-assisted vaginal delivery (RR 1.55; 95% CI: 1.43, 1.69), and forceps-assisted vaginal delivery (RR 1.61; 95% CI: 1.32, 1.97). There was no difference in risk of fetal distress (RR 0.97; 95% CI: 0.89, 1.07) for large-FHC versus average-FHC infants. Risk estimates were unaffected by adjustment for potential confounders.ConclusionsNulliparous mothers of large-FHC infants are at increased risk of primary cesarean section, vacuum-assisted and forceps-assisted vaginal delivery relative to mothers of average-FHC infants. Maternal age modifies the association between FHC and primary cesarean section.

Big head, big trouble? can a large fetal head circumference predict complicated delivery?

This study evaluated the predictive value of fetal head circumference (FHC) for difficult birth and assessed the correlation between FHC and neonatal head circumference (NHC).A prospectively collated database was analysed...

Can pelvic floor injury secondary to delivery be prevented?

The number of women suffering from pelvic floor disorders (PFD) is likely to grow significantly in the coming years with a growing older population. There is an urgent need to investigate factors contributing to the development of PFD and develop preventative strategies. We have reviewed the literature and analyzed results from our own study regarding the association between delivery mode, obstetrical practice and fetal measurements, and damage to the pelvic floor. Based on our findings, we have suggested a flowchart helping the obstetrician to conduct vaginal delivery with minimal pelvic floor insult. Primiparity, instrumental delivery, large fetal head circumference, and prolonged second stage of delivery are risk factors for PFD. Pelvic floor integrity should always be seriously considered in every primiparous woman. All efforts should be aimed at minimizing any insult, which might have a significant impact on the woman's pelvic integrity and future quality of life.